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Attributions of laziness, reflected in teacher comments such as ‘Just try harder and you will shine’, may mask specific cognitive, learning, attentional or emotional problems that could explain low motivation in some children. This paper reports findings from an investigation of 20 children, aged 7 to 10 years, who were regarded as lazy by their parents and teachers. Questionnaire measures provided evidence of low levels of motivation and classroom engagement. Psychometric assessments revealed the presence of a range of difficulties including phonologically based learning disabilities and significant problems with attention in 17 of the 20 children. The paper concludes that the special needs of an unknown number of children may be overlooked because they are simply presumed to be lazy.
Psychological treatments have been shown to be effective in patients with psychosis. However, the studies published to date have included participants across wide age ranges, so few conclusions can be reached about the effectiveness of such treatments in relation to age.
To evaluate outcomes by age in a randomised controlled trial designed to evaluate the effectiveness of cognitive-behavioural therapy (CBT), supportive counselling and treatment as usual.
Outcomes were evaluated in terms of symptoms, social functioning, insight and therapeutic alliance according to age at 3- and 18-month follow-up.
Younger participants responded better to supportive counselling than to treatment as usual and CBTover 3 months. Older participants responded better to CBT than to supportive counselling over 18 months. Younger participants showed a greater increase in insight after CBT compared with treatment as usual and supportive counselling, and were more difficult to engage in therapy.
Young people may have different needs with regard to engagement in psychological treatments. Treatment providers need to take age-specific factors into account.
This article addresses some implications for gender equality and gender policy at European and national levels of transformations in family, economy and polity, which challenge gender regimes across Europe. Women's labour market participation in the west and the collapse of communism in the east have undermined the systems and assumptions of western male breadwinner and dual worker models of central and eastern Europe. Political reworking of the work/welfare relationship into active welfare has individualised responsibility. Individualisation is a key trend west – and in some respects east – and challenges the structures that supported care in state and family. The links that joined men to women, cash to care, incomes to carers have all been fractured. The article will argue that care work and unpaid care workers are both casualties of these developments. Social, political and economic changes have not been matched by the development of new gender models at the national level. And while EU gender policy has been admired as the most innovative aspect of its social policy, gender equality is far from achieved: women's incomes across Europe are well below men's; policies for supporting unpaid care work have developed modestly compared with labour market activation policies. Enlargement brings new challenges as it draws together gender regimes with contrasting histories and trajectories. The article will map social policies for gender equality across the key elements of gender regimes – paid work, care work, income, time and voice – and discuss the nature of a model of gender equality that would bring gender equality across these. It analyses ideas about a dual earner–dual carer model, in the Dutch combination scenario and ‘universal caregiver’ models, at household and civil society levels. These offer a starting point for a model in which paid and unpaid work are equally valued and equally shared between men and women, but we argue that a citizenship model, in which paid and unpaid work obligations are underpinned by social rights, is more likely to achieve gender equality.
The initial phase of a trial of cognitive–behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery.
To test the hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period.
This was an 18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation.
There were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre–treatment interaction, reflecting centre differences in the effect of introducing either treatment, but not in the comparison of CBT and supportive counselling. Medication dosage and compliance did not explain group differences.
Adjunctive psychological treatments can have a beneficial longterm effect on symptom reduction.
Comorbid substance misuse in people with schizophrenia is associated with poor clinical and social outcomes. There are few studies of psychological treatments for this population and little long-term follow-up of their benefits.
To investigate symptom, substance use, functioning and health economy outcomes for patients with schizophrenia and their carers 18 months after a cognitive–behavioural treatment (CBT) programme.
Patients with dual diagnosis from a randomised controlled trial of motivational intervention, individual CBT and family intervention were assessed on multiple outcomes at 18-month follow-up. Carers were assessed on symptom, functioning and needs over 12 months. Health economy data were collected over 18 months.
There were significant improvements in patient functioning compared with routine care over 18 months. No significant differences between treatment groups were found in carer or cost outcomes.
The treatment programme was superior to routine care on outcomes relating to illness and service use, and the cost was comparable to the control treatment.
This was a qualitative research study of parental perceptions of gastrostomy feeding before surgery using an in-depth interview in the parental home to examine the factors parents consider when gastrostomy feeding is recommended and to identify the need for support. Participants were a subgroup of families taking part in a larger research study evaluating gastrostomy placement in children with severe neurodevelopmental disabilities at a major paediatric centre in the UK between 1998 and 2000. Parents of 22 children (13 males, nine females; mean age 4 years 8 months [SD 3 years 6 months]; age range 1 year 1 month to 13 years 3 months) were interviewed. Categories of disability were: cerebral palsy (n=10), a syndrome of chromosomal or genetic origin (n=10), and unconfirmed diagnoses (n=2). Thirteen children were recommended for a gastrostomy and seven were recommended for a gastrostomy with an antireflux procedure. Four families were undecided about surgery at the time of the interview, two of whom went ahead with the procedure some time later. Parental accounts of oral and tube feeding were both contradictory and ambivalent. Concerns about the loss of oral feeding, which was regarded as having a range of psychosocial effects for the child and family, were raised. Both oral and tube feeding have multiple meanings for parents and signify more than obtaining an adequate nutritional intake. The need for additional information about the risks and benefits of gastrostomy and how tube feeding fits into the context of everyday life were dominant themes. The biomedical emphasis on health and weight-gains may fail to reflect parental concerns about tube and oral feeding. There is a need for greater practical and emotional support for families feeding children with severe disabilities.
To test the effectiveness of added CBT in accelerating remission from acute psychotic symptoms in early schizophrenia.
A 5-week CBT programme plus routine care was compared with supportive counselling plus routine care and routine care alone in a multi-centre trial randomising 315 people with DSM–IV schizophrenia and related disorders in their first (83%) or second acute admission. Outcome assessments were blinded.
Linear regression over 70 days showed predicted trends towards faster improvement in the CBT group. Uncorrected univariate comparisons showed significant benefits at 4 but not 6 weeks for CBTv. routine care alone on Positive and Negative Syndrome Scale total and positive sub-scale scores and delusion score and benefits v. supportive counselling for auditory hallucinations score.
CBT shows transient advantages over routine care alone or supportive counselling in speeding remission from acute symptoms in early schizophrenia.
In this paper we use an extensive archive of early New Zealand speakers, together
with comparisons with the other Southern Hemisphere varieties of English, to argue
that dialect mixture and new-dialect formation are not haphazard processes. We
demonstrate that, given sufficient linguistic information about the dialects which
contribute to a mixture, and sufficient demographic information about the
proportions of speakers of the different dialects, it is possible to make predictions
about what the outcome of the mixture will be. We also argue that we have arrived
at a probabilistic solution to the problem of randomness in the transmission of dialect
features from one generation to another in such situations.
In this article we address Labov's claim that
sound changes that are not stigmatized are led especially
by young women who are the “movers and shakers”
in the community, people with energy and enterprise. Such
young women, at the same time, are conservative with respect
to sound changes or stable linguistic variables that are
stigmatized. We investigated this claim by comparing the
pronunciation of the non-stigmatized front vowels /I/,
/ε/, and /æ/ with that of the stigmatized diphthongs
/ai/ and /a[inverted omega]/ in New Zealand English. When we
considered the pronunciation of each variable, the young women did
not unequivocally support Labov's claim. However, when
we examined the behavior of individual speakers across the
two sets of variables, Labov's claim was supported.
This result leads us to emphasize the importance of considering
the behavior of individual speakers in a more holistic
way rather than focusing only on the averaged data for
Background Cognitive-behavioural treatments have previously been explored in the treatment of chronic psychotic problems, but recently, the effectiveness of these treatments has been investigated with regard to recent onset and acute psychosis.
Method The literature relating to cognitive-behavioural treatments in psychosis is explored and the application of the approach to recent onset psychosis is described in detail.
Results There appears to be a growing body of evidence that the advances made in the treatment of people with chronic treatment resistant psychosis can be similarly applied to people with recent onset and acute psychosis.
Conclusions Cognitive-behavioural treatments are feasible with recent onset psychotic patients although further evaluation of their effectiveness is necessary.
The first line of treatment for patients with psychotic disorders such as schizophrenia is neuroleptic medication. Neuroleptics have provided substantial benefits to patients with this type of severe mental illness since their discovery as a treatment for psychosis in the 1950s. Despite this, there are still a large number of patients who do not respond fully to neuroleptic medication or who are not able to tolerate it. For example, although as many as 70% of patients are substantially improved following drug treatment, a considerable proportion continue to experience persistent, distressing and recurrent symptoms. In a survey of patients in a London psychiatric hospital, Curson et al (1988) found that just under half of the patients continued to experience hallucinations and delusions despite the prescription of medication. In addition, many patients experience intolerable side-effects or do not wish to comply with neuroleptic medication, yet look for some effective alternative. Depression, anxiety and a high rate of suicide are additional problems faced by patients with schizophrenia.
Levels of I were determined in selected foods and dietary supplements, and in samples of the British ‘Total Diet’. The average concentration of I in British milk collected in thirteen areas on four occasions during 1990 and 1991 was 150 μg/kg (range 40–310 μg/kg), compared with 230 μg/kg in 1977–79. No difference was found between skimmed and whole milk. Winter milk contained 210 μg/kg while summer milk contained 90 μg/kg. Regional differences were less pronounced than seasonal differences. Levels in fish and fish products were between 110 and 3280 μg/kg. Edible seaweed contained I levels of between 4300 and 2660000 μg/kg. Kelp-based dietary supplements contained I at levels that would result in a median intake of 1000 μg if the manufacturers' recommended maximum daily dose of the supplement was taken, while other I-containing supplements contained a median level of 104 μg in the manufacturers' maximum recommended daily dose. Intake of I, as estimated from the Total Diet Study, was 173 μg/d in 1985 (277 μg if samples with very high I contents were included) and 166 μg/d in 1991. These levels are above the UK reference nutrient intake of 140 μg/d for adults but well below the Joint Expert Committee on Food Additives provisional maximum tolerable intake of 1000 μg/d.
Too often debate about the pros and cons of early schooling, including preschooling, focuses on age. But is age the most significant variable? How does the focus on age of entry align with current perspectives on development in early childhood? TO what extent does the debate take account of recent advances in teaching strategies and curriculum in early childhood? Too often it would appear that decisions concerning school programs are based on considerations which do not give attention to psychological and other evidence. To this extent the paper argues that the links between psychology and social change are tenuous. The paper undertakes a review of the issues from both developmental and educational viewpoints. In addition consideration is also given to the impact of social and cultural factors upon the movement; of children both from home to school and within school. Specifically the paper advances the view that a central concern in early education is the extent to which curriculum and strategies are able to meet individual needs.
Cavities in the septum pellucidum are widely regarded as incidental findings of little clinical importance. The prevalence of such cava on computerized tomography in a mixed sample of 22000 neurological and psychiatric patients is found to be 0·15%. A statistical association between this anomaly and a referral diagnosis of functional psychosis is reported, and 6 cases are described. These cases were male and characterized by an early history of developmental delay, with lifelong disturbances of emotion and behaviour prior to the onset in early adulthood of an atypical schizophrenia-like psychosis with disorders of speech and movement. It is suggested that septal cavities may signal an underlying abnormality of function relevant to the pathogenesis of these illnesses.