Clinical reports suggest that anxiety is a pertinent issue for adults with autism. We compared 34 adults with autism with 20 adults with intellectual disabilities, utilizing informant-based measures of anxiety and stress. Groups were matched by age, gender and intellectual ability. Adults with autism were almost three times more anxious than the comparison group and gained significantly higher scores on the anxiety subscales of panic and agoraphobia, separation anxiety, obsessive-compulsive disorder and generalized anxiety disorder. In terms of sources of stress, significant differences between the two groups were also found, and stress was found to correlate with high anxiety levels for the autism group, particularly the ability to cope with change, anticipation, sensory stimuli and unpleasant events. That is, the more anxious the individual with autism, the less likely they were able to cope with these demands. This has important implications for clinicians in terms of both assessment and treatment.

Eight experiments were conducted to resolve: (1) empirical inconsistencies in repetition effects under intermodality conditions in word identification and lexical decision, and (2) an associated theoretical conflict concerning lexical organization. The results demonstrated that although more facilitation occurs under visual-prime!visual-test (VV) conditions than under auditory-prime/visual-test (AVI conditions, significant repetition facilitation also occurs under AV conditions. The results also indicated that: repetition effects observed for the VV and AV conditions apply to high-as well as to low-frequency words; they are insensitive to a variety of encoding tasks designed to emphasize different properties of words; and they are unaffected by differences in the ease of encoding of isolated auditory and visual words. The results are consistent with the existence of both modality-specific and common or modality-free processes in word recognition, in which word-frequency effects are restricted to the second and, by implication, lexical stage.Research into modality differences has focused on a variety of empirical issues over the last 2 decades. For much of this time, interest has focused on episodic questions concerning, for example, the distinctions among sensory, short-term, and long-term memory systems. At the heart of this problem, however, is the modal specificity of the system responsible for the transition from sensory to categorical representation. If categorical information emanates from a single lexicon, albeit via distinct access routines, it follows that equivalent item information will be available following auditory and visual presentation. In this case, then, modality information must be stored dependently, as an associate of the item information. But if distinct lexical systems are involved in reading and in speech recognition, the item information available following auditory and visual presentation may not be equivalent. In this case, modality information may be provided automatically by the item information.Research into the modal specificity of lexical processes has not yielded a definitive answer. One approach to the question involves observation of repetition effects in word-processing tasks. When equivalent repetition effects are observed under inter-and intramodality conditions, it is assumed that a common system is involved. But when the repetition effects are restricted to intramodality conditions, it is assumed that separate mechanisms are involved in text and speech recognition. sented in Morton's (1979) results and is reflected in his model. Using word recognition, with threshold-estimation procedures in vision and audition, he found no evidence of transfer under intermodality conditions. The model that he subsequently developed includes modality-specific word recognition units, or "logogens." According to Morton, these units are not connected except through a separate cognitive system, so intermodality transfer is absent in tasks that tap only word identification processes. Any task...

Objective:To assess the feasibility of conducting a randomised controlled trial of a home-based virtual reality system for rehabilitation of the arm following stroke.Design:Two group feasibility randomised controlled trial of intervention versus usual care.Setting:Patients’ homes.Participants:Patients aged 18 or over, with residual arm dysfunction following stroke and no longer receiving any other intensive rehabilitation.Interventions:Eight weeks’ use of a low cost home-based virtual reality system employing infra-red capture to translate the position of the hand into game play or usual care.Main measures:The primary objective was to collect information on the feasibility of a trial, including recruitment, collection of outcome measures and staff support required. Patients were assessed at three time points using the Wolf Motor Function Test, Nine-Hole Peg Test, Motor Activity Log and Nottingham Extended Activities of Daily Living.Results:Over 15 months only 47 people were referred to the team. Twenty seven were randomised and 18 (67%) of those completed final outcome measures. Sample size calculation based on data from the Wolf Motor Function Test indicated a requirement for 38 per group. There was a significantly greater change from baseline in the intervention group on midpoint Wolf Grip strength and two subscales of the final Motor Activity Log. Training in the use of the equipment took a median of 230 minutes per patient.Conclusions:To achieve the required sample size, a definitive home-based trial would require additional strategies to boost recruitment rates and adequate resources for patient support.

The results are discussed in relation to the concept of helping and the experience of carers coping with challenging behaviours.

Level of use is variable and can fall far short of recommendations. Competing commitments were a barrier to use of the equipment, but participants reported that the intervention was flexible and motivating. It will not suit everyone, but some participants recorded high levels of use. Implications for practice are discussed.

The General Medical Council's document 'Tomorrow's Doctors' (1993, GMC, London) recommended major changes in the undergraduate curricula of UK medical schools. In Nottingham, the fourth-year psychiatric attachment became shorter in duration, and interactive, problem-oriented, workshop-based learning replaced lectures. We compared the efficacy of this new teaching style in changing medical students' attitudes towards psychiatry and mental illness with that of old-style, didactic, lecture-based teaching. On the first and last days of their psychiatric attachment, 110 fourth-year-medical students (45 old curriculum; 65 new curriculum) completed two self-administered attitudinal measures: the Attitude to Psychiatry Questionnaire (ATP-30) and the Attitude to Mental Illness Questionnaire (AMI). We found that students had favorable attitudes towards psychiatry and mental illness before the attachment. These attitudes became more positive after the attachment in students from both curricula, with no significant difference between the groups and no gender difference. Students found patient contact rewarding, become more accepting of community care, and had greater appreciation of the therapeutic potential of psychiatric interventions. The interactive, student-centred, problem-oriented teaching of the shortened new curriculum appeared as effective in changing medical student' attitudes as a longer attachment with traditional teaching.

Virtual reality (VR) possesses many qualities that give it rehabilitative potential for people with intellectual disabilities, both as an intervention and an assessment. It can provide a safe setting in which to practice skills that might carry too many risks in the real world. Unlike human tutors, computers are infinitely patient and consistent. Virtual worlds can be manipulated in ways the real world cannot be and can convey concepts without the use of language or other symbol systems. Published applications for this client group have all been as rehabilitative interventions. These are described in three groups: promoting skills for independent living, enhancing cognitive performance, and improving social skills. Five groups of studies are reviewed that utilize virtual technology to promote skills for independent living: grocery shopping, preparing food, orientation, road safety, and manufacturing skills. Fears that skills or habits learnt in a virtual setting would not transfer to the real world setting have not been supported by the available evidence, apart from those studies with people with autistic spectrum disorders. Future directions are in the development of more applications for independent living skills, exploring interventions for promoting motor and cognitive skills, and the developments of ecologically valid forms of assessment.

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