Current psychiatric classification adopts a disorder-focused diagnostic approach, as exemplified within ICD-11 and DSM-V. Although this approach has improved reliability of categorization, its validity and utility has been questioned (Harvey, Watkins, Mansell, & Shafran, 2004; Insel et al., 2009; Sanislow et al., 2010). Limitations include high comorbidity between supposedly distinct disorders; heterogeneity within diagnoses; limited treatment efficacy; and similarities across disorders in aetiology, latent symptom structure, and underlying biology. There is also evidence of transdiagnostic cognitive-behavioural processes (Harvey et al., (...) 2004). An alternative approach is therefore to focus on fundamental underlying mechanisms of psychopathology rather than observed symptom clusters. This article considers the possible benefits, hurdles, and steps towards implementation of this transdiagnostic mechanistic approach, using the example of repetitive negative thought. (shrink)

For those open to the possibility that philosophical thought can improve life, David Hume's Essays: Moral, Political, and Literary have something to say. In the first comprehensive study of the Essays, Margaret Watkins engages closely with these neglected texts and shows how they provide important insights into Hume's perspective on the breadth and depth of human life, arguing that the Essays reveal his continued commitment to philosophy as a discipline that can promote both social and individual progress. Addressing topics (...) such as politics, war, slavery, the priesthood, the development of industry, aesthetics, emotional disorders, egoism, friendship, sexuality, gender relations, and the nature of philosophy itself, the volume examines Hume's purposes and aims against the backdrop of the eighteenth century society in which he lived. It will be of interest to scholars of modern thought in philosophy, politics, history, and economics. (shrink)

Observational learning can enhance the acquisition and performance quality of complex motor skills. While an extensive body of research has focused on the benefits of synchronous (i.e., concurrent physical practice) and non-synchronous (i.e., delayed physical practice) observational learning strategies, the question remains as to whether these approaches differentially influence performance outcomes. Accordingly, we investigate the differential outcomes of synchronous and non-synchronous observational training contexts using a novel dance sequence. Using multidimensional cross-recurrence quantification analysis, movement time-series were recorded for novice dancers (...) who either synchronised with (n = 22) or observed and then imitated (n = 20) an expert dancer. Participants performed a 16-count choreographed dance sequence for 20 trials assisted by the expert, followed by one final, unassisted performance trial. Although end-state performance did not significantly differ between synchronous and non-synchronous learners, a significant decline in performance quality from imitation to independent replication was shown for synchronous learners. A non-significant positive trend in performance accuracy was shown for non-synchronous learners. For all participants, better imitative performance across training trials led to better end-state performance, but only for the accuracy (and not timing) of movement reproduction. Collectively, the results suggest that synchronous learners came to rely on a realtime mapping process between visual input from the expert and their own visual and proprioceptive intrinsic feedback, to the detriment of learning. Thus, the act of synchronising alone does not ensure an appropriate training context for advanced sequence learning. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Despite a growing need for mental health services for adolescents, treatment access among adolescents remains poor. Psychologists practicing in the United States are subject to highly variable legal standards for consent and confidentiality of minor clients, which can further suppress treatment accessibility. States permit independent consent for minors according to a wide range of criteria, but whether these criteria are empirically derived remains unknown. Inconsistencies between the law and ethical obligations for psychologists can expose minor clients to harm and force (...) psychologists to make disclosures that violate patients’ rights and ethical standards. These harms may be particularly severe for clients from vulnerable populations such as sexuality and gender diverse youth (SGDY). To prevent ethical dilemmas, psychologists and professional organizations should work toward an empirical understanding of the adolescent capacity to consent to mental health care and use that understanding to promote uniform consent and confidentiality standards. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Difficult Atheism shows how contemporary French philosophy is rethinking the legacy of the death of God in ways that take the debate beyond the narrow confines of atheism into the much broader domain of post-theological thinking. Christopher Watkin argues that Alain Badiou, Jean-Luc Nancy and Quentin Meillassoux each elaborate a distinctive approach to the post-theological, but that each approach still struggles to do justice to the death of God.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Testimony of Sense: Empiricism and the Essay from Hume to Hazlitt by Tim MilnesMargaret WatkinsTim Milnes. The Testimony of Sense: Empiricism and the Essay from Hume to Hazlitt. Oxford: Oxford University Press, 2019. Pp. viii + 278. Hardback. ISBN: 9780198812739. $91.00.In his brief autobiography, “My Own Life,” Hume reports that “almost all [his] life has been spent in literary pursuits and occupations” (E-MOL: xxxi). This is one (...) of at least ten places in this brief work in which he associates himself with “letters” or “literature”—as compared to at most four associations with philosophy. The moral to be inferred is not that Hume considered himself not to be a philosopher. Rather, he conceived of philosophy as a kind of literature. The Treatise was itself a “literary attempt.” Indeed, opposition between the “literary” and “philosophical” aspects of a text would have been foreign to Hume and his contemporaries—a notion for a later age, despite his occasional loose distinction between the relevant genres, as in his list of writings “historical, philosophical, or literary” in “My Own Life” (E-MOL: xxxvi).Yet despite Hume’s own understanding of the continuity between philosophy and literature, broadly conceived, it is still common for contemporary philosophers to ignore literary questions in their examination of Hume’s work, or to presume that one can easily distinguish the “philosophical” parts from the “literary” ones. Tim Milnes’s The Testimony of Sense is therefore a welcome addition to the Hume literature (pun intended). With a particular focus on the essay—a genre of great importance to Hume—Milnes contributes to the small set of engagements with Hume from the disciplinary perspective of English literature. With training in both philosophy and literature, as well as established expertise on Romanticism and its own essays, Milnes is well-qualified for the task. The Testimony of Sense includes sustained engagement with Hume’s contemporaries and successors, but for the purposes of this review, I engage the book primarily as a Hume scholar for Hume scholars.Milnes’s story plays out in three acts. The first establishes the need for public trust created by a skeptical crisis, itself a product of Hume’s criticism of the epistemic program of thinkers in the Cartesian and Lockean traditions. The second explains how the essays of the long eighteenth century constitute a response to that need in various ways. The third reveals in detail how the Romantic essayists, particularly William Hazlitt and Charles Lamb, both respond to and deviate from the “neoclassical” essayists, typified by Hume and Samuel Johnson.The first chapter, “Self and Intersubjectivity,” lays the groundwork by articulating how Hume, Adam Smith, Thomas Reid, and Dugald Stewart identify the need for what we now call intersubjectivity. Milnes describes the common thread as a kind of “natural transcendentalism.” In what sense are these thinkers properly understood as [End Page 175] transcendentalists? The central idea seems to be that all posit things other than reason as “conditions of meaningful thought” (72). For Hume, it is the social, linguistic experience of a community of virtuous judges. The intricate relations between self and other essential to such a community get “internalized within the specular drama of the impartial spectator” (72) in Smith’s writing, which itself takes part in the drama through his “halting, qualified syntax” that mimics “everyday speech” (44). Reid posits a “prescience” of trust, which grounds our reliance on both human testimony and the uniformity of nature, itself undergirded by the design of a benevolent God. Stewart, who posits axiomatic truths that help constitute the “stamina of intellect,” goes furthest, actually calling these truths transcendental (55). This chapter also puts these eighteenth-century thinkers in conversation with twentieth-century theorists, including Habermas, Davidson, and Rorty.Chapter 2, “The Subject of Trust,” deepens the analysis by situating these “natural transcendentalisms” in the broader enlightenment context. In contrast to Descartes, Bacon, and Locke, who were suspicious of our reliance on the opinions of others, the eighteenth-century thinkers understand trust as prior to reason in various ways—though not prior to solidarity. The particulars in each case depend on their responses to skepticism and their accounts of the relation between... (shrink)

The body image with respect to physical disability has long been a woefully under-theorized area of scholarship. The literature that does attend to the body image in cases of physical abnormality or functional impairment regularly offer poorly articulated or problematic definitions of the concept, effectively undermining its historic analytic scope and depth. Here, I revisit the epistemic roots of the body image while also engaging the rich contemporary literature from a body studies perspective in order to situate the narratives of (...) amputees about the relationship between dismemberment, prosthetization, phantom limb syndrome, and body image. Stories about living with artificial, fleshy, phantomed, and residual limbs unquestionably reveal a number of peculiarities unique to amputees. However, they also offer a distinctively productive ingress into the analytic utility of a ‘re-visioned’ conceptualization of the body image more broadly speaking. Indeed, the body image can function as a robust investigative tool for exploring the intersubjective, processual, and relational features of embodiment and corporeality. (shrink)

Efforts to understand gender segregation within and among science disciplines have focused on both supply- and demand-side explanations. Yet we know little about how academic scientists themselves view the sources of such segregation. Utilizing data from a survey of scientists at thirty top U.S. graduate programs in physics and biology and semistructured interviews with 150 of them, this article examines the reasons academic scientists provide for differences in the distribution of women in biology and physics. In quantitative analyses, gender is (...) more salient than discipline in determining the reasons scientists provide for gender disparities between disciplines, suggesting that gender may act as a “master status,” shaping the experiences of scientists regardless of the gender composition of the discipline. Qualitative interviews confirm this interpretation and reveal that scientists also perceive mentoring, natural differences, discrimination, and the history of the disciplines to be important factors. Results contribute to research on the relationship between emotional labor and occupational gender segregation conducted in professions such as law and nursing. (shrink)

This paper focuses on the metaphysical and conceptual structures of reality organization that exist currently in western culture. Taking a feminist perspective, this paper analyzes how some disfavored social groups actively have their identities manipulated and sometimes conceptually erased from the dominant conceptual scheme. Utilizing this analysis, it is concluded that this conceptual scheme perpetuates oppression; therefore, maintained loyalty to it is incompatible with the belief that all people should be treated as full persons.

During the COVID-19 pandemic, the continuity of teaching and learning is very important to provide sustainable education to all pupils. The most difficult aspect of language acquisition has always been the speaking component. Pupils’ lack of interest and the difficulty in teaching and practicing speaking skills in the traditional classroom are the main issues that hinder pupils’ speaking skills. Thus, the purpose of this study was to explore the flipped learning approach to improve primary school pupils’ speaking skills. In this (...) study, Blendspace was used to support the flipped learning method to help pupils improve their speaking skills. This study employed a mixed-method research design. For pre–posttests, questionnaires and interviews were used to collect data from Year 3 primary school students. The findings revealed that the use of Blendspace in teaching speaking has improved pupils’ speaking skills and that the pupils were motivated to practice speaking inside and outside of the classroom. Hence, the utilization of Blendspace in the flipped learning approach is an effective pedagogy to improve pupils’ speaking skills. The findings of this research would be useful for teachers and policymakers to assist pupils in enhancing their speaking abilities. (shrink)

This article argues that Hume's brief essay, "Of the Delicacy of Taste and Passion," offers resources for three claims: (1) Delicate taste correlates with self-sufficiency and thus with a particularly Humean form of Magnanimity -- greatness of mind; (2) Delicate taste improves the capacity for profound friendships, characterized by mutual admiration and true compassion; and (3) magnanimity and compassion are thus not necessarily in tension with one another and may even proceed from and support harmony of character. These claims, in (...) turn, provide reasons to take seriously Hume's view that moral character depends, in part, on aesthetic character. (shrink)

One of the most serious pre-occupations of post-medieval philosophy has been to distinguish those kinds of assertion which are either true or false from those which are neither true nor false. A solution to this problem would be of the highest importance. It would indicate in what areas rational inquiry has some hope of success and in what areas it is doomed to frustration. It would tell us, for example, whether it is worth trying to think about the possible mistakenness (...) of our moral principles, or whether such thinking is bound to be ineffective since no truth or falsity attaches to them. (shrink)

This paper attempts to shed light on Kant’s notion of autonomy in his moral philosophy by considering the extent to which he presents a similar doctrine in his theoretical philosophy, where he strikingly claims (e.g., in the Prolegomena) that the understanding prescribes laws to nature. It argues that even though there are important points of difference between the cases of theoretical legislation of the laws of nature and autonomy in moral philosophy, their extensive parallels make a strong, even if not (...) definitive case in favor of the Prolegomena forming at least an important part of the explanation of the emergence of autonomy in the Groundwork. In addition, the comparison proves instructive insofar as it reveals deep structural parallels between Kant’s theoretical and practical philosophy regarding his conception of laws. (shrink)

The United States health care industry is the second largest in the world, expending an estimated 479 million metric tons (MMT) of carbon dioxide per year, nearly 8 percent of the country's total emissions. The importance of carbon reduction in health care is slowly being accepted. However, efforts to “green” health care are incomplete since they generally focus on buildings and structures. Yet hospital care and clinical service sectors contribute the most carbon dioxide within the U.S. health care industry, with (...) structures/equipment and pharmaceuticals ranking as the third and fourth highest emitters in the industry. Given the magnitude of health care carbon emissions—and the paucity of attention to the carbon of hospital care and clinical services—this essay identifies overuse of health care as a health threat with serious ethical implications, offers a data‐driven action plan for carbon reduction in health care, and provides practical suggestions for more sustainable health care delivery in the United States. (shrink)

History and philosophy complement and overlap each other in subject matter, but the two disciplines exhibit conflict over methodology. Since Hempel's challenge to historians that they should adopt the covering law model of explanation, the methodological conflict has revolved around the respective roles of the general and the particular in each discipline. In recent years, the revival of narrativism in history, coupled with the trend in philosophy of science to rely upon case studies, joins the methodological conflict anew. So long (...) as contemporary philosophy of science relies upon history's methodology to construct its case studies, it subjects itself to a paradoxical situation: the better the history, the worse the philosophy. An example of the methodological conflict is presented in the case of Antoine Lavoisier. This example also serves our ultimateconclusion, which is that distinctively philosophical methods of case-study design promise enhanced prescriptive powers for philosophy of science. (shrink)

I show that the common reading of Thomson, that she argues by analogy for the conclusion that abortion is permissible, is mistaken. The correct reading of Thomson is that she argues by counterexample, showing that arguments against abortion are unsound. The remainder of the paper highlights the lessons learned from Thomson once we read her aright.

This article examines the best contemporary arguments for a feminist epistemology of scientific knowledge as found in recent works by S. Harding. I argue that no feminist epistemology of science is worthy of the name, because such an epistemology fails to escape well-known vicissitudes of epistemic relativism. But feminist epistemology merits attention from philosophers of science because it is part of a larger relativist turn in the social sciences and humanities that now aims to extend its critique to science, and (...) Harding's "standpoint feminism" is the best-developed case. She attempts to make new use of discredited philosophical ideas concerning underdetermination, Planck's Hypothesis, and the role of counterfactuals in historical studies of science. (shrink)

A new method of observation is currently emerging in psychiatry, based on data collection and behavioral profiling of smartphone users. Numerical phenotyping is a paradigmatic example. This behavioral investigation method uses computerized measurement tools in order to collect characteristics of different psychiatric disorders. First, it is necessary to contextualize the emergence of these new methods and to question their promises and expectations. The international mental health research framework invites us to reflect on methodological issues and to draw conclusions from certain (...) impasses related to the clinical complexity of this field. From this contextualization, the investigation method relating to digital phenotyping can be questioned in order to identify some of its potentials. These new methods are also an opportunity to test psychoanalysis. It is then necessary to identify the elements of fruitful analysis that clinical experience and research in psychoanalysis have been able to deploy regarding the challenges of digital technology. An analysis of this theme's litterature shows that psychoanalysis facilitates a reflection on the psychological effects related to digital methods. It also shows how it can profit from the research potential offered by new technical tools, considering the progress that has been made over the past fifty years. This cross-fertilization of the potential and limitations of digital methods in mental health intervention in the context of theoretical issues at the international level invites us to take a resolutely non-reductionist position. In the field of research, psychoanalysis offers a specific perspective that can well be articulated to an epistemology of networks. Rather than aiming at a numerical phenotyping of patients according to the geneticists' model, the case formulation method appears to be a serious prerequisite to give a limited and specific place to the integration of smartphones in clinical investigation. (shrink)

Providing therapy to deaf clients raises important ethical considerations for psychologists related to competence; multiple relationships and boundary issues; confidentiality; assessment, diagnosis, and evaluation; and communication and using interpreters. In evaluating and addressing these, psychologists must consider the American Psychological Association’s Ethics Code and other relevant issues necessary to provide ethical treatment. The current article provides background, ethical considerations, principles and standards relevant to the treatment of deaf clients, and recommendations to support psychologists, training programs, and the field. Psychologists have (...) the responsibility to guarantee that the benefits of mental health treatment are fairly and justly provided to this traditionally underserved population. (shrink)

According to the “adequacy-for-purpose” view of data evaluation, data should be evaluated as better or worse relative to a given research purpose and corresponding research context. In this paper, I apply the adequacy-for-purpose view to a novel case study—concerning the use of paleoecological data to make predictions about coral reef response to contemporary climate change—and then use the case study to suggest two extensions to the adequacy-for-purpose view. First, I argue that we can evaluate research purposes according to their productivity (...) (how well these research purposes serve other, more ultimate purposes). Second, I argue that we can also evaluate research purposes according to their plausibility (including whether we have access to data that are adequate for these research purposes). The relationship between data evaluation and purpose setting should be seen as an iterative one, in which both data and purposes are refined in concert over time. (shrink)

This article examines how public health addresses alcohol use through marketing — place, product, promotion, and price. The article reviews current product trends and how restrictions on certain products designs may reduce youth consumption; how product availability may be restricted through zoning; and the current advertising landscape.

This essay looks at Norplant qua technology and uses analytic frameworks from the social construction of technology to explain the trajectory of its brief history. The author contend that there were multiple uses of Norplant, in terms of rhetorical strategies, symbolic representations, and contraceptive intentions, constructed by reproductive scientists, population control advocates, pharmaceutical manufacturers, doctors, birth control clinic staffers, government regulators, legislators, judges, women’s health activists, potential users, and actual users. However, while relevant social groups shaped the discourse surrounding Norplant (...) in the 1990s, its ultimate fate was determined by choices made by potential users. At the ‘‘consumption junction’’ of the late twentieth-century contraceptive marketplace, American women ignored the meanings constructed for Norplant by developers, producers, providers, and policy makers and made their decisions based on what Norplant meant to them. Individuals’ decisions to choose other methods of preventing pregnancy coalesced into a collective rejection of this contraceptive technology. (shrink)

In their target article, Galasso (2024) highlights the limitations of upstream inclusion in precision medicine research to produce downstream benefits to participants and proposes precision public...

This volume presents the first systematic evaluation of a feminist epistemology of sciences' power to transform both the practice of science and our society. Unlike existing critiques, this book questions the fundamental feminist suggestion that purging science of alleged male biases will advance the cause of both science and by extension, social justice. The book is divided into four sections: the strange status of feminist epistemology, testing feminist claims about scientific practice, philosophical and political critiques of feminist epistemology, and future (...) prospects of feminist epistemology. Each of the essays3/4most of which are original to this text3/4 directly confronts the very idea that there could be a feminist epistemology or philosophy of science. Rather than attempting to deal in detail with all of the philosophical views that fall under the general rubric of feminist epistemology, the contributors focus on positions that provide the most influential perspectives on science. Not all of the authors agree amongst themselves, of course, but each submits feminist theories to careful scrutiny. Scrutinizing Feminist Epistemology provides a timely, well-rounded, and much needed examination of the role of gender in scientific research. (shrink)

This research examined choice behaviour and probability judgement in a counterintuitive reasoning problem called the Monty Hall problem (MHP). In Experiments 1 and 2 we examined whether learning from a simulated card game similar to the MHP affected how people solved the MHP. Results indicated that the experience with the card game affected participants' choice behaviour, in that participants selected to switch in the MHP. However, it did not affect their understanding of the objective probabilities. This suggests that there is (...) dissociation between implicit knowledge gained from the task and the explicit understanding as to why switching was the best strategy. In Experiment 3, the number of prizes and doors were manipulated to examine how participants construed the problem space of the MHP. Results revealed that participants partition the probability judgement to reflect the number of prizes over the number of unopened doors. (shrink)

The 30th anniversary of the first DBS surgery of the subthalamic nucleus (STN) for Parkinson’s disease was celebrated in Grenoble this June. Since this initial surgery, the application of DBS has e...

In his book The Retreat to Commitment Professor Bartley raised an important problem: can rationalism can rationalism be held in a rational way, that is, in a way that complies with its own requirements? Or is there bound to be something irrational in the rationalist's position? Briefly, Hartley's answer was that an element of irrationalism is involved in extant versions of rationalism; however, Bartley proposed a new version of rationalism that can, he claimed, be held in a way that is (...) rational according to its own account of rationality. Bartley called this ‘Comprehensively Critical Rationalism’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Parenting Adults with ASD: Lessons for Researchers and CliniciansCassandra R. Newsom, Amy S. Weitlauf, Cora M. Taylor, and Zachary E. WarrenRecent reviews of treatments for individuals with autism spectrum disorders (ASD) reveal how little we still know about how to help adolescents with ASD and their families successfully transition into adulthood (Shattuck et al., 2012b; Taylor et al., 2012a). Shattuck and colleagues found that services in the United States (...) for adults with ASD were marked by high unemployment rates, a reliance on families to provide care across the lifespan, high turnover rates in front-line service providers, insufficient transition planning for high school students, and generally insufficient services to meet current needs. In a recent Agency for Healthcare Research and Quality (AHRQ) Comparative Effectiveness Review, the authors similarly found that there is very little evidence available to pinpoint specific intervention approaches for adolescents and young adults with ASD due to a lack of good quality studies. This was especially true for evidence-based approaches to support the transition of youth with ASD to adulthood (Taylor et al., 2012a).For the last decade, with dramatic increases in both ASD awareness and estimates of ASD prevalence, our field has understandably focused intensely on improving early detection and treatment of ASD. Our diagnostic tools and understanding of ASD presentation in very young children has improved tremendously. Different from many of the young adults in these stories, who were often diagnosed in their early teens, we now aim to identify children well before their third birthdays. Research has consistently shown that early and intense ASD-specific intervention can dramatically enhance outcomes for children with ASD. As such, there has been heavy investment in attempting to take full advantage of this early window of neuro-plasticity. However, as these stories illustrate, these children grow up. Their needs change, and our systems are often poorly equipped to help them live fulfilling lives, capitalize on their talents, and obtain independence and equal access, while still providing a safe, supportive environment. Without readily accessible and understandable coordinated systems of care, parents are forced to adopt the multiple roles of case manager, teacher, therapist, community educator, advocate, job coach, housing specialist, financial planner, and often, lifelong caregiver. These stories eloquently illustrate those struggles and successes.Grief and Joy: Opposite Sides of the Same Parenting CoinThe idea of grieving a diagnosis is controversial. Many of the writers seemed to feel conflicted about their grief responses and the validity of their feelings. Research shows that many families view the diagnostic process as extremely stressful (Siklos & [End Page 199] Kerns, 2005; Heiman, 2002). Feelings of sadness, anxiety, and depression are common at the point of diagnosis and may reemerge as milestones pass unmet. Families must modify the futures they imagined for their children and begin to envision new goals and dreams. Anonymous Three described this process when she wrote:Most children grow up, go to school, get jobs, move out of their parents’ home, etc. My husband and I have had to seriously consider how much of these are even possible for a young man with autism, even one who has a good number of functional life skills.Tasks of adolescence and adulthood such as starting high school, driving a car, and moving out of the house may be delayed and hard won if met. Raising a child with ASD appears to have particular challenges. Throughout this process, families begin to redefine what “success” means. Rather than ascribing to societal standards, they find joy in personal milestones. McDonald described the triumph of teaching his nephew to shake women’s hands instead of touching their hair, an important safety goal that took three months to accomplish. Each family thereby creates its own path.People outside of the family often do not understand the complicated interplay of love and obligation as well as the frustration and fulfillment that families experience. Just like any family, the parents of children with ASD describe many joys in addition to their struggles. They see their children’s strengths in a world that too often focuses on their weaknesses. Gifted with the everyday experience of their child’s development, they see past the necessity of a... (shrink)