What is narrative therapy and what is it not? The usefulness of Q methodology to explore accounts of White and Epston's (1990) approach to narrative therapy

Objective. ‘What is narrative therapy and how do you do it?’ is a question that is repeatedly asked of narrative therapy, with little consistent response. This study aimed to explore and distil out the ‘common themes’ of practitioner definitions of White and Epston's approach to narrative therapy. Design. This was an Internet‐based study involving current UK practitioners of this type of narrative therapy using a unique combination of a Delphi Panel and Q methodology. Method. A group of experienced practitioners were recruited into the Delphi Poll and were asked two questions about what narrative therapy is and is not, and what techniques are and are not employed. These data combined with other information formed the statements of a Q‐sort that was then administered to a wider range of narrative practitioners. Findings. The Delphi Panel agreed on a number of key points relating to the theory, politics and practice of narrative therapy. The Q‐sort produced eight distinct accounts of narrative therapy and a number of dimensions along which these different positions could be distinguished. These included narrative therapy as a political stance and integration with other approaches. Conclusions. For any therapeutic model to demonstrate its efficacy and attract proponents, an accepted definition of its components and practice should preferably be established. This study has provided some data for the UK application of White and Epston's narrative therapy, which may then assist in forming a firmer base for further research and practice. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? Narrative therapy and how it is carried out remain unclearly defined, which limits studies of the efficacy of this approach. ? Experienced practitioners of narrative therapy were able to identify a set of core concepts, values and techniques over which there was some consensus. ? This study also identified the different ‘positionings’ of narrative therapy that have contributed to its opacity and have highlighted the diversity in therapist practice.     

Face recognition failures in schizotypy

Introduction. Existing eye-tracking literature has shown that both adults and children with autism spectrum disorders (ASD) show fewer and slower fixations on faces. Despite this reduced saliency and processing of other faces, recognition of their own face is reported to be more “typical” in nature. This study uses eye-tracking to explore the typicality of gaze patterns when children with ASD attend their own faces compared to other familiar and unfamiliar faces.

Methods. Eye-tracking methodology was used to explore fixation duration and time taken to fixate on the Eye and Mouth regions of familiar, unfamiliar and Self Faces. Twenty-one children with ASD (9–16 years) were compared to typically developing matched groups.

Results. There were no significant differences between children with ASD and typically matched groups for fixation patterns to the Eye and Mouth areas of all face types (familiar, unfamiliar and self). Correlational analyses showed that attention to the Eye area of unfamiliar and Self Faces was related to socio-communicative ability in children with ASD.

Conclusions. Levels of socio-communicative ability in children with ASD were related to gaze patterns on unfamiliar and Self Faces, but not familiar faces. This lack of relationship between ability and attention to familiar faces may indicate that children across the autism spectrum are able to fixate these faces in a similar way. The implications for these findings are discussed.     

An event‐related source localization study of response monitoring and social impairments in autism spectrum disorder

A number of studies suggest anterior cingulate cortex (ACC) abnormalities in autism spectrum disorder (ASD), which might underlie response monitoring and social impairments exhibited by children and adolescents with ASD. The goal of the present study was to extend this work by examining error and correct response monitoring using event‐related potentials (ERN, Pe, CRN) and LORETA source localization in high functioning adults with ASD and controls. Adults with ASD showed reduced ERN and Pe amplitudes and reduced rostral ACC activation compared with controls. Adults with ASD also showed less differentiation between error and correct ERP components. Social impairments and higher overall autism symptoms were related to reduced rostral ACC activity at the time of the ERN, particularly in adults with ASD. These findings suggest that reduced ACC activity may reflect a putative brain mechanism involved in the origins and maintenance of social impairments and raise the possibility of the presence of stable brain‐behavior relation impairment across development in some individuals with ASD.     

Personal narratives as maps of the social ecosystem.

Research and theory on the development and function of autobiographical narratives are reviewed and synthesized in this discussion article. In our synthesis, these stories are viewed as summaries of long-term and recent historical experiences describing patterns of social contingencies in the narrator's relationships with a variety of people. The pattern, extending from past to present, is assumed to serve a map function for the narrator, guiding this observer's deliberate study of personal social interactions in the here and now. Clarity of the pattern is thought to depend on how well the narrative is structured along dimensions of coherence and richness, characteristics amenable to change through the constructive feedback of listeners. Ways in which clarity is enhanced through natural changes in narrative structure are highlighted as relevant processes for clinical work with adults, adolescents, and children.     

Evidence-Based,Non-Pharmacological Treatment Guideline for Depression in Korea

Although pharmacological treatment constitutes the main therapeutic approach for depression, non-pharmacological treatments (self-care or psychotherapeutic approach) are usually regarded as more essential therapeutic approaches in clinical practice. However, there have been few clinical practice guidelines concerning self-care or psychotherapy in the management of depression. This study introduces the ''Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea.'' For the first time, a guideline was developed for non-pharmacological treatments for Korean adults with mild-to-moderate depression. The guideline development process consisted of establishing several key questions related to non-pharmacologic treatments of depression, searching the literature for studies which answer these questions, assessing the evidence level of each selected study, drawing up draft recommendation, and peer review. The Scottish Intercollegiate Guidelines Network grading system was used to evaluate the quality of evidence. As a result of this process, the guideline recommends exercise therapy, bibliotherapy, cognitive behavior therapy, short-term psychodynamic supportive psychotherapy, and interpersonal psychotherapy as the non-pharmacological treatments for adult patients with mild-to-moderate depression in Korea. Hence, it is necessary to develop specific methodologies for several non-pharmacological treatment for Korean adults with depression.     

Autonomic arousal explains social cognitive abilities in high-functioning adults with autism spectrum disorder

Empirical research into behavioural profiles and autonomic responsivity in individuals with autism spectrum disorders (ASDs) is highly variable and inconsistent. Two preliminary studies of children with ASDs suggest that there may be subgroups of ASDs depending on their resting arousal levels, and that these subgroups show different profiles of autonomic responsivity. The aim of the present study was to determine whether (i) adults with high-functioning ASDs may be separated into subgroups according to variation in resting arousal; and (ii) these ASD arousal subgroups differ in their behavioural profiles for basic emotion recognition, judgements of trustworthiness, and cognitive and affective empathy. Thirty high-functioning adults with ASDs and 34 non-clinical controls participated. Resting arousal was determined as the average skin conductance (SCL) across a 2 min resting period. There was a subgroup of ASD adults with significantly lower resting SCL. These individuals demonstrated poorer emotion recognition, tended to judge faces more negatively, and had atypical relationships between SCL and affective empathy. In contrast, low cognitive empathy was a feature of all ASD adults. These findings have important implications for clinical interventions and future studies investigating autonomic functioning in ASDs.     

Launch of Body,Movement & Dance in Psychotherapy

This article explores time-limited dance movement psychotherapy (DMP) with a female offender diagnosed with borderline personality disorder looking particularly at the development of the therapeutic relationship and attachment theory. DMP can help increase the ‘capacity to think’ and provide alternative approaches for managing emotions opposed to ‘acting out’ difficulties in relating. The therapeutic relationship in DMP can provide a containing, holding environment in the absence of healthy attachments, early experiences of deprivation and trauma. Laban Movement Analysis, psychodynamic and mentalisation approaches were used to underpin the assessment, formulation and therapeutic interventions.     

Shedding light on the specificity of school-aged children’s attachment narratives

A prominent research tradition within the field of attachment involves analyzing relationship narratives for qualities thought to reveal important information regarding the organization of attachment, and the different ways in which attachment insecurity presents. Researchers increasingly use this method to assess attachment in middle childhood, but further work needs to be conducted with respect to the divergent validity of attachment narratives in this age range. Thus, the current study examined differential associations between children’s discursive style and linguistic behavior when completing an attachment interview (Child Attachment Interview [CAI]) and Non-Relational Interview (NRI). In addition, the discriminant validity of attachment narratives was assessed in predicting children’s physiological reactivity to a relational challenge. Children (N = 125) completed the NRI and the CAI at Time 1. A subset of the original sample (n = 64) completed another assessment 1.5 years later involving simulated non-relational and relational challenges. While narrative coherence was moderately associated across the two interviews, CAI narrative coherence uniquely predicted reactivity to a relational probe. We discuss implications for understanding children’s narrative styles across discourse topics as well as the significance of the results for using attachment interviews in this age range.     

Exploring Visual Perspective Taking and body awareness in children with Autism Spectrum Disorder

Introduction: Recent evidence suggests that impairments in social cognition are associated to the cognitive abilities needed to take several viewpoints in perceptual situations and body awareness. The aim of the current study was to investigate Visual Perspective Taking (VPT) and Body awareness performance in a group of children with Autism Spectrum Disorders (ASD) compared with a group of children with Intellectual Disability (ID) and typically developing (TD) children.

Methods: Our groups were administered an IQ test and a VPT task, and body awareness tests.

Results: Children with ASD or ID were more impaired in body awareness development compared to TD (p?p?Conclusions: The current study provides a framework for considering social impairments in autism on a broader scale, including visuoperceptual and body awareness difficulties as a core contributor to social interaction difficulties.     

Structured approaches to implementation of clinical genomics: A scoping review

PurposeThis study aimed to assess the extent to which structured approaches to implementation of clinical genomics, proposed or adapted, are informed by evidence.MethodsA systematic approach was used to identify peer-reviewed articles and gray literature to report on 4 research questions:1. What structured approaches have been proposed to support implementation?2. To what extent are the structured approaches informed by evidence?3. How have structured approaches been deployed in the genomic setting?4. What are the intended outcomes of the structured approaches?ResultsA total of 30 unique structured approaches to implementation were reported across 23 peer-reviewed publications and 11 gray literature articles. Most approaches were process models, applied in the preadoption implementation phase, focusing on a “service” outcome. Key findings included a lack of implementation science theory informing the development/implementation of newly designed structured approaches in the genomic setting and a lack of measures to assess implementation effectiveness.ConclusionThis scoping review identified a significant number of structured approaches developed to inform the implementation of genomic medicine into clinical practice, with limited use of implementation science to support the process. We recommend the use of existing implementation science theory and the expertise of implementation scientists to inform the design of genomic programs being implemented into clinical care.     

Predicting ensuing actions in children and adolescents with autism spectrum disorders

This study investigated the ability to predict others’ action in a group of children and adolescents with autism spectrum disorders (ASD) (n = 18). Their performance was compared with a group of children with mental retardation (n = 13) and a group of children with typical development (n = 19). Participants were presented with short incomplete videotaped movies showing an actor executing familiar and non-familiar actions. When asked to predict the outcome, participants with ASD produced fewer correct responses and their performance did not improve for familiar actions, as compared to both comparison groups. In addition, they committed a greater number of errors of temporal inversion. These results provide new evidence that an impaired means-end analysis process, leading to a diminished sensitivity to the sequence structure of goal-directed actions, would disrupt the ability to understand and predict others’ actions. The comprehension of abnormalities in event knowledge provides a better insight of some of the problems that individuals with ASD encounter in spontaneously understanding real-life social situations.     

Autism spectrum disorders: perceptions of genetic etiology and recurrence risk among Taiwanese parents of affected children

In Taiwan, autism spectrum disorders (ASDs) are an emerging public health concern. The ongoing scientific progress for understanding the genetic etiology of ASD makes it increasingly important to examine how parents of children with ASD perceive the causes and recurrence risk of having another child with ASD. These perceptions may influence their family planning, attitudes toward genetic services, and willingness to take their children for ASD genetic testing. However, previous studies addressing this issue were conducted primarily in Western countries. As culture might shape an individual's views of genetic/genomic disorders, this first‐of‐its‐kind study examined the perceptions of the genetic etiology for ASD and the recurrence risk among Taiwanese parents of children affected with ASD. In‐depth, semi‐structured interviews were conducted among 39 parents having at least one child with ASD. Although the majority of participants believed that ASD has a genetic link, less than half perceived genetic factors as the cause of their own child's ASD. Moreover, most participants articulated their recurrence risk incorrectly. Some parents were concerned about their doctors' limited genomic competencies. To provide parents with better education, counseling, and support for making reproductive decisions, ASD‐related genomic education among Taiwanese physicians is needed.     

An extended multisensory temporal binding window in autism spectrum disorders

Autism spectrum disorders (ASD) form a continuum of neurodevelopmental disorders, characterized by deficits in communication and reciprocal social interaction, as well as by repetitive behaviors and restricted interests. Sensory disturbances are also frequently reported in clinical and autobiographical accounts. However, surprisingly few empirical studies have characterized the fundamental features of sensory and multisensory processing in ASD. The current study is structured to test for potential differences in multisensory temporal function in ASD by making use of a temporally dependent, low-level multisensory illusion. In this illusion, the presentation of a single flash of light accompanied by multiple sounds often results in the illusory perception of multiple flashes. By systematically varying the temporal structure of the audiovisual stimuli, a “temporal window” within which these stimuli are likely to be bound into a single perceptual entity can be defined. The results of this study revealed that children with ASD report the flash-beep illusion over an extended range of stimulus onset asynchronies relative to children with typical development, suggesting that children with ASD have altered multisensory temporal function. These findings provide valuable new insights into our understanding of sensory processing in ASD and may hold promise for the development of more sensitive diagnostic measures and improved remediation strategies.     

Spontaneous Mucosal Lymphocyte Cytokine Profiles in Children with Autism and Gastrointestinal Symptoms: Mucosal Immune Activation and Reduced Counter Regulatory Interleukin-10

A lymphocytic enterocolitis has been reported in a cohort of children with autistic spectrum disorder (ASD) and gastrointestinal (GI) symptoms. This study tested the hypothesis that dysregulated intestinal mucosal immunity with enhanced pro-inflammatory cytokine production is present in these ASD children. Comparison was made with developmentally normal children with, and without, mucosal inflammation. Duodenal and colonic biopsies were obtained from 21 ASD children, and 65 developmentally normal paediatric controls, of which 38 had signs of histological inflammation. Detection of CD3⁺ lymphocyte staining for spontaneous intracellular TNF, IL-2, IL-4, IFN, and IL-10, was performed by multicolor flow cytometry. Duodenal and colonic mucosal CD3⁺ lymphocyte counts were elevated in ASD children compared with noninflamed controls (p<0.03). In the duodenum, the proportion of lamina propria (LP) and epithelial CD3⁺TNF⁺ cells in ASD children was significantly greater compared with noninflamed controls (p<0.002) but not coeliac disease controls. In addition, LP and epithelial CD3⁺IL-2⁺ and CD3⁺IFN⁺, and epithelial CD3⁺IL-4⁺ cells were more numerous in ASD children than in noninflamed controls (p<0.04). In contrast, CD3⁺IL-10⁺ cells were fewer in ASD children than in noninflamed controls (p<0.05). In the colon, LP CD3⁺TNF⁺ and CD3⁺IFN⁺ were more frequent in ASD children than in noninflamed controls (p<0.01). In contrast with Crohns disease and non-Crohns colitis, LP and epithelial CD3⁺IL-10⁺ cells were fewer in ASD children than in nondisease controls (p<0.01). There was a significantly greater proportion of CD3⁺TNF⁺ cells in colonic mucosa in those ASD children who had no dietary exclusion compared with those on a gluten and/or casein free diet (p<0.05). There is a consistent profile of CD3⁺ lymphocyte cytokines in the small and large intestinal mucosa of these ASD children, involving increased pro-inflammatory and decreased regulatory activities. The data provide further evidence of a diffuse mucosal immunopathology in some ASD children and the potential for benefit of dietary and immunomodulatory therapies.     

Effect of yoga on the social responsiveness and problem behaviors of children with ASD in special schools: A randomized controlled trial

ContextAutism spectrum disorder (ASD) is the most common neurodevelopmental disorder and is increasingly reported among school-age children in India. Many children with ASD attend special schools which extend support for learning basic functional and academic skills. Problem behaviors and lack of social responsiveness are frequently associated with children with ASD in a school environment. Many evidence-based studies have explored various interventions in mitigating the lack of social responsiveness and problem behaviors in children. Few studies have examined the impact of yoga on social responsiveness and problem behaviors in special schools.ObjectiveThe objective of the study was to highlight the effect of school-based yoga on the social responsiveness and problem behaviors of children with ASD in special schools. Forty-three children with ASD from four special schools participated in the study.DesignA randomized controlled trial (RCT) design was employed for the study. Children with ASD (n = 43) from four special schools were assessed by their teachers for social responsiveness and problem behaviors with the Social Responsiveness Scale-2 (SRS-2) and Aberrant Behavior Checklist-2 (ABC-2) at the baseline and after the yoga intervention.InterventionStructured yoga of 45 min for 12 weeks was conducted across four special schools with simple yoga practices conducive to children with ASD.ResultsSignificant changes were observed post-intervention in the mean scores of the social communication aspect in social responsiveness (p = .021), irritability (p = .041), and social withdrawal (p = .047) aspects of problem behaviors.     

Autism Spectrum Disorder and Evidence‐Based Practice in Psychology

The article discusses current empirical evidence, also identifying gaps and areas for future research, for the three critical elements of evidence‐based practice in psychology (EBPP) (evidence‐based practice; client characteristics, preferences, and culture; and clinical expertise) as applied to autism spectrum disorder (ASD). We contrast EBPP to a pure EBP approach, outline issues in specifying criteria and sources for defining EBP, and identify gaps in the evidence base (e.g., treatments for adults with ASD). We review the impact on treatment of specific client characteristics (client age, ASD severity, intellectual and language ability, diagnostic comorbidity, cultural/family factors) and outline critical issues affecting clinical expertise and decision making when choosing and adapting treatments. Implications for policy, training, and research are discussed.     

‘Putting themselves out there’ into the unknown: Dance movement psychotherapy as perceived by five educators and three pupils

ABSTRACT

The introduction of dance movement psychotherapy (DMP) to a mainstream secondary school in the United Kingdom was explored from the perspectives of some educators (n = 5) and pupil-clients (n = 3) to discover perceptions of, and influences on the process of establishing a DMP practice to support pupils within this setting. Semi-structured interviews were analysed using constructivist grounded theory by an ethnographically situated therapist-researcher. Two polarities of themes emerged: constraints, normative inhibitions and expectations, versus empowerment, novel perceptions and awareness. These polarities were evident at two levels of process: school structures and community mind-set and individual engagement with DMP. The results highlight inherent dynamics in positioning of therapeutic provision within a school environment, amplified in unconventional, creative and embodied forms of intervention. An awareness of the tension between these opposites may be useful for dance movement psychotherapists in setting themselves within mainstream education.     

The Under- and Over-Identification of Autism: Factors Associated With Diagnostic Referral

As reported prevalence and public awareness of Autism Spectrum Disorder (ASD) have grown in recent years, clinicians will likely see increased referrals for suspected ASD. The current study sought to elucidate factors associated with referral for possible ASD, as well as diagnostic outcome among youth referred for suspected ASD. Youth referred for psychological evaluations at an outpatient clinic (N = 69, 6–18 years, 48 male) were categorized into four groups: referred for suspected ASD and diagnosed as such, referred for ASD and not diagnosed as such, not referred for ASD but diagnosed as such, and neither referred for nor diagnosed with ASD. Approximately half of cases referred for suspected ASD did not meet diagnostic criteria. A significant effect of group was found for cognitive ability and anxiety. Youth receiving ASD diagnoses, regardless of whether they were referred for suspected ASD, demonstrated lower cognitive ability than children not receiving ASD diagnoses. Youth neither referred for nor diagnosed with ASD demonstrated lower anxiety than those who were referred and diagnosed. Maternal education significantly differed among the four groups. Although group differences are seen for youth cognitive ability, anxiety, and maternal education, we found no clear indicators differentiating referrals that were “accurate” (i.e., those diagnosed with ASD) and those that were not (i.e., those who did not receive ASD diagnosis). Comorbidity was high in all groups, including those referred primarily for ASD assessment, underscoring the importance of comprehensive assessment regardless of specificity of the referral.