Randomized controlled trial of parent-enhanced CBT compared with individual CBT for obsessive-compulsive disorder in young people

Objective: Obsessive-compulsive disorder (OCD) in young people can be effectively treated with Cognitive Behavior Therapy (CBT). Practice guidelines in the United Kingdom recommend that CBT be delivered with parental or family involvement; however, there is no evidence from randomized trials that this enhances effectiveness. The aim of this trial was to assess if CBT with high parental involvement was more effective than CBT with low parental involvement (individual CBT) in reducing symptoms of OCD. Method: Fifty young people ages 12–17 years with OCD were randomly allocated to individual CBT or parent-enhanced CBT. In parent-enhanced CBT parents attended all treatment sessions; in individual CBT, parents attended only Sessions 1, 7, and the final session. Participants received up to 14 sessions of CBT. Data were analyzed using intent-to-treat and per-protocol methods. The primary outcome measure was the Children’s Yale-Brown Obsessive Compulsion Scale (Scahill et al., 1997). Results: Both forms of CBT significantly reduced symptoms of OCD and anxiety. Change in OCD symptoms was maintained at 6 months. Per-protocol analysis suggested that parent-enhanced CBT may be associated with significantly larger reductions in anxiety symptoms. Conclusions: High and low parental involvement in CBT for OCD in young people were both effective, and there was no evidence that 1 method of delivery was superior on the primary outcome measure. However, this study was small. Future trials should be adequately powered and examine interactions with the age of the young person and comorbid anxiety disorders.

Human monstrosity: rape, ambiguity and performance in Rosemary’s Baby (Roman Polanski, 1968)

The narrative of Rosemary’s Baby hinges on a central hesitation between pregnancy induced madness and the existence of Satanism. Accordingly, the monstrous element is embodied in both the real and the supernatural: Rosemary’s husband Guy (John Cassavetes) is responsible for her victimisation through rape in either explanation. However, I will argue that the inherent ambiguity of the plot makes it difficult to place him as such a figure typical to the archetypal horror binaries of normality/monster, human/inhuman. By displacing generic convention the film complicates the issue of monstrosity, whilst simultaneously offering the possibility for the depiction of female experience of marriage to be at the centre of the narrative, for the real to be possibly of more significance than the supernatural. Previous writing has tended to concentrate on Rosemary and her pregnancy, so through detailed consideration of Cassavetes’ performance and its placement in the mise-en-scène this focus on Guy aims to demonstrate that he changes almost as much as Rosemary does. The chapter will focus on the film’s depiction of rape, during Rosemary’s nightmare and after it, in order to demonstrate how the notion of performance reveals Guy’s monstrousness and the difficulties this represents in our engagement with him.

An experimental comparison between rival theories of rapid automatized naming performance and its relationship to reading

Two studies investigated the degree to which the relationship between Rapid Automatized Naming (RAN) performance and reading development is driven by shared phonological processes. Study 1 assessed RAN, phonological awareness and reading performance in 1010 children aged 7-10 years. Results showed that RAN deficits occurred in the absence of phonological awareness deficits. These were accompanied by modest reading delays. In structural equation modeling, solutions where RAN was subsumed within a phonological processing factor did not provide a good fit to the data, suggesting that processes outside phonology may drive RAN performance and its association with reading. Study 2 investigated Kail's (1991) proposal that speed of processing underlies this relationship. Children with single RAN deficits showed slower speed of processing than closely matched controls performing normally on RAN. However, regression analysis revealed that RAN made a unique contribution to reading even after accounting for processing speed. Theoretical implications are discussed.

The anterior temporal lobes support residual comprehension in Wernicke’s aphasia

Wernicke’s aphasia occurs following a stroke to classical language comprehension regions in the left temporoparietal cortex. Consequently, auditory-verbal comprehension is significantly impaired in Wernicke’s aphasia but the capacity to comprehend visually presented materials (written words and pictures) is partially spared. This study used fMRI to investigate the neural basis of written word and picture semantic processing in Wernicke’s aphasia, with the wider aim of examining how the semantic system is altered following damage to the classical comprehension regions. Twelve participants with Wernicke’s aphasia and twelve control participants performed semantic animate-inanimate judgements and a visual height judgement baseline task. Whole brain and ROI analysis in Wernicke’s aphasia and control participants found that semantic judgements were underpinned by activation in the ventral and anterior temporal lobes bilaterally. The Wernicke’s aphasia group displayed an “over-activation” in comparison to control participants, indicating that anterior temporal lobe regions become increasingly influential following reduction in posterior semantic resources. Semantic processing of written words in Wernicke’s aphasia was additionally supported by recruitment of the right anterior superior temporal lobe, a region previously associated with recovery from auditory-verbal comprehension impairments. Overall, the results concord with models which indicate that the anterior temporal lobes are crucial for multimodal semantic processing and that these regions may be accessed without support from classic posterior comprehension regions.

Mismatch Negativity (MMN) reveals inefficient auditory ventral stream function in chronic auditory comprehension impairments

Background: Auditory discrimination is significantly impaired in Wernicke’s aphasia (WA) and thought to be causatively related to the language comprehension impairment which characterises the condition. This study used mismatch negativity (MMN) to investigate the neural responses corresponding to successful and impaired auditory discrimination in WA. Methods: Behavioural auditory discrimination thresholds of CVC syllables and pure tones were measured in WA (n=7) and control (n=7) participants. Threshold results were used to develop multiple-deviant mismatch negativity (MMN) oddball paradigms containing deviants which were either perceptibly or non-perceptibly different from the standard stimuli. MMN analysis investigated differences associated with group, condition and perceptibility as well as the relationship between MMN responses and comprehension (within which behavioural auditory discrimination profiles were examined). Results: MMN waveforms were observable to both perceptible and non-perceptible auditory changes. Perceptibility was only distinguished by MMN amplitude in the PT condition. The WA group could be distinguished from controls by an increase in MMN response latency to CVC stimuli change. Correlation analyses displayed relationship between behavioural CVC discrimination and MMN amplitude in the control group, where greater amplitude corresponded to better discrimination. The WA group displayed the inverse effect; both discrimination accuracy and auditory comprehension scores were reduced with increased MMN amplitude. In the WA group, a further correlation was observed between the lateralisation of MMN response and CVC discrimination accuracy; the greater the bilateral involvement the better the discrimination accuracy. Conclusions: The results from this study provide further evidence for the nature of auditory comprehension impairment in WA and indicate that the auditory discrimination deficit is grounded in a reduced ability to engage in efficient hierarchical processing and the construction of invariant auditory objects. Correlation results suggest that people with chronic WA may rely on an inefficient, noisy right hemisphere auditory stream when attempting to process speech stimuli.

Probiotics, prebiotics, and the host microbiome: the science of translation

Recent advances in our understanding of the community structure and function of the human microbiome have implications for the potential role of probiotics and prebiotics in promoting human health. A group of experts recently met to review the latest advances in microbiota/microbiome research and discuss the implications for development of probiotics and prebiotics, primarily as they relate to effects mediated via the intestine. The goals of the meeting were to share recent advances in research on the microbiota, microbiome, probiotics, and prebiotics, and to discuss these findings in the contexts of regulatory barriers, evolving healthcare environments, and potential effects on a variety of health topics, including the development of obesity and diabetes; the long-term consequences of exposure to antibiotics early in life to the gastrointestinal (GI) microbiota; lactose intolerance; and the relationship between the GI microbiota and the central nervous system, with implications for depression, cognition, satiety, and mental health for people living in developed and developing countries. This report provides an overview of these discussions.

Working memory, reading ability and the effects of distance and typicality on anaphor resolution in children

We investigated the time course of anaphor resolution in children and whether this is modulated by individual differences in working memory and reading skill. The eye movements of 30 children (10-11 years) were monitored as they read short paragraphs in which (i) the semantic typicality of an antecedent and (ii) its distance in relation to an anaphor, were orthogonally manipulated. Children showed effects of distance and typicality on the anaphor itself, and also on the word to the right of the anaphor, suggesting that anaphoric processing begins immediately but continues after the eyes have left the anaphor. Furthermore, children showed no evidence of resolving anaphors in the most difficult condition (distant atypical antecedent), suggesting that anaphoric processing that is demanding may not occur online in children of this age. Finally, working memory capacity and reading comprehension skill affect the magnitude and time course of typicality and distance effects during anaphoric processing.

Becoming a written word: eye movements reveal order of acquisition effects following incidental exposure to new words during silent reading

We know that from mid-childhood onwards most new words are learned implicitly via reading; however, most word learning studies have taught novel items explicitly. We examined incidental word learning during reading by focusing on the well-documented finding that words which are acquired early in life are processed more quickly than those acquired later. Novel words were embedded in meaningful sentences and were presented to adult readers early (day 1) or later (day 2) during a five-day exposure phase. At test adults read the novel words in semantically neutral sentences. Participants’ eye movements were monitored throughout exposure and test. Adults also completed a surprise memory test in which they had to match each novel word with its definition. Results showed a decrease in reading times for all novel words over exposure, and significantly longer total reading times at test for early than late novel words. Early-presented novel words were also remembered better in the offline test. Our results show that order of presentation influences processing time early in the course of acquiring a new word, consistent with partial and incremental growth in knowledge occurring as a function of an individual’s experience with each word.

Is children's reading “good enough”? Links between online processing and comprehension as children read syntactically ambiguous sentences

We monitored 8- and 10-year-old children’s eye movements as they read sentences containing a temporary syntactic ambiguity to obtain a detailed record of their online processing. Children showed the classic garden-path effect in online processing. Their reading was disrupted following disambiguation, relative to control sentences containing a comma to block the ambiguity, although the disruption occurred somewhat later than would be expected for mature readers. We also asked children questions to probe their comprehension of the syntactic ambiguity offline. They made more errors following ambiguous sentences than following control sentences, demonstrating that the initial incorrect parse of the garden-path sentence influenced offline comprehension. These findings are consistent with “good enough” processing effects seen in adults. While faster reading times and more regressions were generally associated with better comprehension, spending longer reading the question predicted comprehension success specifically in the ambiguous condition. This suggests that reading the question prompted children to reconstruct the sentence and engage in some form of processing, which in turn increased the likelihood of comprehension success. Older children were more sensitive to the syntactic function of commas, and, overall, they were faster and more accurate than younger children.

Children’s and adults’ processing of syntactically ambiguous sentences during reading

While there has been a fair amount of research investigating children’s syntactic processing during spoken language comprehension, and a wealth of research examining adults’ syntactic processing during reading, as yet very little research has focused on syntactic processing during text reading in children. In two experiments, children and adults read sentences containing a temporary syntactic ambiguity while their eye movements were monitored. In Experiment 1, participants read sentences such as, ‘The boy poked the elephant with the long stick/trunk from outside the cage’ in which the attachment of a prepositional phrase was manipulated. In Experiment 2, participants read sentences such as, ‘I think I’ll wear the new skirt I bought tomorrow/yesterday. It’s really nice’ in which the attachment of an adverbial phrase was manipulated. Results showed that adults and children exhibited similar processing preferences, but that children were delayed relative to adults in their detection of initial syntactic misanalysis. It is concluded that children and adults have the same sentence-parsing mechanism in place, but that it operates with a slightly different time course. In addition, the data support the hypothesis that the visual processing system develops at a different rate than the linguistic processing system in children.

Using eye movements to investigate word frequency effects in children’s sentence reading

While eye movements have been used widely to investigate how skilled adult readers process written language, relatively little research has used this methodology with children. This is unfortunate as, as we discuss here, eye-movement studies have significant potential to inform our understanding of children’s reading development. We consider some of the empirical and theoretical issues that arise when using this methodology with children, illustrating our points with data from an experiment examining word frequency effects in 8-year-old children’s sentence reading. Children showed significantly longer gaze durations to low than high-frequency words, demonstrating that linguistic characteristics of text drive children’s eye movements as they read. We discuss these findings within the broader context of how eye-movement studies can inform our understanding of children’s reading, and can assist with the development of appropriately targeted interventions to support children as they learn to read.

Using E-Z Reader to examine the concurrent development of eye-movement control and reading skill

Compared to skilled adult readers, children typically make more fixations that are longer in duration, shorter saccades, and more regressions, thus reading more slowly (Blythe & Joseph, 2011). Recent attempts to understand the reasons for these differences have discovered some similarities (e.g., children and adults target their saccades similarly; Joseph, Liversedge, Blythe, White, & Rayner, 2009) and some differences (e.g., children’s fixation durations are more affected by lexical variables; Blythe, Liversedge, Joseph, White, & Rayner, 2009) that have yet to be explained. In this article, the E-Z Reader model of eye-movement control in reading (Reichle, 2011; Reichle, Pollatsek, Fisher, & Rayner, 1998) is used to simulate various eye-movement phenomena in adults versus children in order to evaluate hypotheses about the concurrent development of reading skill and eye-movement behavior. These simulations suggest that the primary difference between children and adults is their rate of lexical processing, and that different rates of (post-lexical) language processing may also contribute to some phenomena (e.g., children’s slower detection of semantic anomalies; Joseph et al., 2008). The theoretical implications of this hypothesis are discussed, including possible alternative accounts of these developmental changes, how reading skill and eye movements change across the entire lifespan (e.g., college-aged vs. elderly readers), and individual differences in reading ability.

Children’s eye movements during reading

Children’s eye movements during reading. In this chapter, we evaluate the literature on children’s eye movements during reading to date. We describe the basic, developmental changes that occur in eye movement behaviour during reading, discuss age-related changes in the extent and time course of information extraction during fixations in reading, and compare the effects of visual and linguistic manipulations in the text on children’s eye movement behaviour in relation to skilled adult readers. We argue that future research will benefit from examining how eye movement behaviour during reading develops in relation to language and literacy skills, and use of computational modelling with children’s eye movement data may improve our understanding of the mechanisms that underlie the progression from beginning to skilled reader.