Panning for Gold: The Standardizing Work of Filling “Autistic” Shells – Using institutional ethnography to explore textually mediated health relations in the diagnostic process of autism.

Health reform practices in Canada and elsewhere have restructured the purpose and use of diagnostic labels and the processes of naming such labels. Diagnoses are no longer only a means to tell doctors and patients what may be wrong and indicate potential courses of treatment; some diagnoses activate specialized services and supports for persons with a disability and those who provide care for them. In British Columbia, a standardized process of diagnosis with the outcome of an autism spectrum disorder gives access to government provided health care and educational services and supports. Such processes enter individuals into a complex of text mediated relations, regulated by the principles of evidence-based medicine. However, the diagnosis of autism in children is notoriously uncertain. Because of this ambiguity, standardizing the diagnostic process creates a hurdle in gaining help and support for parents who have children with problems that could lead to a diagnosis on the autism spectrum. Such processes and their organizing relations are problematized, explored and explicated below. Grounded in the epistemological and ontological shift offered by Dorothy E. Smith (1987; 1990a; 1999; 2005), this article reports on the findings of an institutional ethnographic study that explored the diagnostic process of autism in British Columbia. More specifically, this article focuses on the processes involved in going from mothers talking from their experience about their childrens problems to the formalized and standardized, and thus “virtually” produced, diagnoses that may or may not give access to services and supports in different systems of care. Two psychologists, a developmental pediatrician, a social worker – members of a specialized multidisciplinary assessment team – and several mothers of children with a diagnosis on the autism spectrum were interviewed. The implications of standardizing the diagnosis process of a disability that is not clear-cut and has funding attached are discussed. This ethnography also provides a glimpse of the implications of current and ongoing reforms in the state-supported health care system in British Columbia, and more generally in Canada, for people’s everyday doings.

Combinations of Prompt and Target Response Modalities and Their Impact on Emergent Relations and Teaching Efficiency.

In the present study, native Spanish speakers were taught a small English vocabulary (Spanish-to-English intraverbals). Four different training conditions were created by combining textual and echoic prompts with written and vocal target responses. The efficiency of each training condition was examined by analysing emergent relations (i.e., tacts) and the total number of sessions required to reach mastery under each training condition. All combinations of prompt-response modalities generated increases in correct responding on tests for emergent relations but when target responses were written, mastery criterion was reached faster. Results are discussed in terms of efficiency for emergent relations and recommendations for future directions are provided.

From 'trailing wives' to the emergence of a 'trailing husbands' phenomenon: Retirement migration to rural areas

Migration and gender studies have focused on economically active heterogeneous couples and traditionally highlight a dominant male role in migration decision-making. The female partner is commonly portrayed as a 'trailing wife' or 'trailing mother' with the move found to have a negative effect on her employment prospects. Much less is known about if or how the balance of power shifts between husbands and wives when employment or career-motivated moves are removed from the decision-making process. This is analysed with reference to retirement migration to rural areas of the UK and involved interviews with both partners present. For this cohort of retired couples, and in common with the literature, migration during economically active life course stages demonstrates strong 'trailing wife' and 'trailing mother' tendencies. The male's decision to retire signalled the commencement of a retirement life course stage for the couple. However, in contrast to the earlier male dominated decision-making, retirement migration saw the emergence of a 'trailing husband' phenomenon. Wives appear to adapt most successfully to the new rural environment while many husbands found it difficult to adjust (at least initially) to the multiple life changes: moving from largely urban areas to a rural setting alongside exiting the workforce. The findings suggest that the role of leader/ follower changed during the course of these couples' lives together and in relation to their reasons for moving.