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Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The distinction between treatment and enhancement is often considered to be a morally significant boundary, which, at the very least, marks the limits of our moral obligations. This conviction holds despite the fact that treatment and enhancement are situated along a continuum of interventions that are directed towards the improvement of human functioning. The distinction between these two sorts of interventions is based upon a notion of normative normality, which suggests that we are morally obligated to provide interventions which are directed toward the achievement of normal functioning, but that no obligation exists to improve functioning beyond this point. This dissertation will subject this position to critique by examining the constitution of normal functioning, and by suggesting that this kind of functioning cannot operate as a normative standard which determines the limits of our moral obligations. The moral desirability which we attribute to the achievement of normal functioning is based upon the independent ethical imperative to promote the possibilities for well-being of moral agents. This motivation, however, equally suggests that we will be obligated to provide certain kinds of enhancement interventions which will be likely to promote the welfare interests of moral agents, when these become available. This argument also implies that the development of enhancement technologies will require us to rethink our ethical conception of harmful non-benefits. We currently think of the non-provision of medical treatment and some environmental enhancements, such as education, as harmful to the extent that state intervention is justified to rectify this. We recognise that such non-provision, and the resultant failure to promote the welfare interests of moral agents, where such promotion is possible, harms persons by putting them in a worse position than they could have been in, with regards to their chances of leading a good life. The new technological possibilities offered by the prospect of genetic enhancement mean that we might soon have a better alternative, in terms of our chances of leading a good life, to the level of functioning that we have thus far been able to achieve. This implies that the non-provision of these enhancements would be harmful to the extent that intervention to bring about this provision would be justified. / AFRIKAANSE OPSOMMING: Die onderskeid tussen behandeling (“treatment”) en verbetering (“enhancement”) word dikwels geag 'n skeiding daar te stel wat van morele belang is, in soverre dit ten minste, die perke van ons morele verpligtinge afbaken. Hierdie oortuiging geld ten spyte van die feit dat behandeling en verbetering op „n kontinuum van ingrype wat op die verbetering van menslike funksionering gerig is, geleë is. Die onderskeid tussen hierdie twee tipes ingrype is gebaseer op 'n bepaalde begrip van normatiewe normaliteit, wat suggereer dat ons moreel verplig is om ingrype te voorsien wat daarop gerig is om normale funksionering te bewerkstellig, maar dat geen sodanige verpligting bestaan om funksionering duskant hierdie punt te verbeter nie. Hierdie proefskrif sal laasgenoemde posisie aan kritiek onderwerp deur die manier waarop ons normale funksionering verstaan, te ondersoek, en deur aan die hand te doen dat hierdie tipe funksionering nie as normatiewe standaard wat die perke van ons morele verpligtinge bepaal, kan dien nie. Die morele gewenstheid wat ons toeskryf daaraan om normale funksionering mee te bring, is op die onafhanklike etiese imperatief om die moontlikhede vir welstand van morele agente te bevorder, gebaseer. Hierdie motivering doen egter eweseer aan die hand dat ons verplig sal wees om sekere tipes verbeteringsingrype te verskaf wat waarskynlik die welsynbelange van morele agente sal bevorder, wanneer sulke verbeteringsingrype beskikbaar word. Hierdie argument impliseer ook dat die ontwikkeling van verbeteringstegnologieë van ons sal vereis om ons etiese konsepsie van skadelike nie-voordele opnuut te deurdink. Tans dink ons dat die nie-voorsiening van mediese behandeling, sowel as sommige omgewingsverbeterings soos opvoeding, tot so „n mate skadelik is dat staatsinmenging met die doel om dit reg te stel, geregverdig is. Ons erken dat sulke nie-voorsiening en die gevolglike versuim om die welsynsbelange van morele agente te bevorder, waar sulke bevordering moontlik is, mense skade berokken deur hulle in „n slegter posisie te plaas as waarin hul kon gewees het, ten aansien van hul kanse om 'n goeie lewe te leef. Die nuwe tegnologiese moontlikhede wat die voortuitsig van genetiese verbetering ons bied, beteken dat ons binnekort 'n beter alternatief mag hê vir die vlak van funksionering wat ons tot dusver kon bewerkstellig, ooreenkomstig ons kanse om 'n goeie lewe te leef. Dit impliseer dat die nie-voorsiening van hierdie verbeterings skadelik sal wees tot die mate wat ingrype om hierdie voorsiening teweeg te bring, geregverdig sal wees.

Mentaliseringsförmåga handlar om att kunna begripliggöra egna och andras beteenden och sinnestillstånd i termer av bakomliggande mentala tillstånd. Enligt mentaliseringsteorin är brister i detta grundproblemet vid borderline personlighetssyndrom (BPS) men kan också tänkas vara en delförklaring till substansberoende, vilket är vanligt förekommande i patientgruppen. Mentaliseringsbaserad terapi skulle därför kunna vara en effektiv behandlingsform som tillägg till sedvanlig beroendevård för patienter med båda diagnoserna. Föreliggande studie har jämfört behandlingsutfall i termer av mentaliseringsförmåga, operationaliserat som reflective functioning (RF), efter behandling med mentaliseringsbaserad terapi (MBT) i tillägg till sedvanlig behandling för substansberoende (TAU) (N = 12) jämfört med enbart TAU (N = 10) för patienter med BPS och samtidigt substansberoende. En ANOVA visade inte på några skillnader avseende förändring i RF mellan grupperna och inte heller någon förändring i RF efter behandling. Patienter med dubbeldiagnos kan tänkas vara en population där MBT inte har önskad effekt på RF, men nollresultatet kan också tänkas bero på metodologiska tillkortakommanden.

The young child’s experiences of living with cancer are crucial to providing evidence based care. The overall aim of this thesis was to explore and describe experiences of health and functioning in the everyday life of young children with cancer, over a three year period from diagnosis, to provide insights and suggestions to improve evidence based care. The first and second papers in the series of four for this thesis used a qualitative content analysis to describe the child’s experiences shortly after diagnosis and six and 12 months later. The third paper used mixed methods to identify a comprehensive set of ICF-CY codes describing everyday health and functioning in the life of the young child with cancer. The fourth paper used the identified comprehensive set of ICF-CY codes to follow changes in everyday health and functioning over the study’s entire three year period from diagnosis. Entry into the health-illness transition was characterised by trauma and isolation. Health and functioning in everyday life was utterly changed and physical difficulties were at their peak. The passage through transition was characterised by an active striving on the part of the child to make a normal everyday life of the cancer experience. Difficulties affecting health and functioning in everyday life decreased and changed during the trajectory, though feelings of loneliness prevailed. A new period of stability in the child’s post treatment life was seen from two years after diagnosis and onwards, with (re)-entry to preschool/school and other social activities. However, an increase in difficulties with personal interactions with others and access to, and support from healthcare professionals was seen. Variances were seen within individual children’s’ trajectories. In summary it can be stated that the everyday life of young children with cancer changes over time and health care services are not always in phase with these changes. Young children living with cancer want to be participatory in their care and to have access to their parents as protectors. They need access to and ongoing contact with peers and preschool. Although physical difficulties in living an everyday life with cancer reduce over time, new difficulties emerge as the child post cancer treatment re-enters society. A structured follow-up throughout the cancer trajectory and not just during active treatment is necessary. A child-centered philosophy of care would guide the child towards attainment of health and well-being. Both the child’s own perspective and a child’s perspective as described by adults caring for them should be seen on a continuum, rather than as opposites. This view could help ensure that young children become visible and are listened to as valuable contributors to care planning. Knowledge of health-illness transition can be useful in illustrating everyday health and functioning through long term illness trajectories.

A study on the relationship of mindfulness to empathy was conducted with undergraduate students at a large southwestern university. Previous studies suggest that mindfulness may be related to empathy, but are inconclusive due to measurement and methodological limitations. A mindfulness construct that includes axioms related to intention, attention, and attitude is suggested for researching empathy, along with statistical models that include mediation. A multifactored measure of mindfulness was hypothesized to predict perspective taking and empathic concern empathy components, which in turn would mediate the relationship of mindfulness facets to individual and interpersonal outcomes. Study results suggest a relationship of mindfulness to perspective taking, but not to empathic concern. Results from the mediation procedures were not supportive of the theorized role of empathy in relation to mindfulness on individual and interpersonal outcomes. Implications and limitations to the study design and theory are discussed. / text

This investigation examined several dimensions of personality functioning in a longitudinal sample of females. These data are part of an existing project evaluating female development across 3 different time points starting in adolescence and transitioning into adulthood. Subjects were categorized into a clinical group (females with a high degree of psychiatric comorbidity) and a normal control group. All participants were initially recruited when they were between 14-18 years of age, and were followed up twice when they were 19-23, and 24-28. In an attempt to explore possible heterogeneity in personality trait development, the research is presented as three separate studies examining the following: (1) fluctuations in mean-level and rank order stability estimates across time; (2) the validity of established personality trends relative to their association with antisocial behavior; and (3) mechanisms that may contribute to personality trait consistency across development such as neighborhood context. This is the first study to investigate personality functioning across time in females who are disturbed in multiple areas of social and psychological functioning. Results highlight the importance of considering distinct subgroups of the general population when exploring developmental trends in personality.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in communication and socialization, as well as by repetitive and stereotyped behaviours and interests. The ASD phenotype is also characterized by impairments in cognition. A growing body of literature points to attention and executive functioning as being key elements of cognition that are impaired in individuals with ASD. It is very possible that these cognitive difficulties are related to the functional deficits in academic achievement, daily living skills and socialization that are experienced by individuals with ASD throughout their lifetime. Associations between these cognitive and functional abilities have been identified in TD populations; however, this relationship is not well understood in ASD. This is especially true for adolescents with ASD who are a vastly understudied population within the field. The research in this thesis aimed to investigate the nature of cognitive and functional impairments in high-functioning adolescents with ASD, and to better understand the relationship between these deficits. This study made use of a multi-method approach, by obtaining behavioural and parent-report data related to cognition and functioning for both ASD and TD populations. The results indicated that adolescents with ASD may have some impairment in executive functioning, particularly with shifting and planning abilities, and score significantly lower than TD adolescents on measures of academic achievement, adaptive behaviour and social skills. Surprisingly, no evidence was found for attentional deficits in the ASD group. Multiple regression analyses did not reveal any significant predictive relationships of attention and executive functioning with academic ability, adaptive behaviour, or social skills. Limitations of this research are discussed. The results may lend themselves to the development of theoretical frameworks for understanding functional abilities in adolescents with ASD. / Thesis (Master, Psychology) -- Queen's University, 2013-10-07 10:10:42.215

It is apparent from the historical perspective regarding the theories of cognitive development and the cognitive functioning of individuals with visual impairments, that sight plays a major role in the development of certain cognitive processes. However, the affects of visual impairment on cognitive development remain to be at issue. Since sight seems to be highly integral in cognitive development beginning in the early stages of physical development, about the sixth month of life, and then begins to diminish in importance as verbal communication develops around eighteen months, then it should stand to reason that significant visual impairment or blindness occurring prior to this time would adversely impact an individual's cognitive development. Conversely, the occurrence of visual impairment or blindness after this critical period of development would have less of an impact. Cognitive theorists have proposed that visually impaired or blind persons may have developed different cognitive pathways to acquire, process, and accommodate sensory information. As a result, visually impaired or blind (VI/B) persons may "think differently" than sighted individuals. The present study was designed to address these issues as they relate to cognitive and neuropsychological development at various stages of growth and to examine possible differences in neuropsychological functioning dependent on the level of visual functioning a person retains; e.g. both the issues of age at onset and degree of impairment. It was also designed to study the possible interaction effects of degree of impairment with the age of onset. Findings indicated that the only differences in cognitive functioning appear to be related to age of onset and not the level of visual impairment. The findings further suggested that congenitally blind individuals have indeed developed alternate methods of cognitively processing nonverbal, abstract, or complex information, especially information involving a high degree of spatial orientation. Implications of this study may influence the educational methods used to teach congenitally blind individuals in order to reinforce these alternate pathways and facilitate more effective means of negotiating in a sighted environment.

There are a number of evidenced-based practices which aim to improve the social skills of children with high functioning autism (HFA). An emerging field of study is to develop social skills interventions that incorporate restricted and repetitive interests to increase social skills. Their results are promising and suggest improved social skills in students with HFA. The current study has aimed to incorporate a common interest among elementary age children with HFA in social skill instruction within a structured setting. A multiple baseline across behaviors single subject design was used to collect data on the accuracy with which two young males applied social skills within the structured “club” setting. Data were collected by determining whether the students had an opportunity to use the social skill, and whether they used the skill correctly. While the results do not suggest a functional relationships between the participants’ social skill accuracy and the intervention, the data show a positive trend which indicates an overall increase in their social skill accuracy.

Hearing loss (HL) is a health condition that affects more than 360 million people worldwide. The findings from previous research point at the adverse relationship between adults with hearing loss and important aspects of everyday life such as social relations, communication and work-related tasks. However, the overall picture concerning the functional and disabling aspects of adults with HL re- mains incomplete. To identify the functional and disabling aspects, a conceptual and/or theoretical framework is required. The International Classification of Functioning, Disability and Health (ICF) offer a multidimensional framework based on bio-psycho-social assumptions about health. In previous research inves- tigations in which the ICF has been used, some utility problems in the linking (relating) of data to the classification have been highlighted. The aims of the present thesis were to explore the areas of functioning and disability of relevance for adults with HL and to explore how audiological data can be linked to ICF. The aims were explored by applying the methodology of the ‘interdisciplinary evidence-based approach to functioning and disability in adults with HL’, acknowledging the merging of three perspectives designated the Researcher, the Patient and the Professional perspective. Four studies that focus on the three perspectives were conducted. All results were linked to the ICF classification. The results were merged into a model designated ‘the integrative model of functioning and disability in adults with HL’. When the three perspectives were linked, the results revealed several aspects of relevance for the target group. Bodily (individual) dimensions, such as hear- ing, auditory perception, memory, attention, energy, and emotions, were acknowledged. Aspects of everyday life such as conversations, the usage of communication strategies, family relationships and work, were highlighted. Influential environmental factors, such as noise, assistive technical devices, the design of public buildings, social support and the attitudes of people in the envi- ronment, were also identified. In conclusion, interactions seemed to be vital as almost all identified aspects highlighted or were tied to this dimension of human functioning. Further, concerning the linking of the data it was acknowledged that the ICF and the research area of adult HL do not fully comply. Suggestions for improvements in future revisions of the ICF were highlighted and discussed. / <p>Funding agency: Oticon Foundation; Hörselforskningsfonden (Swedish HearingResearch Foundation); the Foundation for Audiological Research (FAR) Forskningskommitten, Region Örebro County</p>