Two modalities of manic defences: Their function in adolescent breakdown

The aim of this paper is to explore two different modalities of manic defences and their specific underlying anxieties. I will describe the relation between these defences and the role of the superego and their specific function in adolescent breakdown. While one type of manic defence operates by the ego’s identification with a sadistic superego the other one operates via evacuation of a guilt-inducing superego. I will illustrate the proposed ideas with clinical examples from the analysis of two adolescents. This paper stresses the specific differences between these two modalities and the clinical importance of both identifying and addressing the enactment in the transference of the unconscious phantasies and anxieties (paranoid and depressive) that give rise to these two types of defences.     

Computerized assessment in neuropsychology: A review of tests and test batteries

This article contains detailed reviews of 13 computerized neuropsychological and performance test batteries and six stand-alone computer tests. Tasks found on these instruments are described and tables illustrate which batteries employ which measures. In addition to issues of reliability and validity, special considerations apply to computerized assessment. These issues are discussed and readers are provided information to help them assess computerized tests in relation to their particular clinical and research needs. Since many computerized tests were developed as performance assessment tools, the relationship between performance and neuropsychological assessment is examined.     

THE USE OF BEHAVIORAL ASSESSMENT TO PRESCRIBE AND EVALUATE TREATMENTS FOR SEVERELY HANDICAPPED CHILDREN

Behavioral assessment procedures were used to prescribe and evaluate treatments of maladaptive behavior for 2 children with severe multiple handicaps. In Experiment 1, the results of an assessment of reinforcer preference were used in conjunction with a functional analysis of the conditions maintaining self-injurious behavior to prescribe a treatment for a child with severe disabilities. The treatment procedure involved the use of a pressure-sensitive microswitch to activate reinforcing stimuli during two solitary conditions, during which self-injurious behavior had occurred at high rates. The results were evaluated with a multiple baseline across settings design and indicated that self-injury decreased with concomitant increases in microswitch activation. Results were maintained at 6 weeks, 8 weeks, and 6 months. In Experiment 2, the results of behavioral assessments of reinforcer preference and self-injurious behavior were combined to develop a treatment for a second severely handicapped child, who exhibited high rates of self-injury in demand situations. This treatment was evaluated with a multiple baseline across tasks design and resulted in the elimination of self-injury for up to 15 months.     

ASSESSMENT OF STIMULUS PREFERENCE AND REINFORCER VALUE WITH PROFOUNDLY RETARDED INDIVIDUALS

We evaluated a procedure for identifying potential reinforcers with profoundly retarded individuals. In Experiment 1, six persons were repeatedly exposed to 16 stimuli, and approach behaviors to each stimulus were used to identify preferred and nonpreferred stimuli. In Experiment 2, we examined the reinforcing properties of preferred and nonpreferred stimuli by delivering them contingently on the occurrence of arbitrarily selected responses. Results revealed that the preferred stimulus conditions typically produced higher rates of responding than did either the baseline or the nonpreferred stimulus conditions, suggesting that the procedure can be used to assess reinforcer value for individuals with limited behavioral repertoires.     

CLINICAL BEHAVIORAL PHARMACOLOGY: METHODS FOR EVALUATING MEDICATIONS AND CONTINGENCY MANAGEMENT

We evaluated methods for comparing the effects of dextroamphetamine (Dexedrine), thioridazine (Mellaril), and contingency management in the control of severe behavior problems. A reversal design was used in which medications were systematically titrated and assessed in unstructured as well as structured settings with three clients. Subsequently, behavioral procedures including timeout, differential reinforcement of other behavior, and visual screening, were used in a multiple-baseline design across settings. The assessment and design methods were useful in comparing the interventions. Dextroamphetamine decreased inappropriate behaviors and improved academic behaviors in one client, but no reliable effects were observed in the other two clients. Thioridazine was variable across clients, settings, behaviors, and dosages. Contingency management produced consistent decreases in inappropriate behaviors and small improvements in academic performance.     

The assessment of type a behavior in children and adolescents: An overview

The present article presents an overview of the instruments that have been used to assess the Type A behavior pattern in children and adolescents. The development, usage, and psychometric properties of each assessment technique are discussed, with methodological concerns being addressed whenever appropriate. The Matthews Youth Test for Health is the assessment of choice for children, because of its brevity, ease of administration, and adequate psychometric properties. The Hunter-Wolf A-B Rating Scale is desirable only for older, highly literate children. The Adolescent Structured Interview appears to be the most promising device for the adolescent age range. The other adolescent assessment devices are relatively unpopular, difficult to administer, and not always conceptually parallel to existing research on Type A behavior. Recommendations for future research are presented.     

FUNCTIONAL ANALYSIS AND TREATMENT OF SEVERE PICA

A two-phase functional analysis of a profoundly retarded 19-year-old male's pica facilitated the design of an effective intervention containing no aversive components. In the first analysis, frequent staff-client interaction resulted in 25% and 66% less pica than limited and no interaction, respectively. Paradoxical effects were obtained in the second analysis, where no protective helmet resulted in 38% and 26% less pica than the helmet with face shield and helmet without face shield, respectively. On the basis of these analyses, limited interaction and no helmet conditions were combined in an effective, staff-implemented treatment at a medium-sized institution.     

Social and solipsistic observer training: Effects on agreement with a criterion

The need to train accurate, not necessarily agreeing, observers is discussed. Intraobserver consistency as an intermediate criterion in such training is proposed and contrasted with the more familiar criterion of interobserver agreement. Videotaped observations of social interactions between handicapped and nonhandicapped preschoolers provided the medium for examining the criterion agreement of four observers trained against each type of standard. Observers generally failed to show high levels of criterion agreement whether trained to a within- or to a between-observer agreement standard. The results varied somewhat with the frequency of behaviors, however. Correlations between interobserver agreement and intraobserver consistency were variable but somewhat higher when interobserver agreement was the training criterion than when intraobserver consistency was the criterion. Correlations between interobserver agreement and criterion agreement ranged from — .16 to .89 during interobserver agreement training. Correlations between intraobserver consistency and criterion agreement ranged from — .23 to .99 during intraobserver consistency training.     

Issues in diagnosing anxiety disorders

Research progress in the anxiety disorders is predicated on a useful classification system. In this paper, we review the reliability and validity data for theDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III) anxiety disorders and discuss the salient issues associated with both the conceptualization of anxiety disorders and the diagnostic criteria offered in the DSM-III. It is concluded that the diagnostic reliability for these disorders is, overall, satisfactory. A dearth of validity data, however, hinders progress in both the diagnosis and the treatment of the anxiety disorders. Nevertheless, the DSM-III work group has proposed several changes in the diagnostic criteria for the anxiety disorders. We find some of these proposed changes helpful in that they clarify current diagnostic criteria; changes in diagnostic criteria that alter the basic classification schema, however, seem to be premature.Preparation of this paper was supported in part by MIMH Research Grant 1368.On sabbatical leave from Indiana State University.