Tuesday, October 20, 2009

Study Addresses Stress in Families of Children with Seizures

There is little research exploring the impact of having a sibling with epilepsy. Mims (1997) explored sibling concerns about epilepsy between two groups of children: siblings of children with frequent seizures (n=10) and siblings of children with infrequent seizures (n=10). The author also compared family stress among families of children with frequent seizures, families of children with infrequent seizures, and families of children with no chronic illness (n=11). Case subjects included children, between the ages of 8 to 12 years, with siblings who have had epilepsy for at least three years and were being treated through The Minnesota Epilepsy Group outpatient clinic. Control subjects were recruited from a neighborhood public school. An additional three control subjects were recruited after suggestion of enrolled subject families. Case siblings were matched to control siblings based on age, gender, and birth order. The dependent variables of self-esteem and behavior of unaffected siblings were compared among the three groups. Self-esteem and behavioral and social functioning were measured using the Piers-Harris Self-Concept Scale and the Child Behavior Checklist, respectively. Family stress was measured using the Family Inventory of Life Events. Sibling concerns were measured using the Sibling Concern About Seizure Scale. The author hypothesized that there would be a relationship between epilepsy and adverse affects in siblings, including lowered self-esteem, increased behavior problems, and more concerns surrounding epilepsy; yet there were no significant differences among any of these variables. Nevertheless, statistically significant levels of family stress were reported in families of children with frequent seizures compared to families of children with infrequent seizures. The finding that the majority of siblings of children with epilepsy have concerns surrounding epilepsy has implications for policy, in that programs for children with epilepsy should also address the needs of siblings.

The author attempts to control for secondary variables (age, gender, birth order) that might confound the results by designing and implementing a cross-sectional case control study. Because of the cross-sectional nature of the study, causal relationships cannot be determined. The author doesn’t describe the procedures for data collection in detail, making it difficult to determine if there were any threats to internal validity, which may have compromised the study. The author does indicate that all study participants were “pleased to be included” indicating that there may be a sampling bias based on self-selection. Perhaps most notable is that the small sample size (n=31) decreases the study’s power and makes it difficult to detect any differences among the groups. Further research with a larger sample size should be conducted to compare to findings from this study.

Mims, J. (1997). Self-esteem, behavior, and concerns surrounding epilepsy in siblings of children with epilepsy. Journal of Child Neurology, 12(3), 187-192.

Sunday, October 18, 2009

Phenomenology and Social Construction

As learners, ‘experts’ tell us what the truth is and we understand this explanation as our own. Yet as researchers, how do we really know what we know? We often call upon our knowledge, beliefs, and ethics to explore and interpret phenomena. This speaks to the world of research. For example, Schutz (1967) explains the process of how we grapple with our understanding of others:

On the one hand, what is understood is the sign itself, then again what the other person means by using this sign, and finally the significances of the fact that he is using the sign, here, now, and in this particular context (p.269).

In grappling with the meanings of others and their actions, we contribute to the accumulation of scientific inquiries.

Schutz’s work testifies to his support of Weber. He emphasizes Weber’s value of freedom in social scientific research, with science asserting itself through other areas of life. As opposed to its association with the natural sciences, Schutz frames social science as a science in its own right, with its own meaning-making strategies, (i.e., research methodologies). The main tenet of science is the same across disciplines: science offers an approach to discover and know reality through experience.

Schutz specifically describes knowledge-gathering through actions without communication, which draws parallels to the role of the complete observer in qualitative methodologies. Even if what we study is very abstract and difficult to explain, there is something in our lived reality that we can use in the interpretation. In raising awareness of others’ experiences, we create our own meaning-context. At the same time, others have arranged their own meaning-contexts. Yet there is a danger in completely adopting the point of view of another. By abandoning objectivity in favor of empathy, there is the risk of losing an understanding of the phenomenon from alternate frames of reference.

What are the labels that we use to give meaning to others? Labels for concepts are merely devices used to organize phenomena and communicate with others. This premise was first described by Berger and Luckmann (1966) as mental representations of other’s actions. These typifications eventually become a part of the social dialogue of meaning-making. As time moves forward, the developed meaning is embedded into the fabric and structure of society, thereby becoming a social construct. Quantitative research methodologies force us to choose constructs and fit people into those constructs. Individuals are viewed, labeled, and analyzed in regards to social constructs, such as gender, age, and socioeconomic status. Some may argue that the shared experience may be lost in quantitative methods, as the individual is often reduced to his constructs.

There is a great need for social researchers to treat the beliefs they study as worthy of respect rather than as objects of condemnation. This can be done by allowing participants to determine the meanings attributed to the phenomena being described in the study. A promising methodology is mixed methods research, which combines qualitative and quantitative approaches to provide a better understanding of research problems than using either single approach alone. In utilizing aspects of both methods, the researcher acknowledges alternate frames of reference for interpreting meaning in others’ lives.

Berger, P. and Luckmann, T. (1966). The social construction of reality: A treatise in the sociology of knowledge. New York, NY: Anchor Books.
Schutz, A. (1967). The phenomenology of the social world. In S. Appelrouth and L. Dasfor Eldes (Eds.), Social theory in the contemporary era: Text and readings. Thousand Oaks, CA: Sage.

Tuesday, October 13, 2009

Study Finds Integrated Service Delivery Network Increases Quality of Life Among Frail Elderly in Eastern Quebec

***What does this study of frail elderly have to do with children? one reader asks. Not much. But it's a good example of quasi-experimental study design, which will help with developing research methodologies for all populations.***

Integrated service delivery (ISD) is a coordinated model emphasizing social interventions based on cooperation between multiple levels of service planning for frail elderly. In their study, Tourigny et al. (2004) evaluated the effectiveness of an ISD network of health and social services for frail elderly living in two semi-urban communities in Quebec. The sample included people 75 years and older (n=482) from two communities. Individuals from Bois-Francs served as the experimental group (n=272) and participants from Drummondville, where there were no ISD services available, served as the control group (n=-210). Measures were taken from both groups prior to the intervention, and every year thereafter for three years. Measures included data on basic demographics, functional autonomy, desire to be institutionalized, caregiver burden, and service utilization. Results did not indicate that ISD had any effect on mortality rates. Nevertheless, the study shows that ISD may contribute to increased quality of life, including less desire to be institutionalized, less deterioration, and decreased caregiver burden. There was no indication that ISD had an effect on utilization of services in either group.

A quasi-experimental study design was chosen because randomization was not possible in this context. The researchers took great care to select a comparable control environment to control any potential biases due to differences between the treatment and control groups. In comparison to the study environment, the control environment had similar percentages of people over 65 (11%), all who had similar access to services and utilization rates of these services. Furthermore, the rate of participants who refused to continue in the study (less than 5%) and the desire to be institutionalized (about 25%) was similar for both groups. Nevertheless, there were some important differences between the groups, which could pose a threat to the study’s internal validity. Groups differed in their score of functional autonomy, with the treatment group measuring as more autonomous than the control group. As the study proceeded, there was a significant loss of subjects - 72% remained for the first year, 54% for the second year, and 45% for the third and final year of the study - due to death and institutionalization. Though this was similar in both groups, thereby eliminating internal validity due to maturation, the cumulative attrition could have an effect on the study’s overall power. Lastly, because this study explored a specific program for a small cohort in only two communities, the generalizability of the results is limited.

Tourigny, A., Durand, P.J., Bonin, L., Hebert, R., and Rochette, L. (2004). Quasi-experimental study of the effectiveness of an integrated services delivery network for the frail elderly. Canadian Journal of Aging, 23(3), 231-246.

Thursday, October 8, 2009

Interactionism and Self in the World

Humanitarianism identifies groups of displaced persons (e.g., refugees and internally displaced persons) as dependent on outside assistance. Rather than being perceived as individuals, people in need are viewed collectively, identified by their ‘problems’ and oftentimes stripped of their individual rights and self-dignity. Interactions between humanitarian ‘helpers’ and the recipients of their help constitutes a power relationship, with the recipients held in a position of obligation to the benefactors. The distribution of goods and services to these populations indicates not simply a material transaction, but also a moral transaction. As an individual in one of these groups, how might one perceive oneself and others and what are the implications of these perceptions? How do perceptions of ‘otherness’ color interactions and meanings developed through these interactions?

The theory of symbolic interactionism contributes to our understanding of the different meanings attributed to individuals and groups in various settings. In differentiating between the ‘I’ and the ‘Me’, Mead (1934) develops his idea of a generalized ‘other’. ‘Other’ and how one thinks one’s group perceives oneself is dependant upon human interaction. It is in realizing one’s role in relation to others that selfhood arises. Furthermore, the ‘I’ represents the self as a subject, whereas the ‘me’ identifies the self as object. Mead addresses the concept of self through his idea that the individual is a product of social interaction. One is first perceived as an object to others. Self is developed when one has an awareness that he himself is an object. This development of self is supported by human action, specifically communication. Language allows us to speak about ourselves in the same way we speak about others, thereby perceiving other and self as interacting objects.

In supporting Mead’s ideas, Blumer (1969) outlines three points related to the methodology of symbolic interactionism. First, people perceive an object depending on the meaning that they attribute to that object. Secondly, meaning is developed based on the process of social interaction. And finally, meanings can change over time. Human society is influenced by culture, derived from what people do rather than what people are. One’s status in society is defined by the way that people interact with others. Using the example of humanitarianism, the action of receiving help from humanitarians defines the recipients as dependent upon this assistance. The concept of culture also contributes to definitions of ‘otherness’.

Being an outsider in a culture speaks to Goffman’s (1959) assertion that society is not homogenous, and therefore we must modify behavior for various settings. Goffman uses the analogy of life as a theater, with the necessity for a parking lot and a cloakroom as well. In other words, the individual is responsible for the maintenance of the social world by playing his role, while at the same time considering the broader context behind simple face-to-face symbolic interactionism. “Putting on a show for the benefit of other people” (p.28) is related to a conception of what others perceive of oneself.

Mead, Blumer, and Goffman speak to the importance of self in relation to other. Rights-based humanitarianism addresses the division between the two. By encouraging interaction with individuals in the group, rather than viewing the group as its own entity defined by ‘other’, the individual rights and dignities of displaced populations are maintained. Meanings should shift away from viewing displaced populations as “vulnerable” and more towards a definition of survival in adverse circumstances.

Blumer, H. (1969). Symbolic interactionism: Perspective and method. Englewood Cliffs, NJ: Prentice-Hall.
Goffman, E. (1959). The presentation of self in everyday life. London, UK: Penguin Books.
Mead, G.H. (1934). Mind, self, and society. Chicago, IL: University of Chicago Press.

Monday, October 5, 2009

Study Finds Group Interpersonal Psychotherapy Reduces Symptoms of Depression Among Adolescent Girls Affected by War in Northern Uganda

Prior research indicates that war-affected youth are at increased risk of mental health issues, and many humanitarian organizations have been implementing interventions to ameliorate these problems. Yet, few rigorous evaluations have been conducted and even fewer have implemented a randomized control design. Using a randomized control design, Bolton et al. (2007) examined the effectiveness of a group interpersonal psychotherapy intervention (IPT-G) and a creative play intervention (CP), as compared to a wait-list control group, in decreasing depression symptoms, anxiety symptoms, and conduct problems among war-affected adolescents. The authors first developed locally derived measures for depression, anxiety, conduct problems, and functioning to create the Acholi Psychosocial Assessment Instrument (APAI), which was found to have strong test-retest reliability and criterion validity. Stage one of the screening asked community leaders, teachers, community workers, and adolescents to create a list of 14 to 17-year-olds who exhibited at least one of the locally-derived depression symptoms. Stage two of the screening process administered the locally derived instrument to community-identified children to determine who should be included in the study. The study employed a pretest-posttest control group design, with participants randomly assigned to one of the three groups. The authors found that all three groups experienced decreased symptoms of depression. However, only girls experienced statistically significant reductions in their depressive symptoms after participating in IPT-G. Neither IPT-G nor CP were associated with improvement in anxiety, conduct problems, or functioning.

Based on previous RCTs in sub-Saharan populations, the authors recognized that attrition could pose a threat to the study’s validity by decreasing sample size and power and compromising the integrity of the random assignment. To address this, the authors employed intent-to-treat analysis, using pretreatment data from subjects who have dropped out as both pre- and post-test data. Intent-to-treat analysis also provided a conservative test of the hypothesis, making the effect of IPT-G all the more compelling. To decrease attrition further, the experimenters used a unique method of obtaining informed consent from the sample, both before the administration of the pre-intervention measure and after random assignment to one of the three groups. This study contributes to the growing knowledge base about ways to address the effects of war among adolescents, and proves that randomized control study designs can be implemented in difficult contexts with vulnerable populations.

Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K.F., Neugebauer, R., Murray, L., and Verdeli, H. (2007). Interventions for depression symptoms among adolescent survivors of war and displacement in Northern Uganda: A randomized control trial. Journal of the American Medical Association, 298(5), 519-527

Thursday, October 1, 2009

Behavior, Development, and Society

In his sixth chapter of Introductory Lectures on Psychoanalysis, Freud focuses on the interpretation of cultural phenomena. Using analysis of the dream world as the basis of interpretation, he suggests “We want something that is sought for in all scientific work – to understand the phenomena” (p. 129). In exploring phenomena, Freud’s writings seem wholly focused on the individual as a singular entity to explore through analysis. Nevertheless, Freud expounds upon the contradictory demands of the individual and society; the interpretation, translation, and analysis of cultural phenomena are associated with the clash between the individual and society.

Whereas Freud emphasizes the conflict between the interests of society and the demands of the individual, Parsons (1954) highlights that these elements are independent, as well as interactive with each other. In other words, the individual supports society, just as society supports the individual. With an emphasis on order and cohesion, Parsons, like Freud, also believes that social phenomena can be described, analyzed, and explained. Parsons’ four-factor model of social system dimensions – adaptation, goal attainment, pattern maintenance, integration – can be used as a model for analyzing any kind of relationship. In beginning to outline his concept of structural-functionalism, Parsons proposes a theory of social action, depicting human action as a system. This system is composed of four interdependent and interaction units making up “a body of logically interdependent generalized concepts of empirical reference” (p. 212): individual, personality, social system, and culture. In Parsons’ world, theory’s purpose is to facilitate description and analysis. By description, he refers to determining verifiable answers to all the scientifically important questions. By analysis, he refers to ensuring that the conceptual structure is delineated through propositions, or building larger concepts upon smaller ones.

Erikson’s (1997) “Major Stages of Psychosocial Development” illustrates Parsons’ concept of propositions, with one stage building upon another like a developmental ladder. Erikson provides an outline of his theoretical system, from infancy through old age, as the individual “gradually becoming what one has caused to be, one eventually will be what one has been” (p. 79). At first glance, the stages alone do not seem to take into account contextual variation among individuals. Yet, the fact that the stages are general and not stringently outlined, makes it more applicable to various contexts. Erikson’s framework of psychosocial development is particularly mindful of the cultural location of the developmental tasks and of the ways in which the natural movement through development may be distorted by external forces. As a powerful external force, armed conflict disrupts the developmental processes of the individual, family, and community. In particular, the role of caregivers is compromised, as they face increasing external demands that prioritize safety and survival. As a result, developmental needs of children are compromised and movement between stages is stalled.

Are the theoretical concepts of Freud, Parsons, and Erikson relevant today? In order to address issues of human development in today’s society, culture must be considered. All individuals are participants in cultural communities, engaging with others in shared endeavors and building upon cultural practices of previous generations. Human development is a process of participation in society, while society represents the culmination of various individuals interacting with others. External forces, such as global crises, create another contextual layer through which the individual must interact and contend with.

Erikson, E. (1997). The Life Cycle Completed. New York, NY: W.W. Norton.
Freud, S. (1991). Introductory Lectures in Psychoanalysis. London, UK: Penguin Books.
Parsons, T. (1954). Essays in Sociological Theory. New York, NY: Macmillan Company.