And for those people who abuse more than one type of substance spasms upper left quadrant buy baclofen 10 mg with visa, treatment is most effective when it addresses the entire set of substances muscle relaxant generic names order genuine baclofen online. The most robust finding about all of the treatments weve discussed is that they work muscle relaxant drugs side effects generic 25mg baclofen overnight delivery, at least in the short term muscle relaxant starting with b discount 25 mg baclofen with visa. Ultimately spasms vhs generic baclofen 10 mg otc, all successful treatments address all three types of factors that are identied in the neuropsychosocial approach spasms with broken ribs cheap baclofen 25mg free shipping. When people with substance abuse or dependence rst stop abusing the substance muscle relaxant liquid cheap baclofen 10 mg overnight delivery, they will experience neurological changes that are muscle relaxant soma generic baclofen 25 mg otc, at minimum, uncomfortable (neurological and psychological factors). Their interactions with others will change (social factors): Perhaps they will make new friends who dont use drugs, avoid friends who abuse drugs, behave differently with family members (who in turn may behave differently toward them), perform better at work, or have fewer run-ins with the law. Other peoples responses to them will also affect their motivation to continue to avoid using the substance and endure the uncomfortable withdrawal effects and ignore their cravings. Thus, as usual, treatment ultimately relies on feedback loops among the three types of factors (see Figure 9. Medications may reduce unpleasant withdrawal sympprovides structure and support to help patients to abstain. Continued use of depresSummary of Use, Abuse, the dopamine reward system by binding to sants leads to tolerance and withdrawal. Tolerance and withtem, which involves the nucleus accumbens dopamine reward system. Psychological factors related to substance sant abuse and dependence include observaResearchers have developed two compatuse disorders include learning: operant reintional learning to expect specic effects from ible explanations of why substance use may forcement of the effects of the drug, classical depressant use and to use depressants as a lead to abuse. The common liabilities model conditioning of stimuli related to drug use coping strategy, positive and negative reinfocuses on underlying factors that may con(which leads to cravings), and observational forcement of the effects of the drug, and clastribute to a variety of problematic behaviors, learning of expectancies about both the efsical conditioning of drug cues that leads to including substance abuse. Social factors related to abuse of and deviduals to progress from using entry drugs to Social factors related to substance use pendence on depressants include the specic using harder drugs. Many people with substance use due, Sierra had hours of work left to do, and in the evenings, she sometimes cant seem to disorders engage in polysubstance abuse. She walk in a straight line, her speech is slurred, Cultures can promote or regulate substance took one of her roommates Ritalin pills and and she reeks of alcohol. Once you saw her vomit after of using amphetamines to help her stay up such an incident. On a few occasions, she hasnt Jorge and his friend Rick worked hard and late and do course work. After college, Sierra been so obviously wasted and has turned to played hard in high school. On weekend took a job with lots of deadlines and lots of you and roughly said, What are you staring at She continued to use stimulants One time, when you smirked as she tried to put binge drink, along with others in their group. What would be with alcohol, and if so, is it abuse or depennings when he was done studying and hed go some specic symptoms that would indicate dence What sympfutes the conclusion that she has an alcohol take Ecstasy or stimulants. What information would you want would you want to know in order to determine taking a high dose of stimulants How would you know whether eimight have led Sierra to abuse stimulants, if what factors might underlie your neighbors ther was dependent on a substance Summary of Stimulants Summary of Other Abused Stimulants, which increase arousal and brain Summary of Depressants activity, are the category of psychoactive Depressants decrease arousal, awareness, Substances substances most likely to lead to depenand nervous system activity level. Unlike many other types of drugs, sants include alcohol, barbiturates, and dull pain and decrease awareness. They and perceptions that each drug induced in drinking and smoking marijuana, but feels also depress the central nervous system and Nat, and why might his friends be concerned that he needs some help to do so. Using an opioid and a depressant at the symptoms might he experience, and why you suggest to him as an appropriate treatsame time is potentially lethal. Hallucinogens heroin before clubbing, what difference might Key Terms have unpredictable effects, which depend in it make in the long term Although the effects of marijuana are Do you think he might develop withdrawal Substance abuse (p. The active ingredient in marijuana, what factors might underlie Nats use of drugs They depress the central include detox to help reduce symptoms of nervous system and affect glutamate activwithdrawal that come from dependence. Use and abuse of this type of drug symptoms or block the pleasant effects of usimpairs cognitive functioning, and can lead to ing the substance, which can help maintain Relief craving (p. Social facilitation provides structure and support Motivational enhancement factors related to substance use disorders into help patients abstain. For additional study aids related to this chapter, go to: Thinking like a clinician Thinking like a clinician His friends marijuana every weekend for the past couple worried about him, though, because every of years. For the next Diagnostic Criteria Eating Disorder Not Otherwise Specied 5 years, she careened from one eating disorder to another. By Hornbachers own account she had been hospitalUnderstanding Eating Disorders Neurological Factors: Setting the Stage ized six times, institutionalized once, had endless hours of Psychological Factors: Thoughts of and therapy, been tested and observed and diagnosed. At the age of Feedback Loops in Action: Eating Disorders 23, Hornbacher wrote Wasted: A Memoir of Anorexia and Treating Eating Disorders Bulimia about her experiences with eating disorders, in Targeting Neurological and Biological which she wonders: Factors: Nourishing the Body Just what was I trying to prove, and to whom This is one of the terTargeting Psychological Factors: rible, banal truths of eating disorders: when a woman is thin in this Cognitive-Behavior Therapy culture, she proves her worth, in a way that no great accomplishment, Targeting Social Factors no stellar career, nothing at all can match. A woman who can control herself is almost as Follow-up on Marya Hornbacher good as a man. It is a protest against cultural stereotypes of An eating disorder characterized by binge women that in the end makes you seem the weakest, the most needy eating along with vomiting or other behaviors and neurotic of all women. Anorexia nervosa Body and mind fall apart from each other, and it is in this ssure that An eating disorder characterized by being an eating disorder may ourish, in the silence that surrounds this conat least 15% below expected body weight fusion that an eating disorder may fester and thrive. Females make up 90% of those diagnosed with an eating disorder, and so in this chapter, we will refer to an individual with an eating disorder as she or her; however, the number of males with eating disorders has been slowly increasing (Hudson et al. In this chapter, we examine the criteria for and the medical effects of these two disorders, and consider the criticisms of the criteria used to diagnose them. We also discuss research ndings that can illuminate why eating disorders arise and the various methods used to treat them. Anorexia Nervosa After years of struggling with bulimia, Marya Hornbacher began inching toward anorexia; she gradually became signicantly underweight by severely restricting her food intake, refusing to eat enough to obtain a healthy weight: Anorexia started slowly. There were an incredible number of painfully thin girls at [school], dancers mostly. We sat at our cafeteria tables, passionately discussing the calories of lettuce, celery, a dinner roll, rice. I would watch girls whod just been near tears in the dorm-room mirrors suddenly become rapt with life, ngers ying over a harp, a violin, bodies elastic with motion, voices strolling through Shakespeares forest of words. Hornbacher wanted to be thin, to be in control of her eating, and to feel more in control of herself generally. She began to eat less and less, to the point where she began to pass out at school. A key feature of anorexia nervosa (often referred to simply as anorexia) is that the person will not maintain at least a low normal weight and employs various methods to prevent weight gain (American Psychiatric Association, 2000). Despite medical and psychological consequences of a low weight, those with anorexia nervosa continue to pursue extreme thinness. A refusal to obtain or maintain a healthy weight (at least 85% of expected body refuse to maintain a healthy weight. An intense fear of becoming fat or gaining weight, despite being signicantly she suffered a heart attack; her anorexia persisted and she was considered to be a danger to underweight. This fear is often the primary reason that the person refuses to herself and banned from campus. Those who have anorexia are obsessed with their body Eating Disorders 437 and food, and their thoughts and beliefs about these topics are usually illogical Amenorrhea or irrational, such as imagining that wearing a certain clothing size is worse the suppression of menstruation; than death. If someone with anorexia eats 50 more calories (for comparison, a single pat of butter provides about 35 calories) than she had allotted for her daily intake, she may experience intense feelings of worthlessness. People who suffer from anorexia often deny that they have a problem and do not see their low weight as a source of concern. People with anorexia often feel that their bodies are bigger and fatter than they actually are (see Figure 10. The suppression of menstruation, called amenorrhea, which is diagnosed after three consecutive missed menstrual cycles in females who have already begun menstruating. If a woman must take hormones to menstruate, she is considered to have amenorrhea. For children and adolescents who have not yet begun menstruating, this criterion does not apply. Refusal to maintain body weight at or above a minimally normal weight for age and height. Disturbance in the way in which ones body weight or shape is experienced, undue inuence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. In postmenarcheal females [those who have already begun menstruating], amenorrhea, i. The most common types of comorbid disorders are depression, anxiety disorders, and personality disorders (Agras, 2001; Blinder, Cumella, & Sanathara, 2006; Cassin & van Ranson, 2005; Godart et al. Half of the deaths are from suicide, and the others are from medical complications of the disorder. People with anorexia who also abuse substances have an even higher risk of death (Keel et al. Some people with anorexia gain enough weight that they no longer meet the criteria for the disorder, but meet the criteria for bulimia nervosa (Keel et al. Many Chinese girls and women with anorexia have not reported the fear of becoming fat that is typical among people with anorexia in Western cultures. Rather, the reasons they give for their minimal food intake are discomfort when eating or the poor taste of the food (Lee & Lee, 1996). Its] very hard to see the larger picture of options that is your life, very hard to consider what else you might need or want or fear were you not so intently focused on one crushing passion. In secret, and with painstaking deliberation, I carved an apple and one-inch square of cheddar cheese into tiny bits, sixteen individual slivers, each one so translucently thin you could see the light shine through it if you held it up to a lamp. Then I lined up the apple slices on a tiny china saucer and placed a square of cheese on each. And then I ate them one by one, nibbled at them like a rabbit, edge by tiny edge, so slowly and with such concentrated precision the meal took two hours to consume. I planned for this ritual all day, yearned for it, carried it out with the utmost focus and care. Two Types of Anorexia Nervosa: Restricting and Binge-Eating/Purging People with anorexia become extremely thin and maintain their very low weight in either of two ways: through restricting what they eat or through binge eating and then purging. Low weight is achieved and maintained through severe undereating; there is no binge eating or purging. Among people with anorexia, binge eating is followed by purging, which is an attempt to reduce the ingested calories by vomiting or by using diuretics, laxatives, or enemas. Medical, Psychological, and Social Effects of Anorexia Nervosa Anorexia has serious negative effects on many aspects of bodily functioning. Because of the daily decit between calories needed for normal functioning and calories taken in, the body tries to make do with less. One possible effect of anorexia is that the heart muscle becomes thinner as the body, searching for an energy source to meet the its caloric demands, cannibalizes muscle generally, and the heart muscle in particular. Muscle wasting is the term used when the body breaks down muscle in order to obtain needed calories. Excessive exercise is actively discouraged in people with anorexia, and even modest exercise may be discouraged, depending on the persons weight and medical status. A physical examination and lab tests are likely to reveal other medical effects of anorexia, which arise through the bodys adjustments to conserve energy. These include low heart rate and blood pressure, abdominal bloating or discomfort, constipation, loss of bone density (leading to osteoporosis and easily fractured bones), and a slower metabolism (which leads to lower body temperature, difficulty tolerating cold temperatures, and downy hairs forming on the body to provide insulation). More visible effects include dry and yellow-orange skin, brittle nails, and loss of hair on the scalp. People, particularly females, with anorexia may also appear hyperactive or restless, which is probably a by-product of starvation, given that such behavior also occurs in starved animals (Klein & Walsh, 2005). People with anorexia who purge may believe that they are getting rid of all the calories theyve eaten, but theyre wrong. In a starved state, the body so desperately needs calories that once food is in the mouth, the digestive process begins more rapidly than normal and calories may begin to be absorbed before the food reaches the stomach; even if vomiting occurs, some calories are still absorbed, although water the body needs is lost. Diuretics only decrease water in the body, not body fat or muscle, and laxatives and enemas simply get rid of water and the bodys waste before it would otherwise be eliminated. Psychological and Social Effects of Starvation Researchers in the 1940s documented a number of unexpected psychological and social effects of extreme caloric restriction in what is sometimes called the starvation study (Keys et al. When healthy young men were given half their usual caloric intake for 6 months, they lost 25% of their original weight and suffered other changes: They became more sensitive to the sensations of light, cold, and noise; they slept less; they lost their sex drive; and their mood worsened. The men lost their sense of humor, argued with one another, and showed symptoms of depression and anxiety. These striking effects persisted for months after the men returned to their normal diets. It is sobering that, even on this diet, the participants in the starvation study still ate more each day than do many people with anorexia. The participants in the starvation study were psychologically healthy adult men, and they developed the noticeable symptoms after less than 6 months of caloric intake that would now be considered a relatively strict diet. In fact, recent studies of the longterm consequences of starvation during puberty indicate an increased risk of heart disease (Sparen et al. Moreover, patients with anorexia generally maintain unhealthy eating patterns for much longer than the 6-month study period. The long-term effects of starvation can also lead people with anorexia to forget what it was like to live without the medical and psychological effects of the disorder. Marya Hornbacher described this kind of mental state: I was beginning to harbor [the] delusion. When you coast without eating for a signicant amount of time, and you are still alive, you begin to scoff at those fools who believe they must eat to live. You get up in the morning, you do your work, you run, you do not half their usual daily calories for 6 months. You forget that you preoccupied with food, as frequently occurs used to feel all right. You forget what it means to feel all right because you feel like shit among people with anorexia. They also developed all of the time, and you cant remember what it was like before. People take the feeling symptoms of depression and anxiety, which are often comorbid with anorexia. They take for granted the feeling of steadiness, of hands that do not a researcher obtaining information about a shake, heads that do not ache, throats not raw with bile and small rips from ngernails participants physiology before the participant forced in haste to the gag spot. A minority may come to view anorexia as a lifestyle choice rather than a disorder.
Specically infantile spasms 6 weeks order baclofen amex, a medical professionals cursory genital observation instantiates gender/sex at birth muscle relaxant drugs medication order genuine baclofen, and nB/L reinstantiate gender/sex at transition by recapitulating the newborn process spasms just below ribs buy discount baclofen on-line, necessitating surgical modication of genitals for the updated genital observation spasms in abdomen buy 25 mg baclofen with mastercard. The use of contemporary sex-related technologies reinforce nB/ L: they are employed in newborns only to resolve nondenitive genital observations or to infer true gender/sex for surgical correction (Dreger 1998; Fausto-Sterling 2000; Kessler 1998) spasms pelvic area order baclofen 10mg on-line. Trace bio/logics (tB/L) reect a biologic trajectory whereby corporeal features that inuence later sex development are privileged as determinants of gender/sex yellow round muscle relaxant pill buy discount baclofen line. In contrast to iB/L muscle relaxant vocal cord buy generic baclofen 25mg on line, where the most interior features are the most deterministic of gender/sex spasms below sternum order generic baclofen canada, tB/L denote gender/sex starting points as the most denitive. Gonads and genitals are thought to be immutably present regardless of removal or absence, and the trace might operate in several ways. It might be material, as with hormones: once-gonads (ovaries; testes) release hormones in utero and postnatally in ways that affect sex/ual development. Or the trace might be heteronormatively conceptual, as with genitals: born-penises are meant to penetrate, born-vaginas to be penetrated (and born-vulvas to be ignored). Recent works include Beyond Masculinity: Testosterone, Gender/Sex, and Human Social Behavior in a Comparative Context (Frontiers in Neuroendocrinology, August 2013) and Nomenclature and Knowledge-Culture; or, We Dont Call Semen Penile Mucus (Psychology and Sexuality, forthcoming). Proponents of these technologies often argue that objective computer Downloaded from read. However, cultural critics of biometrics have argued that these machines are infrastructurally encoded with assumptions about race, gender, and ability and thereby continue to enforce bodily norms consistent with proling practices (Pugliese 2007, 2010). The analog antecedents of contemporary digitized biometrics highlight 2 the legacy of biometrics as techniques of subjugation. For example, British colonists used ngerprinting to distinguish Indian subjects, whom British officers could not otherwise tell apart (Pugliese 2007: 120). Furthermore, practices of measuring the body arose from the racist science of anthropometry, a branch of physical anthropology that sought to determine intelligence, for example, through a system of cranial measurements. These cranial measurements were used to support arguments that white men were more intelligent and civilized than women and the other races (Pugliese 2007; Amoore and Hall 2009; Magnet 2011). Though anthropometry is widely discredited, biometrics researchers continue to cite anthropometric methods (Magnet 2011: 39). Sir Francis Galtons use of the term biometry additionally highlights the connection between anthropometry and contemporary biometrics. In 1910, Galton used this term to describe 3 the process of collecting measurements in service of anthropometric hypotheses. Though practices of measuring the body have a long history, the contemporary meaning of biometrics appeared in the early 1980s. The Oxford English Dictionarys rst noted use of the term appeared in American Banker in 1981, in which authors hoped that biometrics would prove useful for unspecied bank4 ing operations. In particular, when trans bodies confound body scanners and individuals with dark skin tones reveal the racialized calibrations of facial geometry analysis, we are reminded that gender and race remain central to contemporary identity projects in spite of claims to the contrary by the bio5 metrics industry. Gates argues that biometric systems respond to the need to bind identities to bodies while our identity information supposedly circulates untethered through computer networks. Because our vocabularies of gender and race have such limited ability to provide useful information about an individual, one might think that attempts to secure identities to bodies would be minimally invested in gender or race. Nevertheless, manufacturers persistently encode normative assumptions about gender and race into biometric systems even as they claim to produce objective technologies. As Dean Spade emphasizes in Normal Life (2011), the most vulnerable transpeople are the ones most exposed to mechanisms of surveillance. Biometrics are not only deployed to protect expensive, privatized resources (such as banking assets); these techniques are frequently imposed upon the most vulnerable populations in the most coercive relationships. For trans theory, then, biometrics are a focal point for examining the biopolitical nexus of gendered, raced, and sexualized concerns. Exploring the connections between our experiences of biometrics and those of other, similarly targeted groups reveals the bodily norms encoded into and enforced by these technologies. The science of biometry deals with studies of this sort (Oxford English Dictionary Online, s. Joseph Pugliese (2007) has noted that the cameras photographing faces to be analyzed for facial geometry patterns are calibrated to the optimal exposure for the reectivity of white skin. This means that for those with very dark skin, the computer sometimes cannot detect a face in the photograph. Our Biometric Future: Facial Recognition Technology and the Culture of Surveillance. Biopolitics, generally speaking, describes the calculus of costs and benets through which the biological capacities of a population are optimally managed for state or state-like ends. In its Foucauldian formulation, the term refers specically to the combination of disciplinary and excitatory practices aimed at each and every body, which results in the somaticization by individuals of the bodily norms and ideals that regulate the entire population to which they belong. In Foucauldian biopolitics, the individualizing and collectivizing poles of biopower are conjoined by the domain of sexuality, by which Foucault means reproductive Downloaded from read. Sexuality, in this double sense of the biological reproduction of new bodies that make up the body politic as well as the ensemble of techniques that produce individualized subjectivities available for aggregation, supplies the capillary space of powers circulation throughout the biopoliticized populus. To accept Foucaults account of sexualitys biopolitical function is to encounter a lacuna in his theoretical oeuvre: the near-total absence of a gender analysis. This is perhaps unsurprising given the anglophone roots of the gender concept, which was developed by the psychologist John Money and his colleagues at Johns Hopkins University in the 1950s during their research on intersexuality, and which was only gradually making its way into the humanities and social science departments of the English-speaking academy in the 1970s when Foucault was delivering his rst lectures on biopolitics in France (Germon 2009; Scott 1986). Yet as an account of how embodied subjects acquire behaviors and form particularized identities and of how social organization relies upon the sometimes xed, sometimes exible categorization of bodies with differing biological capacities, gender as an analytical concept is commensurable with a Foucauldian perspective on biopolitics. The identity of the desiring subject and that of the object of desire are characterized by gender. Gender conventions code permissible and disallowed forms of erotic expression, and gender stereotyping is strongly linked with practices of bodily normativization. Gender subjectivizes individuals in such a manner that socially constructed categories of personhood typically come to be experienced as innate and ontologically given. It is a system lled with habits and traditions, underpinned by ideological, religious, and scientic supports that all conspire to give bodies the appearance of a natural inevitability, when in fact embodiment is a highly contingent and recongurable artice that coordinates a particular material body with a particular biopolitical apparatus. Gender, rather, is an apparatus within which all bodies are taken up, which creates material effects through bureaucratic tracking that begins with birth, ends with death, and traverses all manner of state-issued or state-sanctioned documentation practices in between. It is thus an integral part of the mechanism through which power settles a given population onto a given territory through a given set of administrative structures and practices. Consequently, transgender phenomena constantly icker across the threshold of viability, simultaneously courting danger and attracting death even as they promise life in new forms, along new pathways. Bodies that manifest such transgender phenomena have typically become vulnerable to a panoply of structural oppressions and repressions; they are more likely to be passed over for social investment and less likely to be cultivated as useful for the body politic. They experience microaggressions that cumulatively erode the quality of psychical life, and they also encounter major forms of violence, including deliberate killing. And yet, increasingly, some transgender subjects who previously might have been marked for death now nd themselves hailed as legally recognized, protected, depathologized, rights-bearing minority subjects within biopolitical strategies for the cultivation of life from which they previously had been excluded, often to the point of death. The criterion for this bifurcation of the population along the border of life and death is race, which Foucault (1997: 254) describes as the basic mechanism of power. However, Foucault critically disarticulates race and color to enable a theorization of racism capable of doing more than pointing out that people of color tend to suffer more than whites, and this theorization is particularly useful for transgender studies. Race and racism are therefore broadly understood as the enmeshment of hierarchizing cultural values with hierarchized biological attributes to produce distinct Downloaded from read. Race thus construed conceptually underpins the biopolitical division not only of color from whiteness but of men from women, of queers from straights, of abled-bodied from disabled, and of cisgender from transgender, to the extent that a body on one side of any of these binaries is conceptualized as biologically distinct from a body on the other side. Biopower constitutes transgender as a category that it surveils, splits, and sorts in order to move some trans bodies toward emergent possibilities for transgender normativity and citizenship while consigning others to decreased chances for life. Recent work in transgender studies addressing this biopolitical problematic includes Dean Spade 2011, Toby Beauchamp 2009, Aren Z. A critical theoretical task now confronting the eld is to advance effective strategies for noncompliance and noncomplicity with the biopolitical project itself. Her most recent publication is the Transgender Studies Reader 2 (coedited with Aren Z. The methods used to conduct this research attempt to gather data representing structures, function, or activity. The visual monitor shows structures and activation based on how the brain interacts with the environment. Such observations illuminate how certain parts of the brain function contingently upon specic stimuli. The ethical stakes of studies into sexual dimorphism and gender identity in particular are quite high in the context of state policy informed by such research (see Fleck 1979; Fine 2010; Fausto-Sterling 1985a, 1985b). To date, no consistent evidence of brain-based sexual dimorphism exists, in part because there are no stable criteria that distinguish sexes reliably or concretely (Fausto-Sterling 1985a). Despite this fact, the theory of sexual dimorphism remains entrenched within Western culture. The book explains the language barrier across elds for dening terms of gender, sex, and sexual Downloaded from read. Jordan-Young calls for a departure from brain organization theory, with its poor experiment design, and for a genuine exploration of the complex nature of sex, gender, and sexuality (3, 9). The studies reviewed for this introduction to transgender phenomena utilize brain imaging in conjunction with sex-hormone measurements to explore multiple questions: to determine if transsexuals are born this way, to ascertain which brain structures are markers of gender identity, and to evaluate how hormones inuence specic brain structures. Underlying these overarching questions is a renewed discussion of sexuality with regard to gender identity and biological sex. There is no serious consideration given to the experiences of these individuals, rather than their inherent transsexualism, in shaping their brains. The brain structures in transsexuals are scrutinized prior to and during hormonal transition, mediated through structural and functional imaging methods that may illustrate that the deviance in transsexual activation patterns and/or microstructures examined is distinct from those of individuals of their biological sex and much closer to those of individuals who share their gender identity. Currently the trajectory of this research is a retelling of the same predominant concepts with different subjects and still lacks proper scientic acumen. What is needed is not new data to support current theories but, rather, new theories that support the data gathered. Critically utilized for understanding sexual dimorphism, gender identity, and sexual orientation, the brain imaging of transgender phenomena is a fertile site for reimagining concepts of embodiment (Salamon 2010). Armes Gauthier is an alumnus of the University of California, San Diego, with degrees in cognitive science, neuroscience, and critical gender studies. Note this article is based on my thesis, written under the direction of Lisa Cartwright. Gratitude for support from Lisa Cartwright, PhD; Cristina Visperas; Kaya DeBarbaro, PhD; Ang[e] Moore; friends, lovers, family, especially Cathy. Cole, founder of the Brown Boi Project, discovered that mentorship, connection, and the power of language were ways to connect queer people of color from common lived experiences. Cole discovered that masculine-identied people of color were using various labels to describe their identity. Cole coined masculine of center as an umbrella term to include all gendernonconforming masculine people of color. The term is elaborated in the Projects mission statement: Masculine of Center (MoC), in its evolving denition, recognizes the cultural breadth and depth of identity for lesbian/queer womyn and gender-nonconforming/trans people who tilt toward the masculine side of the gender spectrum (Brown Boi 2010). The term masculine of center reaches beyond identication and commonality and calls for social action and change. Social action and change are needed to reteach healthy notions of brown bois relationship to masculinity. Understanding holistic health and unpacking masculinity only assist brown bois in moving toward a gender justice framework for Downloaded from read. Gender justice holds brown bois accountable to challenge the structural imbalances of masculinity and femininity (Brown Boi 2012). The organization strives to generate a gender-inclusive framework that includes a practice of nonoppressive masculinity rooted in self-love, honor, community, and collaboration with feminine-identied people, particularly women and girls (ibid. The Praxis of Self-Love and Social Change In 2010, after creating the term masculine of center, B. Cole was inspired to tap into community resources, including discovering dynamic community partners, to create the concept of the brown boi. A brown boi seeks to impact the lives of straight and queer boys/bois of color through a culturally based gender-transformative leadership approach that cultivates strength, learning, and accountability (Brown Boi 2012). Much of the existing research regarding boys/bois of color in learning environments is rooted in racialized norms. These norms are created in how we understand race and its reproduction through lived and observed behavior. However, there is a lack of knowledge about how gendered behavior as it relates to masculinity impacts learning for boys/bois of color (Shepard et al. The organization desires to create a new conversation regarding gender in people of color communities. Boys/bois of color allowed to acknowledge their strengths can in turn accept their privileges through in-depth personal exploration, mentorship, and connection to community. Self-love allows for the dismantling of shaming around privilege and strength and in turn pushes individuals to be accountable for their privileges. Gender-transformative learning inspires masculine-of-center people to realize their full potential through selfactualization. Feminine-identied people are included through actions of love that reimagine healthy masculinities. This self-actualization acknowledges structural power and misogyny, disarms shame, and encourages emotive connection and community accountability (Brown Boi 2012). The Brown Boi Project is a praxis of transgender studies and leadership development. Transgender studies must continue to expand the conversations of race, gender, and masculinity in order to transform leadership development strategies. They are trained leaders who embark on the journey of love and self-work in order to dismantle systems of harm, including institutions that perpetuate misogyny. Brown bois are more than members of a nonprot organization; they are leaders in the movement to dismantle traditional notions of masculinity, a movement that includes all women in gender and racial justice movements. Only when exercised do capacities become fully apparent, and they may lie in wait to be activated. Transgender capacity is the ability or the potential for making visible, bringing into experience, or knowing genders as mutable, successive, and multiple. It can be located or discerned in texts, objects, cultural forms, situations, systems, and images that support an interpretation or recognition of proliferative modes of gender nonconformity, multiplicity, and temporality. In other words, transgender capacity is the trait of those many things that support or demand accounts of genders dynamism, plurality, and expansiveness. Such strictures always encode their own possibilities for collapse and deconstruction, and transgender capacity erupts at those moments when such reductive norms do not hold. A capacity need not be purposefully planted or embedded (though of course it may be), and it does not just result from the intentions of sympathetic or self-identied transgendered subjects. It may emerge at any site where dimorphic and static understandings of gender are revealed as arbitrary and inadequate. Transgender phenomena can be generated from a wide range of positions and competing (even antagonistic) subjects, and it is important to recognize that a transgender hermeneutic can and should be pursued at all such capacitating sites. The usefulness of this concept is primarily methodological and is meant as a tool for resisting the persistent erasure of the evidence of transgender lives, gender diversity, nondimorphism, and successive identities. Its questions are valid to many areas of scholarly inquiry, including such different elds as biology, sociology, and economics. It is a retort to charges of anachronism and a reminder to search widely for the nascence of transgender critique. With regard to historical analysis, transgender capacity poses particularly urgent questions, since it is clear that there is a wealth of gender variance and nonconformity that has simply not been registered in the historical record. Without projecting present-day understandings of transgender identities into the past, one must recognize and make space for all of the ways in which self-determined and successive genders, identities, and bodily morphologies have always been present throughout history as 2 possibilities and actualities. Dimorphic and static denitions of gender and sexual difference obscure such diversity and facilitate the obliteration of the complex and innitely varied history of gender nonconformity and strategies for survival. To recognize transgender capacity is not to equate all episodes of potential but rather to allow the recognition of their particularity and to resist the normative presumptions that have enforced their invisibility. Transgender epistemologies and theoretical models fundamentally remap the study of human cultures. Their recognition of the mutable and multiple conditions of the apparatus we know as gender has wide-ranging consequences. That is, once gender is understood to be temporal, successive, or transformable, all accounts of human lives look different and more complex. It would be a mistake to limit this powerful epistemological shift to clearly identiable trans topics and histories.
In fact spasms buy baclofen 25 mg line, transference is an integral part of psychodynamic therapy muscle relaxant glaucoma purchase baclofen 25 mg fast delivery, and the therapist encourages it by nonjudgmentally asking the patient about his or her feelings toward the therapist and encouraging the patient to explore and accept such feelings spasms that cause coughing cheap baclofen 10 mg overnight delivery. As part of a corrective emotional experience spasms right upper quadrant buy baclofen no prescription, patient and therapist talk about the patients feelings toward the therapist spasms 2012 buy baclofen 25mg low price, which serves to help the patient better understand his or her transferred feelings and how they inuence his or her behavior muscle relaxant drugs side effects 10 mg baclofen sale. B began her multiyear psychoanalysis when she was 29 years old muscle relaxant constipation cost of baclofen, and felt she was stagnating in my own anger muscle relaxant vitamins buy baclofen 10mg otc. B was passed over for advancement and thought that she Transference might have to leave the [law] rm [where shed worked for a number of years]. The psychodynamic process by which the eldest of ve sisters and two brothers, Ms. B came from a middle-class neighborpatients interact with the therapist in the hood in New York City where her parents owned a mom and pop candy store that everyone same manner that they did with their parents called Pops because my mother was always pregnant. Foundations of Treatment 121 depressed, living in fantasies, and preoccupied with having children. She recalls the years following Cs birth as being lled with a constant need to be with her mother and a sense of panic and rage at her mothers unavailability. B felt that I was an empathic and reliable person who was available to her in a special way. Client-Centered Therapy As discussed in Chapter 1, therapists who provide treatment within the framework of humanistic psychology view psychopathology as arising from blocked personal growth. Client-centered therapy, a humanistic therapy developed by psychologist Carl Rogers, is intended to promote personal growth so that a client can reach his or her full potential. The Goal of Client-Centered Therapy Rogers believed that a clients symptoms arise from an incongruence between the real self (that is, the person the client knows himself or herself to be) and the ideal self (that is, the person he or she would like to be). This incongruence leads to a fragmented sense of self and blocks the potential for personal growth. The goal of treatment, according to Rogers, should be to decrease the incongruence, either by modifying the ideal self or by realizing that the real self is closer to the ideal self than previously thought, which in turn leads to a more integrated sense of self, and an enhanced ability for the client to reach his or her full potential. According to the theory, the clients emotional pain should diminish as the real self and the ideal self become more congruent. Methods of Client-Centered Therapy the two basic tenets of client-centered therapy are that the therapist should express genuine empathy and unconditional positive regard toward clients. Genuine Empathy the therapist does not interpret the clients words, but rather accurately reects back the key parts of what the client said, which allows the client to experience the therapists genuine empathy (Kirschenbaum & Jourdan, 2005). Were Leon in client-centered therapy, for instance, the therapist would try to convey his or her Client-centered therapy empathy for Leons situation by paraphrasing his descriptions of his feelings and A humanistic therapy developed by Carl reactions to situations. According to Rogers (1951), if the therapist simply repeats Rogers that is intended to promote personal the same words, reects the clients words inaccurately, or seems to express false growth so that a client can reach his or her empathy, the therapy tends to fail. The therapist can honestly do so by continually showing that the client is inherently worthy as a human being, distinguishing between the client as a person and the particular thoughts, feelings, and actions of the client (about which the therapist may not necessarily have a positive opinion). According to proponents of client-centered therapy, when clients experience genuine empathy and unconditional positive regard from the therapist, they come to accept themselves as they are, which decreases the incongruence between real and ideal selves. Cognitive-Behavior Therapy Behaviorism and cognitive psychology each led to explanations for how psychopathology can arise (see Chapter 2); in turn, each of these approaches gave rise to its own form of therapy. Behavior therapy rests on two ideas: (1) Maladaptive behaviors, cognitions, and emotions stem from previous learning, and (2) new learning can allow patients to develop more adaptive behaviors, cognitions, and emotions. Lets look rst at the unique elements of each type of therapy and then consider cognitive-behavior therapy. Behavior therapy stresses changing behavior rather than identifying unconscious motivations or root causes of problems (Wolpe, 1997). Behavior therapy has appealed to psychologists in part because of the ease in determining whether the treatment is effective: the patients maladaptive behavior either changes or it doesnt. In some cases, a behavior itself may not be immediately maladaptive, but it may be followed by unwanted consequences at a later point in time. The ultimate goal is for the the form of treatment that rests on the ideas patient to replace problematic behaviors with more adaptive ones; the patient acthat (1) maladaptive behaviors, cognitions, and emotions stem from previous learning and quires new behaviors through classical and operant conditioning (and, to a lesser (2) new learning can allow patients to develop extent, modeling). The antecedents the form of treatment that combines methods might include his (irrational) thoughts about what will happen if he goes into a from cognitive and behavior therapies. The consequences of his avoidant behavior include relief from the anticipatory anxiety. The therapist assigns homework, important tasks that the patient completes between therapy sessions. Homework for Leon, for instance, might consist of his making eye contact with a coworker during the week, or even striking up a brief conversation about the weather. To prepare for this task, Leon might spend part of a therapy session practicing making eye contact or making small talk with his therapist. The success of behavior therapy is measured in terms of the change in frequency and intensity of the maladaptive behavior and the increase in adaptive behaviors. The Role of Classical Conditioning in Behavior Therapy As we saw with Little Albert in Chapter 2, classical conditioning can give rise to fears and phobias and, more generally, conditioned emotional responses. To treat the conditioned emotional responses that are associated with a variety of symptoms and disorders and to create new, more adaptive learning, behavioral therapists may employ classical conditioning principles. Treating Anxiety and Avoidance A common treatment for anxiety disorders, particularly phobias, is based on the principle of habituation: the emotional response to a stimulus that elicits fear or anxiety is reduced by exposing the patient to the stimulus repeatedly. The technique of exposure involves such repeated contact with the (feared or arousing) stimulus in a controlled setting, and usually in a gradual way. The patient rst creates a hierarchy of feared events, arranging them from least to most feared (see Table 4. Over multiple sessions, this process is repeated with items higher in the hierarchy until all items no longer elicit signi cant symptoms. The Fear column contains the rating (from 0 to 100, with 100 = very intense fear) that indicates how the patient would feel if he or she were in the given situation. The Avoidance column contains the rating (from 0 to 100, with 100 = always avoids the situation) that indicates the degree to which the person avoids the situation. Although Leon avoids almost all the situations on the completed form, some situations arouse more fear than others. Situation Fear Avoidance Give a 1-hour formal lecture to 30 coworkers 100 100 Go out on a date 98 100 Ask a colleague to go out on a date 97 100 Attend a retirement party for a coworker who is retiring 85 100 Habituation Have a conversation with the person sitting next to me on the bus 70 100 the process by which the emotional response Ask someone for directions or the time 60 99 to a stimulus that elicits fear or anxiety is reduced by exposing the patient to the Walk around at a crowded mall 50 98 stimulus repeatedly. Leons social phobia could be treated in any or all of these ways: He could vividly imagine interacting with others, he could use virtual reality software to have the experience of interacting with others without actually doing so, or he could interact with others in the esh. Virtual reality exposure has been used to treat a variety of psychological disorders, including posttraumatic stress disorder (Ready et al. Patients are less likely to refuse treatment with virtual reality exposure than with in vivo exposure (Garcia-Palacios et al. Whereas exposure relies on habituation, systematic desensitization relies on (Krijn et al. Systematic desensitization is used less frequently than exposure because it is usually not as efficient or effective; however, it may be used to treat a fear or phobia when a patient chooses not to try exposure or has tried it but was disappointed by the results. The rst step of systematic desensitization is learning to become physically relaxed through progressive muscle relaxation, relaxing the muscles of the body in sequence from feet to head. Once the patient has mastered this ability, the therapist helps the patient construct a hierarchy of possible experiences relating to the feared stimulus, ordering them from least to most feared, just as is done for exposure (see Figure 4. Over multiple therapy sessions, the patient practices becoming relaxed and then continuing to remain relaxed while imagining increasingly feared experiences. Although systematic desensitization and biofeedback both involve relaxation, systematic desensitization uses relaxation as the rst step in reducing anxiety in response to feared stimuli and does not utilize any equipment. In contrast, the goal of biofeedback is learning to control what are generally involuntary responses. Treating Compulsive Behaviors In some cases, avoidance or fear of a specic stimulus is not the primary maladaptive behavior. After grocery shopping, for example, a person may feel compelled to reorganize all the canned goods in the cupboard so that the contents remain in alphabetical order. Similarly, some people with bulimia nervosa feel compelled to make themselves throw up after eating even a bite of a dessert. These Systematic desensitization compulsive behaviors temporarily serve to decrease anxiety that has become part of the behavioral technique of learning to relax a conditioned emotional response to a particular stimulus. Foundations of Treatment 125 To treat compulsive behaviors, behavior therapists may use a variant of exposure called exposure with response prevention, whereby the patient is carefully prevented from engaging in the usual maladaptive response after being exposed to the stimulus (Foa & Goldstein, 1978). Using this technique with someone who compulsively alphabetizes his or her canned goods, for instance, involves exposing the person to a cupboard full of canned goods arranged randomly and then, as agreed, preventing the typical maladaptive response of alphabetizing the cans. Similarly, someone with bulimia might eat a bite or two of a dessert and, as planned, not throw up. Once she is out of the habit of purging, she may use exposure with response stimulus). Others may binge (habitual maladaptive behavior) when they eat dessert prevention to learn to eat cookies without (the stimulus). To treat such disorders, the behavior therapist may seek to limit the patients contact with the stimulus. This technique, called stimulus control, involves changing the frequency of a maladaptive conditioned response by controlling the frequency or intensity of exposure to the stimulus that elicits the response. For example, the person who drinks too much in bars would refrain from going to bars; the person who binges after eating even a bit of dessert might avoid buying desserts or going into bakeries. Stimulus control will be described more fully when we discuss treatment for substance abuse (Chapter 9). The Role of Operant Conditioning in Behavior Therapy Whereas classical conditioning methods can be used to decrease maladaptive behaviors related to conditioned emotional responses, operant conditioning techniques can be used to modify maladaptive behaviors more generally. When operant conditioning principles such as reinforcement and punishment are used to change maladaptive behaviors, the process is called behavior modication. Making Use of Reinforcement and Punishment the key to successful behavior modication is setting appropriate response contingencies, which are the specic consequences that follow maladaptive or desired behaviors. It is these specic consequences (namely, reinforcement or punishment) that modify an undesired behavior. Some behaviors are too complex to learn or perform immediately and must be developed gradually. Lets consider a woman who has had the eating disorder anorexia nervosa for a number of years. As we discuss in detail in Chapter 10, this eating disorder involves an inadequate intake of calories, which is a consequence of Exposure with response prevention the behavioral technique in which a patient the individuals irrational belief about being fat. They may not exposed to a stimulus that usually elicits the be able to go from their daily intake of perhaps a serving of yogurt, a glass of milk, response. Sometimes the desired behavior change (in this case, resumthe behavioral technique for changing the ing normal eating) can only occur gradually, and reinforcement follows small and frequency of a maladaptive conditioned then increasingly larger components of the desired new complex behavior. Thus, a response by controlling the frequency or woman recovering from anorexia nervosa might be reinforced for increasing her intensity of exposure to the stimulus that dinner from only a glass of milk and an apple to also include a small helping of sh. On subsequent meals, she might be expected to eat the sh (without reinforcement) Behavior modication and be reinforced for adding a piece of bread. This process would continue until she the use of operant conditioning principles to ate normal meals. Making Use of Extinction In addition to using reinforcement and punishment, therapists also rely on the principle of extinction, which is the process of eliminating a behavior by not reinforcing it. To see how extinction can work to change behavior, lets consider someone who has a mild version of Leons problem of social phobia. This man only gets anxious in certain types of social situations, such as going to a party where there will be unfamiliar people. Therapist and patient might decide that the maladaptive behavior to change is his complaining, because it leads his wife to decline the invitation (or to leave him at home). Patient and therapist agree to have the wife come to a therapy session and propose to her that she extinguish her husbands complaining. That is, when he complains about parties, she should ignore these comments, and they both then go to the party. The date, day of the week, and time of day can help the patient to identify triggers related to time. Information about the context can help the patient to identify whether particular situations or environments have become conditioned stimuli. Identifying thoughts, feelings, interactions with others, or other stimuli that triggered the problematic behavior (right-hand column in Figure 4. Daily self-monitoring logs are used in treatments for anxiety, poor mood, smoking, compulsive gambling, overeating, and sleep problems, among others. Behavioral techniques that rely on operant conditioning principles are often used in inpatient psychiatric units, where clinicians can intensively monitor and treat patients 24 hours a day, 7 days a week. Under these conditions, caregivers can change the response contingencies for desired and undesired behavior. In order to change behavior, treatment programs for psychiatric patients, mentally retarded children and adults, and prison inmates often employ secondary reinforcers, objects and events that do not directly satisfy a biological need but are desirable nonetheless. Examples of secondary reinforcers are praise or the opportunity to enjoy a favorite activity, such as watching television or using a computer. In addition, a common Shaping form of secondary reinforcement relies on a system in which participants can earn the process of reinforcing a small component a token or chit by engaging in desired behaviors. The tokens or chits can be of behavior at a time and then progressively exchanged at a store for small items such as candy or for privileges such as adding components until the desired complex behavior occurs. A treatment program that uses such secondary reinforcers to change behavior is called a token economy. In particular, many individuals with psychological disorders have automatic but irrational thoughts or incorrect beliefs that were formed Token economy A treatment program that uses tokens or as a result of past experiences. Such dysfunctional thoughts and beliefs, in turn, conchits as secondary reinforcers to change tribute to maladaptive behaviors and poor mood. Treatment might focus on his social anxiety and avoidance at the outset; as those lessen, so should his depression. Leon, for example, has irrational, dysfunctional thoughts about being evaluated, and he expects to feel embarrassed and humiliated. With cognitive therapy, Leon would have an opportunity to reassess whether his automatic thoughts and beliefs are realistic and, if not, learn to substitute more realistic ones that will make social interactions less anxiety-provoking. Leon should then be more likely to participate in social situations, which in turn may reduce his depression. In general, then, cognitive therapy promotes more rational and realistic thoughts and beliefs, which in turn alter the patients behavior, which should then lead the symptoms to subside. Although there are some differences between the specic positive emotions and adaptive behaviors. Elliss Rational Emotive Behavior Therapy To help people counter their irrational, destructive thoughts with rational ones, Ellis developed rational-emotive therapy, in which the therapist challenges the patients irrational thoughts in detail and then encourages the patient to cultivate more realistic thoughts (Hollon & Beck, 1994, 2004). Over the years, however, Ellis incorporated behavioral techniques into his therapy. Thus, this therapy also is designed to reduce self-blame (based on faulty beliefs), which is viewed as getting in the way of rational thinking. A successful dispute leads to (E) an effect or an effective new philosophy, a new idea or a new pattern of emotion or behavior. The patient and therapist often start a session by agreeing on the desired effect of the sessions intervention. In Leons case, the desired effect for a session might be to modify enough of his beliefs about being laughed at that he feels able to say hello to a coworker the next day. A main intervention during the dispute step involves helping the patient distinguish between a belief that something is necessary (a must, such as When I talk to someone, I must be suave and brilliant) and a belief that something is simply preferred (When I talk to someone, Id like them to think of me as suave and brilliant).
Autism is the pervasive developmental disorder that has been the most widely investigated (and spasms pancreas cheap baclofen 25mg on line, as noted in Table 14 spasms sternum buy baclofen 25mg with amex. Therefore spasms when excited buy baclofen 25 mg line, most of the discussion that follows pertains to autism muscle relaxant ratings purchase baclofen 10 mg visa, unless otherwise noted spasms just below rib cage order 10mg baclofen with visa. Autism appears to be rooted primarily in neurological factors spasms eye buy baclofen 25 mg online, which interact with psychological and social factors spasms pronunciation effective baclofen 25 mg. Neurological Factors Like schizophrenia muscle relaxant list purchase baclofen 25 mg on line, autism is marked by signicant abnormalities in brain structure and function. Brain Systems Children who have autism have an unusually large head circumference, which is probably due to an above-average increase in white and gray matter during infancy (Hardan et al. However, adults with autism do not have larger than average heads, so the early accelerated growth is followed by slower growth during childhood (Herbert, 2005). The connections and communication among brain areas also appear abnormal in autism (Minshew & Williams, 2007). Brain areas in the same region appear to communicate excessively, while there is too little communication among distant areas (Courchesne & Pierce 2005), in particular, between the frontal lobes and other brain areas (Murias et al. In addition, parts of the frontal lobe are less active among those with autism than among control group participants, which is consistent with the deficits in executive function that have been documented in autism (Silk et al. Aspergers is associated with a variety of problems with motor coordination, which suggests abnormalities in the central nervous system; these coordination problems continue into adulthood (Tani et al. Researchers have long observed that autism tends to run in families; 8% of siblings of affected children will also have the disorder (compared to at most 0. Even stronger evidence comes from twin studies: Monozygotic twin-pairs are up to nine times more likely to have the disorder than are dizygotic twin pairs (Bailey et al. However, researchers have not located a single gene that always gives rise to autism (Weiss et al. Research suggests that one possible cause of the genetic mutations associated with some cases of autism is the fathers age at conception (Croen et al. Older mothers were also more likely to have children with an autism spectrum disorder (Croen et al. Certain stimuli may trigger autism in genetically vulnerable children (Waldman et al. Although researchers had earlier suggested that the cause of autism might be thimerisol, an ingredient in a widely used vaccine for measles-mumpsrubella, no studies have so far been able to document a causal link between this vaccine and the disorder (Muhle, Trentacoste, & Rapin, 2004; Thompson et al. In fact, autism rates continue to increase even among children who received vaccines without thimerisol (Schechter & Grether, 2008), which indicates that factors other than thimerisol are at work. Another possibility was suggested by the Childhood Disorders 639 discovery that in 2005 more children had autism in counties of the Northwest states Theory of mind (California, Oregon, and Washington) that had more days of rain from 1987 to A theory about other peoples mental states 2001. The researchers conjectured that bad weather may lead children to spend (their beliefs, desires, and feelings) that allows a person to predict how other people more time indoors, possibly increasing their television viewing, their risk for a vitawill react in a given situation. Like autism, Aspergers disorder appears to have a genetic basis: Compared to the general population, relatives of someone with Aspergers are more likely to have an autism spectrum disorder (Cederlund & Gillberg, 2004). Psychological Factors: Cognitive Decits Neurological factors give rise to psychological symptoms, particularly cognitive deficits in shifting attention and in mental exiblilty (Ozonoff & Jensen, 1999). These decits underlie the extreme difficulty in transitioning from one activity to another that individuals with autism spectrum disorders experience; people with autism also tend to focus on details at the expense of the broader picture (Frith, 2003). N Normal children exhibited greater brain activity in response to the fear expressions P S than to the neutral expressions. But children with autism responded to both types of facial expressions with the same pattern of brain activity (Dawson et al. Because a theory of mind requires thinking about somebody else, by denition, this ability involves both psychological and social factors. An impaired theory of mind is demonstrated with the false belief test (Baron-Cohen, Leslie, & Frith, 1985), which requires that the participant keep in mind the point of view of someone else: Two dolls, Sally and Anne, are used to act out a scene. Sally puts a marble in a basket and then leaves the room without taking the basket. The child is then asked to say where Sally will look for the marble when she comes back in the room. The correct answer, that Sally will look in the basket, requires the participant to appreciate the point of view of Sally, who does not know that the marble was moved. In this study, 80% of the children with autism answered incorrectly that Sally would look in the box. These children were not able to override what they knew and take Sallys perspective. Although some individuals with milder symptoms of autism may be able to answer correctly on the false belief test, they are not able to do so when the task involves more complex processing of social cues, such as understanding white lies or irony (Happe, 1994). However, these problems are less severe than in people with autism (Ziatas, Durkin, & Pratt, 2003). In addition, even the normal siblings of individuals with Aspergers have an impaired theory of mind (Dorris et al. Social Factors: Communication Problems the earliest indications of autism arise in interactions with other people: Children with autism pay attention to other peoples mouths, not their eyes (Dawson, Webb, & McPartland, 2005) and dont respond to their own name or to parents voices (Baranek, 1999). As they get older, they dont develop the typical ability to N recognize faces, and they also have problems recognizing emotion, both in voices P S (Rutherford, Baron-Cohen, & Wheelwright, 2002) and in facial expressions (Bolte & Poustka, 2003). And, despite adequate verbal skills, adults with autism often dont understand elements of conversation involving a back-and-forth exchange of information and interest in the other person, and so cannot interact normally. However, there is very little research on how various factors might contribute to autism as compared to Aspergers disorder. In sum, autism and Aspergers disorder are primarily caused by neurological factors (including those that are consequences of genetics); the neurological factors give rise to symptoms of the disorder, which are psychological and social in nature. However, at present, it appears that psychological and social factors contribute to autism and Aspergers disorder only indirectly. For this reason, in this section we do not discuss feedback loops for autism spectrum disorders. Treating Autism Spectrum Disorders Treatment of autism generally focuses on increasing communication skills and appropriate social behaviors. Unfortunately, there is no Jason McElwain, at 17, was manager of his high cure for autism, and no one type of intervention is helpful for all those with the schools basketball team; he was thought to be disorder. The treatments that are most effective are time-intensive (at least 25 hours too small to be on the team. At the nal home game, which his team was losing, with 4 minutes per week), have strong family involvement, are individualized to the child, and beto go, he was allowed to play. Early treatment depends on cheered by his teammates and the crowd after early diagnosis of the disorder; to ensure early diagnosis, the American Academy of he went on to score 20 points and win the game. Pediatrics recommends that all children receive screening tests for autism before the Jason was diagnosed with autism when he was age of 2 (Johnson, Meyers, & Council on Children with Disabilities, 2007). As he Targeting Neurological Factors grew older his social skills improved (McElwain & No treatments successfully target the neurological factors that appear to underlie auPaisner, 2008). Medication may help treat symptoms of comorbid disorders or of agitation or aggression. Some research suggests that people with autism may be more likely than other people to experience side effects from medications (Harden & Lubetsky, 2005). Medication is not usually prescribed for people with Aspergers disorder (Campbell & Morgan, 1998), unless it is for a comorbid disorder. Targeting Psychological Factors: Applied Behavior Analysis the technique most widely used to modify the maladaptive behaviors associated with autism is called applied behavior analysis. This method uses shaping (described in Chapter 4) to help individuals learn complex behaviors. The key idea is that a complex behavior is divided into short, simple actions that are reinforced and then ultimately strung together. For example, many children with autism eat with their hands and resist eating with utensils, which can create problems when eating with classmates or when the family goes out to eat. Thus, learning to use a spoon is one behavior that is often shaped via applied behavior analysis. Targeting Social Factors: Communication Treatment for autism and Aspergers disorder that addresses social factors often focuses, in one way or another, on facilitating communication and interpersonal interactions. Parents are asked to continue social skills training at home by modeling desired social behaviors and reinforcing their children for improved behavior (Kransny et al. In fact, there is a pilot project that uses a computer game to provide such training (Golan & Baron-Cohen, 2006). Another tool to develop the ability to read social cues is social stories, which are stories in which the important social cues and responses are made explicit (Konstantareas, 2006). Although intriguing, research on the outcomes of various training programs and their tools is in its infancy. The extent to which a change in one factor affects another factor is unknown for the autism spectrum disorders. Thus, we do not include a discussion of treatment-related feedback loops among the three types of factors. Childhood Disintegrative Disorder In contrast to autism, which involves decits in communication and interest in others since birth, childhood disintegrative disorder is characterized by normal development until at least 2 years old, followed by a profound loss of communication skills, normal types of play, and bowel control. The loss of normal functioning may occur as early as 2 years old or as late as 10 years old. Normal functioning is often lost in all ve areas (American Childhood disintegrative disorder Psychiatric Association, 2000). Thus, a clinician can distinguish childhood disinteA pervasive developmental disorder grative disorder from autism by the age of the child when the symptoms began and characterized by normal development until at by the course of the symptoms: Symptoms of childhood disintegrative disorder usuleast 2 years old, followed by a profound loss ally do not improve over time (Ozonoff, Rogers, & Hendren, 2003), whereas sympof communication skills, normal types of play, and bowel control. Childhood disintegrative disorder is a rare neurological disorder that is caused by factors that appear to be unrelated to Retts disorder those of autism. Specically, Retts disorder is slows and she loses the ability to control characterized by normal prenatal development and normal functioning after birth normal muscle movements, interest in other through at least 5 months of age (up to about 2 years), after which the growth of people, and previously developed skills. The skills that are lost include the voluntary movement of hands (which is replaced by recurrent hand gestures that resemble hand-washing or hand-wringing) and coordination of the trunk. In addition to the loss of skills, a girl with Retts disorder has language problems and psychomotor retardation. Although Retts disorder includes some of the problems in communicating that mark autism and childhood disintegrative disorder, it has three unique features: a slowed rate of growth of the childs head circumference, coordination problems, and the loss of hand skills. Moreover, symptoms of Retts disorder emerge by 2 years of age, at the latest; childhood disintegrative disorder symptoms emerge between 2 and 10. Retts disorder occurs only in females because it is an X-linked genetic disorder that impedes normal brain development related to movement and cognition (Amir et al. Treatment for autism that targets psychological factors der, childhood disintegrative disorder, and Retts disorder. Individuals with autism are oblivious to other people sions of others, as well as how to initiate and respond in social and do not pay attention to or understand basic social rules and situations. The child loses interest in other people and the With Aspergers, however, language and cognitive development ability to control normal muscle movements. People with Aspergers avoid eye conalways accompanies Retts disorder, which affects only females. Specically, People with Aspergers have less severe problems in using a list which criteria apply and which do not. Childhood Disorders 643 Learning Disorders: Problems with the Three Rs Richie Enriquezs older brother, Javier, is in the 4th grade. Javiers teacher has noted that his reading ability doesnt seem up to what it should be. Javier is a bright boy, but when the students take turns reading aloud, Javier isnt able to read as well as his classmates. The specic ability, as measured by individually administered standardized tests, is substantially below that expected given the persons chronological age, measured intelligence, and age-appropriate education. The disturbance in Criterion A signicantly interferes with academic achievement or activities of daily living that require reading skills. If a sensory decit is present, the learning difficulties are in excess of those usually associated with the sensory decit. Additional facts about learning disorachievement or activities of daily functioning ders are presented in Table 14. The teacher handed each student a sheet of paper, the top Onset half of which was covered with writing. My insides churned, and I began to perusually emerge until early in elementary spire as I wondered what I was going to do. As it happened, the boy who sat right in front of school (typically kindergarten through 3rd grade), when the relevant academic me was the most able reader in my class. Because everyone praised me when I did well on tests, I did my best to hide my inadequate reading skills. Unfortunately, learning disorders may cast a long shadow over many areas of life Course for many years. They tion, a signicant number of children are also more likely to suffer from poor self-esteem. Social factors can lead a child to be incorrectly diagnosed with a learning disorder. For example, immigrant children may not have English language skills advanced Gender Differences enough to allow their reading, writing, or math skills to approach the expected level of performance. At Javiers school, when a teacher thinks that a child may have a learning diswhich calls attention to their difficulties. Understanding Learning Disorders Source: Unless otherwise noted, the source for Like mental retardation and pervasive developmental disorders, learning disorders information is American Psychiatric Association, 2000. Neurological Factors Among the three types of learning disorders, dyslexia has been studied the most extensively. Evidence is growing that impaired brain systems underlie this disorder and that genes contribute to these impaired systems. Childhood Disorders 645 Brain Systems In most forms of dyslexia, the brain systems involved in auditory processing do not function as they should (Marshall et al. For example, one study used electrodes placed on the scalp to examine the brain waves of infants while they listened to syllables coming out of a speaker. Eight years later, the childrens reading abilities were assessed, and the children classied as dyslexic, poor readers, or normal readers. The children who were classied as dyslexic at 8 years old had brain-wave patterns in infancy (while they listened to spoken syllables) that were different from those of the children whose reading ability was classied as normal, which suggests that the children with dyslexia were born with processing problems in the auditory system (Molfese, 2000). Further research has suggested that these brain-wave differences continue at least through the rst 4 years of life (Espy et al. The results of many neuroimaging studies have converged to identify a set of brain areas that is disrupted in people who have dyslexia (Shaywitz, Lyon, & Shaywitz, 2006).
