Am I delusional?

Background Delusions are a significant feature of mental illnesses and can occur in many clinical conditions (Maher, 2001) yet the standard clinical definition (American Psychiatric Association. DSM-5 Task Force, 2013) is highly contentious. Much of the literature holds elements such as bizarreness of content and incorrigibility of belief as defining factors of delusion. However, on closer inspection, delusions are not so easy to pin down. The difficulty in defining delusion is not a new one as “…we are all capable of having convictions and it is a universal human characteristic to hold on to our own mistaken judgements.” (Jaspers, 1963, p.63). Objective I intend to highlight some of the difficulties associated with the definition of delusion and perhaps clarify the phenomenology. Methodology I examine some of the philosophical, psychological and psychiatric literature with regard to the definition of delusion. I also consider my experience of my own mental activity and experiences from my therapeutic work. Results/Conclusion I identify that delusions are a heterogeneous group and that there may be more than one ‘class’ of delusion. I also show that delusions are multi-dimensional with characteristics on a continuum with normal beliefs and that further research is needed to clarify the phenomenology

Neighborhood Context, Poverty, and Urban Children’s Outdoor Play

Although research consistently demonstrates a link between neighborhood conditions and physical activity for adults and adolescents, less is known about residential context and young children’s physical activity. Using data from the Fragile Families and Child Wellbeing Study (N=2,210), we explore whether outdoor play and television watching are associated with children’s body mass indexes (BMIs) at age five; and whether subjective and objective neighborhood measures are associated with children’s outdoor play and television watching. Hours of outdoor play and television viewing are associated with BMI. Higher maternal perceptions of neighborhood collective efficacy are associated with more hours of outdoor play, fewer hours of television viewing, and more trips to a park or playground. In addition, we find that neighborhood physical disorder is associated with more outdoor play and more television watching. Finally, we find that children living in public housing have one-third more outdoor play time than other children.residential context, physical activity, young children, body mass indexes, Fragile Families and Child Wellbeing Study, television viewing

ATTENTION AND SCHOOL SUCCESS: The Long-Term Implications of Attention for School Success among Low-Income Children

This study examined the longitudinal associations between sustained attention in preschool and children’s school success in later elementary school within a low-income sample (N = 2,403). Specifically, two facets of sustained attention (focused attention and lack of impulsivity) at age 5 were explored as independent predictors of children’s academic and behavioral competence across eight measures at age 9. Overall, the pattern of results indicates specificity between the facets of attention and school success, such that focused attention was primarily predictive of academic outcomes while impulsivity was mainly predictive of behavioral outcomes. Both facets of attention predicted teacher ratings of children’s academic skills and approaches to learning, which suggests that they jointly influence outcomes that span both domains of school success. Patterns of association were similar for children above and below the poverty line. Implications of these findings for interventions targeting school readiness and success among at-risk children are discussed.sustained attention, academic achievement, behavioral competence, low-income children

Associations among Family Environment, Attention, and School Readiness for At-Risk Children

This study examined the developmental pathways from children’s family environment to school readiness within an at-risk sample (N = 1,701). Measures of the family environment (maternal parenting behaviors and maternal mental health) across early childhood were related to children’s observed sustained attention as well as to academic and behavioral outcomes at age 5 years. Results suggest specificity in the associations among attention and its correlates. Maternal parenting behaviors but not mental health explained individual differences in sustained attention, which in turn were associated with variability in children’s academic school readiness. Mediation tests confirmed that sustained attention partially accounted for the link between parenting behaviors and academic school readiness. While maternal mental health was associated with children’s behavioral school readiness, sustained attention did not play a mediating role. Findings indicate sustained attention as a potential target for efforts aimed at enhancing academic school readiness among predominantly poor and minority children.child development, educational success, parenting behaviors, school readiness, mental health

Strengthening Families Programme: an inter-agency approach to working with families.

This article describes the authors’ experience of a Strengthening Families skills programme delivered in the Ballymun area of Dublin from March to June 2008. This was an inter-agency initiative that brought together partners from the community, voluntary and statutory sectors. The Ballymun Network for Assisting Children and Young People (the Network) – a forum for statutory, voluntary and community agencies – had already identified the difficulties experienced by many young people and their families in the area. The Network, already working from an inter-agency, interdisciplinary ethos, was attracted to the Strengthening Families Programme as it is evidence-based and operated on a systemic model functioning on an inter-agency basis. The goal for the network in piloting the Strengthening Families Programme was to improve the wellbeing of young people and their families

Delusion and affective framing

Clinically significant delusion is a symptom of a number of mental illnesses. We rely on what a person says and how she behaves in order to identify if she has this symptom and it is clear from the literature that delusions are heterogeneous and extremely difficult to define. People with active delusions were interviewed to explore what it is like to develop and experience delusion. The transcribed interview data was analysed to identify themes and narrative trajectories that help to explain the phenomenon. Results showed that delusions can sometimes provide pragmatic (protective) benefits and that the genesis of some delusions can be characterised in terms of the enactivist notion of affective framing. Affective framing is a term that captures the background emotions that enable know-how in terms of goal directed action and cognition. If a person’s affective frame alters the world is no longer understood and know-how is lost. The way in which a person relates to her environment can be highly anomalous thus requiring her to find an extraordinary explanation. I argue that delusions arise as a result of a breakdown in affective framing and offer a conceptualisation of delusion supported by empirical findings

What makes a belief delusional?

In philosophy, psychiatry, and cognitive science, definitions of clinical delusions are not based on the mechanisms responsible for the formation of delusions. Some of the defining features of delusions are epistemic and focus on whether delusions are true, justified, or rational, as in the definition of delusions as fixed beliefs that are badly supported by evidence). Other defining features of delusions are psychological and they focus on whether delusions are harmful, as in the definition of delusions as beliefs that disrupt good functioning. Even if the epistemic features go some way towards capturing what otherwise different instances of clinical delusions have in common, they do not succeed in distinguishing delusions as a clinical phenomenon from everyday irrational beliefs. Focusing on the psychological features is a more promising way to mark the difference between clinical and non-clinical irrational beliefs, but there is wide variability in the extent to which delusions are psychologically harmful, and some everyday irrational beliefs can affect functioning in similarly negative ways. In this chapter we consider three types of belief that share similar epistemic features and exhibit variation with respect to how psychologically harmful they are: (1) delusions of thought insertion, (2) alien abduction beliefs, and (3) self-enhancing beliefs. In the light of the similarities and differences between these cases, we highlight the difficulty in providing an answer to what makes an irrational belief delusional

Objective and Subjective Residential Context and Urban Children’s Weight Status and Physical and Sedentary Activities

This paper fills this gap by addressing two research questions: first, we ask, are the activity patterns (outdoor play and television watching) of five-year-old children living in large cities associated with children’s weight status? Second, we ask, is residential context, and neighborhood safety in particular, associated with children’s activity patterns? Consistent with past research, we find that outdoor play is negatively associated with weight status, while television watching is positively associated with weight status. We also find, unexpectedly, that the poorest children are playing outdoors the most and watching the most television. Finally, we find that three measures of residential context: living in public housing, mothers’ perceptions of neighborhood collective efficacy, and interviewer-assessed neighborhood physical disorder, are positively associated with children’s physical activity, but that neighborhood socioeconomic disadvantage is not. Thus, this paper answers calls both for more research into the determinants of child obesity as well as more work integrating objective and subjective neighborhood characteristics and physical activity (Foster and Giles-Corti 2008)

Delusion formation as an inevitable consequence of a radical alteration in lived experience

The definition of delusion is usually couched in terms of false beliefs held with conviction despite evidence to the contrary. Such beliefs are usually seen as impossible or implausible by others. In order to be classed as clinically significant, a delusion would lead a person to be distressed or to have significant problems with functioning. We note that a person ordinarily understands and negotiates the world based on familiar patterns derived from her cultural and historical experience. Thus, when her lived experience is altered, these assumptions about how the world works may be called in to question. Drawing on interviews conducted with people experiencing clinically significant delusions, we show how this alteration in lived experience manifests as emotional, affective and/or perceptual anomalies. We adopt the framework of the Enactive Approach which posits that a person interacts with her environment in terms of sense-making and we argue that radical alterations in lived experience can demand a renegotiating of how a person makes sense of this new world. We suggest that if the alteration in lived experience is sufficiently radical, then delusion formation is inevitable

Feasibility and Acceptability of a Wrist-worn Transdermal Alcohol Biosensor to Collect Data in the Field

Transdermal alcohol monitoring allows for continuous, non-invasive, objective, and remote measurement of alcohol consumption. We evaluated feasibility and acceptability of participant use of the BACtrack Skyn biosensor bracelet in daily life. Heavy drinkers (n=20) wore the Skyn and self-reported drinking behavior for 7 days, followed by an individual interview. Recruitment and retention benchmarks were met, supporting feasibility. Participants provided both positive and constructive feedback on the Skyn during interviews, and usability of the bracelet was deemed “good”. Most missing data were inconsequential (<5 mins), with data available 85% of the time participants were asked to wear it. Missing data was largely expected and due to bracelet removal during bathing or charging. Overall, results indicate promise in our ability to integrate this tool into research and/or clinical practice, passively and objectively monitoring alcohol use in participants and/or patients with minimal burden