Posts

What is Alexithymia?

Published on by Andrew Marshall6 Comments

Introduction

Alexithymia is a personality trait characterised by the subclinical inability to identify and describe emotions experienced by one’s self.

The core characteristic of alexithymia is marked dysfunction in emotional awareness, social attachment, and interpersonal relation. Furthermore, people with high levels of alexithymia can have difficulty distinguishing and appreciating the emotions of others, which is thought to lead to non-empathic and ineffective emotional responses.

High levels of alexithymia occur in approximately 10% of the population and can occur with a number of psychiatric conditions as well as any neurodevelopmental disorder. Difficulty with recognising and talking about their emotions appears at subclinical levels in men who conform to western cultural notions of masculinity (such as thinking that sadness is a feminine emotion). This is called normative male alexithymia by some researchers. However, both alexithymia itself and its association with traditionally masculine norms are consistent across genders.

Lexicology

The term alexithymia was coined by psychotherapists John Case Nemiah and Peter Sifneos in 1973. The word comes from Greek: ἀ- (a-, ‘not’, privative prefix, alpha privative) + λέξις (léxis, ‘words’) + θῡμός (thȳmós, ‘heart’ or ’emotions’ or ‘seat of speech’) (cf. dyslexia), literally meaning “no words for emotions”.

Another etymology: Greek: Αλεξιθυμία ἀλέξω (to ward off) + θῡμός. Means to push away emotions, feelings

Nonmedical terms describing similar conditions include emotionless and impassive. People with the condition are called alexithymics or alexithymiacs.

Classification

Alexithymia is considered to be a personality trait that places affected individuals at risk for other medical and psychiatric disorders while reducing the likelihood that these individuals will respond to conventional treatments for the other conditions. Alexithymia is not classified as a mental disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. It is a dimensional personality trait that varies in intensity from person to person. A person’s alexithymia score can be measured with questionnaires such as the Toronto Alexithymia Scale (TAS-20), the Perth Alexithymia Questionnaire (PAQ), the Bermond-Vorst Alexithymia Questionnaire (BVAQ), the Levels of Emotional Awareness Scale (LEAS), the Online Alexithymia Questionnaire (OAQ-G2), the Toronto Structured Interview for Alexithymia (TSIA), or the Observer Alexithymia Scale (OAS). It is distinct from the psychiatric personality disorders, such as antisocial personality disorder.

Traditionally, alexithymia has been conceptually defined by four components:

  • Difficulty identifying feelings (DIF).
  • Difficulty describing feelings to other people (DDF).
  • A stimulus-bound, externally oriented thinking style (EOT).
  • Constricted imaginal processes (IMP),

However, there is some ongoing disagreement in the field about the definition of alexithymia. When measured in empirical studies, constricted imaginal processes are often found not to statistically cohere with the other components of alexithymia. Such findings have led to debate in the field about whether IMP is indeed a component of alexithymia. For example, in 2017, Preece and colleagues introduced the attention-appraisal model of alexithymia, where they suggested that IMP be removed from the definition and that alexithymia be conceptually composed only of DIF, DDF, and EOT, as each of these three are specific to deficits in emotion processing. In practice, since the constricted imaginal processes items were removed from earlier versions of the TAS-20 in the 1990s, the most used alexithymia assessment tools (and consequently most alexithymia research studies) have only assessed the construct in terms of DIF, DDF, and EOT.

Studies (using measures of alexithymia assessing DIF, DDF, and EOT) have reported that the prevalence rate of high alexithymia is less than 10% of the population. A less common finding suggests that there may be a higher prevalence of alexithymia amongst males than females, which may be accounted for by difficulties some males have with “describing feelings”, but not by difficulties in “identifying feelings” in which males and females show similar abilities.

Psychologist R. Michael Bagby and psychiatrist Graeme J. Taylor have argued that the alexithymia construct is inversely related to the concepts of psychological mindedness and emotional intelligence and there is “strong empirical support for alexithymia being a stable personality trait rather than just a consequence of psychological distress”.

Signs and Symptoms

Typical deficiencies may include problems identifying, processing, describing, and working with one’s own feelings, often marked by a lack of understanding of the feelings of others; difficulty distinguishing between feelings and the bodily sensations of emotional arousal; confusion of physical sensations often associated with emotions; few dreams or fantasies due to restricted imagination; and concrete, realistic, logical thinking, often to the exclusion of emotional responses to problems. Those who have alexithymia also report very logical and realistic dreams, such as going to the store or eating a meal. Clinical experience suggests it is the structural features of dreams more than the ability to recall them that best characterises alexithymia.

Some alexithymic individuals may appear to contradict the above-mentioned characteristics because they can experience chronic dysphoria or manifest outbursts of crying or rage. However, questioning usually reveals that they are quite incapable of describing their feelings or appear confused by questions inquiring about specifics of feelings.

According to Henry Krystal, individuals exhibiting alexithymia think in an operative way and may appear to be super-adjusted to reality. In psychotherapy, however, a cognitive disturbance becomes apparent as patients tend to recount trivial, chronologically ordered actions, reactions, and events of daily life with monotonous detail. In general, these individuals can, but not always, seem oriented toward things and even treat themselves as robots. These problems seriously limit their responsiveness to psychoanalytic psychotherapy; psychosomatic illness or substance abuse is frequently exacerbated should these individuals enter psychotherapy.

A common misconception about alexithymia is that affected individuals are totally unable to express emotions verbally and that they may even fail to acknowledge that they experience emotions. Even before coining the term, Sifneos (1967) noted patients often mentioned things like anxiety or depression. The distinguishing factor was their inability to elaborate beyond a few limited adjectives such as “happy” or “unhappy” when describing these feelings. The core issue is that people with alexithymia have poorly differentiated emotions limiting their ability to distinguish and describe them to others. This contributes to the sense of emotional detachment from themselves and difficulty connecting with others, making alexithymia negatively associated with life satisfaction even when depression and other confounding factors are controlled for.

Associated Conditions

Alexithymia frequently co-occurs with other disorders. Research indicates that alexithymia overlaps with autism spectrum disorders (ASD). In a 2004 study using the TAS-20, 85% of the adults with ASD fell into the “impaired” category and almost half fell into the “severely impaired” category; in contrast, among the adult control population only 17% were “impaired”, none “severely impaired”. Fitzgerald & Bellgrove pointed out that, “Like alexithymia, Asperger’s syndrome is also characterised by core disturbances in speech and language and social relationships”. Hill & Berthoz agreed with Fitzgerald & Bellgrove (2006) and in response stated that “there is some form of overlap between alexithymia and ASDs”. They also pointed to studies that revealed impaired theory of mind skill in alexithymia, neuroanatomical evidence pointing to a shared aetiology and similar social skills deficits. The exact nature of the overlap is uncertain. Alexithymic traits in ASD may be linked to clinical depression or anxiety; the mediating factors are unknown and it is possible that alexithymia predisposes to anxiety. On the other hand, while the total alexithymia score as well as the difficulty in identifying feelings and externally oriented thinking factors are found to be significantly associated with ADHD, and while the total alexithymia score, the difficulty in identifying feelings, and the difficulty in describing feelings factors are also significantly associated with symptoms of hyperactivity/impulsivity, there is no significant relationship between alexithymia and inattentiveness symptom.

There are many more psychiatric disorders that overlap with alexithymia. One study found that 41% of US veterans of the Vietnam War with post-traumatic stress disorder (PTSD) were alexithymic. Another study found higher levels of alexithymia among Holocaust survivors with PTSD compared to those without. Higher levels of alexithymia among mothers with interpersonal violence-related PTSD were found in one study to have proportionally less caregiving sensitivity. This latter study suggested that when treating adult PTSD patients who are parents, alexithymia should be assessed and addressed also with attention to the parent-child relationship and the child’s social-emotional development.

Single study prevalence findings for other disorders include 63% in anorexia nervosa, 56% in bulimia, 45% to 50% in major depressive disorder, 34% in panic disorder, 28% in social phobia, and 50% in substance abusers. Alexithymia is also exhibited by a large proportion of individuals with acquired brain injuries such as stroke or traumatic brain injury.

Alexithymia is correlated with certain personality disorders, particularly schizoid, avoidant, dependent and schizotypal, substance use disorders, some anxiety disorders and sexual disorders as well as certain physical illnesses, such as hypertension, inflammatory bowel disease and functional dyspepsia. Alexithymia is further linked with disorders such as migraine headaches, lower back pain, irritable bowel syndrome, asthma, nausea, allergies and fibromyalgia.

An inability to modulate emotions is a possibility in explaining why some people with alexithymia are prone to discharge tension arising from unpleasant emotional states through impulsive acts or compulsive behaviours such as binge eating, substance abuse, perverse sexual behaviour or anorexia nervosa. The failure to regulate emotions cognitively might result in prolonged elevations of the autonomic nervous system (ANS) and neuroendocrine systems, which can lead to somatic diseases. People with alexithymia also show a limited ability to experience positive emotions leading Krystal (1988) and Sifneos (1987) to describe many of these individuals as anhedonic.

Alexisomia is a clinical concept that refers to the difficulty in the awareness and expression of somatic, or bodily, sensations. The concept was first proposed in 1979 by Dr. Yujiro Ikemi when he observed characteristics of both alexithymia and alexisomia in patients with psychosomatic diseases.

Causes

It is unclear what causes alexithymia, though several theories have been proposed.

Early studies showed evidence that there may be an interhemispheric transfer deficit among people with alexithymia; that is, the emotional information from the right hemisphere of the brain is not being properly transferred to the language regions in the left hemisphere, as can be caused by a decreased corpus callosum, often present in psychiatric patients who have suffered severe childhood abuse. A neuropsychological study in 1997 indicated that alexithymia may be due to a disturbance to the right hemisphere of the brain, which is largely responsible for processing emotions. In addition, another neuropsychological model suggests that alexithymia may be related to a dysfunction of the anterior cingulate cortex. These studies have some shortcomings, however, and the empirical evidence about the neural mechanisms behind alexithymia remains inconclusive.

French psychoanalyst Joyce McDougall objected to the strong focus by clinicians on neurophysiological explanations at the expense of psychological ones for the genesis and operation of alexithymia, and introduced the alternative term “disaffectation” to stand for psychogenic alexithymia. For McDougall, the disaffected individual had at some point “experienced overwhelming emotion that threatened to attack their sense of integrity and identity”, to which they applied psychological defences to pulverise and eject all emotional representations from consciousness. A similar line of interpretation has been taken up using the methods of phenomenology. McDougall has also noted that all infants are born unable to identify, organize, and speak about their emotional experiences (the word infans is from the Latin “not speaking”), and are “by reason of their immaturity inevitably alexithymic”. Based on this fact McDougall proposed in 1985 that the alexithymic part of an adult personality could be “an extremely arrested and infantile psychic structure”. The first language of an infant is nonverbal facial expressions. The parent’s emotional state is important for determining how any child might develop. Neglect or indifference to varying changes in a child’s facial expressions without proper feedback can promote an invalidation of the facial expressions manifested by the child. The parent’s ability to reflect self-awareness to the child is another important factor. If the adult is incapable of recognising and distinguishing emotional expressions in the child, it can influence the child’s capacity to understand emotional expressions.

Molecular genetic research into alexithymia remains minimal, but promising candidates have been identified from studies examining connections between certain genes and alexithymia among those with psychiatric conditions as well as the general population. A study recruiting a test population of Japanese males found higher scores on the Toronto Alexithymia Scale among those with the 5-HTTLPR homozygous long (L) allele. The 5-HTTLPR region on the serotonin transporter gene influences the transcription of the serotonin transporter that removes serotonin from the synaptic cleft, and is well studied for its association with numerous psychiatric disorders. Another study examining the 5-HT1A receptor, a receptor that binds serotonin, found higher levels of alexithymia among those with the G allele of the Rs6295 polymorphism within the HTR1A gene. Also, a study examining alexithymia in subjects with obsessive-compulsive disorder found higher alexithymia levels associated with the Val/Val allele of the Rs4680 polymorphism in the gene that encodes Catechol-O-methyltransferase (COMT), an enzyme which degrades catecholamine neurotransmitters such as dopamine. These links are tentative, and further research will be needed to clarify how these genes relate to the neurological anomalies found in the brains of people with alexithymia.

Although there is evidence for the role of environmental and neurological factors, the role and influence of genetic factors for developing alexithymia is still unclear. A single large scale Danish study suggested that genetic factors contributed noticeably to the development of alexithymia. However, such twin studies are controversial, as they suffer from the “equal environments assumption” and the “heritability” estimates in no way correspond to actual DNA structures. Traumatic brain injury is also implicated in the development of alexithymia, and those with traumatic brain injury are six times more likely to exhibit alexithymia.

In Relationships

Alexithymia can create interpersonal problems because these individuals tend to avoid emotionally close relationships, or if they do form relationships with others they usually position themselves as either dependent, dominant, or impersonal, “such that the relationship remains superficial”. Inadequate “differentiation” between self and others by alexithymic individuals has also been observed. Their difficulty in processing interpersonal connections often develops where the person lacks a romantic partner.

In a study, a large group of alexithymic individuals completed the 64-item Inventory of Interpersonal Problems (IIP-64) which found that “two interpersonal problems are significantly and stably related to alexithymia: cold/distant and non-assertive social functioning. All other IIP-64 subscales were not significantly related to alexithymia.”

Chaotic interpersonal relations have also been observed by Sifneos. Due to the inherent difficulties identifying and describing emotional states in self and others, alexithymia also negatively affects relationship satisfaction between couples.

In a 2008 study alexithymia was found to be correlated with impaired understanding and demonstration of relational affection, and that this impairment contributes to poorer mental health, poorer relational well-being, and lowered relationship quality. Individuals high on the alexithymia spectrum also report less distress at seeing others in pain and behave less altruistically toward others.

Some individuals working for organisations in which control of emotions is the norm might show alexithymic-like behaviour but not be alexithymic. However, over time the lack of self-expressions can become routine and they may find it harder to identify with others.

Treatment

Generally speaking, approaches to treating alexithymia are still in their infancy, with not many proven treatment options available.

In 2002, Kennedy and Franklin found that a skills-based intervention is an effective method for treating alexithymia. Kennedy and Franklin’s treatment plan involved giving the participants a series of questionnaires, psychodynamic therapies, cognitive-behavioural and skills-based therapies, and experiential therapies. After treatment, they found that participants were generally less ambivalent about expressing their emotion feelings and more attentive to their emotional states.

In 2017, based on their attention-appraisal model of alexithymia, Preece and colleagues recommended that alexithymia treatment should target trying to improve the developmental level of people’s emotion schemas and reduce people’s use of experiential avoidance of emotions as an emotion regulation strategy (i.e. the mechanisms hypothesized to underlie alexithymia difficulties in the attention-appraisal model of alexithymia).

In 2018, Löf, Clinton, Kaldo, and Rydén found that mentalisation-based treatment is also an effective method for treating alexithymia. Mentalisation is the ability to understand the mental state of oneself or others that underlies overt behaviour, and mentalisation-based treatment helps patients separate their own thoughts and feelings from those around them. This treatment is relational, and it focuses on gaining a better understanding and use of mentalising skills. The researchers found that all of the patients’ symptoms including alexithymia significantly improved, and the treatment promoted affect tolerance and the ability to think flexibly while expressing intense affect rather than impulsive behaviour.

A significant issue impacting alexithymia treatment is that alexithymia has comorbidity with other disorders. Mendelson’s 1982 study showed that alexithymia frequently presented in people with undiagnosed chronic pain. Participants in Kennedy and Franklin’s study all had anxiety disorders in conjunction with alexithymia, while those in Löf et al. were diagnosed with both alexithymia and borderline personality disorder. All these comorbidity issues complicate treatment because it is difficult to examine people who exclusively have alexithymia.

What is the Association for Behavioural and Cognitive Therapies?

Published on by Andrew Marshall1 Comment

Introduction

The Association for Behavioural and Cognitive Therapies (ABCT) was founded in 1966.

Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, marriage and family therapists, nurses, and other mental-health practitioners and students. These members support, use, and/or disseminate behavioural and cognitive approaches.

Brief History

ABCT was founded in 1966 under the name Association for Advancement of Behavioural Therapies (AABT) by 10 behaviourists who were dissatisfied with the prevailing Freudian/psychoanalytic model (Its founding members include: John Paul Brady, Joseph Cautela, Edward Dengrove, Cyril Franks, Martin Gittelman, Leonard Krasner, Arnold Lazarus, Andrew Salter, Dorothy Susskind, and Joseph Wolpe). The Freudian/psychoanalytic model refers to the Id, Ego, and Superego within each individual as they interpret and interact with the world and those around them. Although the ABCT was not established until 1966, its history begins in the early 1900s with the birth of the behaviourist movement, which was brought about by Pavlov, Watson, Skinner, Thorndike, Hull, Mowrer, and others – scientists who, concerned primarily with observable behaviour, were beginning to experiment with conditioning and learning theory. By the 1950s, two entities – Hans Eysenck’s research group (which included one of AABT’s founders Cyril Franks) at the University of London Institute of Psychiatry, and Joseph Wolpe’s research group (which included another of AABT’s founders, Arnold Lazarus) in South Africa – were conducting important studies that would establish behaviour therapy as a science based on principles of learning. In complete opposition to the psychoanalytic model, “The seminal significance of behaviour therapy was the commitment to apply the principles and procedures of experimental psychology to clinical problems, to rigorously evaluate the effects of therapy, and to ensure that clinical practice was guided by such objective evaluation”.

The first president of the association was Cyril Franks, who also founded the organisation’s flagship journal Behaviour Therapy and was the first editor of the Association for Advancement of Behavioural Therapies Newsletter. The first annual meeting of the association took place in 1967, in Washington, DC, concurrent with the American Psychological Association’s meeting.

An article in the November 1967 issue of the Newsletter, entitled “Behaviour Therapy and Not Behaviour Therapies” (Wilson & Evans, 1967), influenced the association’s first name change from Association for Advancement of Behavioural Therapies to Association for Advancement of Behaviour Therapy because, as the authors argued, “the various techniques of behaviour therapy all derive from learning theory and should not be misinterpreted as different kinds of behaviour therapy…”. This issue remains a debate in the field and within the organization, particularly with the emergence of the term “cognitive behavioural therapies.” This resulted in yet another name change in 2005 to the Association for Behavioural and Cognitive Therapies.

The Association for Advancement of Behavioural Therapies/Association for Behavioural and Cognitive Therapies has been at the forefront of the professional, legal, social, and ethical controversies and dissemination efforts that have accompanied the field’s evolution. The 1970s was perhaps the most “explosive” and controversial decade for the field of behaviour therapy, as it suffered from an overall negative public image and received numerous attacks from the press regarding behaviour modification and its possible unethical uses. In Gerald Davison’s (AABT’s 8th president) public “Statement on Behaviour Modification from the AABT”, he asserted that “it is a serious mistake … to equate behaviour therapy with the use of electric shocks applied to the extremities…” and “a major contribution of behaviour therapy has been a profound commitment to full description of procedures and careful evaluation of their effects”. From this point, AABT became instrumental in enacting legislative guidelines that protected human research subjects, and they also became active in efforts to educate the public.

Mission Statement

The ABCT is an interdisciplinary organisation committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition. These aims are achieved through the investigation and application of behavioural, cognitive, prevention, and treatment. While primarily an interest group, ABCT is also active in:

  • Encouraging the development, study, and dissemination of scientific approaches to behavioural health.
  • Promoting the utilisation, expansion, and dissemination of behavioural, cognitive, and other empirically derived practices.
  • Facilitating professional development, interaction, and networking among members.

Professional Activities

Through its membership, publications, convention and education committees, the ABCT conducts a variety of activities to support and disseminate the behavioural and cognitive therapies. The organization produces two quarterly journals, Behaviour Therapy (research-based) and Cognitive and Behavioural Practice (treatment focused), as well as its house periodical, the Behaviour Therapist (eight times per year). The association’s convention is held annually in November. ABCT also produces fact sheets, an assessment series, and training and archival videotapes. The association maintains a website on which can be found a “Find-a-Therapist” search engine and information about behavioural and cognitive therapies. The organisation provides its members with an online clinical directory, over 30 special interest groups, a list serve, a job bank, and an awards and recognition programme. Other offerings available on the website include sample course syllabi, listings of grants available, and a broad range of offerings of interest to mental health researchers.

Mental Health Professionals

The training of mental health professionals has also been a significant priority for the association. Along with its annual meeting, AABT created an “ad hoc review mechanism” in the 1970s through the 1980s whereby a state could receive a review of a behaviour therapy programme. This led to the yearly publication of a widely used resource, “The Directory of Training Programmes”. With growing concerns over quality control and standardisation of practice, the certification of behaviour therapists also became an issue in the 1970s. This debate led to the development of a Diplomate in behaviour therapy at APA and for those behavioural therapy practices from a more radical behavioural perspective, the development of certification in behaviour analysis at the master level.

An ongoing debate within the association concerns what many consider to be a movement away from basic behavioural science as the field has attempted to advance and integrate more and more “new” therapies/specialisations, particularly the addition of cognitive theory and its variety of techniques. John Forsyth, in his special issue of Behaviour Therapy] entitled “Thirty Years of Behaviour Therapy: Promises Kept, Promises Unfulfilled”, summarised this opposition as follows:

“(a) cognition is not behaviour, (b) behaviour principles and theory cannot account for events occurring within the skin, and most important, (c) we therefore need a unique conceptual system to account for how thinking, feeling, and other private events relate to overt human action”.

The field’s desire to maintain its scientific foundations and yet continue to advance and grow, was reflected in its most recent discussion about adding the word “cognitive” to the name of the association.

Many notable scholars have served as president of the association, including Joseph Wolpe, Arnold Lazarus, Nathan Azrin, Steven C. Hayes, and David Barlow. The current executive director of the ABCT is Mary Jane Eimer, CAE. For a wealth of historical specifics (governing bodies, lists of editors, past presidents, award winners, SIGs, and conventions from the past 40 years) see ABCT’s 40th anniversary issue of the Behaviour Therapist.

About Behavioural and Cognitive Therapies

Cognitive and behavioural therapists help people learn to actively cope with, confront, reformulate, and/or change the maladaptive cognitions, behaviours, and symptoms that limit their ability to function, cause emotional distress, and accompany the wide range of mental health disorders. Goal-oriented, time-limited, research-based, and focused on the present, the cognitive and behavioural approach is collaborative. This approach values feedback from the client, and encourages the client to play an active role in setting goals and the overall course and pace of treatment. Importantly, behavioural interventions are characterized by a “direct focus on observable behaviour”. Practitioners teach clients concrete skills and exercises – from breathing retraining, to keeping thought records to behavioural rehearsal – to practice at home and in sessions, with the overall goal of optimal functioning and the ability to engage in life fully.

Because cognitive behavioural therapy (CBT) is based on broad principles of human learning and adaptation, it can be used to accomplish a wide variety of goals. CBT has been applied to issues ranging from depression and anxiety, to the improvement of the quality of parenting, relationships, and personal effectiveness.

Numerous scientific studies and research have documented the helpfulness of CBT programmes for a wide range of concerns throughout the lifespan. These concerns include children’s behaviour problems, health promotion, weight management, pain management, sexual dysfunction, stress, violence and victimisation, serious mental illness, relationship issues, academic problems, substance abuse, bipolar disorder, developmental disabilities, autism spectrum disorders, social phobia, school refusal and school phobia, hair pulling (trichotillomania) and much more. Cognitive-behavioural treatments are subject randomised controlled trials and “have been subjected to more rigorous evaluation using randomised controlled trials than any of the other psychological therapies”. There is discussion of using technology to determine diagnosis and host interventions according to research done by W. Edward Craighead. This would be done using “genetic analysis” and “neuroimaging” to create more individualised treatment plans.

Special Interest Groups

The ABCT has more than 40 special interest groups for its members. These include groups for issues involving African-Americans, Asian-Americans, Hispanics and other ethnic groups such as children and adolescents; couples; gay, lesbian, bisexual and transgender people; students; military personnel; and the criminal justice system. The ABCT works within these groups to overcome addictive behaviours and mental illnesses that may cause negativity in these groups life. A group that the ABCT has supported well is the special interest group of the criminal justice system. The ABCT helps provide the prison system with knowledge of how to more humanely treat those who committed crimes and give people the proper care and attention to become great citizens.

On This Day … 02 December

Published on by Andrew MarshallLeave a comment

People (Deaths)

  • 1957 – Manfred Sakel, Ukrainian-American neurophysiologist and psychiatrist (b. 1902).
  • 1986 – John Curtis Gowan, American psychologist and academic (b. 1912).

Manfred Sakel

Manfred Joshua Sakel (06 June 1900 to 02 December 1957) was an Austrian-Jewish (later Austrian-American) neurophysiologist and psychiatrist, credited with developing insulin shock therapy in 1927.

Sakel was born on 06 June 1900, in Nadvirna (Nadwórna), in the former Austria-Hungary Empire (now Ukraine), which was part of Poland between the world wars. Sakel studied Medicine at the University of Vienna from 1919 to 1925, specialising in neurology and neuropsychiatry. From 1927 until 1933 Sakel worked in hospitals in Berlin. In 1933 he became a researcher at the University of Vienna’s Neuropsychiatric Clinic. In 1936, after receiving an invitation from Frederick Parsons, the state commissioner of mental hygiene, he chose to emigrate from Austria to the United States of America. In the USA, he became an attending physician and researcher at the Harlem Valley State Hospital.

Dr. Sakel was the developer of insulin shock therapy from 1927 while a young doctor in Vienna, starting to practice it in 1933. It would become widely used on individuals with schizophrenia and other mental patients. He noted that insulin-induced coma and convulsions, due to the low level of glucose attained in the blood (hypoglycaemic crisis), had a short-term appearance of changing the mental state of drug addicts and psychotics, sometimes dramatically so. He reported that up to 88% of his patients improved with insulin shock therapy, but most other people reported more mixed results and it was eventually shown that patient selection had been biased and that it didn’t really have any specific benefits and had many risks, adverse effects and fatalities. However, his method became widely applied for many years in mental institutions worldwide. In the USA and other countries it was gradually dropped after the introduction of the electroconvulsive therapy in the 1940s and the first neuroleptics in the 1950s.

Dr. Sakel died from a heart attack on 02 December 1957, in New York City, NY, USA.

John Curtis Gowan

John Curtis Gowan (21 May 1912 to 02 December 1986) was a psychologist who studied, along with E. Paul Torrance, the development of creative capabilities in children and gifted populations.

John Curtis Gowan was born 21 May 1912 in Boston, Massachusetts. Graduating from Thayer Academy, Braintree, Massachusetts, in 1929, John Gowan was only 17 when he entered Harvard University, earning his undergraduate degree four years later. A master’s degree in mathematics followed; he then moved to Culver, Indiana, where he was employed as a counsellor and mathematics teacher at Culver Military Academy from 1941 to 1952. Earning a doctorate from UCLA, he became a member of the founding faculty at the California State University at Northridge, where he taught as a professor of Educational Psychology from 1953 until 1975, when he retired with emeritus status.

Dr. Gowan became interested in gifted children after the Russians gained superiority in space with the 1957 launch of Sputnik. He formed the National Association for Gifted Children the following year. He was the group’s executive director and president from 1975 to 1979 and over the years wrote more than 100 articles and fourteen books on gifted children, teacher evaluation, child development, and creativity.

While at Northridge, he developed a programme to train campus counsellors, was nominated in 1973 as outstanding professor, and had been a counsellor, researcher, Fulbright lecturer, and visiting professor at various schools including the University of Singapore, the University of Canterbury in Christchurch, New Zealand, the University of Hawaii, and Connecticut State College. He was a fellow of the American Psychological Association and was also a colleague of the Creative Education Foundation.

Besides his work in Educational Psychology as specifically related to gifted children, he also had an interest in psychic (or psychedelic) phenomena as it relates to human creativity. His work in this area was inspired by the writings of Aldous Huxley and Carl Jung. Based on his work in creativity and with gifted children, Dr. Gowan developed a model of mental development that derived from the work of Jean Piaget and Erik Erikson, but also included adult development beyond the ordinary adult successes of career and family building, extending into the emergence and stabilization of extraordinary development and mystical states of consciousness. He described the entire spectrum of available states in his classic Trance, Art, & Creativity (1975), with its different modalities of spiritual and aesthetic expression. He also devised a test for self-actualisation, (as defined by Abraham Maslow), called the Northridge Developmental Scale.

Dr. Gowan died on 02 December 1986. He was survived by his adult twin children from his first marriage, John Gowan Jr. of Albany, NY and Ann Gowan Curry, of Anchorage, Alaska as well as seven grandchildren and his second wife Jane Thompson Gowan. His godson, Cameron Scott Matheson sang at his memorial service which was attended by friends and colleagues.

An Overview of Mental Health in China

Published on by Andrew MarshallLeave a comment

Introduction

Mental health in China is a growing issue. Experts have estimated that about 173 million people living in China are suffering from a mental disorder.

The desire to seek treatment is largely hindered by China’s strict social norms (and subsequent stigmas), as well as religious and cultural beliefs regarding personal reputation and social harmony. While the Chinese government is committed to expanding mental health care services and legislation, the country struggles with a lack of mental health professionals and access to specialists in rural areas.

Brief History

China’s first mental institutions were introduced before 1849 by Western missionaries. Missionary and doctor John G. Kerr opened the first psychiatric hospital in 1898, with the goal of providing care to people with mental health issues, and treating them in a more humane way.

In 1949, the country began developing its mental health resources by building psychiatric hospitals and facilities for training mental health professionals. However, many community programs were discontinued during the Cultural Revolution.

In a meeting jointly held by Chinese ministries and the World Health Organisation (WHO) in 1999, the Chinese government committed to creating a mental health action plan and a national mental health law, among other measures to expand and improve care. The action plan, adopted in 2002, outlined China’s priorities of enacting legislation, educating its people on mental illness and mental health resources, and developing a stable and comprehensive system of care.

In 2000, the Minority Health Disparities Research and Education Act was enacted. This act helped in raising national awareness on health issues through research, health education, and data collection.

Since 2006, the government’s 686 Program has worked to redevelop community mental health programs and make these the primary resource, instead of psychiatric hospitals, for people with mental illnesses. These community programs make it possible for mental health care to reach rural areas, and for people in these areas to become mental health professionals. However, despite the improvement in access to professional treatment, mental health specialists are still relatively inaccessible to rural populations. The program also emphasizes rehabilitation, rather than the management of symptoms.

In 2011, the legal institution of China’s State Council published a draft for a new mental health law, which includes new regulations concerning the rights of patients to not to be hospitalised against their will. The draft law also promotes the transparency of patient treatment management, as many hospitals were driven by financial motives and disregarded patients’ rights. The law, adopted in 2012, stipulates that a qualified psychiatrist must make the determination of mental illness; that patients can choose whether to receive treatment in most cases; and that only those at risk of harming themselves or others are eligible for compulsory inpatient treatment. However, Human Rights Watch has criticised the law. For example, although it creates some rights for detained patients to request a second opinion from another state psychiatrists and then an independent psychiatrist, there is no right to a legal hearing such as a mental health tribunal and no guarantee of legal representation.

Since 1993, WHO has been collaborating with China in the development of a national mental health information system.

Current Situation

Though China continues to develop its mental health services, it still has a large number of untreated and undiagnosed people with mental illnesses. The aforementioned intense stigma associated with mental illness, a lack of mental health professionals and specialists, and culturally-specific expressions of mental illness may play a role in the disparity.

Prevalence of Mental Disorders

Researchers estimate that roughly 173 million people in China have a mental disorder. Over 90 percent of people with a mental disorder have never been treated.

A lack of government data on mental disorders makes it difficult to estimate the prevalence of specific mental disorders, as China has not conducted a national psychiatric survey since 1993.

Conducted between 2001 and 2005, a non-governmental survey of 63,000 Chinese adults found that 16 percent of the population had a mood disorder, including 6% of people with major depressive disorder. Thirteen percent of the population had an anxiety disorder and 9 percent had an alcohol use disorder. Women were more likely to have a mood or anxiety disorder compared to men, but men were significantly more likely to have an alcohol use disorder. People living in rural areas were more likely to have major depressive disorder or alcohol dependence.

In 2007, the Chief of China’s National Centre for Mental Health, Liu Jin, estimated that approximately 50% of outpatient admissions were due to depression.

There is a disproportionate impact on the quality of life for people with bipolar disorder in China and other East Asian countries.

The suicide rate in China was approximately 23 per 100,000 people between 1995 and 1999. Since then, the rate is thought to have fallen to roughly 7 per 100,000 people, according to government data. WHO states that the rate of suicide is thought to be three to four times higher in rural areas than in urban areas. The most common method, poisoning by pesticides, accounts for 62% of incidences.

It is estimated that 18% of the Chinese population, about 244 million people believe in Buddhism. Another 22% of the population, roughly 294 million people believe in folk religions which are a group of beliefs that share characteristics with Confucianism, Buddhism, Taoism, and shamanism. Common between all of these philosophical and religious beliefs is an emphasis on acting harmoniously with nature, with strong morals, and with a duty to family. Followers of these religions perceive behaviour as being tightly connected with health; illnesses are often thought to be a result of moral failure or insufficiently honouring one’s family in current or past life. Furthermore, an emphasis on social harmony may discourage people with mental illness from bringing attention to themselves and seeking help. They may also refuse to speak about their mental illness because of the shame it would bring upon themselves and their family members, who could also be held responsible and experience social isolation.

Also, reputation might be a factor that prevents individuals from seeking professional help. Good reputations are highly valued. In a Chinese household, every individual shares the responsibility of maintaining and raising the family’s reputation. It is believed that mental health will hinder individuals from achieving the standards and goals- whether academic, social, career-based, or other- expected from parents. Without reaching the expectations, individuals are anticipated to bring shame to the family, which will affect the family’s overall reputation. Therefore, mental health issues are seen as an unacceptable weakness. This perception of mental health disorders causes individuals to internalise their mental health problems, possibly worsening them, and making it difficult to seek treatment. Eventually, it becomes ignored and overlooked by families.

In addition, many of these philosophies teach followers to accept one’s fate. Consequently, people with mental disorders may be less inclined to seek medical treatment because they believe they should not actively try to prevent any symptoms that may manifest. They may also be less likely to question the stereotypes associated with people with mental illness, and instead agreeing with others that they deserve to be ostracised.

Lack of Qualified Staff

China has 17,000 certified psychiatrists, which is 10% of that of other developed countries per capita. China averages one psychologist for every 83,000 people, and some of these psychologists are not board-licensed or certified to diagnose illnesses. Individuals without any academic background in mental health can obtain a license to counsel, following several months of training through the National Exam for Psychological Counsellors. Many psychiatrists or psychologists study psychology for personal use and do not intend to pursue a career in counselling. Patients are likely to leave clinics with false diagnoses, and often do not return for follow-up treatments, which is detrimental to the degenerative nature of many psychiatric disorders.

The disparity between psychiatric services available between rural and urban areas partially contributes to this statistic, as rural areas have traditionally relied on barefoot doctors since the 1970s for medical advice. These doctors are one of the few modes of healthcare able to reach isolated parts of rural China, and are unable to obtain modern medical equipment, and therefore, unable to reliably diagnose psychiatric illnesses. Furthermore, the nearest psychiatric clinic may be hundreds of kilometres away, and families may be unable to afford professional psychiatric treatment for the afflicted.

Physical Symptoms

Multiple studies have found that Chinese patients with mental illness report more physical symptoms compared to Western patients, who tend to report more psychological symptoms. For example, Chinese patients with depression are more likely to report feelings of fatigue and muscle aches instead of feelings of depression. However, it is unclear whether this occurs because they feel more comfortable reporting physical symptoms or if depression manifests in a more physical way among Chinese people.

Misuse

According to various scholars, China’s psychiatric facilities have been manipulated by government officials in order to silence political dissidents. In addition to misuse by the state psychiatric facilities in China are also misused by powerful private individuals who use the system to advance their personal or business ends. China’s legal system lacks an effective means of challenging involuntary detentions in psychiatric facilities.

Chinese Military Mental Health

Overview

Military mental health has recently become an area of focus and improvement, particularly in Western countries. For example, in the United States, it is estimated that about twenty-five percent (25%) of active military members suffer from a mental health problem, such as PTSD, Traumatic Brain Injury, and depression. Currently, there are no clear initiatives from the government about mental health treatment towards military personnel in China. Specifically, China has been investing in resources towards researching and understanding how the mental health needs of military members and producing policies to reinforce the research results.

Background

Research on the mental health status of active Chinese military men began in the 1980s where psychologists investigated soldiers’ experiences in the plateaus. The change of emphasis from physical to mental health can be seen in China’s four dominant military academic journals: First Military Journal, Second Military Journal, Third Military Journal, and Fourth Military Journal. In the 1980s, researchers mostly focused on the physical health of soldiers; as the troops’ ability to perform their services declined, the government began looking at their mental health to provide an explanation for this trend. In the 1990s, research on it increased with the hope that by improving the mental health of soldiers, combat effectiveness improves.

Mental health issue can impact active military members’ effectiveness in the army, and can create lasting effects on them after they leave the military. Plateaus were an area of interest in this sense because of harsh environmental conditions and the necessity of the work done with low atmospheric pressure and intense UV radiation. It was critical to place the military there to stabilize the outskirts and protect the Chinese citizens who live nearby; this made it one of the most important jobs in the army, then increasing the pressure on those who worked in the plateaus. It not only affected the body physically, like in the arteries, lungs, and back, but caused high levels of depression in soldiers because of being away from family members and with limited communication methods. Scientists found that this may impact their lives as they saw that this population had higher rates of divorce and unemployment.

Comparatively, assessing the mental health status of the People’s Liberation Army (PLA) is difficult, because military members work a diverse array of duties over a large landscape. Military members also play an active part in disaster relief, peacekeeping in foreign lands, protecting borders, and domestic riot control. In a study of 11,000 soldiers, researchers found that those who work as peacekeepers have higher levels of depression compared to those in the engineering and medical departments. With such diverse military roles over an area of 8.4 million square kilometres (3.25 million square miles), it is difficult to gauge its impacts on soldiers’ psyche and provide a single method to address mental health problems.

Researches have increased over the last two decades, but the studies still lack a sense of comprehensiveness and reliability. In over 73 studies that together included 53,424 military members, some research shows that there is gradual improvement in mental health at high altitudes, such as mountain tops; other researchers found that depressive symptoms can worsen. These research studies demonstrate how difficult it is to assess and treat the mental illness that occurs in the army and how there are inconsistent results. Studies of the military population focus on the men of the military and exclude women, even though the number of women that are joining the military has increased in the last two decades.

Chinese researchers try to provide solutions that are preventative and reactive, such as implementing early mental health training, or mental health assessments to help service members understand their mental health state, and how to combat these feelings themselves. Researchers also suggest to improve the mental health of the military members, programmes should include psychoeducation, psychological training, and attention to physical health to employ timely intervention.

Implementation

In 2006, the People’s Republic Minister for National Defence began mental health vetting at the beginning of the military recruitment process. A Chinese military study consisting of 2500 male military personnel found that some members are more predisposed to mental illness. The study measured levels of anxious behaviours, symptoms of depression, sensitivity to traumatic events, resilience and emotional intelligence of existing personnel to aid the screening of new recruits. Similar research has been conducted into the external factors that impact a person’s mental fortitude, including single-child status, urban or rural environment, and education level. Subsequently, the government has incorporated mental illness coping techniques into their training manual. In 2013 leak by the Tibetan Centre for Human Rights of a small portion of the People’s Liberation Army training manual from 2008, specifically concerned how military personnel could combat PTSD and depression while on peacekeeping missions in Tibet. The manual suggested that soldiers should:

“…close [their] eyes and imagine zooming in on the scene like a camera [when experiencing PTSD]. It may feel uncomfortable. Then zoom all the way out until you cannot see anything. Then tell yourself the flashback is gone.”

In 2012, the government specifically addressed military mental health in a legal document for the first time. In article 84 of the Mental Health Law of the People’s Republic of China, it stated, “The State Council and the Central Military Committee will formulate regulations based on this law to manage mental health work in the military.”

Besides screening, assessments and an excerpt of the manual, not much is known about the services that are provided to active military members and veterans. Analysis of more than 45 different studies, moreover, has deemed that the level of anxiety in current and ex-military personnel has increased despite efforts of the People’s Republic due to economic conditions, lack of social connects and the feeling of a threat to military livelihood. This growing anxiety manifested in both 2016 and 2018, as Chinese veterans demonstrated their satisfaction with the system via protests across China. In both instances, veterans advocated for an increased focus on post-service benefits, resources to aid in post-service jobs, and justice for those who were treated poorly by the government. As a way to combat the dissatisfaction of veterans and alleviate growing tension, the government established the Ministry of Veteran Affairs in 2018. At the same time, Xi Jinping, General Secretary of the Communist Party of China, promised to enact laws that protect the welfare of veterans.

What is the Behaviour Analysis of Child Development?

Published on by Andrew Marshall1 Comment

Introduction

The behavioural analysis of child development originates from John B. Watson’s behaviourism.

Brief History

In 1948, Sidney Bijou took a position as associate professor of psychology at the University of Washington and served as director of the university’s Institute of Child Development. Under his leadership, the Institute added a child development clinic and nursery school classrooms where they conducted research that would later accumulate into the are that would be called “Behaviour Analysis of Child Development”. Skinner’s behavioural approach and Kantor’s interbehavioural approach were adopted in Bijou and Baer’s model. They created a three-stage model of development (basic, foundational, and societal). Bijou and Baer looked at these socially determined stages, as opposed to organising behaviour into change points or cusps (behavioural cusp). In the behavioural model, development is considered a behavioural change. It is dependent on the kind of stimulus and the person’s behavioural and learning function. Behaviour analysis in child development takes a mechanistic, contextual, and pragmatic approach.

From its inception, the behavioural model has focused on prediction and control of the developmental process. The model focuses on the analysis of a behaviour and then synthesizes the action to support the original behaviour. The model was changed after Richard J. Herrnstein studied the matching law of choice behaviour developed by studying of reinforcement in the natural environment. More recently, the model has focused more on behaviour over time and the way that behavioural responses become repetitive. it has become concerned with how behaviour is selected over time and forms into stable patterns of responding. A detailed history of this model was written by Pelaez. In 1995, Henry D. Schlinger, Jr. provided the first behaviour analytic text since Bijou and Baer comprehensively showed how behaviour analysis – a natural science approach to human behaviour – could be used to understand existing research in child development. In addition, the quantitative behavioural developmental model by Commons and Miller is the first behavioural theory and research to address notion similar to stage.

Research Methods

The methods used to analyse behaviour in child development are based on several types of measurements. Single-subject research with a longitudinal study follow-up is a commonly-used approach. Current research is focused on integrating single-subject designs through meta-analysis to determine the effect sizes of behavioural factors in development. Lag sequential analysis has become popular for tracking the stream of behaviour during observations. Group designs are increasingly being used. Model construction research involves latent growth modelling to determine developmental trajectories and structural equation modelling. Rasch analysis is now widely used to show sequentially within a developmental trajectory.

A recent methodological change in the behavioural analytic theory is the use of observational methods combined with lag sequential analysis can determine reinforcement in the natural setting.

Quantitative Behavioural Development

The model of hierarchical complexity is a quantitative analytic theory of development. This model offers an explanation for why certain tasks are acquired earlier than others through developmental sequences and gives an explanation of the biological, cultural, organisational, and individual principles of performance. It quantifies the order of hierarchical complexity of a task based on explicit and mathematical measurements of behaviour.

Research

Contingencies, Uncertainty, and Attachment

The behavioural model of attachment recognises the role of uncertainty in an infant and the child’s limited communication abilities. Contingent relationships are instrumental in the behaviour analytic theory, because much emphasis is put on those actions that produce parents’ responses.

The importance of contingency appears to be highlighted in other developmental theories, but the behavioural model recognises that contingency must be determined by two factors:

  • The efficiency of the action; and
  • That efficiency compared to other tasks that the infant might perform at that point.

Both infants and adults function in their environments by understanding these contingent relationships. Research has shown that contingent relationships lead to emotionally satisfying relationships.

Since 1961, behavioural research has shown that there is relationship between the parents’ responses to separation from the infant and outcomes of a “stranger situation.”. In a study done in 2000, six infants participated in a classic reversal design (refer to single-subject research) study that assessed infant approach rate to a stranger. If attention was based on stranger avoidance, the infant avoided the stranger. If attention was placed on infant approach, the infant approached the stranger.

Recent meta-analytic studies of this model of attachment based on contingency found a moderate effect of contingency on attachment, which increased to a large effect size when the quality of reinforcement was considered. Other research on contingency highlights its effect on the development of both pro-social and anti-social behaviour. These effects can also be furthered by training parents to become more sensitive to children’s behaviours, Meta-analytic research supports the notion that attachment is operant-based learning.

An infant’s sensitivity to contingencies can be affected by biological factors and environment changes. Studies show that being placed in erratic environments with few contingencies may cause a child to have conduct problems and may lead to depression (see Behavioural Development and Depression below). Research continues to look at the effects of learning-based attachment on moral development. Some studies have shown that erratic use of contingencies by parents early in life can produce devastating long-term effects for the child.

Motor Development

Since Watson developed the theory of behaviourism, behaviour analysts have held that motor development represents a conditioning process. This holds that crawling, climbing, and walking displayed by infants represents conditioning of biologically innate reflexes. In this case, the reflex of stepping is the respondent behaviour and these reflexes are environmentally conditioned through experience and practice. This position was criticised by maturation theorists. They believed that the stepping reflex for infants actually disappeared over time and was not “continuous”. By working with a slightly different theoretical model, while still using operant conditioning, Esther Thelen was able to show that children’s stepping reflex disappears as a function of increased physical weight. However, when infants were placed in water, that same stepping reflex returned. This offered a model for the continuity of the stepping reflex and the progressive stimulation model for behaviour analysts.

Infants deprived of physical stimulation or the opportunity to respond were found to have delayed motor development. Under conditions of extra stimulation, the motor behaviour of these children rapidly improved. Some research has shown that the use of a treadmill can be beneficial to children with motor delays including Down syndrome and cerebral palsy. Research on opportunity to respond and the building of motor development continues today.

The behavioural development model of motor activity has produced a number of techniques, including operant-based biofeedback to facilitate development with success. Some of the stimulation methods such as operant-based biofeedback have been applied as treatment to children with cerebral palsy and even spinal injury successfully. Brucker’s group demonstrated that specific operant conditioning-based biofeedback procedures can be effective in establishing more efficient use of remaining and surviving central nervous system cells after injury or after birth complications (like cerebral palsy). While such methods are not a cure and gains tend to be in the moderate range, they do show ability to enhance functioning.

Imitation and Verbal Behavior

Behaviourists have studied verbal behaviour since the 1920s. E.A. Esper (1920) studied associative models of language, which has evolved into the current language interventions of matrix training and recombinative generalisation. Skinner (1957) created a comprehensive taxonomy of language for speakers. Baer, along with Zettle and Haynes (1989), provided a developmental analysis of rule-governed behaviour for the listener. and for the listener Zettle and Hayes (1989) with Don Baer providing a developmental analysis of rule-governed behaviour. According to Skinner, language learning depends on environmental variables, which can be mastered by a child through imitation, practice, and selective reinforcement including automatic reinforcement.

B.F. Skinner was one of the first psychologists to take the role of imitation in verbal behaviour as a serious mechanism for acquisition. He identified echoic behaviour as one of his basic verbal operants, postulating that verbal behaviour was learned by an infant from a verbal community. Skinner’s account takes verbal behaviour beyond an intra-individual process to an inter-individual process. He defined verbal behaviour as “behaviour reinforced through the mediation of others”. Noam Chomsky refuted Skinner’s assumptions.

In the behavioural model, the child is prepared to contact the contingencies to “join” the listener and speaker. At the very core, verbal episodes involve the rotation of the roles as speaker and listener. These kinds of exchanges are called conversational units and have been the focus of research at Columbia’s communication disorders department.

Conversational units is a measure of socialisation because they consist of verbal interactions in which the exchange is reinforced by both the speaker and the listener. H.C. Chu (1998) demonstrated contextual conditions for inducing and expanding conversational units between children with autism and non-handicapped siblings in two separate experiments. The acquisition of conversational units and the expansion of verbal behaviour decrease incidences of physical “aggression” in the Chu study and several other reviews suggest similar effects. The joining of the listener and speaker progresses from listener speaker rotations with others as a likely precedent for the three major components of speaker-as-own listener – say so correspondence, self-talk conversational units, and naming.

Development of Self

Robert Kohelenberg and Mavis Tsai (1991) created a behaviour analytic model accounting for the development of one’s “self”. Their model proposes that verbal processes can be used to form a stable sense of who we are through behavioural processes such as stimulus control. Kohlenberg and Tsai developed functional analytic psychotherapy to treat psychopathological disorders arising from the frequent invalidations of a child’s statements such that “I” does not emerge. Other behaviour analytic models for personality disorders exist. They trace out the complex biological-environmental interaction for the development of avoidant and borderline personality disorders. They focus on Reinforcement sensitivity theory, which states that some individuals are more or less sensitive to reinforcement than others. Nelson-Grey views problematic response classes as being maintained by reinforcing consequences or through rule governance.

Socialisation

Over the last few decades, studies have supported the idea that contingent use of reinforcement and punishment over extended periods of time lead to the development of both pro-social and anti-social behaviours. However research has shown that reinforcement is more effective than punishment when teaching behaviour to a child. It has also been shown that modelling is more effective than “preaching” in developing pro-social behaviour in children. Rewards have also been closely studied in relation to the development of social behaviours in children. The building of self-control, empathy, and cooperation has all implicated rewards as a successful tactic, while sharing has been strongly linked with reinforcement.

The development of social skills in children is largely affected in that classroom setting by both teachers and peers. Reinforcement and punishment play major roles here as well. Peers frequently reinforce each other’s behaviour. One of the major areas that teachers and peers influence is sex-typed behaviour, while peers also largely influence modes of initiating interaction, and aggression. Peers are more likely to punish cross-gender play while at the same time reinforcing play specific to gender. Some studies found that teachers were more likely to reinforce dependent behaviour in females.

Behavioural principles have also been researched in emerging peer groups, focusing on status. Research shows that it takes different social skills to enter groups than it does to maintain or build one’s status in groups. Research also suggests that neglected children are the least interactive and aversive, yet remain relatively unknown in groups. Children suffering from social problems do see an improvement in social skills after behaviour therapy and behaviour modification (refer to applied behaviour analysis). Modelling has been successfully used to increase participation by shy and withdrawn children. Shaping of socially desirable behaviour through positive reinforcement seems to have some of the most positive effects in children experiencing social problems.

Anti-Social Behaviour

In the development of anti-social behaviour, aetiological models for anti-social behaviour show considerable correlation with negative reinforcement and response matching (refer to matching law). Escape conditioning, through the use of coercive behaviour, has a powerful effect on the development and use of future anti-social tactics. The use of anti-social tactics during conflicts can be negatively reinforced and eventually seen as functional for the child in moment to moment interactions. Anti-social behaviours will also develop in children when imitation is reinforced by social approval. If approval is not given by teachers or parents, it can often be given by peers. An example of this is swearing. Imitating a parent, brother, peer, or a character on TV, a child may engage in the anti-social behaviour of swearing. Upon saying it they may be reinforced by those around them which will lead to an increase in the anti-social behaviour. The role of stimulus control has also been extensively explored in the development of anti-social behaviour. Recent behavioural focus in the study of anti-social behaviour has been a focus on rule-governed behaviour. While correspondence for saying and doing has long been an interest for behaviour analysts in normal development and typical socialisation, recent conceptualisations have been built around families that actively train children in anti-social rules, as well as children who fail to develop rule control.

Developmental Depression with Origins in Childhood

Behavioural theory of depression was outlined by Charles Ferster. A later revision was provided by Peter Lewisohn and Hyman Hops. Hops continued the work on the role of negative reinforcement in maintaining depression with Anthony Biglan. Additional factors such as the role of loss of contingent relations through extinction and punishment were taken from early work of Martin Seligman. The most recent summary and conceptual revisions of the behavioural model was provided by Johnathan Kanter. The standard model is that depression has multiple paths to develop. It can be generated by five basic processes, including: lack or loss of positive reinforcement, direct positive or negative reinforcement for depressive behaviour, lack of rule-governed behaviour or too much rule-governed behaviour, and/or too much environmental punishment. For children, some of these variables could set the pattern for lifelong problems. For example, a child whose depressive behaviour functions for negative reinforcement by stopping fighting between parents could develop a lifelong pattern of depressive behaviour in the case of conflicts. Two paths that are particularly important are:

  1. Lack or loss of reinforcement because of missing necessary skills at a developmental cusp point; or
  2. The failure to develop adequate rule-governed behaviour.

For the latter, the child could develop a pattern of always choosing the short-term small immediate reward (i.e. escaping studying for a test) at the expense of the long-term larger reward (passing courses in middle school). The treatment approach that emerged from this research is called behavioural activation.

In addition, use of positive reinforcement has been shown to improve symptoms of depression in children. Reinforcement has also been shown to improve the self-concept in children with depression comorbid with learning difficulties. Rawson and Tabb (1993) used reinforcement with 99 students (90 males and 9 females) aged from 8 to 12 with behaviour disorders in a residential treatment program and showed significant reduction in depression symptoms compared to the control group.

Cognitive Behaviour

As children get older, direct control of contingencies is modified by the presence of rule-governed behaviour. Rules serve as an establishing operation and set a motivational stage as well as a discrimintative stage for behaviour. While the size of the effects on intellectual development are less clear, it appears that stimulation does have a facilitative effect on intellectual ability. However, it is important to be sure not to confuse the enhancing effect with the initial causal effect. Some data exists to show that children with developmental delays take more learning trials to acquire in material.

Learned Units and Developmental Retardation

Behaviour analysts have spent considerable time measuring learning in both the classroom and at home. In these settings, the role of a lack of stimulation has often been evidenced in the development of mild and moderate mental retardation. Recent work has focused on a model of “developmental retardation,”. an area that emphasizes cumulative environmental effects and their role in developmental delays. To measure these developmental delays, subjects are given the opportunity to respond, defined as the instructional antecedent, and success is signified by the appropriate response and/or fluency in responses. Consequently, the learned unit is identified by the opportunity to respond in addition to given reinforcement.

One study employed this model by comparing students’ time of instruction was in affluent schools to time of instruction in lower income schools. Results showed that lower income schools displayed approximately 15 minutes less instruction than more affluent schools due to disruptions in classroom management and behaviour management. Altogether, these disruptions culminated into two years worth of lost instructional time by grade 10. The goal of behaviour analytic research is to provide methods for reducing the overall number of children who fall into the retardation range of development by behavioural engineering.

Hart and Risely (1995, 1999) have completed extensive research on this topic as well. These researchers measured the rates of parent communication with children of the ages of 2-4 years and correlated this information with the IQ scores of the children at age 9. Their analyses revealed that higher parental communication with younger children was positively correlated with higher IQ in older children, even after controlling for race, class, and socio-economic status. Additionally, they concluded a significant change in IQ scores required intervention with at-risk children for approximately 40 hours per week.

Class Formation

The formation of class-like behaviour has also been a significant aspect in the behavioural analysis of development. This research has provided multiple explanations to the development and formation of class-like behaviour, including primary stimulus generalisation, an analysis of abstraction, relational frame theory, stimulus class analysis (sometimes referred to as recombinative generalisation), stimulus equivalence, and response class analysis. Multiple processes for class-like formation provide behaviour analysts with relatively pragmatic explanations for common issues of novelty and generalisation.

Responses are organised based upon the particular form needed to fit the current environmental challenges as well as the functional consequences. An example of large response classes lies in contingency adduction, which is an area that needs much further research, especially with a focus on how large classes of concepts shift. For example, as Piaget observed, individuals have a tendency at the pre-operational stage to have limits in their ability to preserve information. While children’s training in the development of conservation skills has been generally successful, complications have been noted. Behaviour analysts argue that this is largely due to the number of tool skills that need to be developed and integrated. Contingency adduction offers a process by which such skills can be synthesized and which shows why it deserves further attention, particularly by early childhood interventionists.

Autism

Ferster (1961) was the first researcher to posit a behaviour analytic theory for autism. Ferster’s model saw autism as a by-product of social interactions between parent and child. Ferster presented an analysis of how a variety of contingencies of reinforcement between parent and child during early childhood might establish and strengthen a repertoire of behaviours typically seen in children diagnosed with autism. A similar model was proposed by Drash and Tutor (1993), who developed the contingency-shaped or behavioural incompatibility theory of autism. They identified at least six reinforcement paradigms that may contribute to significant deficiencies in verbal behaviour typically characteristic of children diagnosed as autistic. They proposed that each of these paradigms may also create a repertoire of avoidance responses that could contribute to the establishment of a repertoire of behaviour that would be incompatible with the acquisition of age-appropriate verbal behaviour. More recent models attribute autism to neurological and sensory models that are overly worked and subsequently produce the autistic repertoire. Lovaas and Smith (1989) proposed that children with autism have a mismatch between their nervous systems and the environment, while Bijou and Ghezzi (1999) proposed a behavioural interference theory. However, both the environmental mismatch model and the inference model were recently reviewed, and new evidence shows support for the notion that the development of autistic behaviours are due to escape and avoidance of certain types of sensory stimuli. However, most behavioural models of autism remain largely speculative due to limited research efforts.

Role in Education

One of the largest impacts of behaviour analysis of child development is its role in the field of education. In 1968, Siegfried Englemann used operant conditioning techniques in a combination with rule learning to produce the direct instruction curriculum. In addition, Fred S. Keller used similar techniques to develop programmed instruction. B.F. Skinner developed a programmed instruction curriculum for teaching handwriting. One of Skinner’s students, Ogden Lindsley, developed a standardized semilogrithmic chart, the “Standard Behaviour Chart,” now “Standard Celeration Chart,” used to record frequencies of behaviour, and to allow direct visual comparisons of both frequencies and changes in those frequencies (termed “celeration”). The use of this charting tool for analysis of instructional effects or other environmental variables through the direct measurement of learner performance has become known as precision teaching.

Behaviour analysts with a focus on behavioural development form the basis of a movement called positive behaviour support (PBS). PBS has focused on building safe schools.

In education, there are many different kinds of learning that are implemented to improve skills needed for interactions later in life. Examples of this differential learning include social and language skills. According to the NWREL (Northwest Regional Educational Laboratory), too much interaction with technology will hinder a child’s social interactions with others due to its potential to become an addiction and subsequently lead to anti-social behaviour. In terms of language development, children will start to learn and know about 5-20 different words by 18 months old.

Critiques of Behavioural Approach and New Developments

Behaviour analytic theories have been criticized for their focus on the explanation of the acquisition of relatively simple behaviour (i.e. the behaviour of nonhuman species, of infants, and of individuals who are intellectually disabled or autistic) rather than of complex behaviour. Michael Commons continued behaviour analysis’s rejection of mentalism and the substitution of a task analysis of the particular skills to be learned. In his new model, Commons has created a behaviour analytic model of more complex behaviour in line with more contemporary quantitative behaviour analytic models called the model of hierarchical complexity. Commons constructed the model of hierarchical complexity of tasks and their corresponding stages of performance using just three main axioms.

In the study of development, recent work has been generated regarding the combination of behaviour analytic views with dynamical systems theory. The added benefit of this approach is its portrayal of how small patterns of changes in behaviour in terms of principles and mechanisms over time can produce substantial changes in development.

Current research in behaviour analysis attempts to extend the patterns learned in childhood and to determine their impact on adult development.

Professional Organisations

The Association for Behaviour Analysis International has a special interest group for the behaviour analysis of child development.

Doctoral level behaviour analysts who are psychologists belong to American Psychological Association’s division 25: behaviour analysis.

The World Association for Behaviour Analysis has a certification in behaviour therapy. The exam draws questions on behavioural theories of child development as well as behavioural theories of child psychopathology.

What is Single-Subject Research?

Published on by Andrew Marshall2 Comments

Introduction

Single-subject research is a group of research methods that are used extensively in the experimental analysis of behaviour and applied behaviour analysis with both human and non-human participants. Principal methods in this type of research are: A-B-A-B designs, Multi-element designs, Multiple Baseline designs, Repeated acquisition designs, Brief experimental designs and Combined designs.

These methods form the heart of the data collection and analytic code of behaviour analysis. Behaviour analysis is data driven, inductive, and disinclined to hypothetico-deductive methods.

Experimental Questions

Experimental questions are decisive in determining the nature of the experimental design to be selected. There are four basic types of experimental questions: demonstration, comparison, parametric, and component. A demonstration is “Does A cause or influence B?”. A comparison is “Does A1 or A2 cause or influence B more?”. A parametric question is “How much of A will cause how much change or influence on B?”. A component question is “Which part of A{1,2,3} – A1 or A2 or A3… – causes or influences B?” where A is composed of parts that can be separated and tested.

The A-B-A-B design is useful for demonstration questions.

A-B-A-B

A-B

An AB design is a two-part or phase design composed of a baseline (“A” phase) with no changes and a treatment or intervention (“B”) phase. If there is a change then the treatment may be said to have had an effect. However, it is subject to many possible competing hypotheses, making strong conclusions difficult. Variants on the AB design introduce ways to control for the competing hypotheses to allow for stronger conclusions.

Reversal or A-B-A

The reversal design is the most powerful of the single-subject research designs showing a strong reversal from baseline (“A”) to treatment (“B”) and back again. If the variable returns to baseline measure without a treatment then resumes its effects when reapplied, the researcher can have greater confidence in the efficacy of that treatment. However, many interventions cannot be reversed, some for ethical reasons (e.g. involving self-injurious behaviour, smoking) and some for practical reasons (they cannot be unlearned, like a skill).

Further ethics notes: It may be unethical to end an experiment on a baseline measure if the treatment is self-sustaining and highly beneficial and/or related to health. Control condition participants may also deserve the benefits of research once all data has been collected. It is a researcher’s ethical duty to maximise benefits and to ensure that all participants have access to those benefits when possible.

A-B-C

The A-B-C design is a variant that allows for the extension of research questions around component, parametric and comparative questions.

Multi-element

Multi-element designs sometimes referred to as alternating-treatment designs are used in order to ascertain the comparative effect of two treatments. Two treatments are alternated in rapid succession and correlated changes are plotted on a graph to facilitate comparison.

Multiple Baseline

The multiple baseline design was first reported in 1960 as used in basic operant research. It was applied in the late 1960s to human experiments in response to practical and ethical issues that arose in withdrawing apparently successful treatments from human subjects. In it two or more (often three) behaviours, people or settings are plotted in a staggered graph where a change is made to one, but not the other two, and then to the second, but not the third behaviour, person or setting. Differential changes that occur to each behaviour, person or in each setting help to strengthen what is essentially an AB design with its problematic competing hypotheses.

Repeated Acquisition

In addition to multiple baseline designs, a way to deal with problematic reversibility is the use of repeated acquisitions.

Brief

A designed favoured by applied settings researchers where logistical challenges, time and other limits make research difficult are variants of multi-element and A-B-A-B type designs.

Combined

The combined design has arisen from a need to obtain answers to more complex research questions. Combining two or more single-case designs, such as A-B-A-B and multiple baseline, may produce such answers.

Multiple-Probe

Popular in Verbal Behaviour research, the multiple-probe research design has elements of the other research designs.

Changing-Criterion

In a changing-criterion research design a criterion for reinforcement is changed across the experiment to demonstrate a functional relation between the reinforcement and the behaviour.

What is the Society for the Experimental Analysis of Behaviour?

Published on by Andrew Marshall1 Comment

Introduction

The Society for the Experimental Analysis of Behaviour was founded in 1957 by a group of researchers in the field of behaviourism.

Background

It publishes the Journal of the Experimental Analysis of Behaviour and the Journal of Applied Behaviour Analysis.

The Certificate of Incorporation (dated 29 October 1957) of the society states that:

The purpose and objects of this corporation shall be to encourage, foster, and promote the advancement of the science of experimental analysis of behavior; the promotion of research in the said science and the increase and diffusion of knowledge of the said science by the conduct of a program of education by meetings, conferences and symposia, and by the publication of journals, papers, periodicals and reports.

The Journal of the Experimental Analysis of Behaviour was established to meet the needs of those who were attracted to the behaviour-analytic approach but were unhappy with the lack of a journal specialising in that rapidly growing area. As described on its inside front page ever since, the journal is “primarily for the original publication of experiments relevant to the behaviour of individual organisms.” It started as a quarterly in 1958 but has appeared bimonthly since 1964. The initial Board of Editors also served as the first Board of Directors of the society.

Journal

In 1968, the society established the Journal of Applied Behaviour Analysis for “the original publication of reports of experimental research involving applications of the experimental analysis of behaviour to problems of social importance.”

It appears quarterly.

What is the Association for Behaviour Analysis International?

Published on by Andrew MarshallLeave a comment

Introduction

The Association for Behaviour Analysis International (ABAI) is a professional association of psychologists, educators, and practitioners whose scholarship and practice derive from the work of B.F. Skinner.

ABAI organises conferences in the US and abroad, publishes journals, and offers accreditation programs for behaviour analysis training programmes. As of March 2021, ABAI has 97 regional associate chapters both in the United States and abroad, many of which offer their own annual conferences. As of 2019, ABAI had over 9,000 members and membership in its affiliate chapters was greater than 28,000.

Refer to Clinical Behaviour Analysis, Applied Behaviour Analysis, and Licensed Behaviour Analyst.

Brief History

The Association for Behaviour Analysis International (ABAI) was founded in 1974 as the MidWestern Association for Behaviour Analysis (MABA) to serve as an interdisciplinary group of professionals, paraprofessionals, and students. Behaviour analysis was well-represented in the Midwest of the US, but many behaviour analysts were disappointed with the level of support their relatively new field received at the existing psychology conferences. Gerald Mertens and Israel Goldiamond organised the first two-day conference, which was held at the University of Chicago, and speakers included, Sidney Bijou, James Dinsmoor, Roger Ulrich and Goldiamond.

MABA’s first headquarters were located on the campus of Western Michigan University (WMU) in Kalamazoo, Michigan. By 1977, the annual conference was extended four days and included 550 events, and MABA had grown to 1,190 members from 42 states and five foreign countries.

In 1978, MABA began publishing its first journal, The Behaviour Analyst (renamed Perspectives in Behavioural Science in 2018), and in 1979, the organisation changed its name to the Association for Behaviour Analysis (ABA), subsequently adopting the name Association for Behaviour Analysis International (ABAI). In 2001, it sponsored its first international meeting in Venice, Italy.

Association for Behaviour Analysis (ABA) began offering APA credits for the first time in 1994, at their 20th Annual Convention in Atlanta, GA. While the BACB solidified itself in the field, ABA offered its first BACB credits in 2000 at their 26th Annual Convention in Washington, DC.

Activities

Conferences

ABAI organises conferences related to the theory and practice of behaviour analysis. In addition to the annual conference, which is held at a location in the US or Canada, every other year, ABAI hosts an international conference. The association also holds an annual autism conference and has hosted several single-track conferences on topics of special interest to behaviour analysts, such as theory and philosophy, climate change, behavioural economics, and education.

Many conference sessions offer approved continuing education credits (CEUs) for practitioners who wish to maintain their professional certification. Among the organisations that approve ABAI presentations for CEU credit are the American Psychological Association, the National Association of School Psychologists, and the Behaviour Analyst Certification Board.

Accreditation Programme

ABAI operates an accreditation programme for universities offering master’s and doctoral degrees in behaviour analysis. Degree programs that achieve ABAI accreditation meet the organization’s standards of training and will satisfy the Behaviour Analyst Certification Board requirements to achieve certification as a behaviour analyst.

Society for the Advancement of Behaviour Analysis

ABAI is supported by the Society for the Advancement of Behaviour Analysis (SABA), a 501(c)(3) organisation that accepts tax-exempt charitable contributions. SABA maintains a number of funds to support research in child development, international development, public awareness of behavioural science, and diversity, equity, and inclusion. SABA also provides grants to support student research, student travel to the annual ABAI conference, and graduate research focused on issues of diversity, equity, and inclusion.

Position Statements

As of 2021, ABAI had released six policy statements on: right to effective behavioural treatment (1989), student’s right to effective education (1990), facilitated communication (1995), restraint and seclusion (2010), sexual harassment (2019), and commitment to equity (2020).

Awards

SABA administers an awards programme at the annual convention of ABAI that recognises distinguished service to behaviour analysis, scientific translation, international dissemination of behaviour analysis, effective presentation of behaviour analysis in the mass media, and enduring programmatic contributions to behaviour analysis. Past recipients of the award for distinguished service to behaviour analysis include Sidney Bijou, James Dinsmoor, A. Charles Catania, Jack Michael and Murray Sidman.

Journals

The Association of Applied Behaviour Analysis International publishes six peer-reviewed journals.

  • Perspectives on Behaviour Science, is ABAI’s first journal, published from 1978-2017 as The Behaviour Analyst. It is a semiannual journal publishing articles on theoretical, experimental, and applied topics in behaviour analysis, including literature reviews, re-interpretations of published data, and articles on behaviourism as a philosophy.
  • The Analysis of Verbal Behaviour is a collection of experiments and theoretical papers regarding verbal behaviour and applied behaviour analysis.
  • Behaviour Analysis in Practice is a peer-reviewed journal that includes articles on how to efficiently practice applied behaviour analysis.
  • The Psychological Record includes articles concerning behavioural analysis, behavioural science, and behaviour theory. It was founded in 1937 by Jacob Robert Kantor. Its first experimental area editor was B.F. Skinner. After being published most recently at Southern Illinois University at Carbondale, the journal was adopted as an official publication of ABAI. The Psychological Record publishes empirical and conceptual articles related to the field of behaviour analysis, behaviour science, and behaviour theory.
  • Behaviour and Social Issues, is an interdisciplinary journal publishing articles analysing human social behaviour, particularly with regard to understanding and influencing significant social problems such as social justice, human rights, and sustainability.
  • Education and Treatment of Children.

On This Day … 01 December

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1930 – Marie Bashir, Australian psychiatrist, academic, and politician, 37th Governor of New South Wales.
  • 1937 – Vaira Vīķe-Freiberga, Latvian psychologist and politician, President of Latvia.

Marie Bashir

Dame Marie Roslyn Bashir AD CVO (born 01 December 1930) is the former and second longest-serving Governor of New South Wales. Born in Narrandera, New South Wales, Bashir graduated from the University of Sydney in 1956 and held various medical positions, with a particular emphasis in psychiatry. In 1993 Bashir was appointed the Clinical Director of Mental Health Services for the Central Sydney Area Health Service, a position she held until appointed governor on 01 March 2001. She has also served as the Chancellor of the University of Sydney (2007-2012).

Bashir retired on 1 October 2014 and was succeeded as governor by General David Hurley.

Vaira Vike-Freiberga

Vaira Vīķe-Freiberga (born 1 December 1937) is a Latvian politician who served as the sixth President of Latvia from 1999 to 2007. She is the first woman to hold the post. She was elected President of Latvia in 1999 and re-elected for the second term in 2003.

Dr. Vaira Freiberga is a professor and interdisciplinary scholar, having published eleven books and numerous articles, essays and book chapters in addition to her extensive speaking engagements. As President of the Republic of Latvia 1999-2007, she was instrumental in achieving membership in the European Union and NATO for her country. She is active in international politics, was named Special Envoy to the Secretary General on United Nations reform and was official candidate for UN Secretary General in 2006.

She remains active in the international arena and continues to speak in defence of liberty, equality and social justice, and for the need of Europe to acknowledge the whole of its history. She is a well-known pro-European, as such, in December 2007 she was named vice-chair of the Reflection group on the long-term future of the European Union. She is also known for her work in psycholinguistics, semiotics and analysis of the oral literature of her native country.

After her presidency Vaira Vīķe-Freiberga serving as Co-Chair Nizami Ganjavi International Centre, served as the President of Club of Madrid, the world’s largest forum of former Heads of State and Government, from 2014 to 2020. She is also a member of the International Programme Board of the Prague European Summit.

What is the Yale-Brown Obsessive Compulsive Scale?

Published on by Andrew MarshallLeave a comment

Introduction

The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) is a test to rate the severity of obsessive-compulsive disorder (OCD) symptoms.

The scale, which was designed by Wayne K. Goodman and his colleagues, is used extensively in research and clinical practice to both determine severity of OCD and to monitor improvement during treatment. This scale, which measures obsessions separately from compulsions, specifically measures the severity of symptoms of obsessive-compulsive disorder without being biased towards or against the type of content the obsessions or compulsions might present. Following the original publication the total score is usually computed from the subscales for obsessions (items 1-5) and compulsions (items 6-10) but other algorithms exist.

Accuracy and Modifications

Goodman and his colleagues have developed the Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCS-II) in an effort to modify the original scale which, according to Goodman, “[has become] the gold standard measure of obsessive-compulsive disorder (OCD) symptom severity”. In creating the Y-BOCS-II, changes were made “to the Severity Scale item content and scoring framework, integrating avoidance into the scoring of Severity Scale items, and modifying the Symptom Checklist content and format”. After reliability tests, Goodman concluded that “Taken together, the Y-BOCS-II has excellent psychometric properties in assessing the presence and severity, of obsessive-compulsive symptoms. Although the Y-BOCS remains a reliable and valid measure, the Y-BOCS-II may provide an alternative method of assessing symptom presence and severity.”

Studies have been conducted by members of the Iranian Journal of Psychiatry & Clinical Psychology to determine the accuracy of the Yale-Brown Obsessive Compulsive Scale (specifically as it appears in its Persian format). The members applied the scale to a group of individuals and, after ensuring a normal distribution of data, a series of reliability tests were performed. According to the authors, “[the] results supported satisfactory validity and reliability of translated form of Yale-Brown Obsessive-Compulsive Scale for research and clinical diagnostic applications”.

Children’s Version

The children’s version of the Y-BOCS, or the Children’s Yale-Brown Obsessive Compulsive Scales (CY-BOCS), is a clinician-report questionnaire designed to assess symptoms of obsessive compulsive disorder from childhood through early adolescence.

The CY-BOCS contains 70 questions and takes about 15-25 minutes. Each question is designed to ask about symptoms of obsessive compulsive behaviour, though the exact breakdown of questions is unknown. For each question, children rate the degree to which the question applies on a scale of 0-4. Based on research, this assessment has been found to be statistically valid and reliable, but not necessarily helpful.

Other Versions

The CY-BOCS has been adapted into several self- and parent-report versions, designed to be completed by parent and child working together, although most have not been psychometrically validated. However, these versions still ask the child to rate the severity of their obsessive compulsive behaviours and the degree to which each has been impairing. While this measure has been found to be useful in a clinic setting, scores and interpretations are taken with a grain of salt, given the lack of validation.

Another version, which is parent-focused, is similar to the original CY-BOCS and is administered to both parent and child by the clinician. This version was distributed by Solvay Pharmaceuticals in the late 1990s, creating an association between the measure and a number of pharmaceutical groups that has caused it to be avoided by most clinicians. Severity cut-off scores for this version have not been empirically determined.