The Pervasive Refusal Syndrome was only recently described in a British sample of four children. This article presents an Australian sample of seven children seen over a period of four years at the Royal Alexandra Hospital for Children, Sydney. Criteria for case inclusion are specified. The features of this sample of children are described and the components of our treatment programme are summarized. Outcome is reported briefly. Issues of differential diagnosis are elaborated highlighting the distinctive nature of the syndrome and its relationship to other disorders. The study of the syndrome and the relationship of the Australian sample to the British sample are considered.
The Pervasive Refusal Syndrome is a recently described syndrome of child psychiatric disorder. The theory of learned helplessness has an extensive research and treatment literature. We present the case of a 15-year-old girl with Pervasive Refusal Syndrome as an example of learned helplessness. The theory of learned helplessness is traced from its original descriptions to more recent formulations in which the behaviours of helplessness are linked to the loss of hope. The criteria of helplessness and the phenomenology of the Pervasive Refusal Syndrome are compared. The Pervasive Refusal Syndrome is a difficult condition to treat. The learned helplessness/hopelessness formulation provides a helpful theoretical paradigm within which to conceptualise phenomenology, aetiology and treatment.
The management of pervasive refusal syndrome illustrates the practical application of hope promoting principles in clinical work. It involves a multidisciplinary team approach and a structured yet flexible management plan with a clear rationale employed over months to years. This article details the components of such a plan, including nursing management, physiotherapy, individual and family therapy. Pre-admission expectations, the necessary assessments on admission, and the establishment of management goals are also discussed. The issue of consent is elaborated, emphasizing the problematic role that refusal plays. Steps to ensure the child's survival and optimal development are outlined. Specific problem behaviours in the child and the family are described, and the need for adequate support within the treatment team to deal with these problems is considered. Attitudes that facilitate staff survival of the long haul of treating these children are described. Despite the difficulties, however, the typically favourable outcome of treatment is reported. The high cost, in terms of money and morale, means that more efficient management plans need to be developed.
Homogeneous copolymers of ethylene and 1‐alkenes have been prepared using an ethyl aluminum sesquichloride–vanadium oxychloride catalyst system. Branches were varied from CH3 to C16H33 by appropriate choice of 1‐alkene. Size exclusion studies of copolymers of ethylene‐d4 and 1‐alkenes show that the comonomer content of a given sample is essentially constant over the whole molecular weight range. A random distribution of branches is inferred from the simplicity of the 13C‐NMR spectra and from the melting behaviour of the copolymers. Comonomer contents varying from 1 mol% to 15 mol% were readily determined by 13C‐NMR spectroscopy. The copolymers can be used to study the separate effects of branch length, branch frequency, and molecular weight on physical properties including melting point and crystallinity.
In the presence of many alkylphenols, cationic polymerization of styrene by aluminium chloride leads to low‐molecular‐weight polystyrenes that contain end groups derived from the phenols. The fraction of phenolic end groups in the polymer is estimated by ultraviolet (UV) measurements to be 40–70% dependent on phenol and the reaction conditions. Phenol is incorporated into the polymer over the whole range of molecular weights (up to 7000). At high phenol concentrations, a significant proportion of the product consists of 1:1 and 1:2 phenol‐styrene adducts. The position of attack of the growing carbenium ion on the phenol can be determined by 13C‐NMR spectroscopy. With 2,6‐dialkylphenols, such as 2,6‐di‐tert‐butylphenol, the high field aromatic resonance near 119.7 ppm is shifted downfield by about 16 ppm when the phenol is incorporated into the polystyrene as an end group. This is interpreted as an exclusive attack of the growing carbenium ion on the 4‐position of the phenol. With 2,4‐dialkylphenols, such as 2‐tert‐butyl‐4‐methylphenol, a corresponding downfield shift shows that reaction occurs only at the 6‐position. The preferred site of attack for phenols such as 2‐alkylphenols which lack both ortho‐ and parasubstituents, is the 4‐position. With such phenols attack at the 6‐position is not excluded. Low‐molecular‐weight adducts contain 1‐methylbenzyl end groups and 13C‐spectra are consistent with their presence in the higher‐molecular‐weight polystyrenes.
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