In mid-February, the growing number of parents of autistic children who insist the condition is triggered by thimerosal, a mercury-laced preservative in vaccines, were dealt a setback when a federal court ruled firmly that, "The evidence . . . has fallen far short of demonstrating such a link [between vaccines and autism]." Rather than settling things, the ruling further enflamed the controversy over whether childhood autism is actually increasing, and if it is, why?
About 1 in 150 American children are now thought to have autism or related conditions such as Asperger's disorder, Rett's disorder, or childhood disintegrative disorder. For the last decade, however, some researchers have contended that there's been no increase in incidence, but rather an increase in diagnosed cases resulting from an expansion of identified disorders on the autistic spectrum, a broadened definition of the symptoms, and better surveillance (see Clinician's Digest, January/
Despite the court's ruling, many parents point out that the time frame of the increased use of thimerosal-infused vaccines roughly paralleled the rise in autism diagnoses. If there's no danger in thimerosal, they ask, why did the government urge manufacturers to discontinue its use in 1999? Today, although the use of thimerosal has been eliminated from some vaccines, it's still prevalent in most flu shots, and both the Centers for Disease Control and the American Association of Pediatricians have greatly expanded annual flu shot recommendations. "One flu shot alone can expose a child to a dangerous amount of mercury," says Northwestern University psychologist Alexandra Solomon, whose interest in autism was triggered when her son Brian was diagnosed with Asperger's.
Those who insist there's an increase in autism believe that the recent discovery of genetic susceptibilities supports their case. They wonder whether even trace amounts of thimerosal, other vaccine ingredients, and environmental toxins like the mercury present in fish and coal plant emissions could trigger the disorder for a subset of children. None of the large-scale studies that found no thimerosal-autism link examined the preservative's possible effects on children who might have had a genetic susceptibility.
All this is relatively moot if there's been no increase in the actual incidence of autism. But now a report, led by an epidemiologist from the Department of Public Health Sciences at the University of California, Davis, suggests the increase may be real. Writing in the January journal Epidemiology, Irva Hertz-Picciotto reports that changing diagnostic criteria and surveillance patterns account for only about one-third of the 600 percent increase in California cases.
So, with only the conflicting claims about the dangers of thimerosal and other vaccine ingredients to guide them, should parents vaccinate their children? Some doctors have begun to inquire into the family history of autism or other autoimmune diseases before advising about whether to vaccinate, but in most instances, the correct decision remains far from clear. But it seems more and more likely that there's an actual increase. "Continuing to argue about whether there really are more kids with autism only diverts attention from the more important issue of determining what's causing the increase," says Solomon.
Self-Injuring Adolescents on the Rise
Years ago, adolescents who deliberately injured themselves were usually considered to be in danger of suicide or in the throes of serious pathology. But today, an estimated 14 to 17 percent of adolescents deliberately cut, bite, pinch, burn, or abrade themselves, and while such behavior is always a cause for concern, it's no longer necessarily a cause for alarm. Even the behavior's designation has changed, from self-mutilation to the less frightening non-suicidal self-injury (NSSI).
Why the increase in NSSI? For one thing, the behavior has gained more peer acceptance. Among the heavily tattooed and pierced crowd, says Janis Whitlock, director of Cornell University's Research Program on Self-Injurious Behaviors, it's often a ritualistic act—an initiation and a declaration of where you stand. The wider culture has also made NSSI more acceptable. "We've gone from having almost no pop coverage of self-injury to celebrities like Princess Diana, Johnny Depp, and Angelina Jolie saying this is something they themselves used to express their emotional state," says Whitlock. Paradoxically, when the glamorati try to discourage NSSI, they may inadvertently encourage it. A 1999 study of eating disorder prevention programs for college students led by psychologist Traci Mann suggests that young people who see successful people who've survived the behavior believe that they, too, can eventually transcend its negative effects.
Whitlock sees several other motivations for the growing incidence. For some, it's primarily a novelty: their friends have done it and they want to see what it feels like. For others, it's a drive for self-preservation—an attempt to remind themselves that they can physically or emotionally feel something. Amid the confusion, despair, and isolation that goes along with adolescence, NSSI can often be an attempt to achieve self-efficacy, rather than a practice session for annihilation.
But for a small subset of self-injurers, severe pathology and suicide are distinct possibilities. A study in the February 2008 Journal of Consulting and Clinical Psychology by David Klonsky of New York's Stony Book University finds that about 11 percent of self-injuring college students are suicidal risks. Unlike other self-injurers, they're less likely to hurt themselves for socially reinforcing reasons, but do it in private and keep it secret, attempting to deliberately punish themselves.
Many kids who self-injure, says Whitlock, may just need help identifying and coping with their own feelings or with peer or family issues, which can be done relatively quickly with brief counseling. A few sessions often will be enough to help them realize that they have agency and that they can make other choices, like exercising or talking to friends, when they need to feel better. "The last thing we want to do for these kids," she says, "is reinforce the narrative that they're victims and that this behavior isn't something they can choose to stop, and without a lot of help."
However, if the behavior persists, it should be taken seriously, notes Whitlock. "Our studies show that someone with a history of NSSI is nine times more likely to make a suicide attempt than someone without one. Because of this, we suggest that the presence of NSSI history trigger suicide assessment."
Can Therapists Spot Liars?
Each week on the Fox TV series Lie to Me, a lie-detection expert and his team use their observational skills to exonerate or nail accused criminals, terrorists, adulterers, and other liars. The series is loosely based on the work of psychologist Paul Ekman, the show's technical advisor, who began studying the meanings of facial expressions and body movements a half-century ago. Ekman's discovery that almost imperceptible facial expressions reveal lies has had such a wide-ranging influence that the American Psychological Association named him one of the 20th century's most influential psychologists.
In the 1990s, Ekman and his associate Maureen O'Sullivan (psychologist Holly Foster in the show) tested 1,200 therapists on their lie-detection abilities at a workshop Ekman was giving. In this preliminary testing, therapists did very well: 50 of them could identify lies in one test with 90-percent accuracy. However, O'Sullivan's subsequent research on expert lie detectors required that the therapists complete two additional lie-detection tests and obtain scores of at least 80 percent on one of them to achieve Truth Wizard certification. That's when the therapists began dropping fast. Only 20 of the 1,200 got 80 percent or more on one of the additional tests and only one therapist got that score on all three tests to become a Truth Wizard
To date, O'Sullivan has identified 50 Truth Wizards, only some of whom are therapists. Most are lawyers, arbitrators, and law enforcement officers who regularly interrogate others. What sets them apart from other lie-sensitive souls? "Most wizards are highly motivated to know the truth and are in professions that give them feedback about their accuracy," says O'Sullivan. Many came from difficult or unusual early childhoods, when the stakes were high for learning to read people.
Why aren't more therapists wizards? One reason is that wizards have a multidimensional lie-detection radar. On an emotional plane, they exercise an auditory and visual sensitivity, picking up on incongruities between people's words, voices, faces, and body language. Many therapists are good at this because such incongruities can indicate conflict. But lies don't always produce conflict, and wizards also operate on a logical plane, spotting discrepancies within narratives and between a narrative and subtle physical cues. For example, someone might repeat a particular small gesture whenever there's an inconsistent narrative detail.
O'Sullivan found that therapists were particularly good at detecting lies or incongruities about felt emotion, and but less proficient in detecting lies about crimes. Police exhibited the opposite pattern: they were successful in detecting lies about crime and not as successful with lies related to emotions.
MFTs Endorse Myths about Marriage
A study finds that a surprising number of marriage and family therapists (MFTs) believe the same myths about marriage that many nonprofessionals do. Two hundred and twenty-three MFTs surveyed by therapists Benjamin Caldwell and Scott Woolley of the California School of Professional Psychology at Alliant International University correctly identified on average only about 9 of 21 statements as untrue. Among the myths most frequently endorsed: college educated women are less likely to marry than women with less education (only three percent got that one right); if divorced parents put forth positive attitudes about relationships, their children are no more likely to divorce than are children of married parents; single women are at less risk for violence than married women; and men reap far greater benefits from marriage than women.
The study, in the December American Journal of Family Therapy, suggests that the life experiences and theoretical perspectives of marriage and family therapists influence their beliefs more than research findings do. For instance, cognitive-behavioral therapists, who focus on communication patterns, often endorsed the myth that high-conflict couples are likelier to divorce. Single therapists were likelier to erroneously believe that single people's sex lives were better than those of married couples. And while Christians knew that cohabitation before marriage increases the chances of divorce, their more worldly colleagues said that was a myth.
This news may not be as bad as it seems at first glance. Caldwell and Woolley point out that no research has demonstrated a link between therapists' erroneous beliefs about marriage and adverse therapy outcomes. And MFTs might not be as uninformed as the survey suggests. Several of Caldwell and Woolley's 21 "myths" about marriage were boiled down from a large body of nuanced and conflicting research. Is it really a myth, for example, that "Children are better off with divorced parents than with parents who are unhappily married?" Psychologist Paul Amato, whose research on this issue is among the studies that Caldwell and Woolley cite, insists the issue is too complicated to merit a true or false answer. And therapist Constance Ahrons, author of The Good Divorce, adds that some of the statements Caldwell and Woolley designate as myths may say more about their own values than about what the research says. But Caldwell insists that each statement's true/false designation is backed by a considerable preponderance of evidence. They may be based upon averages, he says, but "we're confident about our statements."
Nuanced research questions aside, the study does suggest that there are serious deficiencies in the knowledge base of MFTs. The survey included four "common knowledge" statements—factual statements based on hard, quantifiable data that every therapist ought to know. Although the therapists did better on these, about 20 percent didn't know that couples who marry before they're 18 are likelier to divorce, that the divorce rate increased from 1960 to 1990, and that nearly half the couples marrying this year will divorce. Only 64 percent knew that most young, single, never-married people will eventually marry.
A Therapy for the Times?
The traditional sources of meaning for many people—money, possessions, work, and some version of retirement Valhalla—have been disappearing fast recently. Facing the effects of these unsettling times in their own and their clients' lives, many therapists may find personal comfort and reenergized sessions by returning to an approach that's been largely forgotten in recent decades-—logotherapy, a humanistic-existential form of psychotherapy that preceded the cognitive therapies—says University of Mississippi psychologist Stefan Schulenberg.
This approach to therapy, which has deep roots in our cultural ethos, was given popular expression in Viktor Frankl's 1946 publication Man's Search for Meaning. As a Nazi death camp prisoner, Frankl asked himself in the book how, under the worst possible circumstances, we may not just endure, but find the kind of purposeful and even joyful motivation to transcend what's happening around us.
In an article in the December issue of Psychotherapy: Theory, Research, Practice, Training, Schulenberg explains the principal tenet of logotherapy: that the desire for meaning is a fundamental human drive. In fact, logotherapists insist that the drive to find meaning is innate, whereas the drives for power, possessions, and sex are not.
Logotherapy helps people recognize and prioritize their values, such that meaning is discovered through participation in activities and pursuits that are perceived as important by the individual—expressing love and maintaining strong interpersonal relationships, for instance. When one participates in meaningful activities, the perceived meaning of one's life increases, which acts as a protective factor with regard to physical and mental illness. When people do experience illness, logotherapy helps them galvanize the internal resources required to take an adaptive or proactive stance and face their circumstances.
Another feature of this approach is that logotherapists grapple for meaning alongside their clients. Although the ultimate answer of what provides meaning will be different for therapist and client, the journey is mutual. Thus logotherapy offers help to therapists who may themselves be struggling to find meaning these days.
"For logotherapy to be conducted successfully," says Schulenberg, "clinicians must not only . . . apply it clinically, they must learn to live logotherapy as well; and each day, each moment, presents new opportunities to live meaningfully.
The Baby Cry Decoder
Most experts on parenting agree that babies cry for one of five reasons: they're hungry, annoyed, bored, stressed (which includes feeling pain), or sleepy. The crying will continue and usually escalate until the parent responds appropriately to the baby's distress. Like gurgling and smiling, crying is an excellent system for strengthening parent/child bonding. It gives parents a powerful incentive to figure out what's going on with their babies and quick feedback about whether they've succeeded. And, by crying, babies learn the most essential attachment lesson of all—that their fundamental needs can be met and they'll be comforted. As cries subside into contented sleep or happy gurgles, the positive feedback loop between baby and parent is reinforced, to their mutual benefit.
Successful empathic encounters engendered by crying thus are a primary building block of babies' developing neural networks. But empathic failures can have dire consequences. Some parents can't figure out what's causing the crying because of their own excessive anxiety, depression, narcissism, or autism or some other disorder that smothers empathy. As they become more frustrated, the crying crescendos, and the parent and child become locked in a negative feedback loop that, if entrenched, can result in developmental delays, emotional disorders, and even child abuse.
So when Spanish engineer Pedro Monagas couldn't figure out what his crying baby wanted, he invented WhyCry, a baby monitor that analyzes the pitch, rhythm, and volume of a baby's cries. Within 20 seconds, one of five icons appears, identifying whether the baby is hungry, annoyed, bored, sleepy, or stressed.
Is WhyCry accurate? Researchers know that babies' gestures reveal their moods. For example, babies stick their fists into their mouths when they're hungry and kick and shake their arms gently and move their heads when they're bored. When Monagas crosschecked WhyCry's readouts against about 85 babies' physical gestures, he found a 98 percent agreement. Parents who buy WhyCry—available for about $100—receive charts describing the physical gestures, so they can double-check the icons' accuracy.
But a closer look at independent research on the importance of voice in caregiver-baby interactions suggests that WhyCry may be counterproductive. Vanderbilt University psychologist Jo-Anne Bachorowski, who researches the role of vocal acoustics in emotional intelligence, finds that the parent's voice is critical in establishing an empathic bond between parent and baby. Research finds that the pitch and rhythm of a parent's voice are more powerful than even their facial expressions in eliciting responses from infants or modulating their emotions. Because the acoustical characteristics of the parent's voice are instinctual—crossculturally, parents use different voices when talking with babies than with adults—it's possible that while WhyCry may tell parents what their baby needs, it may also interfere with their instinctively empathic vocal response. When it comes to empathic communication, says Bachorowski, the melody is the real message, and WhyCry may destroy the music.
Autism: Epidemiology 20, no. 1 (January 2009): 84-90. Self-Injury: Journal of Consulting and Clinical Psychology 76, no. 1 (February 2008): 22-27. Myths: American Journal of Family Therapy 36, no. 5 (December 2008): 367-87. Existential Therapy: Psychotherapy: Theory, Research, Practice, Training 45, no. 4 (December 2008): 447-63.
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