Advances in Psychology Research. Volume 72

ADVANCES IN PSYCHOLOGY RESEARCH

ADVANCES IN PSYCHOLOGY RESEARCH. VOLUME 72

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ADVANCES IN PSYCHOLOGY RESEARCH

ADVANCES IN PSYCHOLOGY RESEARCH. VOLUME 72

ALEXANDRA M. COLUMBUS EDITOR

Nova Science Publishers, Inc. New York

Copyright © 2011 by Nova Science Publishers, Inc.

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Published by Nova Science Publishers, Inc.  New York

CONTENTS Preface Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

vii Intuition in the Scientific Process and the Intuitive ―Error‖ of Science Hayo Siemsen Effortful Control: Linkages to Regulation Disorders and Attention-Deficit/Hyperactivity Disorder Kimberly Renk, Brea-Anne Lauer, Rebecca Weaver, Samantha L. Scott, Melissa Middleton and Rachel White

1

63

Intelligent Social Tutoring System for Children: Application of Interactive Software Technology to the Assessment and Development of Social Problem Solving Melissa E. DeRosier, Janey Sturtz McMillen and James M. Thomas

99

Children and Advertising: What Do They Think About Advertisements, How Are They Affected by Advertisements? Arzu Şener, Seval Güven and Ayfer Aydıner Boylu

133

Verbal Agitation in Dementia: A Manifestation of a Need for Comfort? Marianne Lemay and Philippe Landreville

161

I Can See for Miles and Miles: Serenity and Self-Reported Extra-Sensory Perceptions Belinda M. Boyd-Wilson and Frank H. Walkey

181

―Managing Disruptive Behaviors in the Health Care Setting: Process, Policy, Prevention and Intervention‖ Alan H. Rosenstein

197

Human-Centred Designed Interface in Problem-Solving Activities: The Example of Computerised Medical Regulation William Guessard, Alain Puidupin, Richard Besses and Paul-Olivier Miloche

211

vi Chapter 9

Index

Contents Self-Expansion as an Aid in Smoking Abstinence and Cessation Xiaomeng Xu, Anna H. L. Floyd, J. Lee Westmaas and Arthur Aron

221

229

PREFACE This continuing series presents original research results on the leading edge of psychology analysis. Each article has been carefully selected in an attempt to present substantial results across a broad spectrum. This new book reviews research on intuition in the psychology of the scientific process; intelligent social tutoring for children; verbal agitation in dementia; ESP and spiritual well-being; self-expansion as an aid in smoking cessation and managing disruptive behaviors in the health care setting. Chapter 1 – The role of intuition in the psychology of the scientific process has been systematically overlooked for millennia. Even today, many scientists (intuitively) assume that all scientific thought, such as concept formation or research into the unknown, is completely conscious and rational (i.e. logical). They consider anything not fitting to this schema as unscientific. It has been known for a long time that by careful inspection, this assumption does not correspond to the facts. Not even in mathematics, the science supposedly the most ―free‖ from empirical ―constraints‖. Since Archimedes‘ account for Eratosthenes of his own thought process in his ―method‖ there have been many similar accounts by scientists, such as Henri Poincaré, E.W. Beth, Ernst Mach, etc. From their accounts, one can assume as a hypothesis that intuition is an actually widespread phenomenon in scientific thought and the scientific process in general. This phenomenon is often just not recognized, i.e. it becomes hidden by a ―rationalization‖ in retrospect. If intuition is not an ―error‖ in thought, but even an integral part of the (abstract) scientific process, it must be an integral part of all thought processes. The interesting question is why intuition has been overlooked for so long. In principle, this attitude results from a ―bias‖ towards conscious thought in psychology versus unconscious thought. The latter is seemingly less accessible to introspection and behavioural approaches of measurement. But this bias is also the result of our fundamental concepts of psychology and of the philosophy of science in general. Even widely used fundamental concepts, such as ―induction‖ and ―deduction‖ are biased towards conscious thought. By including the unconscious into the frame of basic scientific concepts, for instance ―induction‖ and ―deduction‖, the concepts become inherently inconsistent and lose their empirical meaning. The bias thus becomes an ―error‖ (i.e. either an inconsistency with the facts or an internal inconsistency). Many basic scientific concepts are in this sense not metaphysical, but metapsychical. How then shall one avoid this ―Intuitive Error of Science‖? An epistemologically consistent conceptual framework for intuition is required. The concept of intuition needs to

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correspond to the known psychological facts. Other concepts (from psychology and science in general) have to be adapted to this concept. Intuition has not been neglected by all of the scientific community. Indeed some of the most prominent scientists have already suggested solutions for this problem, such as William James, Hugo Münsterberg, Pierre Janet, Alfred Binet or Max Wertheimer in psychology and especially Ernst Mach in the psychology of science. There has also recently been a renewed interest in this topic (for instance ―The New Unconscious‖, Hassin et al. 2005 or ―Where Mathematics Comes From‖, Lakoff & Núñez 2000). The following chapter will try to combine the existing ideas with the facts from psychology of science and draw the outline of a consistent conceptual framework for the role of intuition in the psychology of science. It will also evaluate the implications on modern (cognitive) psychology and the psychology and philosophy of science in general. Chapter 2 – Thus, to examine these relationships and provide a foundation for future work, this chapter will examine a number of related constructs. First, this chapter will define ‗temperament‘ and examine the importance of temperament for children‘s relationships with their caregivers and their overall emotional and behavioral functioning throughout childhood. Next, this chapter will examine two disorders that may be of particular interest in terms of difficult temperament styles and effortful control (i.e., Regulation Disorders and ADHD). Throughout this discussion, this chapter will note the extant literature suggesting that having particular temperament styles (particularly difficulties with effortful control) may predispose children to exhibit behaviors consistent with these disorders. Finally, this chapter will outline the best course of assessment for determining whether children meet criteria for Regulation Disorders and ADHD (versus exhibiting difficult temperament style only) and will discuss potential treatment options for children who may benefit from improvements in managing their difficult temperament characteristics and behaviors consistent with these diagnoses. Chapter 3 – In this chapter, the author will first review the research literature regarding children‘s peer relations and their impact on adjustment. The author will also summarize how social skills training can be used to effectively enhance children‘s social literacy, social behavior, and peer relations. Then, author will describe the development process for the initial version of the ISTS software, including the theoretical and empirical foundation for the ISTS‘ instructional methods. The author will also present initial test results comparing performance on the ISTS social problem solving tasks with independent measures of children‘s social skills and behavior. In the last section of this chapter, author will explore the implications of this work for the measurement of social problem solving as well as the therapeutic potential of interactive computer models for enhancing the effectiveness of social skills training efforts with children. Chapter 4 – In all circumstances television advertisements affect children of different age and gender groups in terms of consumption. Because of the ease to affect and lead children, advertisers consider them as the target audience. Today, since television advertisements have an important and effective role in the conscious raising of children who will be socialized as the consumers of the future, author are confronted by the imperative to focus on television ads. For this reason, this study has been planned and conducted with the aim of determining the effects of television advertisements on primary school age children and understanding their attitude towards advertisements. The sample of this research is constituted by 225 students, who are selected by random sampling method from the 6th, 7th and 8th grades of 5 primary schools within Ankara city territories. The results of the research show that girls

Preface

ix

watch more television advertisements than boys do (p<.05) and that the ratio of those who ―always‖ watch television advertisements, decline with the increase in education level. Furthermore, at the end of the research it was found that children, be it a girl or a boy at any education level, want to possess the goods and services that they see on television advertisements. However, it was also seen that there is a high ratio of those who think that goods and services that they purchase sometimes carry the characteristics stated in the advertisements. Moreover, the findings of the research also indicate that while most of the children agree with the fact that advertisements are ―entertaining‖ and ―effective in shopping,‖ a considerable number of children think that advertisements cause prodigality. More critical than that, findings pinpoint that the ratio of those who think that advertisements are ―honest and real‖ decline while the ratio (p<.05) of those who think that advertisements are ―misguiding and deceptive‖ increase with the increase in grade level. Chapter 5 – Verbal agitation (VA) is a problem frequently observed among people suffering from dementia. Although several researchers have suggested that VA conveys a need for comfort, few studies have actually examined the relationship between these variables. The goals of the study reported in this chapter are a) to verify whether physical pain, depression and sleep disturbances are associated with discomfort, b) to identify which variables among physical pain, depression and sleep disturbances are related to VA, and c) to determine which VA manifestations are related to discomfort, physical pain, depression and sleep disturbances. Sixty-four people suffering from dementia were recruited from two longterm care facilities participating in the study. The results, based on correlational analyses, demonstrate no association between discomfort and VA, pain, depression, or sleep disturbances. Furthermore, pain and depression significantly contribute to VA, beyond cognitive functioning, disabilities and medication. Some specific manifestations of VA, such as negativism and complaining, seem equally related to pain and depression. The relationships between the variables studied and other agitation subtypes are also analysed for exploratory purposes. This information furthers our understanding of VA and potential for reducing behavioral problems. Chapter 6 – A growing body of evidence suggests that extra-sensory perception (ESP) is relatively common. Generally, ESP may produce some degree of apprehension in the perceiver initially but it tends to be a positive experience. Several authors (e.g., Wolman, 2001) have noted an association between ESP and spiritual well-being. Serenity is a form of spiritual well-being, and is characterized not by feelings of happiness so much as a sense of inner wholeness, security, and peace. Boyd-Wilson, Walkey, and McClure (2004, 2007) found a unidimensional and improved structure for a 20-item measure of serenity, derived directly from Roberts and Aspy‘s (1993) multi-factorial 40-item Serenity Scale. In the present exploratory research, an association between serenity scores on the 20-item measure and selfreported ESPs was sought. The results showed, as predicted, that the serenity scores of participants who reported ESPs were higher than the serenity scores of participants who did not report ESPs. Almost a third of the entire group reported ESPs, with women more likely to than men. The results suggest that ESP is an indicator of spiritual well-being, and support the concurrent validity of the 20-item measure. They were discussed in terms of social exigencies and the limitations of a narrow science. She kept her gaze to the ground, on her feet, stepping on the gray stone path. She was aware of the presence of people in the garden, murmuring, stepping aside, as she and Jalil

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walked past. She sensed the weight of eyes on her [italics added], looking down from the windows upstairs. - Hosseini Chapter 7 – Disruptive behavior in the healthcare environment can have a significant impact on staff relationships, communication efficiency, and patient outcomes of care. The ever increasing introduction of new research, knowledge, and medical technology has made health care an increasingly complex industry which is becoming more and more dependent on mutual understanding and respect of individual roles and responsibilities with the need for more interactive team collaboration to assure effective information flow and task accountability. Despite the noted impact of human factor issues affecting quality and safety of patient care, until recently, the health care industry has been reluctant to address the issue of disruptive behavior head on. Much of has to do with the history and autonomy of physician practice. The call for action is here. What health care organizations need to do is to get a better understanding of the dynamics related to the cause and effect and ramifications of disruptive behaviors and take a proactive approach toward preventing such episodes from occurring, mitigating the acute and down steam effects if they do, and have policies in place to address chronic offenders. This is what author are trying to do. Chapter 8 – Medical regulation consists in matching the needs of the patient or casualty with the most appropriate medical capabilities, whether in terms of equipment, personnel or technical support centre. According to the severity of the wounds, the tactical and logistical situation, the physician in charge of the regulation has to choose the right medical team to drive the casualties to the right medical and surgical capacities. Therefore, he makes his decision based on what he imagines of the patient's situation and of the capacities of the rescue teams, that are both unstable. Medical regulation is part of problem-solving processes, at the "knowledge-based level" of the Rasmussen's model. According to J. Reason's description of human error production, especially during problem-solving processes, author think that Human-Computer interfaces have to be ecologically designed. This Human centred design is the best way to improve the resilience of the system (the capacity to resist to Human error). Quantitative and qualitative factors combined with the time factor determine the critical character of situations (need to make choices), decisions having to be made by vulnerable, stressable and fatigable men. This design implies the analysis of the activities observed during medical regulation (both for the physician in charge of the regulation and the teams caring for casualties) to understand how they co-operate and the nature of the shared representation of the situation. The purpose of this paper was to share the author thoughts on the design of an operatorcentred software program, based on the cognitive mechanisms of problem solving, decision making and human error. Human decision in medicine cannot be replaced but the level of human performance is fluctuating, both naturally circadian and likely to be rapidly degraded under constraint. Man has thus to be employed for what he is irreplaceable, his abilities have to be conserved and he must be released from what only concerns automatism. In order to avoid the pitfall of a software program imposing an action not desired by the operator, author have thus wanted to put him in the centre of the system. To that end, author consider that situation awareness is one of the key points. Author aim to support him to create a shared representation of the situation, both with the medical team in charge of the casualties and the operational structures in charge of the military actions.

Preface

xi

Chapter 9 – Health complications from smoking are the number one preventable cause of death in the US. Although there are effective treatments available, none have proven to be completely successful, and it is important to explore novel methods of helping smokers abstain from cigarettes for good. Particularly valuable would be smoking abstinence aids that are cost-effective, easily accessible, and likely to be implemented and sustained. Author review one such potential aid which has not been discussed in prior smoking abstinence/cessation literature: self-expansion. Self-expanding (novel, exciting, and/or challenging) activities/events activate the mesolimbic dopamine reward system associated with pleasure and motivation. Author review the theory and evidence for the idea that the reward from self-expanding activities/events can supplant the reward and reinforcement from smoking cigarettes. Author propose that self-expanding activities/events have the potential to be useful in aiding smoking abstinence and cessation, and that they should be given more attention in both research and treatment practices. This is particularly important as selfexpansion is accessible to most, cost-effective, easily added to/used in conjunction with smoking cessation treatments, and may elicit lower levels of relapse. Finally, author give an example of what a self-expansion intervention might look like and outline some future directions in this new and exciting area of research.

In: Advances in Psychology Research. Volume 72 ISSN: 1532-723X Editor: Alexandra M. Columbus © 2011 Nova Science Publishers, Inc.

Chapter 1

INTUITION IN THE SCIENTIFIC PROCESS AND THE INTUITIVE “ERROR” OF SCIENCE Hayo Siemsen Ernst Mach Institute for Philosophy of Science, INK, FH Emden/Leer (University of Applied Sciences)

ABSTRACT The role of intuition in the psychology of the scientific process has been systematically overlooked for millennia. Even today, many scientists (intuitively) assume that all scientific thought, such as concept formation or research into the unknown, is completely conscious and rational (i.e. logical). They consider anything not fitting to this schema as unscientific. It has been known for a long time that by careful inspection, this assumption does not correspond to the facts. Not even in mathematics, the science supposedly the most ―free‖ from empirical ―constraints‖. Since Archimedes‘ account for Eratosthenes of his own thought process in his ―method‖ there have been many similar accounts by scientists, such as Henri Poincaré, E.W. Beth, Ernst Mach, etc. From their accounts, one can assume as a hypothesis that intuition is an actually widespread phenomenon in scientific thought and the scientific process in general. This phenomenon is often just not recognized, i.e. it becomes hidden by a ―rationalization‖ in retrospect. If intuition is not an ―error‖ in thought, but even an integral part of the (abstract) scientific process, it must be an integral part of all thought processes. The interesting question is why intuition has been overlooked for so long. In principle, this attitude results from a ―bias‖ towards conscious thought in psychology versus unconscious thought. The latter is seemingly less accessible to introspection and behavioural approaches of measurement. But this bias is also the result of our fundamental concepts of psychology and of the philosophy of science in general. Even widely used fundamental concepts, such as ―induction‖ and ―deduction‖ are biased towards conscious thought. By including the unconscious into the frame of basic scientific concepts, for instance ―induction‖ and ―deduction‖, the concepts become inherently inconsistent and lose their empirical meaning. The bias thus becomes an ―error‖ (i.e. either an inconsistency with the facts or an internal inconsistency). Many basic scientific concepts are in this sense not metaphysical, but metapsychical.

2

Hayo Siemsen How then shall one avoid this ―Intuitive Error of Science‖? An epistemologically consistent conceptual framework for intuition is required. The concept of intuition needs to correspond to the known psychological facts. Other concepts (from psychology and science in general) have to be adapted to this concept. Intuition has not been neglected by all of the scientific community. Indeed some of the most prominent scientists have already suggested solutions for this problem, such as William James, Hugo Münsterberg, Pierre Janet, Alfred Binet or Max Wertheimer in psychology and especially Ernst Mach in the psychology of science. There has also recently been a renewed interest in this topic (for instance ―The New Unconscious‖, Hassin et al. 2005 or ―Where Mathematics Comes From‖, Lakoff & Núñez 2000). The following chapter will try to combine the existing ideas with the facts from psychology of science and draw the outline of a consistent conceptual framework for the role of intuition in the psychology of science. It will also evaluate the implications on modern (cognitive) psychology and the psychology and philosophy of science in general.

Keywords: intuition, error, consciousness ―When we analyze our thoughts, even the most abstract, we have to notice that they directly or indirectly contain the elements of our sensual perceptions in an undefined form and newly interconnected.‖ (Ernst Mach 1906a, p. 603)

1. HUMAN KNOWLEDGE AND THE BASIC INTUITIONS OF SCIENCE What is the meaning of intuition? Are there physiological and psychological phenomena, which can only be fully and consistently described by postulating such a concept? Up to now, intuition is nearly always described in relation to ―consciousness‖. It has thereby been defined as delimiting introspective thought1. Tacitly, it is even often used in delimiting reflective (i.e. ―rational‖) thought. The question is, if this view is a) necessary and b) consistent with the known facts in this direction. The initial view on this question will be by looking into the basic intuitions of science. These necessarily form a part of our own assumptions as scientists as well as a part of our concept of intuition.2 V.S. Ramachandran (as a prominent example of a contemporary neuroscientist) for instance states that ―Ironically, after extensive training in Western medicine and more than fifteen years of research on neurological patients and visual illusions, I have come to realize that there is much truth to [the Indian] view – that the notion of a single unified self 1

For the purpose of this article it should be clarified from the beginning, that thought and language are considered different concepts. Language is regarded as a sub-process in which thought is adapted to a communicable version of it. Language in its spoken, heard, written and read form is in turn a sub-process. The adaptation process of course has also in turn an influence on the initial thought process. Concepts are therefore primarily concepts of thought and only secondarily of language. This view is consistent even with the view of some prominent philosophers of language, such as Wittgenstein (see Visser 2002), although this shall not be argued in detail here. 2 As a methodological result of this dual relationship, some of the language used in this article might seem unusual to some readers. This language deliberately keeps to a relatively low level of construction (―close to the axioms‖) in order to a) avoid or at least reduce the use of potentially self-referential concepts and b) be consistent with general concepts from other related areas, such as biology, physics, mathematics, epistemology, history or anthropology. The dual relationship also shifts the epistemological world view. This shift in turn changes many empirical meanings of fundamental concepts and consequently of all concepts constructed on them as well as the relations between these concepts.

Intuition in the Scientific Process and the Intuitive ―Error‖ of Science

3

―inhabiting‖ the brain may indeed be an illusion. Everything I have learnt from the intensive study of both normal people and patients who have sustained damage to various parts of their brains point to an unsettling notion: that you create your own ―reality‖ from mere fragments of information, that what you ―see‖ is a reliable – but not always accurate – representation of what exists in the world, that you are completely unaware of the vast majority of events going on in your brain.‖ (Ramachandran & Blakeslee 1998, p. 207/208) Contrary to Ramachandran‘s further assumption that his evidence is new, these empirical insights in psychology are actually nearly 150 years old with very similar conclusions drawn by many prominent psychologists of that time (see James 1885, 1904, 1905a, 1905b, Mach 1886, Ribot 1889, Binet 1889, Wernicke 1879, 1880, etc.; see also Münsterberg et. al. 1910).3 The interesting question is why these empirically based conclusions have not led to the clarification Ramachandran calls for? My hypothesis would be that the reasons are threefold. First, there was too much ―cultural rubble‖ left over from the World Wars. Science has built on this rubble without taking the time to systematically ―clear it up‖. Many eminent scientists died or emigrated from Europe, mainly to the US.4 The long-term effects of this can for example be empirically observed in science education, see Siemsen & Siemsen (2009). Secondly – and this certainly enhanced the effects of the first – there have been cultural and epistemological problems in enculturating these ideas from Europe to the US. In Europe, much of the traditions were destroyed in the process, except in some remote countries less affected by the turmoil of the wars (see Siemsen & Siemsen 2009). In the US, the enculturation process5, especially the incomplete translation of foundational texts, the shift in empirical meanings in the translation of central concepts or the understanding of the meaning of ideas, led to many misunderstandings and the creation of historical myths based on erroneous facts.6 Finally, the conclusions one needs to draw from Ramachandran‘s empirical observations in order to retain epistemological consistency are strongly counterintuitive to very basic human intuitions at least concerning the intuitions learnt in current Western cultures. The epistemological gestalt shift results in a shift in one‘s ―world view‖. It therefore presents a major cognitive gap, a step ―too large to take‖ for many people. Therefore, the

3

For instance Piaget (Beth & Piaget 1966, p. 140) in writing about the main psychological results of Marbe and the Würzburg school of psychology recalls ―Binet‘s disillusioned outburst: ―thought is an unconscious activity of the mind‖‖. 4 In the history of psychology, for instance, the gestalt concept did not take hold in the US within the concept of thinking (or epistemology) and had to be reinvented, for instance as ―emergence‖ concept. Both concepts give explanations for a ―holistic‖ view, but the gestalt concept – at least in its original non-physicalistic version – postulates a consistent psychological (thought economical) explanation which one can research, while the ―emergence‖ concept relies on a more mystical appeal to the principle inexplicability of complexity. The central question of what the empirical meanings of complexity and simplicity are remains unresearched. As we shall see, this belongs to the area of metaphysics and ―metapsychology‖. The main problem is that the epistemological origins of the gestalt concept became forgotten (see later). 5 The term here is used in the sense of Jerome Bruner as a dual process of adaptation. The idea is adapted to a different culture and the culture can also become adapted to the idea (see Cole 2000). 6 For instance the concept of ―psychophysical parallelism― in the description of the relation between the physical and the psychical is one out of several possible descriptions, but unfortunately one, which intuitively ―suggests the idea of two distinct processes running alongside of each other. Thus a false conception might arise from the word, and where a fundamental question is concerned a term leading to misunderstandings can do endless harm.‖ (Semon 1923, p. 61) I recently asked a German historian of science about this. He answered that of course he knew that the concept of parallelism is a wrong description for the psychophysical concept at least in its later phases of development, but he continues to use it, because ―all the US-Americans use it‖.

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study of intuition can help in understanding these intuitive conflicts and how to resolve them by finding a freer (also intuitively rooted) position. It can help in bridging the cognitive gap. It is very difficult to avoid already inducing one‘s (partly intuitive) assumptions on intuition into the concept of it, because intuition is conceptually so close and dependent on the concept of knowledge. Knowledge by definition is the foundational concept of epistemology (i.e. the philosophy of knowledge). If we change the concept of intuition, we also by necessity change the concept of knowledge and thereby the concept which – on a meta-level – defines what intuition is about in the first place. One thus needs to analyze what I will in the following call ―double-dependency‖. It is a double-dependency in this case between psychology and the ―metapsychical‖.7 I assume (as a hypothesis) that a fundamental epistemological issue has been the origin of much confusion concerning the concept of intuition: The necessary consistency of the concept of knowledge in ―knowledge of‖ as well as in ―knowledge about‖ and the interrelations inbetween these two usages of knowledge. A methodological problem arises especially because the two usages are mainly observed by different (and competing) sciences: by psychology and physiology for ―knowledge of‖ and philosophy or philosophy of science for ―knowledge about‖. Each science uses a different focus on the phenomena. It thereby develops its own meanings from them. In turn, this raises the question of how to reconcile these different perspectives. Even for many people researching around this field, it seems for instance unclear, if they deal with different perspectives or different types of ―knowledge‖. This of course is an epistemological question, which needs to be resolved before any consistent meaning of the concept of intuition can be stated. The following chapter will pursue the question of the meaning of intuition from a specific philosophy of science perspective (Erkenntnistheorie, literally translated ―cognition theory‖). This perspective is very similar to the one William James developed in his late years as a result of his empirical observations. These observations brought him to doubting the existing philosophical concept of consciousness.8 I am sharing his doubt, but not necessarily the way, how he stated the conclusions he drew from it. I will instead follow the ideas of the person from whom James, at least to a larger part, took the inspiration for the development of his own idea. It is the person who – according to James himself9 – he continuously ―intensively

7

The metapsychical is for psychology what metaphysics is for physics. The concept does not need more detailed description at this time. This will be developed during the article. 8 The concept of the unconscious used in the following is explicitly not the concept as Freud and his students developed it. As Münsterberg et al. (1910) have already noted, Freud‘s conceptual frame is constructed on very specific assumptions, many of which I regard as metaphysical. The concept of the unconscious used here just denotes that it is not accessible to introspection. As a result of the following deconstruction of the concept of consciousness, also the concept of the unconscious becomes usable only in the context of describing introspection. 9 See Thiele (1978, pp. 169/173). James writes about Mach (1882): ―I don‘t think anyone ever gave me so strong an impression of pure intellectual genius.‖ In 1902, thereby shortly before criticizing the concept of consciousness and developing his ―radical empiricism‖, James thanks Mach for the dedication of the third German edition of Mach‘s Popular Science Lectures: ―[…] I trust […] that you and I may […] contribute jointly to the establishment of the truly philosophic way of thinking – which I believe to be ‗on the whole‘ our way!‖ […] ‖I am now trying to build up before my students a sort of elementary description of the construction of the world as built up of ‗pure experiences‘ related to each other in various ways, which are also definite experiences in their turn. «There is no logical difficulty in such a description to my mind, but the genetic questions concerning it are hard to answer.» I wish you could hear how frequently your name gets mentioned, and your books referred to.― We will later come back to the relation between James‘ ―radical empiricism‖ and the ―genetic questions‖.

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discussed‖ with his colleagues and students. It is one of the three persons10 who had the most epistemological influence on James, namely Ernst Mach.11

2. THE HISTORICAL GENESIS12 OF THE CONCEPT OF KNOWLEDGE: EPISTEMOLOGIES OF INTUITION Which epistemologies of intuition are influential today? In order to initially describe the main epistemologies and clarify their differences, I will use a metaphor, which is frequently invoked by different representatives of each epistemological direction: the phase-difference of the water level. If one takes a river (or sea) as a metaphor for thought, then for the materialists, the ―physical‖ river is thought (seen from an observer standing besides the river). For the dualists, either there are icebergs in the water, which are partly above the surface (which represents the metaphorical ―phase transition‖ between consciousness and unconsciousness), or the river represents the thoughts having material undercurrents obscuring the clear view of the upper part. For the neutral monists, the river in the metaphor would represent the thoughts and consciousness its surface. With this picture in mind and as a result of considerations from philosophy of science (described in detail afterwards), one can categorize current ideas about thought into dualism and monism with different variations, depending on how mind and matter are seen in relation to each other and how the relation between rational and empirical thinking is evaluated. Four main epistemologies have thus been used in order to describe ―intuitive phenomena‖: 1. Dualism, postulating mainly one of two possibilities: a. either intuition and consciousness belong to the ―mental world‖ in which case intuition is often regarded as superior to consciousness in its qualities b. or intuition belongs to the ―material world‖ in which case it is often regarded as inferior to consciousness 2. Monism a. Monistic materialism (mostly in the sub-forms of mechanism, physicalism and behaviourism), in which consciousness is an illusion (e.g. Richard Dawkins, Daniel Dennett) 10

According to the biographer of James, Perry (1935). According to Boring (1950; 1957, p. 392/393), ―Mach exerted a great influence on psychology. [… He] furnished the epistemology of the relation of psychology to physics which Külpe and Titchener later adopted and made the rule for modern parallelists.‖ As has been stated before, Mach‘s concept of psychophysics has been unfortunately misunderstood by the parallelists. This has led to epistemological inconsistencies, which will be central to this article. 12 Genesis is understood here as the general process resulting from the interrelated genetic processes of the biological development (phylogeny), the development of the individual from birth (ontogeny), the cultural development, the development of science as part of culture, etc. (for the question of the interrelations between these processes, see for instance Boas 1911; 1938 or Zilsel 1931; 1976). In this type of analysis, there is of course the problem of ―reverse engineering‖, i.e. in any genetic reconstruction several ways are possible of which one needs to take the most probable according to research at the given time. Even if the historical details of the genetic process cannot be known anymore, experiments and observations from anthropology and developmental psychology can be found and repeated. Thus, several genetic perspectives are brought together into consistency. 11

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Hayo Siemsen b. Psychomonism relating everything to mind. Sub-forms include idealism, panpsychism or mind-in-the-machine analogies in which we infer problems in operating a machine as a (malign) will of the machine c. Neutral monism, in which consciousness is a construct. It has in principle two variants:  

reconstruction by allowing only the ―given‖ facts (e.g. in the ―radical empiricism‖ of William James)13 reconstruction by taking a genetically early position (early childhood, etc., e.g. Ernst Mach)

Epistemologically, all these approaches and their variants can internally be mostly consistent, but not all describe the same facts or consider the same circumstances under which they appear, nor are all their axioms necessarily consistent to each other. The different approaches can be compared in order to see, if they can describe the diversity of facts and in how far they are dependent on teleology, i.e. by postulating their concept of consciousness (which is supposed to be one result of the analysis) already into their main assumptions. As a result, a more general concept of intuition can be developed.

The Genesis of Ideas Leading to the Copernican Question of World Views How does one need to conceptualize these epistemologies in order to understand the epistemological shift of the late William James (and Mach)? In the following I will provide a brief overview of the historical developments14 which led to James‘s epistemological ―gestalt‖ shift and their influence on current psychology. For this I will begin with what is – at least according to Bertrand Russell – one of the most firmly established (i.e. thus intuitivized) distinctions in ―popular philosophy‖ (Russell 1921; 1922, p. 10). Within the categories of ―mind‖ and ―matter‖15, in principle all people16 (in Western cultures) believe that they are ultimately either one (monism) or that they are two (dualism). 13

One can object here (see for instance Tolman 1989) that James himself saw an inconsistency between monism and pluralism and preferred to side with the latter. From a Machian perspective, this is a pseudoquestion. From different senses we would also not infer that they belong to different ―worlds―, but one. If there are different (and potentially inconsistent) descriptions (interpretations) of this world from different perspectives – that is another question. In this sense, James epistemologically remains a monist. 14 For the current purpose, this historical view will only concern one ―time layer‖ (in the sense of Koselleck 2003), namely the epistemological perspective from the late James and Mach. 15 ―Mind‖ and ―matter‖ are also popular concepts in much of the psychological literature, categorizing what has also been called the ―psychophysical‖. Unfortunately, from a genetic perspective, mind and matter are both already highly constructed concepts. They are relatively far away from the empirical physical and psychical phenomena and heavily dependent on metaphysical conventions (as shown in detail later in the article). For my own investigation, such fixed concepts would unnecessarily narrow down the inquiry right from the beginning. Instead in the following, I will use the deliberately vague concepts ―physical‖ and the ―psychical‖, which just represent the phenomena, whatever their later interpretation. Similarly, the popular distinction between ―mind‖ and ―brain‖ will be disregarded. These categories assume that exclusively the brain ―thinks‖, i.e. is involved in ―higher‖ acts of interpretation, while the ―lower‖ senses ―just‖ measure. The distinction between what is ―higher‖ and ―lower‖ already involves a lot of constructive interpretation and is therefore an epistemologically ―unsafe‖ starting point (i.e. metaphysical and not empirical) not to mention the conceptual problems involved in the construction of ―measuring‖, etc.

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These fundamental belief systems probably developed out of different syntheses concerning two fundamental human questions: The concept of ―human knowledge‖ relative to ―God‘s knowledge‖ and the question resulting from the introduction of the idea of monotheism: if there is one God, how can there be good as well as evil in the world?17 Though still fundamentally based on these questions, the change initiating most ―modern‖ interpretations and therefore the current approaches to what ―thought‖ is, has been what became known as the ―the Copernican revolution‖ (see for instance Kuhn 1957, Cohen 1985). It was a new synthesis of ―touchable‖18 physics on earth and the necessarily more visually oriented (astronomical) ―translunar‖ physics by Copernicus, Kepler and Galileo. Because of consistency, the revolution synthesis also implied an adaptation of the concept of ―thought‖.19 If formerly fundamental and undisputable systems, such as the Ptolemaic geocentric model, could underlie fundamental revisions, what – if anything – could be considered ―safe‖ knowledge? How could one discern ―illusions‖ or ―errors‖ in knowledge? It thus becomes a central question, what an illusion is in the first place in terms of world views. As Mach noted, we cannot have several world views at the same time. It is very tedious to continuously construct and adapt all resulting concepts. In the interpretation of Aristotle (see later for a more detailed analysis of Aristotle), illusions could not exist in sensory perception, but only in the interpretation of them (one would call this ―qualia‖ in current terminology). The problem is the psychophysical relation. Is it possible to make a consistent conceptual ―cut‖ between sensory perception and interpretation? As the physiological facts of sensory perception, e.g. how the retina is arranged, the time intervals in which stimuli can still be differentiated, etc., already involve a high degree of (biological) ―interpretation‖. No such consistent conceptual ―cut‖ exists empirically. At least none exists, 16

This is not only true for scientists as Carter (2002, p. 58) notes. One might therefore assume that this belief is transmitted in early childhood, just like the intuitive basis of the concept of knowledge (see Bransford et al. 1999). As these concepts tend to be relatively stable in life, the question is, if and in how far they are changed by academic studies. Considering that these questions are not consciously addressed in most academic studies, one could assume that most scientists rely on a ―folk theory‖ of epistemology. 17 This idea can be traced back at least to Zoroaster or his successors (see Eliade 1975). In the Gāthās (Zoroaster 1900), the supreme god Ahura Mazdā creates the two spirits Spenta Mainyu and Angra Mainyu. Angra Mainyu ―decides‖ to become evil, while Spenta Mainyu as the spiritual principle becomes good and remains one with Ahura Mazdā. When the spirits meet, they ―decree life and death‖ and ―how all at the last shall be ordered‖. They are afterwards representing the principles of ―best mind‖ (as the ―good‖ principle) and ―worst life‖ (as the ―evil‖ principle). The interpretation of this mythical idea has been the source for countless interpretation and attempts of synthesis in many cultures and in philosophy. The two spirits can be interpreted as ―mind‖ and ―matter‖, but as we can see from the original text, it is open to different and sometimes very subtle interpretations. In a modern interpretation without explicit reference to Zoroaster, William James for instance calls the result a ―pseudomonism‖, where the unitary principle can only be known by its two aspects of mind and matter (see later for quotation). The mythological theme of the two spirits can also be found in the biblical story of the Genesis (see also Eliade 1975), although here they do not play such an initially dominant role. The roles of Spenta and Angra Mainyu are later theologically becoming apparent again as the Holy Spirit and the devil (the older gods ―daeva‖ and their worshippers, whom Zoroaster fought, deciding for the ―wrong‖ side). In other syntheses by different Gnostic ideas in early Christianity, aspects of the two spirits appear again closer to their Zoroastrian form. In Platonist theology, their aspects appear in the personification of the demiurgos, i.e. the ―public worker‖ or (conscious) maker of the world. Here the aspect of the decision (whether it is independent of the maker or not) becomes that of omniscient cognition, i.e. our current concept of consciousness. Jungians will easily spot the archetypal adolescent initiation theme in this conceptual development. For a more detailed analysis, see Siemsen (2010c). 18 The term is deliberately vague and includes, for instance, tactile, haptic, motor, enactive, orientation and other sensual experiences. The reasons for this and other conceptual vagueness will become clear later. 19 Duhem (1908) first brought this to scientific conscience and analyzed it.

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which would be consistent with the psychophysical facts. If the empirical meanings cannot be consistently divided between concepts, also no epistemological ―cut‖ can be introduced at this point. It would equally not be consistent. All postulation of such an epistemological cut is therefore based on ―naïve physics‖ or ―naïve psychology‖. Depending on the initial training of the researcher as natural scientist or as psychologist, the facts appearing from a more elaborate inquiry of the other perspective remain unknown or interpreted as epiphenomenal anomalies. Both views are naïve in the sense that they disregard many facts and the circumstances under which they appear. Mach (1906a) describes this in his article for psychologists in l‟Anneé Psychologique: ―The physicist ―relies on concepts so abstract, that he during his work tends to forget the countless sensual elements, which serve as basis for his measures and apparatus. He holds the result of his research for something objective, which can be generally applied and that deserves more trust than the special perception. […] The physiologist studies the organism of the human or the animal as a pure physicist and chemist. But as soon as an analogous induction prompts him to add perception to the purpose of his research, he fancies that he is leaving the objective and entering the area of the unknown, intangible. He does not think about that the physicist does constantly make use of these analogous inductions, for example when he sees the moon, which is only accessible to his eye, as a tangible mass […]. The psychologist is submitted to the prejudices of physics, – as the biological callings urge every human to behave as a physicist –, the psychologist assumes the contrariety of two heterogeneous worlds; whereas for the physicist the psychological world seems intangible, he instead sees in the latter something immediately given, the necessary starting point; but from his philosophical position, the physical world is projected into an unreachable distance.‖ In Mach‘s view, there are no illusions (Mach 1905). Error is an integral part of the knowledge process and what is regarded as error often depends on the point of view and the frame of reference. The ―error‖ of illusions only seemingly exist within a given reference framework. If one changes the perspectives, illusions suddenly ―disappear‖. If one puts a stick partway into water, it appears ―broken‖. When one takes it out, it is ―whole‖ again. What is the illusion, the part of the stick above or the part underneath the surface? When one learns about optics and light refraction in different media, there suddenly is no illusion anymore. It is a physical (and physiological) phenomenon. Similarly, many optical ―illusions‖, such as Mach bands, i.e. bands of adapted brightness appearing around a sudden border of sharp 21 black-white contrasts, still exist in a ―third person perspective‖ and can be photographed. The main question of the Copernican system versus the Ptolemaic one is a question of reference. There is no inherent reason for not taking the earth as the main reference. Indeed in most of our astronomical observations we still do this. It would simply be tedious to recalculate everything as it would be seen from the sun. The question of the Copernican system was more: If the sun is much larger than the earth and the other planets, should one see the sun at the centre or the earth? From the perspective of this question, one would intuitively tend to take the larger body as a reference. Of course after Kepler, Galileo and 20

For a detailed analysis, see for example Uexkuell (1957). For a newer account of the same idea, see Nagel‘s article ―How is it like to be a bat?‖ (1974). 21 As an anecdote, the photographer, who was supposed to take a picture of the effect for Mach on a rotating disc, repeated his photography several times, because he initially thought that the result was an ―error‖.

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Newton one can also argue that this system of reference is easier (more economical) for description, as one has to calculate a lot less epicycles. But this was not yet the case for the Copernican version, which equally had many epicycles to calculate (see Kuhn 1957). Even today, one could fly to the moon with a Ptolemaic system of reference (as geometrical representation system only, for the physical system one still needs Newton). Though by now, there would be many more epicycles to calculate and the process would be very tedious. So the question between the Ptolemaic and the Copernican world view is not easy to decide. It is basically a matter of the thought economy of one theory describing many facts instead of adding more and more anomalies to a theory describing fewer facts and fewer of the circumstances under which they appear. We could now equally propose the centre of the galaxy or a calculative ―centre‖ of the universe as the centre of reference. Here, many good intuitions would be speaking for this, but even more speaking against as on this scale our concepts on which we would base such views do not seem to make much sense anymore. Nevertheless, our world view is a matter of convention.

The Historical Genesis of the Empirical and Rational Descriptions of the World Before James and Mach Which fundamental philosophical ideas did the ―Copernican revolution‖ initiate concerning the scientific world view? The major philosophical approaches regarding this question were based on two observations of the ―Copernican revolution‖: that it was seemingly based on ―rational‖ critical thought (adapting the thoughts to each other) and that it was based on empirical observations (adapting the thoughts to the facts).22 Following these observations, two different schools of thought developed. The main proponent of an initially ―rational‖ interpretation has probably been René Descartes with his famous (intuitive) dictum ―cogito ergo sum‖ (―I think therefore I am‖). The main proponent of the second, the ―empirical‖ interpretation of thought became David Hume with his famous example of the ―white raven‖.23 To be sure, both schools of thought allowed for the influence of the other idea to different degrees. But both supposed that ―their‖ champion had given the initial impetus and therefore deserved to be at the basis of their philosophical reconstruction. This would later result in different interpretation of what ―metaphysics‖ meant, in its positive and (especially) negative sense. The question is what constitutes ―good‖ (i.e. scientific) and ―bad‖ (i.e. erroneous) metaphysics. Two attempts of synthesis of these two ideas will be important for our analysis: Isaac Newton in physics and Immanuel Kant in philosophy. Newton followed the open question 22

The expressions in both parentheses are taken from Mach. At the current stage, this type of description should not be considered necessary, but helpful for some conceptual clarifications, especially because of the sketchy historical-genetic overview without detailed analysis. For more details, see Duhem (1908) or Siemsen (2009a). 23 This was later restated by Karl Popper as the ―black swan‖ example (see also Taleb 2007). If we only saw white swans before, we would assume as a fact that that all swans are white. Only when we see our first black swan we notice that ―all swans are white‖ is only a hypothesis (and a false one). Equally the hypothesis ―everything falls down‖ is heuristic, albeit the statistical probability of us experiencing it to be false according to quantum physics is extremely low. Such probabilities can of course become extremely high if we do something very much outside of our regular (daily) experience, such as go into space or wearing special spectacles, which turn the world upside down for our eyes. Of course in the latter case, we would think of this as an optical illusion (again trusting the motor part of our senses more than the visual part), but we can only do so, if we compare the experience to our ―normal‖ experience considered to be part of our intuition. This explanatory ―illusion‖ hypothesis in turn creates a ―black swan‖ problem, but on the more general perception level as we will see later.

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why the moon in Kepler‘s heavenly mechanics does not ―fall‖ to earth like an apple.24 He answered it in separating the property of mass (―heaviness‖) from the concept of (―touchable‖) matter. In the process, Newton used Descartes‘ (intuitive) assumption that space and time were absolute and independent, which led to Mach‘s critique on Newton. Kant initially set himself the goal of abolishing all metaphysics (i.e. not empirically derived entities). He did so from his perspective. But from a Machian perspective, he missed the a priori and the thing-in-itself (―Ding an sich‖).25 These, Kant himself expected to be highly intuitive and therefore empirical. From a Machian perspective, they are, except for their genetic metaphysical interpretations, which after a while became dominant with his successors. In both cases, Newton and Kant, intuition starts to become the proxy for longterm empirical experiences. From our perspective at this point, the differentiation between empirical and metaphysical intuition becomes important, or more precisely the differentiation between the empirical and metaphysical part of intuitions. As James had noted, many of our intuitions are formed by default. We often do not encounter a direct empirical feedback, especially on metaphysical ideas. We tend to interpret the missing feedback as a positive feedback. As intuitions are by definition unconscious, it makes the process of differentiation difficult within the classic rational framework. For this, a genetic framework is required. The development of such a methodological framework became possible with the publication of Charles Darwin‘s ―Origin of the Species‖ in 1859. After the theory of evolution was able to consistently describe many facts accumulated in geology, biology and other sciences without taking recourse to a teleological goal, the question of human knowledge (for instance in relation to animal knowledge or God‘s knowledge) acquired a specific twist: What is human knowledge as a result of an evolutionary (genetic) process? Humans now could not consistently be described without looking into their evolution, unless one would disregard a large number of geological and biological facts and take recourse to an ad-hoc creation hypothesis. The strength of Darwin‘s theory was that it could describe these facts without recourse to teleological and therefore inherently anthropomorphic explanations.26 Anthropomorphic explanations depend on postulating an Aristotelian ―final goal‖ or ―final cause‖, which runs into the ―white swan hypotheses‖-type problem of human experiences. One assumes that we know what is final, although our experience is limited. It is very metaphysical (i.e. not empirical) to extrapolate current knowledge to all future knowledge. In a sense, one thereby assumes to know ―God‘s thoughts‖. Even in the case of assuming an ―initiation‖ to God‘s knowledge, the question remains how one can then safely assume to have God‘s thoughts. Could human thought and scientific thought as a specific part of human thought be described without teleology? The first (after Darwin‘s ―Origin‖) to address this question was Ernst Mach. He famously criticized the anthropomorphic assumption of ―causality‖ as a

24

Interestingly, in modern depictions of this intuition, the moon is often dropped out of the picture. This is an example of poorly understood intuitions without their historical genesis, like a form without content. The empirical meaning of the concept of gravity is lost in this process. 25 Mach was wondering ―If the great Koenigsbergian [i.e. Kant] in his metaphyisical clean-up has not forgotten some fungus spore, which has been proliferating all over ever since.‖ (Mach 1893b; 1923, p. 588). 26 This aspect was interestingly mentioned in the defence of Darwin‘s theory especially by one of the most speculative of Darwin‘s successors, Ernst Haeckel (1905).

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―natural law‖27 and (resulting from this) Newton‘s intuitive assumptions of absolute and independent space and time. The result was the development of the ―new physics‖, i.e. quantum mechanics and relativity theory (see for instance Einstein 1916).28

Other World Views: Dualism, Materialism, Etc After explaining the point of view of neutral monism, this view will in the following be applied to the other world views. The ―neutral monism‖ perspective was central to the world view of William James and Ernst Mach. Both (together with Alfred Binet, see Siemsen 2010b) have been very influential in the long term, because they laid the epistemological foundations for many resulting fruitful ideas in science, especially also in psychology. But these resulting ideas have often been founded only on aspects of their epistemology, especially not encompassing (and often not understanding) their shift in world view, which made this epistemology possible in the first place. From the perspective of neutral monism (in the sense of James and especially Mach), the other world views, such as dualism as well as material and psychical monisms, have inconsistencies, which are based on the central question of this chapter, i.e. the question of consciousness and of intuition. James‘ and Mach‘s criticisms are based on these fundamental inconsistencies, which will therefore in the following be elaborated in more detail. As the chapter actually argues that these other views are based on specific definitions of the concept of consciousness, which are not consistent with the facts, it is important to have a look into what effects these definitions have on the higher construct level of these other world views, first dualism and then the other monisms. Dualism is founded on the intuition of the ―self‖ being ―conscious‖ of itself (Descartes‘ ―cogito ergo sum‖, which can in a similar way already found with Aristotle). It takes into account that there are physical and mental phenomena and that both cannot be reduced onto each other without losing some central properties. From a monistic perspective, the philosophical ―price‖ is that all entities need to be mentally duplicated and described in two ways. This makes later adaptations of the concepts difficult, as additionally the relation between the two has to be adapted as well. Dualism makes two important assumptions, namely that the ―self‖ and that ―consciousness‖ exist a priori. They are some form of ―direct‖ perception or ―God‘s thoughts‖ with no construction involved in the process. Unfortunately, many phenomena in psychology (such as multiple selves or multiple consciousnesses) point to the fact that both experiences – the experience of a ―self‖ as well as the experience of a ―consciousness‖ – are already highly constructed to begin with. Ramachandran‘s initial quote leads into the same direction. But then, one has to leave the belief in dualism. Dualism‘s intuitive basis is fundamentally not consistent with Ramachandran‘s (and many other psychologists‘) observations, so it leads to empirical contradictions. Materialism is a form of monism. Its principle concept of matter is based on strong physical assumptions, which often can only be consistently provided by certain forms of folk physics. In its more refined forms of behaviourism and mechanism, it is based on Newtonian 27

According to Mach (1911), the concept of causality is a psychical (―thought economical‖) result of human curiosity and inquiry. Mach started to write about these ideas already in 1863, four years after Darwin‘s ―Origin‖ and much before Darwin or Haeckel would publish on this question. 28 The example will be elaborated below in an analysis of intuition in science.

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physics as in both forms the concept of matter is still assumed to be consistent.29 In modern physics there is no concept of matter consistent with all known physical phenomena on which materialism could be based upon. There are only different (internally inconsistent) concepts of matter describing these different phenomena. The type of physics used by materialists is mostly not made explicit, but intuitively assumed. The difference can be analyzed by the physical context in which the concept of matter is used, for instance if ―air‖ is considered material (in folk physics it often is not and all examples are conspicuously taken from solid bodies). In current physics, gases, such as air, are considered material bodies. Also it is telling, if objects are considered material. Contrary to bodies, which are considered physical, objects are metaphysical. Objects (or rather particles30) in physics, such as photons, gravitons, neutrinos, etc. do not have a continuous existence nor do they have an individual identity (e.g. they might have no ―material body‖ more than a mathematical point – which by definition has no spatial dimensions). Some particles can mainly be mathematically described and are in so far metaphysical (a thing of thought and not of empiry, see Wilczek 2002, 2004a). Here one can see that the origin of materialism lies in the sensual intuition of ―touching‖ and observe the limitations of its application in modern physics (see also Avenarius 1891). In this view, physical phenomena are considered to be independent of the observer and his psychology.31 Materialism thereby assumes that our concept of ―matter‖ is not anthropomorphic and non-teleological, i.e. it is independent of previous and current human interpretation and future developments in science. The intuition is that the touching/haptical experience is the initial perception and the preferential one in detecting ―illusions‖, i.e. inconsistencies in sense perceptions. This concept of matter would then at first view constitute a ―safe basis‖ (i.e. a basis independent of future changes in science) for constructing all of science on it. The mechanistic hypothesis additionally assumes that because mechanics has been so successful in describing physical phenomena and human manipulation of these phenomena, it can be taken as a conceptual basis for all of science. As a result of assuming psychical phenomena as epiphenomena of physical phenomena (physical phenomena thereby must be considered to be not metaphysical), all introspection and ―first person‖ accounts of psychical phenomena are rejected. Materialists try to supplant them by the so called ―third-person perspective‖ of an ―independent‖ observer. Thereby, the approach tries to avoid the problems within consciousness, but at the ―cost‖ of introducing the constructedness of consciousness and limitations of measurement as problems of the observation. As an example of the ―possibility‖ of in principle unsubjective observation, Martians are postulated, who would be able to observe human consciousness without actually sharing it. Unfortunately, from an empirical perspective (which most materialists certainly claim to hold), Martians must currently be supposed to be an unobservable entity. Therefore, all 29

Thus, as Zilsel (1941; 1976, p. 168) observes, ―The mechanistic conception of nature is anthropomorphical and interprets natural processes after the pattern of human actions.‖ 30 The concept of ―particles‖ fits better than that of an ―object‖ to the physical phenomenon as they are derived by parting empirically (i.e. sensually) better known entities. 31 In quantum mechanics, the observer is necessarily a part of the phenomenon as the very act of observation changes the phenomenon. According to Pauli (Laurikainen 1989), this also implies that the psychology of the observer becomes part of the phenomenon. The observer interprets what the circumstances of the phenomenon are and what is considered and observed as a phenomenon in the first place. Physical instruments, for instance, depend on how we build them, i.e. which ideas (based on our experiences) we ―build into‖ them.

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speculation on how Martians would behave must not be classified as a thought experiment, but as a purely metaphysical fictional speculation.32 Conceptually, the actual descriptions of Martians (for instance by Dennett 2006), have a remarkable anthropomorphic similarity with humans.33 Even the tentative ideas from Uexkuell (1957) about the ―world views‖ of animals already show fundamentally different experiences leading to what as a result must be radically different worlds. Maybe Martians would not have culturally developed the concept of consciousness and therefore regard it as a pseudoproblem in the first place. All such thoughts are as speculative as postulating any ignorabimus limit to knowledge34. We simple do not know, in what ways the world view of future generations might be different from ours. Our limits of knowledge might in the future look like a result of ―local‖ theories of knowledge, the reference of which to general knowledge just became obsolete together with the concepts and facts it included. Today we do not worry anymore about a growing number of epicycles nor do many people remember what they were good for in the first place. Assumptions that these patterns might change in the future are anthropomorphic. Mach (1920, p. 434) writes on materialism: ―For most natural scientists and many philosophers, who do not admit it, the thought that all psychical could be deducible to the material in private is very congenial. Even if this materialism has a catch, it is not the worst possibility; it stands at least with one foot on secure ground. But if all psychical should be understandable physically, why not the other way round? […] Is the other [psychical] foot standing in the air? I would prefer […] to stand on both feet.‖35 From Mach‘s perspective, the inconsistency of the concept(s) of matter poses little problem. ―‘[M]atter‘ must be regarded merely as a highly natural, unconsciously constructed mental symbol for a complex of sensuous elements […]. Still less, therefore, should the monstrous idea ever enter our heads of employing atoms to explain psychical processes; seeing that atoms are but the symbols of certain peculiar complexes of sensuous elements which we meet with in the narrow domain of physics.‖ (Mach 1886; 1919, p. 152/153) ―There is no necessity to become dualist thereby for 32

As Vaihinger (1911; 2008) stated in his (Machian inspired) ―philosophy of the ‗As If‘‖ (Philosophie des als ob), fictions are not wrong a priori, but they need to have a descriptive (explanatory) value, which in this case they do not have. Because of their high anthropomorphic character, Martians as explanatory fictional entities for science are rather misleading than enlightening. 33 If one wants to think about the question, how a Martian would think, one should first try to imagine a Martian very different from human experience, maybe as the planet Solaris described by Stanislav Lem in the novel ―Solaris‖. Interestingly, in Lem‘s novel, the human scientists first start learning anything meaningful about the planet when they start psychologically observing themselves after all mechanistic observation has failed. 34 This is similar to the ―homununculus― problem (see Wegner 2005) in which one assumes a (mostly implicit) homununculus ―directing― our thoughts. One thereby simply redefines the problem into another one without solving it. 35 The argument that physics has been ―the most successful science‖ (as many intuitive materialists claim) is no argument for the physicist Mach. Such historical ―success‖ can be misleading, as the 2000 years of ―success‖ for the Ptolemaic world view shows. Additionally, modern physics is not reducible to classical mechanics (which is mainly the one with the alleged success, but considered outdated and wrong from a current perspective, see Wilczek 2004b). Materialism intuitively assumes that the concept of matter is necessarily foundational to physics and that it does not change over time. Unfortunately these assumptions are not true. One could for instance with at least equal reasons consider energy as foundational concept of physics as Wilhelm Ostwald has done. The concept has undergone considerable changes and there currently cannot even be considered any broad consensus among physicists as to the exact meaning of matter. For instance anti-matter is defined as (at least in one property) the opposite of matter. The basic intuition of materialists is that matter exists tangibly and constantly. Now anti-matter by definition annihilates matter. What stays constant in this process is energy and not matter. Do materialists believe in anti-matter if physics says that it experimentally exists? Even within its own epistemological framework, the assumptions of materialism lead to rather large paradoxes.

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the one, who considers both feet as equal and both floor spaces under the soles to belong not to two different worlds.‖ (Mach 1920, p. 434)36

3. THE CRITIQUE FROM WILLIAM JAMES AND ERNST MACH ON THE EXISTING WORLD VIEWS James and Mach developed their new world view as a ―safer basis‖, which would avoid the inconsistencies of the other world views existing at their time. For instance, William James develops his idea of what he calls ―radical empiricism‖ from an empirical critique of dualism: ―All the schools – Scholastic, Cartesian, Kantian, Neo-Kantian – are in agreement on this, all admit to a fundamental dualism. It is true that the positivism or agnosticism of our own day – which prides itself as coming under the physical sciences – freely assumes the name of monism. But it is a monism in name only. It posits an unknown reality, but then tells us that this reality always presents itself under two ―aspects,‖ on the one side consciousness and on the other matter.― (James 1905a; 1967, p. 184)37 ―Now psychology takes precisely for its domain the field of the facts of consciousness. It postulates these facts without criticizing them, and opposes them to material facts; and, also without criticizing the notion of the latter, psychology relates them to consciousness by the mysterious bond of knowing, of apperception, which is for psychology a third kind of fundamental and ultimate fact. By following this approach contemporary psychology has enjoyed great triumphs. It has been able to fashion a sketch of the evolution of conscious life by conceiving the latter as adapting itself more and more completely to the environing physical world. It has been able to establish a parallelism within dualism, that of physical facts and cerebral events.‖ (James 1905a; 1967, p. 185) ―Experience, I believe, has no such inner duplicity; and the separation of it into consciousness and content comes, not by way of substraction, but by way of addition – the addition, to a given concrete piece of it, of other sets of experiences, in connection with which severally its use or function may be of two different kinds.‖(James 1904; 1967, p. 172) ―It is very difficult, or even absolutely impossible, to know solely by intimate examination whether certain phenomena are of a physical nature – occupying space, etc. – or whether they are of a purely psychical and inner nature. […] in the final accounting it could well be that all our usual classifications may have derived their motives more from practical needs than from some faculty we possess of perceiving two ultimate and diverse stuffs which together are supposed to comprise the scheme of things.‖ (James 1905a; 1967, p. 189) According to James‘ psychological critique on philosophers, intuition in this sense takes two roles in introspection: on the one hand it ―frees‖ attention from already intuitivized properties, on the other hand it ―hides‖ these properties from further introspection. It even sometimes hides the empirical basis of the concept itself from which it derives its meaning (see for instance Mach 1905 or Kaila 1930). As a result, philosophers (and mathematicians) attribute the character of ―pure‖ to concepts, which they assume to have become abstracted from all roots of concrete experience. This has for instance been one of the claims of formalism, i.e. the idea, that one can consider only the form of something, devoid of any 36

Because psychomonism as a theoretical position in science is relatively rare, it shall not be considered in detail here, especially as many arguments on materialism apply analogously. 37 One can recognize here indirectly the idea from Zoroaster of Ahura Mazdā and the two spirits.

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contents. What instead happens psychically, is that the empirical meanings gathered by concrete experiences become so intuitivized and ―repressed‖ into the unconscious (here the Freudian notion fits relatively well), that it ―appears‖ to introspection as if one can use the concept without. But under close inspection of intuition, this can be shown not to be the case. But James not only criticizes philosophers for their psychically inconsistent concept of consciousness, but also psychologists (and physiologists) for adopting this concept uncritically, especially by giving it a physiological meaning (which of course is problematic if it is a psychical or psychophysical construction). For the origin of this epistemological inconsistency, one has to go back to the origin of the use of consciousness in physiology. Wernicke (in 1879 and in a further discussion in 1880), as a psychiatrist and one of the first to adapt the concept of consciousness to brain functions, describes the inherent problems: ―The sum of the memory images (Erinnerungsbilder) – transferred spatially the whole cortex – I called consciousness and thereby had won a spatial and anatomic basis for a psychical thing, which could not be exactly defined. But I did not miss the awkwardness, which lies in such a naming. As the mental processes up to now had never been brought into a definite relation with the brain, but had been the object of an own discipline, which is philosophy, therefore it was not to be expected, that the concepts put up by philosophy would correspond with the ones derived from the properties of the brain. One therefore has to, where an expression for mental properties, conditions or processes is used, determine its sense as exactly as possible, but the terminology of Philosophy could not everywhere be avoided, because it at the same time makes up an indispensible part of our German vocabulary. So it was with the word consciousness; because of linguistic usage it seemed justified, but criticisable as a philosophical terminus.‖ This problem unfortunately seems to have become forgotten in later use in a process of intuitive ―hiding‖, just as James‘ has predicted. What then of course becomes especially problematic here is the unconscious inheritance of the intuitive meanings of consciousness conveyed by millennia of philosophical tradition in Western scientific concepts. As becomes clear from Wernicke, the use of the concept of consciousness in physiology was not due to a synthesis, but a matter of default. It is therefore still necessary to work on a synthesis in the sense of James.

The Effects of Intuition on Mathematical Thought Can William James‘ ―hiding‖ of intuitive thought be observed as a general phenomenon of the psychology of science? I will take the role of mathematics in developing scientific thought and the intuitions of science as an example, as here the effects of this phenomenon are most prominent. From the point of view of intuition, it is for instance curious that 38 mathematics should be considered the clearest of all sciences. The ―clearness‖ depends on 38

It is not by chance that what is considered the ―foundational article‖ of pragmatism by C.S. Pierce is titled ―How to Make Our Ideas Clear‖. This was then also the point, where the logician Pierce saw the difference to the psychologist James (in a letter to James published in Perry 1935, p. 437): ―I just have one lingering whish […]. It is that you, if you are not too old, would try to learn to think with more exactitude. […] but perhaps I do not sufficiently take account of other psychical conditions than purely rational ones. … I have often […] pointed out how far higher is the faculty of reasoning from rather inexact ideas than of reasoning from formal definitions; and though I am so bound up in my narrow methods as often to lament that you could not furnish me with the exact forms that I am skilled in dealing with […]‖ Pierce admires James‘ skill in coming close to the truth nevertheless and especially his ability of transmitting ideas to an audience understandably. The origins of

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the point of view. While mathematics is the most clear from a logical perspective, it hides the psychological process leading to new mathematical ideas. Thus, from the psychological point of view, especially regarding the analysis of the intuitive process, it is very unclear. What do I mean by this psychological ―opacity‖? Mathematics played an important role in the psychological development of science. For instance, in the case of the Copernican versus the Ptolemaic world view, mathematics helped to describe the phenomenon, i.e. the anomalies of planetary movement discovered after the Aristotelian synthesis. Mathematics was used to ―attach‖ the anomalies of planetary movement to the theory in retrospect as ―epicycles‖. These auxiliary descriptions, as well as idealizations, such as Newtonian ―frictionless movement‖, after a while became an intuitively integral part of the theory. 39 Scientists started to assume them as empirical. Through the abstraction of mathematics, scientific ideas and intuitions can be described more economically. But at the same time, their empirical or metaphysical origin becomes more obscured as a result. Epistemologically, one therefore has to keep the roles of the ―physikos‖ and the ―mathematikos‖ clearly apart in order not to be confused in intuitive processes (see Krafft 1964). As we will see later, these ―roles‖ additionally have methodological implications for the formation of intuitions in science. One might still think that these intuitive phenomena in science happened long ago and have no bearing on modern scientific thought. The (intuitive) mathematician Hadamard provides an example for such phenomena in modern mathematical thinking, regarding the origins of formalism as it was developed by Hilbert. Hadamard (1945, p. 87/88) describes it as ―[…] another rigorous treatment of the principles of geometry, which, logically speaking, has been fully freed from any appeal to intuition, has been developed on quite different basis by the celebrated mathematician Hilbert. His beginning, which is now classic among mathematicians, is ―Let us consider three systems of things. The things composing the first system, we will call points; those of the second, we will call straight lines, and those of the third system, we will call planes,‖ clearly meaning that we ought by no means to inquire what those ―things‖ may represent.

Logically, of course – and this is all that is essential – the result announced is fully attained and every intervention of geometrical sense eliminated: that is, theoretically unnecessary to follow the reasoning from the beginning to the end. Is it the same from the psychological point of view? Certainly not. There is no doubt that Hilbert, in working out his Principles of Geometry, has been constantly guided by his geometrical sense. If anybody could doubt that (which no mathematician will), he ought simply to cast one glance at Hilbert‘s book. Diagrams appear at practically every page. They do not hamper mathematical readers in ascertaining that, logically speaking, no concrete picture is needed.‖ From this, Hadamard (1945, p. 112) concludes: ―This carries, in the first place, the consequence that, strictly speaking, there is hardly any completely logical discovery. Some intervention of intuition issuing from the unconscious is necessary at least to initiate the pragmatism shall not be further considered here, but they bear a close relation to the topic discussed here and have not been properly researched as yet. 39 This happened for instance in the assumption of the quest of ―saving the phenomena‖. The question then becomes, what is the meaning of ―saving‖. As a result, the metapsychical relation between the physikos and the mathematikos changes and needs to be observed in detail, see Kraft (1964).

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logical work.‖ The question is more, if the results of intuitions are already in consciousness at the time when the introspection begins. ―One sees that there can be apparent logicians, who are logical in the enunciation of their ideas, after having been intuitive in their discovery. […] There is often a great difference between the discovery of an idea and its enunciation.‖ (Hadamard 1945, p. 113) Thus, reason and logic are (re)constructed in retrospect. We shall have a closer look into Hadamard‘s hypothesis and its bearings on the relation between the ―mathematikos‖ and the ―physikos‖ later. Since Hadamard‘s time, one telling aspect has changed in the intuition of mathematicians. Today, many mathematicians would doubt the role of intuition. The idea of ―pure‖ mathematics is built on this assumption. One can see this as an example of the intuitive process in science: Constant repetition of mainly theoretical concepts also increases their ―strength‖ in intuition (see for instance Binet 1910). This has happened several times in mathematics during history, for instance through Euclid. Because of Euclid‘s omission of 40 describing the intuitive methods he must have used and due to his dominance in geometry, many people started assuming that geometry is independent of the empirical experience and measurement of bodily dimensions.

Emotion and the Role of Empiricism In order to ―mentally work‖ against the problems related to this type of intuitive abstraction at the beginning of scientific construction processes, James and Mach proposed to implement empiricism as a continuous ―checks and balances‖ of intuitivized habits of thoughts. One would think that this is done by experience anyway, but as James (1905b; 1967, p. 206) observed: ―I speak also of ideas which we might verify if we would take the trouble, but which we hold for true although unterminated perceptually, because nothing says ‗no‘ to us, and there is no contradicting truth in sight. To continue thinking unchallenged is, ninety-nine times out of a hundred, our practical substitute for knowing in the completed sense. As each experience runs by cognitive transition into the next one, and we nowhere feel a collision with what we elsewhere count as truth or fact, we commit ourselves to the current as if the port were sure.‖ James then continues even more emphatically ―We live as it were, upon the front edge of an advancing wave-crest, and our sense of a determinate direction in falling forward is all we cover of the future of our path.‖ According to Perry, James wrote on the margins of Mach‘s ―Erkenntnis und Irrtum‖ (Knowledge and Error): ―W. J., but not emphatic enough‖ (see Thiele 1978, p. 174). Mach would probably have agreed to the first and second quotation from James, but not to the last. One can see here the difference in James‘ more speculative and Mach‘s more careful analysis. If one observes children when they learn walking, they need to lose their balance. We need to ―fall‖ in order to take a step. If they take the step before they are surefooted enough, they are really likely to fall, which of cause they try to avoid. The result is an adaptive process between daring and carefulness. As a child, James would have had more bleeding noses, Mach would have been more careful in trying. The latter method is not necessarily the slower in learning – as James‘ supposed in his comment –

40

This effect (the process of the origin of ideas becoming unconscious) in mathematics will be described more in detail later.

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if one notices and eliminates the problems earlier with it. Their different solutions are thus also due to their difference in character. Did Mach with his approach find a problem which the late James overlooked? James‘ intuition which he expresses in the sentences above is obviously dependent on character. It is dependent on a specific construction of the self. Here he fully follows Bergson‘s emotional concept of intuition. ―I can not help that, however, for I, too, have my intuitions and I must obey them.‖ (James 1904; 1967, p. 183) James generalizes from his own intuition to the character of everybody (every self), which – at least in the case of Mach as we saw – does not fit as a description. James‘ intuition in this case is not universal, although he assumes it to be universal. And in this sense then, Mach‘s approach to intuition has its advantage over James‘: it is more widely applicable. James speaks of it as we shall see later, but he does not apply it thoroughly as it is counterintuitive to some of his intuitions. Here we can also observe that the more intuitions are foundational (for instance to the concept of ―self‖), the more difficult they are to change, which is also an inherent difficulty to the ideas from James and Mach on intuition in principle. A property cannot exist without empirical reference. One can easily test this by trying to teach somebody the abstracted property without its empirical meaning. The answer in those cases very often is that the person is considered ―just too stupid to understand‖. That this assumption is an insufficient explanation, can be tested by teaching the empirical meaning with the property. The difference tends to be empirically staggering (see for instance Siemsen 1981, Siemsen & Siemsen 2009, Siemsen 2009b). ―Pure‖ (as in ―pure mathematics‖) thus acquires the meaning of ―everything else hidden in intuition‖.

James and Mach‟s Genetic Questions James discussed this point with Mach (see Mach 1896, p. 151 footnote) and Mach basically agreed with James‘ perspective. Nevertheless, Mach saw this similar to Avenarius‘ introjection (i.e. the mistaking of the inner for the outer world by continuous efforts to objectivise) as merely one specific form of a more general phenomenon of the psychology of science. James and Avenarius found specific forms of the workings of intuition in science. These forms were initial simplifications, which in the long run resulted in inconsistencies. Mach proposed that this is a more general psychological phenomenon in science: the process of intuition resulting from an economy of thought. The Machian principle of thought economy is a continuous optimization41 process, constantly requiring adaptation. It is a genetic process. Science is just a specifically refined version of it. James in the end of his article on ‗Does “Consciousness” Exist?‘ gives a summary of the genetic task for psychology after discarding the concept of consciousness: ―If one were to make an evolutionary construction of how a lot of originally chaotic pure experiences became gradually differentiated into an orderly inner and outer world, the whole theory would turn upon one‘s success in explaining how or why the quality of an experience, once active, could become less so, and, from being an energetic attribute in some cases, elsewhere lapse into the status of an inert or merely internal ‗nature.‘ This would be the ‗evolution‘ of the psychical 41

Economy in economics is the optimization of the result (from several variables) and not a minimum process such as Occam‘s razor. As the environment and the process itself continuously changes, every optimum is sub-optimal in the long run. Reaching a higher optimum thereby often requires adaptations (e.g. investments) involving a temporary reduction of the result.

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from the bosom of the physical, in which the aesthetic, moral and otherwise emotional experiences would represent halfway stage.‖ (James 1904; 1967, p. 182) ―But a last cry of non possumus will probably go up from many readers. ―All very pretty as a piece of ingenuity,‖ they will say, ―but our consciousness itself intuitively contradicts you. We, for our part, know that we are conscious. We feel our thought, flowing as a life within us, in absolute contrast with the objects which it so unremittingly escorts. We can not be faithless to this immediate intuition. The dualism is a fundamental datum: Let no man join what God as put asunder.‖ My reply to this is my last word, and I greatly grieve that to many it will sound materialistic. I cannot help that, however, for I, too, have my intuitions and I must obey them. [… Consciousness] is fictitious, while thoughts in the concrete are fully real. But thoughts in the concrete are made of the same stuff as things are.‖ (James 1904; 1967, p. 183) As James states, he is criticizing the concept of matter as well as consciousness. If one takes an object and now considers it to be a body, does it change? And if so, what of ―it‖ does change and why? Would it be a body without us thinking of it as one? Would we still consider it a body when its molecules, atoms, electrons have disintegrated in some thousands of years? If our perception of time would be the one of Konrad Lorenz‘s (1959) Chronos, for whom a thousand years are like a second, would we consider the object or the body as a process instead or not notice it at all as it would vanish in an instant? Does a body or an object therefore exist only, because of our perception of time? James sees the solution to this conundrum in a genetic approach, a concept which he by-and-large took from Mach as we have seen from his letters in the beginning. Mach develops James‘ critique into a genetic analysis.42 ―I think that one should not begin one‘s philosophical considerations with a ready, fixed theory which will not let go of us. The core of my explication lies in the demonstration of Fig. I43 of the ―Analysis‖. We get

42

As I will show, Mach had these ideas before James, who rather took them from Mach and developed some similar ones on his own in parallel. 43 Fig. I in the ―Analysis of Sensations‖ depicts the famous ―view from the left eye‖, in which one sees the room in which Mach is as viewed from his left eye (including perspective, his own body lying on the couch and his hand raised as if drawing this picture, as well as less detailing on the outer parts of the picture). The unusual part is that this view includes the frame of the view as part of it by depicting also the eyelid, nose and moustache, so the parts of one‘s view, which are normally abstracted from and not seen consciously, but only intuitively, especially if both eyes are open. In the ―Analysis‖, Mach comments that if one is observing an element A in the field of vision and investigates its relation to another element B of the same field, one transverses from the field of physics to the one of physiology or psychology if B ―passes the skin‖. It thereby seamlessly passes the usual (intuitive) ―epistemological cut‖ between physics, physiology and psychology (where the phenomena and concepts of one would ―end‖ and the other would ―begin‖). In this (and many other psychophysical experiments), Mach found no meaningful epistemological cut (especially not the skin) and thereby concluded that physics, physiology and psychology must ultimately be ―one‖. Conceptual unities, such as ――body‖ or ―ego‖ are only makeshifts, designed for provisional orientation and for definite practical ends (so that we may take hold of bodies, protect ourselves against pain, and so forth), we find ourselves obliged, in many more advanced scientific investigations, to abandon them as insufficient and inappropriate. The antithesis between ego and world, between sensation (appearance) and thing, then vanishes, and we have simply to deal with the connexion of the elements […], of which this antithesis was only a partially appropriate and imperfect expression. […] The philosophical spiritualist is often sensible of the difficulty of imparting the needed solidity to his mind-created world of bodies; the materialist is at a loss when required to endow the world of matter with sensation. The monistic point of view, which reflexion has evolved, is easily clouded by our older and more powerful intuitive notions.‖ (Mach 1914, p. 13/14) The idea of this, Mach developed in 1870 after reading the philosopher C.F. Krause, who had written ―‘Problem: To carry out the self-inspection of the Ego. Solution: It is carried out immediately.‘ In order to illustrate in a humorous manner this philosophical ‗much ado about nothing‘, and at the same time to show

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to it by observing our children and by thinking ourselves back into our early youth, as we just begin to differentiate between our body and its surrounding. There we do not know anything about matter and spirit, of physical and psychical, of object and subject, of stimulus and perception. All still consists of similar parts ABCD …, which by themselves are neither physical nor psychical, but neutral, indifferent. Physical and psychical they become only because of the special form of dependency, which we take into account. […] Now we have to research everything either from the physical or from the psychic side. If one time the tunnel between the physical and psychical will be built or nearly built we will probably not be limited to this. […] The astronomers from today know that the Ptolemaic and the Copernican world view both are conventional practical limitations, and that one can allow oneself a freer type of question.― (Mach 1920, p. 434) In the following, one area of intuitive phenomena will be described in detail, because of its specific role in science, namely phenomena of invention in the mathematical field. It shows exemplarily both sides: how intuition develops science and how science and the concepts of intuition and consciousness as part of it have developed.

4. INTUITION AND INTROSPECTIVE CASES OF INTUITION IN SCIENCE The concept of intuition has a long history, in general language, but also in psychology. It was even used by people, such as Bergson and Poincaré as a basis for philosophical and mathematical programs. The concept has therefore acquired many (often inconsistent) meanings. Is the concept of intuition still inconsistent today? My hypothesis is that it is still inconsistent (for examples, see for instance Hassin et al. 2005 or Lakoff & Núñez 2000), which is why I propose a deconstruction and reconstruction of the concept in the first place. But before, I will briefly give examples of two interrelated areas, which have specifically added to this inconsistency, namely language and concept formation.

Problems of Language and Concept Formation The first problem one encounters in this direction is one of concepts and their translation: Many of the concepts have been taken back and fourth between languages such as Greek, Latin, French, German and English. As a result, also their properties changed substantially, often without the scientists involved noticing. For instance the German word ―Anschauung‖, which was often used by Kant in different contexts, has been translated into English into so different terms as image, sensual, non-sensuous and ―pure‖ visualization, intuition or 44 apperception. A similar concept, but which is more based on memory called ―Vorstellung‖ was translated in Mach‘s Knowledge and Error as ―intuition‖. Additionally, of course, the meanings of these concepts by Mach and by Kant are very different. Even for one author and the same book it can be different. Mach‘s Mechanics has gone through seven editions by Mach himself with several hundred pages added and changed in the process. One time there how the self-inspection of the Ego could be really ‗carried out‘, I embarked on the above drawing.‖ (Mach 1914, p. 20). 44 On the difficulties that the translation of these concepts between German and English pose, even for professional translators, see for instance the discussion at: http://dict.leo.org/forum/viewUnsolvedquery.php?idThread=370933&idForum=1&lp=ende&lang=de.

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was even a book reprinting only the changes made in the latest German edition relative to the last English edition. Also during this time, Mach changed his world view at least two times. 45 Because of this, he necessarily adapted the meaning of many of his concepts. The accumulation of such problems led to many misunderstandings and confusions still currently prevalent especially in the English speaking world. These effects have been additionally enhanced as a result of the enculturation problem already mentioned due to the World Wars and the breaks they caused in the transmission of knowledge. But these enculturation effects were already considered a problem before the wars. William James himself criticized (for instance in his lectures to teachers) the scientific fashions resulting from the arbitrary use of terminology. This problem led to confusion and imprecision in the meanings of concepts until today and has been especially prevalent in psychology. One aspect, which has a strong connection with this problem, is that an increasing epistemological ―wedge‖ can be observed between the direct sensual experience and the theoretical reflection about it. This difference led James to the radical formulation of his empiricism. In order to avoid these confusions, the definition of intuition used here is a positive attempt of reconstruction in order to replace the concept of the unconscious in the genetic sense. My starting point46 is the concept of the unconscious, which is defined as ―not accessible to conscious introspection‖. From this starting point, a positive concept of intuition will be developed in the following by first looking into intuitive phenomena in mathematics. The concept will be successively enlarged by adding more descriptions of unconscious phenomena of thought from other sciences and from the general genesis of thoughts. In the last part of the chapter I will try to form a consistent theoretical framework for developing the concept further. Based on this genetic adaptive approach, the intuitive phenomena mentioned here make no claim to completeness. On the contrary, by the multiple-genetic approach taken, probably more phenomena of intuition can be integrated or found in future research.

Intuition in Mathematics The following view on intuition will first concern empirical facts focused on a specific area, which then can be used to construct a common, more general empirical meaning of intuition. This area will concern the ―hardest‖ area, which – from the perspective of other epistemologies – would be seen as the furthest away from the position elaborated here. If one takes a ―normal‖ stand of assuming knowledge as the iceberg (partly above the water), what would most people from this perspective regard as the ―very tip of the iceberg‖? Probably mathematics. From a rationalist perspective, what would one consider the most rational one? Probably logic and mathematics. Both mathematics and logic see each other as a part of themselves. They also assume their foundations as similar and many foundational concepts (such as truth, construction, computation) are the same. As mathematics is considered the more initial of the two, it will be the first focus.47 For the purposes of this chapter, I will 45

For example, Mach adapted his central concept of ―thought economy‖ from a minimum principle of parsimony to a much more complex optimization principle. 46 I am well aware that this is of course not necessarily the starting point of the reader. This is why in the previous part I tried to provide a historical-genetic account of the epistemological questions leading to this starting point. 47 As Wittgenstein noted (in F.P. Ramsey‘s exemplar of the ―Tractatus‖ 1922; 2003, p. 113) ―The beginning of logic presupposes calculation and so number.‖ Genetic considerations would agree with this logical result. It will nevertheless be possible to show that in such other ―tip of the iceberg‖ areas of science as logic or physics, the observations are probably similar.

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additionally focus on the question of the ―very, very tip of the iceberg‖, so on the process of how new mathematics is developed. This narrow initial focus will then successively be broadened by adding examples from other sciences and finally from the development of the intuitive process in childhood. These ideas are then applied to the broader empirical contexts of facts concerning intuition. The probably most known case of intuition in science and one described explicitly for psychologists48 is certainly Poincaré‘s experience on ―the genesis of mathematical discovery‖ (Poincaré 1908; 2003, p. 46) during discovering a new type of mathematical functions.49 ―I shall say for example, that I have found a theorem under such circumstances. This theorem will have a barbarous name, unfamiliar to many, but that is unimportant; what is of interest for the psychologist is not the theorem, but the circumstances.‖ Poincaré originally wrote the article for Alfred Binet‘s L‟année Psychologique.50 ―A mathematical demonstration is not a simple juxtaposition of syllogisms; it consists of syllogisms placed in a certain order, and the order in which these elements are placed is much more important than the elements themselves. If I have the feeling, so to speak the intuition, of this order, so that I can perceive the whole of the argument at a glance, I need no longer be afraid of forgetting one of the elements; each of them will place itself naturally in the position prepared for it, without my having to make any effort of memory.51 […] Discovery, as I have said, is selection. But this is perhaps not the right word. It suggests a purchaser who has been shown a large number of samples, and examines them one after the other in order to make his selection. In our case the samples would be so numerous that a whole life would not give sufficient time to examine them. Things do not happen in this way. Unfruitful combinations do not so much as present themselves to the mind of the discoverer. In the field of his consciousness there never appear any but really useful combinations, and some that he rejects, which, however, partake to some extent of the character of useful combinations. Everything happens as if the discoverer were a second examiner who had only 48

Materialists (and behaviourists in particular in psychology) may object that many of the following observations are taken from introspection and not from a third-person perspective. This objection will not concern us here for several reasons: First, this article is explicitly based on a different epistemology. This epistemology considers no differences between the first and the third person perspective in their respective physical and mathematical intuitions, i.e. the measurements, calculations and apparatus, which the so called third-person perspective is mainly built upon. This is basically the same criticism, which the proponents of the third-person perspective in psychology use in the first place, only here it is applied metapsychological. As both epistemologies are ―aimed‖ at dissolving an inherently dualist concept of consciousness, at least part of the way might be less different than it seems initially. This is because we secondly want to observe inconsistencies of the concept of consciousness by introspection, so seen from its own perspective (in this respect it confirms to the third-person perspective). The view I present here is internally consistent and (as I will argue) observes more of intuitive phenomena than a materialistic perspective. 49 It is interesting to note here that Poincaré had the idea partly from a survey developed by the psychologists of the Rousseau Institute in Geneva, Flournoy and Claparède. They also had a close contact with Binet. Claparède‘s student and successor at the institute was Piaget (for details and the relation to Mach, see Siemsen 2010b). Claparède then organized a series of lectures in 1937 at the Centre de Synthèse on invention in various sciences to which Poincaré‘s student and successor Hadamard attended. Inspired from this, Hadamard (1945) continued more detailed research in Poincaré‘s direction. Many of the following examples are taken from this work. 50 Binet made an interesting reply to the article in which he basically states that Poincaré‘s description is not generalizable. He is not able to immediately synthesize Poincaré‘s results with his psychological concepts, although at the time he had developed concepts, which would have made this possible, such as his concept of ―mental orthopaedics‖. Unfortunately, Binet dies shortly afterwards. See also Siemsen (2010b). 51 Poincaré in principle here describes a mathematical gestalt formation process. The importance of the gestalt concept for understanding this intuitive process will be discussed later.

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to interrogate candidates declared eligible after passing a preliminary test.― (Poincaré 2003, pp. 49-52) Then Poincaré introspectively describes his experiences: ―Every day I sat down at my table and spent an hour or two trying a great number of combinations, and I arrived at no result. One night I took some black coffee, contrary to my custom, and was unable to sleep. A host of ideas kept surging in my head; I could almost feel them jostling one another, until two of them coalesced, so to speak, to form a stable combination. […] Then I wished to represent these [Fuchsian] functions by the quotient of two series. This idea was perfectly conscious and deliberate; I was guided by the analogy with elliptical functions. […] At this moment I left Caen […] The incidents of the journey made me forget my mathematical work. When we arrived at Coutances, we got into a break to go for a drive, and, just as I put my foot on the step, the idea came to me, though nothing in my former thoughts seemed to have prepared me for it, that the transformations I had used to define Fuchsian functions were identical with those of non-Euclidean geometry. […]‖ (Poincaré 2003, pp. 52/53) ―I then began to study arithmetical questions without any great apparent result, and without suspecting that they could have the least connection with my previous researches. Disgusted at my want of success, I went away to spend a few days at the seaside, and thought of entirely different things. One day, as I was walking on the cliff, the idea came to me, again with the same characteristics of conciseness, suddenness, and immediate certainty, that arithmetical transformations of indefinite ternary quadratic forms are identical with those of non-Euclidean geometry. […]‖ (Poincaré 2003, pp. 53/54) ―One is at once struck by these appearances of sudden illumination, obvious indications of a long course of previous unconscious work. The part played by this unconscious work in mathematical discovery seems to me indisputable, and we shall find traces of it in other cases where it is less evident.‖ (Poincaré 2003, p. 55) Before coming to other examples, some general observations can be drawn from Poincaré‘s description.52 First of all, in Poincaré‘s description a substantial part of his thoughts are not accessible to his consciousness, even though he obviously focussed his conscious observation on his thoughts as intensively as he could. Secondly, by this focus one can observe that there are different unconscious processes (the one with the coffee is different from the ―sudden ideas‖). Thirdly, Poincaré is quite clear about the fact that this unconscious process cannot be explained by giving it an ―automatic‖ character. It involves interpretation and intuitions about new, i.e. previously unknown ideas. It is a creative process. It is automatic in the sense that it is seemingly not consciously wilful, but not automatic in the sense of a machine or computer. The question therefore is not one of mechanicism, but of the concepts of ―will‖ and ―consciousness‖. Finally, these unconscious processes are not ―rational‖, but guided by patterns from previous often also unconscious experiences. It is a process of adaptation of thoughts to the facts and to each other, i.e. fitting patterns to the facts into one single ―whole‖. 52

The dependency of these observations on the meaning of consciousness itself became very clear from the observations before. The genetic way of analysis proceeds from this locally defined ―given‖ and then compares it to observations from other perspectives. We will see then that (maybe unexpectedly) the choice of this specific starting point does not pose major difficulties in the generalization of the description. The epistemic claim here is of course only that of one ―possible‖ description. If other starting points yield other descriptions will not be elaborated here, but as I chose the starting point deliberately opposite from the expected result, it would at least be difficult to find.

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Can this intriguing experience of Poincaré be generalized for mathematics? Hadamard basically agrees that it can and gives several examples from his own experience. He systematically interviewed many eminent mathematicians of his time and found many similar experiences and only few divergent ones. Also historically, he finds mathematicians with similar experiences, for instance Gauss. As one more independent example, who had asked himself the same question, but wrote down the answer himself I will quote E.W. Beth. Beth additionally enquired independently on the related genetic questions. In his joint book with Piaget ―Mathematical Epistemology and Psychology‖53, he in principle agrees with Poincaré‘s description, but adds a more long-term process: ―I have noticed that a mathematical problem which interests me gives rise to three successive reactions, as follows: a first reaction, which is instantaneous; a second reaction after a few days; a third belated reaction only after several months.‖ (Beth & Piaget 1966, p. 90) For him mainly the third reaction leads to the Poincarétian process. Apart from Poincaré, another example of intuition in mathematics is outstanding. On the one hand it is very old and on the other, it leads to a more general view on the question of intuition in science: Archimedes (1972, p. 383) in his ―Method― describes for Eratosthenes the ―[…] peculiarity of a certain method, by which it will be possible for you to get a start to enable you to investigate some of the problems in mathematics by means of mechanics. The procedure is, I am persuaded, no less useful even for the proof of the theorems themselves; for certain things first came clear to me by a mechanical method, although they had to be demonstrated by geometry afterwards because their investigation by the said method did not furnish an actual demonstration. But it is of course easier, when we have previously acquired, by the method, some knowledge of the questions, to supply the proof than it is to find it without any previous knowledge.― Archimedes thereby uses an empirical (heuristic) method, which became a continuous inspiration for mathematicians (see Hadamard 1945). Georg Polya even elaborated this method towards a general methodology of finding mathematical theorems. Nevertheless, maybe Archimedes‘ observation points to something more: an intricate genetic relation between the origins of sensation, of physics and of mathematics. One of these relations has been researched in detail by Mach,54 between the physiological and psychological origins of the perception of space, of the movement and measurement of bodies (and our body) in space and of geometry.55 Archimedes‘ example thus provides an idea for 53

Interestingly, in the book, Beth takes a strong recourse to Mach and his epistemology, while Piaget in the same book describes the genesis of the relation between logic and psychology, but without any mention of Mach‘s ideas. 54 Another one, namely the genetic origins of algebra, can be found in an early article of gestalt psychology from Wertheimer (1912), which will be cited in some length later. 55 What are the sensational origins of the basic intuitions of the geometer? Poincaré and Mach both researched on this question. Late in his life, Mach published a series of articles on this in ―The Monist‖ (1901-1903), which were republished as ―Space and Geometry‖ (Mach 1906b) and in slightly adapted form in his Analysis of Sensations. Also Poincaré had published an article ―On the Foundations of Geometry‖ in ―The Monist‖ in 1898. Mach (1901) mentions in a footnote that his article ―rests on researches begun almost forty years ago‖ and that they are ―at variance with the views on sensible space‖ of Poincaré. Mach still agrees with Poincaré‘s ―subsequent discussions‖ though. Poincaré (1898, p. 1) thinks about how a ―single immovable eye‖ could give us the notion of space and from this deduces that the notion of space ―is built up by the mind from elements which pre-exist in it.‖ Mach (1914) instead assumes that the motor experience of space is genetically more basic than the visual sensations (especially concerning the orientational sensations of the inner ear, muscular, tactile and haptic sensations). ―All systems of space-sensation, however different they may be, are connected by a common

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two lines of thought: a) The relation between physics and mathematics as sciences and b) the question of multiple methods of thinking in different sciences and in science in general.

Methods of Thinking in Science Before the question, if the ideas in mathematics can be generalized for physics and even more to thought in general, I will first elaborate, if different methods of thought ―train‖ scientists to think in a specific way, but not another, and if such specialization is necessary for science or for science education.56 Hadamard (1945, pp. 100) already provides a whole chapter on the topic on ―Different Kinds of Mathematical Minds‖. For instance he follows Poincaré‘s distinction between geometrically and algebraically thinking mathematicians as well as distinguishing intuitive and logical mathematicians. But these distinctions do not only concern their preferred field of work and of elaboration, but even the ―type‖ of proofs they would find. Hadamard describes this, for instance for Poincaré and Hermite. Poincaré‘s proofs were always immediately intelligible in their genesis, i.e. how Poincaré had come to his idea. Of his teacher Hermite, Hadamard (1945, p. 109) remembers, that he on the contrary seems to have been so intuitive, that ―the accuracy [of his results] was certain, but whose origin in his brain and way of discovery he did not explain and we could not guess.‖ The cognitive gap to his way of thinking was seemingly large57: ―Methods always seemed to be born in his mind in some mysterious ways.‖ Hadamard describes even more extreme cases, such as Fermat‘s theorem. In a posthumously discovered note, Fermat had stated that he could prove a specific theorem, which became one of the most famous puzzles in mathematics ever. It was actually proven more than 350 years later. A similar case is Galois (Hadamard 1945, pp. 110), who proved a theorem (shortly after which he died) requiring mathematical concepts, which at his time was not even remotely invented. Similar examples can also be found between different sciences, which promote different methods of thought, such as the natural sciences versus the social sciences.

associative link, – the movements which they serve to guide.‖ Poincaré‘s ―immovable eye‖ is therefore for Mach not a thought experiment, but a fiction, which misses the main genetic questions. For instance Mach experimentally details the connection between the motorical apparatus of the eye, without which Poincaré‘s ―immovable eye‖ could not adjust its lens to see anything in the first place. The biologically ―given‖ for Mach are for instance the asymmetries in perception between ―up‖ and ―down‖, ―far‖ and ―near‖ and – a little less asymmetrical but also slightly so – ―left‖ and ―right‖. ―At the first moment of sight, all the associations connected with the optical process, which may be utilized intellectually, are wanting.‖ (Mach 1905, p. 111) Visual sensations gain their seeming dominance only later in childhood. Our Euclidean heritage for instance gives us a strong intuition of the dominance of visual sensation in geometry. Mach (1914, p. 112) notices this intuitive bias towards the visual, which makes it so difficult to imagine how blind geometers think: ―Even so acute a mind as Diderot‘s can fall on occasion into the strange error of denying the blind any spatial imagination.‖ Later Uexkuell (1957) has experimentally investigated the genetic question of the development of human spatial sensations in detail in relation to animals. As can be seen from the relation between Poincaré and Mach, the examples in this article have a more intricate genetic relationship then it may initially seem. 56 The answer is slightly different as the starting point is different and therefore, the effects in education are more immediate. This will be briefly elaborated at the end of the article. 57 This relates to a specific question of genetic enquiry, namely the replicability of ideas. If one does not understand an idea, looking into how the idea was historically developed (including the difficulties) tends to be a good approach. Also this is a central question for the popularization of science (in the sense that everybody should be able to understand scientific ideas, see Siemsen 2010a). It is a basic question for science education. The basic hypothesis is that one can teach everything, but maybe we have not found a good way to teach for many things. For this one might need to look more closely into the intuitive ways of learning.

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Are these phenomena ―given‖, or just an unintended and hitherto not explicitly analyzed by-product of the development of science? Can methods (and using multiple methods) be specifically trained? And if so, are there advantages of such training? Titchener was one of the first, who in psychology tried such training in an auto-education experiment (Titchener 1909, p. 98). He trained himself to think in concrete rather than abstract images, because he thought that visual images would help him to avoid becoming too rigid and metaphysical in his way of thinking.58 He found that he achieved quite some success with this behavioural therapy. It is hereby not so much interesting what he trained, but that it was possible to train one‘s intuition regarding scientific thought. What Titchener did in fact from the point of view taken here was training the method of his intuition. Therefore, it seems to be possible to do so even at later age (Titchener was already well into his scientific career when he tried).59 A similar account to this psychology of metaphysics was given by the geologist Thomas C. Chamberlin.60 In an article for Science (1890), he proposed a method of deliberately pursuing ―multiple hypotheses‖ in order to avoid premature explanation ―when it runs before a serious inquiry into the phenomenon itself. […] The moment one has offered an original explanation for a phenomenon which seems satisfactory, that moment affection for his intellectual child springs into existence. […] There is an unconscious selection and magnifying of the phenomena that fall into harmony with the theory and support it and an unconscious neglect of those that fail of coincidence. There springs up, also, an unconscious pressing of the theory to make it fit the facts, and a pressing of the facts to make them fit the theory. […] Dust and chaff are mingled with the grain in what should be a winnowing process.‖ But for Chamberlin, this does not speak against the use of theory without which facts collected become ―dead‖ and ―unmeaning‖. It rather argues for a better process of the two aspects. When facts are sought and chosen, there are two types: the initial, open search of all aspects of phenomena and the later, experimental search along the line of specific questions and hypotheses. ―[The multiple working hypotheses method] differs from the former method in the multiple character of its genetic conceptions and of its tentative interpretations.‖ Finally, Chamberlin adds a very Machian result of his methodological suggestion. ―The imperfections of our knowledge are more likely to be detected, for there will be less confidence in its completeness in proportion as there is a broad comprehension of the possibilities of varied action, under similar circumstances and with similar appearances. So, also the imperfections of evidence as to the motives and purposes inspiring the action will become more discernable in proportion to the fullness of our conception of what the evidence should be to distinguish between action from the one or the other of possible motives.―61 58

Titchener (1909, p. 12) stated that ―More serious is the temptation to allow one‘s visual schemata to harden, to become rigid. I have constantly to fight against the tendency to premature systematisation.‖ 59 This idea is typical for Mach‘s epistemology. It is probably related to the strong long-term (again mostly intuitive) influence of Mach‘s ideas on Titchener, which his student Boring (1950, p. 399) described, especially on the ―systematic‖ (i.e. methodological) side. 60 Chamberlin was the intellectual ―competitor‖ of Lyell (see Oreskes 1999), who was the intellectual father of Darwin‘s ideas on geology and of the accumulation of many small changes over long periods of time resulting in seeming gestalt shifts. Chamberlin was inspired in his ideas by G.K. Gilbert, who – although a geologist – had a strong influence from ideas in physics and mathematics. The details of the genesis of the ideas concerned here still need detailed research. 61 Similar methods of accessing ideas from different parts of our intuition were developed by the Dadaists and Surrealists. There are for instance descriptions of deliberately creating ―automatic writings‖, not directed by a voluntary conscious reflection. These games were of course initially focussed on stimulating artistic creativity by

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From a Machian perspective, one should add that one can also apply multiple perspectives and multiple methods of inquiry or additional to multiple hypotheses instead. But all these will not ultimately make one‘s view impartial. Therefore one needs to be aware of the fact that science is always a narrowing of attention to a few aspects and maybe to the seemingly most important single one. ―Local‖ investigation in terms of pursuing a single hypothesis, a single perspective, a single method or even of teleological nature is possible and sometimes very productive, if one does not forget the limitations relative to the general frame of investigation. In this sense the investigation of this chapter is also one-sided, but necessarily and ―consciously‖ so. Even if sometimes the mentioning of its limitations may sound a bit tedious. Equally, when a theory is rejected, it tends to be rejected in totality (see also Kuhn 1962) including its ―good‖ parts. Later, the ―good‖ ideas are rediscovered, often under a different name, but with similar contents.62 Ideas can thus become conscious, unconscious and then conscious again. Actually, most ideas – even in science – have to be considered to be (and remain) unconscious, as Hayek (1975) noted.63 Also for individuals, ideas tend to become successively unconscious and intuitive, especially if acquired in one‘s youth. This is what Wittgenstein described with the metaphor of a ―ladder‖ one can ―throw away‖ after having climbed it.64 But if one ―throws away‖ the ladder, the next people cannot follow anymore. The genetic origins of one‘s ideas become hidden. One does not tend to retrace one‘s steps in order to find the origin of potential mistakes in intuition. This as well can happen with the various influences of fundamental ideas. Nevertheless, it seems that this phenomenon does not apply to all ideas in a similar way. Even for fundamental epistemological ideas, there are strong differences. These differences have to do with the closeness of the ideas to the phenomenal or sensational (and genetically ―early‖) level of experience.65 If one compares for instance Kant and Mach, the former is certainly remembered more consciously with his ideas, while even strong ―Machians‖ often do not later remember Mach‘s influence. For instance, Einstein was, as we will see, strongly influenced by Mach in his youth. But as he told to his friend Besso in 1948 (Speziali 1972, Doc. 153): ―Now, as far as Mach‘s influence on my development is concerned, it was certainly great. […] How far [Mach‘s writings] influenced my own work is, to be honest, not clear to me. In so far as I can be aware, the immediate influence of D. Hume on me was greater. […] However, as I said, I am not in a position to analyze what is anchored in unconscious thought.‖ following ―wild‖ associations. Nevertheless, the method of using games later led to a focus of ―unlocking‖ unconscious ideas. The applications of such methods in psychology, such as the Rorschach test, are well known. 62 Examples will be elaborated in the following, for instance for the concepts of ―mneme‖ and ―meme‖ and the concepts of ―gestalt‖ and ―emergence‖. 63 The mention of Hayek is not coincidental here. He is known as an economist, but first studied psychology and wrote one of his earliest works ―The Sensory Order – An Inquiry into the Foundations of Theoretical Psychology‖ based ―particularly‖ on Mach‘s ideas (Hayek 1952; 1963, p. vi). 64 Wittgenstein (1922, 6.54): ―My propositions [in the Tractatus] serve as elucidations in the following way: anyone who understand me eventually recognizes them as nonsensical, when he has used them – as steps – to climb up beyond them. (He must, so to speak, throw away the ladder after he has climbed up it.) He must transcend these propositions, and then he will see the world aright.‖ Basically, Wittgenstein is thereby stating that logically speaking, the Tractatus is superfluous, while genetically, it is not. In this sense, the genesis process needs to be considered to be always prior to logic. The changing of world views is for instance not independent from metapsychological questions, such as the role of crutches or of intuition in the process. 65 The reasons will be elaborated in more detail later.

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Intuition in Physics After looking at the methodology of science in general, we shall now return to the second question, which Archimedes example poses: namely the applicability of the ideas on the psychology of invention in the mathematical field to physics and from there to other sciences and to thinking in general. For this I will turn to the person, who is regarded as the most prominent inventor in modern physics, namely Albert Einstein. Einstein (1916, p. 102) gives a detailed example of this type of intuitive influence. He commented in his obituary to Mach regarding the view of some other physicists, such as Planck: ―I think that even those who think of themselves as enemies of Mach, don‘t remember how much of Mach‘s approach they have – so to speak – imbibed with their mother‘s milk.‖66 Einstein (1916, p. 102/103) continues on Mach‘s method to train scientists against the trappings of intuition ―It is therefore no idle play, if we become trained to analyze the long-time prevalent concepts and to show, of which circumstances their eligibility and usefulness depends upon, how they have grown in detail out of the conditions of experience. Thereby, their excessive authority is broken.‖ After that, Einstein gives examples, how Mach helped him to break the ―excessive authority‖ of Newton‘s notions of absolute space and time. In a letter to Hadamard (1945, p. 142/143) Einstein reflects on intuition: ―[…] the desire to arrive finally at logically connected concepts is the emotional basis of this rather vague play with the above mentioned elements. [...] this combinatory play seems to be the essential feature in productive thought - before there is any connection with logical construction […] The above mentioned elements are, in my case, of visual and some of muscular type. Conventional words or other signs have to be sought laboriously only in a secondary stage, when the mentioned associative play is sufficiently established and can be reproduced at will. According to what has been said, the play with the mentioned elements is aimed to be analogous to certain logical connections one is searching for. […] It seems to me that what you call full consciousness is a limit case, which can never be fully accomplished.‖ Einstein then mentions Wertheimer‘s research on what Einstein calls the ―distinction between mere associating or combining of reproducible elements and between understanding (―organisches Begreifen‖)‖. Einstein notes that he cannot judge the psychological analysis of Wertheimer. Hadamard agrees to this idea as an interesting point to follow (which will be done later in this chapter). According to Einstein‘s observations, the way how Hadamard phrases his questions (with consciousness as a well defined rational entity) are slightly misleading. Also Einstein sees logic as a cultural aim, which has little to do with the actual process of thought. He finds the focus on symbols, images67 and consciousness too narrow, hinting instead at sensations and 66 67

For an introspective example of what Einstein means with this expression, see Mautner later. This view is very similar to Mach‘s view on the relation between images and concepts and the relation between concepts in mathematics and in physics (Mach 1900). ―The concept is enigmatic for the reason that on the one hand it appears in a logical aspect as the most definite of psychical constructs; while on the other hand, in a psychological aspect, when we seek for its real visualisable contents, we discover a very hazy picture only. Now the latter, whatever its composition, must necessarily be an individual picture. The concept, however, is not a finished image, but a body of directions for testing some actually existing image with respect to certain properties, or of constructing some image from given properties. The definition of the concept, or the name of the concept, disengages a definite activity, a definite reaction which has a definite result. […] Just as a technical operation may serve for testing a given object […], or for constructing a new object […], so also a concept may be used in a testing or constructive sense. The concepts in mathematics are mostly of this character, whereas the

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especially motor sensations. This difference, otherwise not mentioned by any of the mathematicians, is probably due to the more empirical nature of physical investigation, even in such theoretical areas as Einstein‘s. His observation is insofar important, as it provides a direction towards the distinction between empirical sensations and the more metaphysical adaptation of thoughts to each other. This difference also has implications for the methodological question of forming the intuition of what physics is in the first place. If as part of a methodology, one tends to repeat metaphysical thought processes, one might for instance gain the intuition that they precede empirical thought processes. Additionally, genetically early processes of sensation, such as motor sensations may ―disappear‖ completely into the unconscious. This might happen for mathematicians, but probably not as much for physicists, leading them to different introspective observations. Mathematicians would thus think they know physics, but actually remember it only in a sensationally reduced form. Empirically, it would not be the same. They look only at specific physical facts, but unconsciously neglect others. As an example, in the following I will repeat68 Einstein‘s selection of Mach‘s arguments here, as they illustrate a psychological view of what I will call ―naïve Newtonian physics‖69. William James‘ description of mistaking ―knowledge of‖ and ―knowledge about‖ and the differentiation of ―true‖ and ―apparent‖ have their psychological origins here. ―We must suppose that the change in the point of view from which the system of the world is regarded which was initiated by Copernicus, left deep traces in the thought of Galileo and Newton. But while Galileo, in his theory of the tides, quite naively chose the sphere of the fixed stars as the basis of a new system of co-ordinates, we see doubts expressed by Newton as to whether a given fixed star is at rest only apparently or really (Principia, 1687, p. 11). This appeared to him to cause the difficulty of distinguishing between true (absolute) and apparent (relative) motion. Thereby, he was also impelled to set up the conception of absolute space.‖ Mach (1883; 1976, p. 223) then cites Newton: ―But how we are to collect the true [absolute] motions from their causes, effects, and apparent [relative; dependent on the observer] differences, and vice versa; how from the motions, either true or apparent, we may come to the knowledge of their causes and effects shall be explained more at large in the following Tract.‖ Mach adds that these words give the intuitive ―impression that Newton was glad to be able to pass over to less precarious questions that could be tested by experience‖. Mach continues in order to criticize this point of view of Newton (1883; 1976, p. 224) ―When we say a body K alters its direction and velocity solely through the influence of another body K‟, we have asserted a conception that is impossible to come at unless other concepts of physics which cannot create its objects, but finds them already present in nature, are ordinarily of the first-mentioned kind. But even in mathematics, figures arise independently of the inquirer, furnishing material for subsequent investigation; and in physics also concepts are constructed for economical reasons. But the fact that mathematics operates in the main with constructions of its own creation, containing only that which it itself has put into them, whilst physics must wait before it finds out how far the objects of nature answer to its concepts, – this fact is the foundation of the logical superiority of mathematics.‖ 68 The first part on Newton is actually taken from a later edition of the Mechanics than the one used by Einstein. It contains an additional interesting hint from Mach on intuitive notions in science (e.g. Newton‘s ―Principia‖). 69 The term has been used extensively by several prominent psychologists, for instance by Dennett (1991). One should note here that for Mach, error is an integral part of the knowledge process (which by and large is not additive, but gestaltist). Therefore ―naïve‖ is always relative to another view, which is also necessarily inherently erroneous. The naivité is therefore not meant pejoratively. Mach (1883; 1976) in a defence against Husserl‘s version of logically based phenomenalism emphasizes that he sees ―vulgar thought‖ clearly superior to scholarly metaphysical speculation.

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bodies A, B, C… are present with reference to which the motion of the body K has been estimated. In reality, therefore, we are simply cognisant of a relation of the body K to A, B, C…. If now we suddenly neglect A, B, C… and attempt to speak of the deportment of the body K in absolute space, we implicate ourselves in a twofold error. In the first place, we cannot know how K would act in the absence of A, B, C…; and in the second place, every means would be wanting of forming a judgement of the behaviour of K and of putting to the test what we had predicated – which latter therefore would be bereft of all scientific significance. […] The motion of a body K can only be estimated by reference to other bodies A, B, C…. But since we always have at our disposal a sufficient number of bodies, that are as respects each other relatively fixed, or only slowly change their positions, we are, in such reference, restricted to no one definite body and can alternately leave out of account now this one and now that one. In this way the conviction arose that these bodies are indifferent generally.― Mach then shows that of course the relation between K and A, B, C… might only be collateral (i.e. a correlation) dependent on a medium (―filling space‖) on which K and A, B, C… jointly depend. But this medium has not been found by experiment, nor does Newton ―entertain the idea‖. Mach here details the scientific psychological process that Newton followed. Interestingly, this process was not a logical necessity. Mach shows that Newton could have thought otherwise. Scientific descriptions are thereby not arbitrary, but they are not determined either. They depend on (often intuitive) assumptions.

Intuition in Science How exactly do such intuitive assumptions come about? A very detailed account on the intuitive effect of Mach‘s ideas was given by Fritz Mautner70: ―Mach himself has reminded me [around 1895] that as a young student in Prague, […] Mach let me read his lecture on the ―Conservation of Work‖ and I received an impetus, which must have continued for decades without my knowledge. Because when I read this lecture nearly thirty years later, without remembering its first reading, I was astonished about its critical linguistics anticipations and I was instantly of the decided opinion that I had already once assimilated these forceful verbalizations. Mach‘s positivistic philosophy of science – which does not hate the metaphysical words, like Auguste Comte, but psychologically describes, so explains them – had continued to have an effect in my subconsciousness.‖ (Mautner, cited in Thiele 1978, p. 158) In the example of Mautner (as Einstein had noted, there are many more similar examples, especially concerning Mach‘s epistemological influence) one can see that further to Poincaré‘s and Hadamard‘s examples, unconscious influences in science can last over long time, especially regarding ideas, which are acquired during youth. This process often concerns the initial formation of very general gestalt patterns, which we can describe in the sense of Mach as world views. Examples of such ―initiatory‖ experiences include Mach himself, Eino Kaila, or his latest successor Kaarle Kurki-Suonio (see Siemsen & Siemsen 2009, Siemsen 2010d). Because of the long time-frame involved over the lifespan of a researcher, these long-term processes are rarely reported. 70

Mautner is regarded as one of the initiators of linguistic critique (actually critical linguistics, but this terminology has today acquired a different meaning), which became very influential in philosophy. Mautner has been a basis for the ideas of Wittgenstein (see Visser 2002) and through him on the logical positivism of the Vienna Circle.

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As the examples show, intuition in science is used in several contexts. It initially describes the intuitive process in developing scientific thought. But, intuition is also used as an analytic tool for the psychology of science on the meta-level in the sense of a psychological description of the genesis of ideas and as a methodological critique of the excessive authority of long-used concepts. Because of these two uses, it will therefore be interesting to have a closer look into what kind of ideas tend to have this intuitive effect. In the case of Mach, the conceptual gestalts of fundamental concepts are changed. This in turn requires the change of all subsequent concepts. So the outcome is a fundamental deconstruction and reconstruction of a whole set of scientific ideas. This process can require several generations of researchers. Only from the end of the process results a new ―shiny‖ theory. From the genetic point of view, the process of initial scientific concept formation – the status nascendi71 – is the most important and decisive part of the whole process, even though the most impressive developments tend to happen later. Seemingly small metaphysical conventions in the beginning, such as Newton‘s absolute and independent space and time, can have large effects on the interpretation of a theory. As the intuitive processes are unconscious by definition, information for a psychological analysis on the status nascendi is becoming increasingly difficult with time. Existing concepts are intuitively ―engrained‖ (in the sense of James) by frequent repetition over the life of a scientist. This process is then further ―intuitivized‖ by his students, who often do not share the initiatory status nascendi process as an experience, but copy the results tacitly, like an apprentice observing the master. This is increasingly hiding the intuitive process of the status nascendi for internal as well as external analysis of concepts. The genetic analysis thus often resembles a process of re-engineering (backwards engineering) where the process has to be ―reinvented‖ from the result.72 As this opens several possible paths and time-layers, several points of view have to be used simultaneously and their results combined into a consistent whole. This methodology also requires a deliberate training of one‘s intuition for keeping the habits of thoughts open to several alternatives. As we saw in the example of Titchener, one can seemingly train the habit (intuitive method) of one‘s own thoughts in this methodological direction.

The Genesis of Consciousness In the letter to Hadamard mentioned above, Einstein had seen Hadamard‘s concept of consciousness as a ―limit case which can never be fully accomplished‖. Our thoughts adapt to an (culturally provided) ―ideal‖, which is only achieved in retrospect. Thus, contrary to Aristotle‘s initial assumption (in De Anima) that judgements are logical, logic denotes the dependency of judgements from each other and makes this dependency explicit. Judgements themselves instead are made intuitively. Their relationships are then constructed in retrospect 71

The status nascendi is called ―tentative stage‖ by Chamberlin (1890) ―in which the affections enter with their binding influence‖. 72 People who think that this is impossible should remember that all of biological research into evolution is based on such a genetic process. Often one has to assume the most probable path and keep searching for more clues into the direction as well as looking for clues excluding other possible paths of development. The seemingly most direct paths from the perspective in retrospect are often not the most direct from a genetic perspective. Mach (1886; 1919, p. 85) for instance observes that our own experience can mislead us in a genetic analysis: ―It is natural for the learner to proceed from the simpler to the more complex. Nature does not necessarily have to go the same way.‖

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to become conscious. Therefore, in the famous Libet experiment, people show an activation of the muscles before they consciously ―decide‖ to press a button (see for instance Carter 2002). Judgement is only seemingly the most conscious of thought activities. It is the activity happening just after it, which becomes conscious. There is interconnectivity of conscious and unconscious, even in judgement. A metaphor often used to describe consciousness (for instance by Hobbes, Galton, the Würzburg school of psychology) is the idea of ―King and Court‖. In it, the self is the omniscient monarch who judges over the ideas, which his (unconscious) advisors let pass as important. Thus the pre-judgement is done by a number of (unconscious) public servants of the royal court. Although the idea of an omniscient monarch became a bit unfashionable in democratic societies, it still persists in current psychological literature in the Platonist/Marxist variant of the omniscient central planner (for instance Donald 2001). Nevertheless, one should be careful with this metaphor. Empirically, the planners with the best theoretical intentions were often the worst as politicians. On the contrary, most ―successful‖ managers or governors are not conscious of why they do what they do.73 They just do the ―right‖ thing (which can then prove to be wrong in retrospect). If, on the contrary, theoreticians are successful as politicians, it is often difficult to analyze why. For instance the mathematician Spiru Haret74 is known as a very good minister of education in Romania, but he never really reflected in writing on the question why and from where he developed his ideas. Hayek (1964) has elaborated that, if knowledge is relative and mostly unconscious, the idea of an omniscient personally detached decision maker is not consistent with the facts, neither in law, nor in economics, nor in psychology. The idea is also fundamentally not consistent with a concept of knowledge based on evolutionary theory. Even if one takes for consciousness the metaphor of a stage, where the actors appear closer or further away (as for instance Taine does), the metaphor requires a script and a director. Thereby again, consciousness is indirectly assumed as a (self-contradictory) prerequisite to explain consciousness. From this perspective, symbols are also not a prerequisite, but a result of our concept of consciousness. Hadamard (1945, p. 89) mentions an example, which the economist Sidgwick reported to the International Congress of Experimental Psychology in 1892. In his reasoning on economic questions, ―the images were often curiously arbitrary and sometimes almost undecipherably symbolic. For example, it took him a long time to discover that an odd, symbolic image which accompanied the word ‗value‘ was a faint, partial image of a man putting something on a scale‖. Thus the symbol of the concept of ―value‖ was constructed from the sensations of using (or observing somebody to use) a scale. If we go back into childhood, our concept of consciousness might not exist in the form we are used to think about it. Our current concept is the result of a genetic adaptation process. We only cannot remember how sensations were before this process. The experience does not fit the conceptual frames of adults (in Western culture). For instance the deafblind Hellen Keller wrote to William James about her experiences before her ―‘consciousness‘ was awakened by instruction.‖75 Mach (1905) states that ―Every human discovers within himself, when waking up to his complete consciousness, already a completed image of the world, to 73

Much of management literature then tries to provide an interpretation. He wrote his thesis in Paris on a question from the mathematics of Poincaré. 75 The passage is indirectly quoted by James (Perry 1935, p. 455) in his return letter. 74

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which accomplishment he did not at all willingly contribute to and which he accepts on the contrary as a gift from nature and of the civilization and as something immediately intelligible. This image was built up under the pressure of the practical life; extremely valuable, in this regard, it is inerasable and never ceases to act upon us, no matter which are the philosophical views that we will later adopt.‖ Consciousness is thus the result of ones‘ initial world view, not the origin of it.76 Maybe it is not so much judgement, as the continuity of sensations and the process of attention on which of them to focus on, which gives the impression of a phenomenon of consciousness. Hadamard (1945, p. 65) quotes a description from Rodin: ―Till the end of his task, it is necessary for [the sculptor] to maintain energetically, in the full light of his consciousness, his global idea, so as to reconduct unceasingly to it and closely connect with it the smallest details of his work. And this cannot be done without a severe strain of thought.‖ As one can see from this description, the gestalt process is hidden, while the role of attention in the gestalt process is prominent. But also attention can be guided unconsciously. However we turn the concept of consciousness, unconscious intuition always plays a strong role in it.

Adaptive Judgement What is judgement then, if not conscious logical thought? For analyzing this, we shall again deliberately shift our perspective in order to see, if the results gained from cases of scientific thought are also consistent with the general and especially genetically early development of thought. For Mach (1896, p. 156), science is only a specific form of continuation of what goes on in daily life: ―The adaptation of thoughts to facts [and the thoughts to each other] is the aim of all scientific research. In this, science only deliberately and consciously pursues what in daily life goes on unnoticed and of its own accord.‖ Both, scientific thought and the thought of daily life are already constructed by consciousness. ―As soon as we become capable of self-observation, we find our thoughts, in large measure, already adjusted to the facts. [But] almost every new fact necessitates a new adaptation, which finds its expression in the operation known as judgement.‖ Mach (1896, p. 156/157) gives an example he observed with his three year old child. ―This process of judgement is easily followed in children. A child, on its first visit from the town to the country, strays, for instance, into a large meadow, looks about, and says wonderingly: ―We are in a ball. The world is a blue ball.‖ [In this case actually a physiological fact is stated, which of course was realized only belatedly. The old scientific astronomy begins with such naïve statements, which it deems to be physical.] Here we have two judgements. What is the process accompanying their formation? In the first instance, the existing sensual conception77 of ―us‖ (the accompanying group) is complemented by the – also already existing – concept of a sphere to a joint image.78 Likewise, in the second 76

Our limited memory of our early childhood might be a result of many experiences (clusters of sensual elements) not fitting to the conceptual gestalts formed later. 77 I have adapted the translation in several instances. The original used by Mach here is ―sinnliche Vorstellung‖, which for instance could also be translated as ―sensual perception‖ or ―sensual image‖. The translation depends on the different empirical meaning of the concepts used. My usage of ―concept‖ here is specific and unusual, but empirically relatively precise in contrast to a more metaphysical use. The linguistic (translation) problems involved in concepts close to consciousness will be discussed in more detail later. 78 Mach as the originator of the idea of gestalt psychology (via von Ehrenfels, Wertheimer and Köhler, see Ash 1995) describes here the formation of a new gestalt from different parts: two existing concepts and an ―analogous

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judgement, the image of the ―world‖ (i.e. all objects in the environment) is supplemented with the concept of an enveloping blue ball (the image of which must also have been present, since otherwise the name for it would have been wanting). A judgement is thus always the supplementing of a sensual conception to the more complete representation of a sensual fact. […] When the process is over and the image became familiar, making its appearance in consciousness as a ready concept, then we have no longer to do with a judgement but merely with a simple element of memory. Natural science and mathematics mainly owe their growth to the forming of such ―intuitive knowledge‖ (as Locke calls them).‖79 ―Intuitive knowledge […] impresses itself upon the memory and makes its appearance in the form of complementing recollections which spontaneously complements every sensual fact. But the facts are not all alike. The common parts of the different cases of sensual concepts are strengthened, and this results in the principle of the broadest possible generalization or continuity in memory.‖ At the same time, memory also has to ―sufficiently differentiate‖ between different concepts. ―A considerable portion of mental adaptation takes place unconsciously and involuntarily, under the natural guidance of the sensual facts. If this adaptation has been sufficiently comprehensive to comply with the vast majority of the occurring facts, and subsequently we come upon a fact which runs violently counter to our customary course of thoughts, without us being able to discover at once the determinative factor likely to lead to a new differentiation, then a problem arises. The new, unusual, and marvellous acts as a stimulus, which irresistibly attracts the attention. Practical considerations, or even bare intellectual discomfort, may enable the will to remove the inconsistency, to the new adaptation of thoughts. Thus arises the deliberate adaptation of thoughts, scientific research.‖ (Mach 1896, p. 159/160) Thereby, Mach shows the continuity between the intuitive adaptation of thoughts in children and the consciously deliberate version in science. In science, this implies that only some part of the adaptation is deliberate, i.e. the part on which our attention is focussed. It does not mean that all the process of thought adaptation involved thus becomes automatically conscious. On the contrary, a larger part remains unconscious and it is a continuous part of the process to try to make more parts accessible to conscious reflection and scrutiny. Otherwise, we ourselves as well as other people might not be able to notice and criticize these parts. The horror vacui kept people from accepting Aristarchos instead of Ptolemaios. Is there a horror psyche (the fear of losing oneself), when we need to leave our old beloved concept of consciousness? In a certain way it seems to be so, paradoxically because of our intuition and the counterintuitivity of this notion.

5. METAPSYCHICS In principle, the Copernican and the Darwinian revolution have changed the erkenntnistheoretical nature of knowledge, although neither Copernicus nor Darwin have been aware of all such consequences of their initial ideas. The Copernican world view finally showed (in its judgement‖ based on the observation of a new fact. The new fact is thereby integrated with the previous facts into a new thought economical gestalt image. 79 Locke: ―Certainty depends so wholly on this intuition, that, in the next degree of knowledge which I call demonstrative, this intuition is necessary in all the connexions of the intermediate ideas, without which we cannot attain knowledge and certainty.― (Essay, Chap II, 1. I.)

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Machian, i.e. post Newtonian interpretation) that empirically, one cannot define an absolute reference system, also not by defining any such system as god‘s thoughts. The ―final jurisdiction‖ over any scientific world view is empirical, not metaphysical.80 Similarly, Darwin‘s detailed synthesis of biological and geological facts exposed teleology as an anthropomorphic principle. Again, it was Mach who first brought the implications of the two together. He showed in a synthesis the psychological and erkenntnis-theoretical shift necessary for a less anthropomorphic and consistent world view, which would integrate physics, physiology, psychology and epistemology. He finally also integrated mathematics into this synthesis. From this final synthesis results the recognition of teleologies in fundamental concepts of mathematics. The intuitionists used this for their fundamental critique: for instance the tacit teleology of the principle of the excluded third (apart from ―true‖ and ―false‖) is not consistent with the facts of evolution. The simplifying assumption of the excluded third might be helpful in more efficiently constructing mathematics within limits (for instance for the concept of infinity). But the concept of the excluded third can certainly not be used for the foundation of psychology, especially concerning its genetic aspects in which the psychical is a result of Darwin‘s non-teleological evolution. As the following chapter will show, exactly this is still the case and needs to be erkenntnistheoretically addressed in psychology. It leads to a fundamentally different understanding of the concept of intuition. From the previous analysis we have seen that the most important epistemological distinction for Mach (1896, p. 156) is the one between sensual (empirical) conceptions and auxiliary (i.e. metaphysical) conceptions: ―All auxiliary conceptions, laws and formulae are but the quantitative regulation of my sensual conception.‖ This differentiation is not absolute, but relative. The more adapted the concepts become (through the process described above), the more difficult the differentiation between the empirical and the metaphysical part of a concept becomes. This in turn is the starting question for a genetic conceptual analysis. If we make the same distinction between sensual conceptions and auxiliary psychological conceptions, the latter of course cannot be described as metaphysical, but must be described as metapsychical. This conceptual differentiation is doubly important, because it also more specifically denotes the psychology of metaphysical construction. Depending on the epistemology used, the psychical sensual conceptions and the auxiliary psychological conceptions use physical and metaphysical concepts to a varying degree. Equally, physics (and mathematics) in turn uses sensual conceptions with their psychological meaning and makes use of metapsychical auxiliary descriptions (both mostly called indiscriminately ―intuitions‖). These meanings are often confused with current terminology. But as many examples from this chapter showed, a larger number of facts are thereby systematically overlooked. The whole phenomenon of intuition in science cannot be properly framed. As a result, many scientists assume that this phenomenon – even if they think it exists – cannot be scientifically described as it affects our description itself. They therefore conclude that one should not saw off the branch one is sitting on. But this ignorabimus (we cannot know) is not necessary. For such an inquiry one needs of course to find a freer position. The position shown by James and elaborated by Mach fulfils this criterion. From this position, many of the seemingly self-referential paradoxes suddenly appear as pseudoproblems.

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This does not exclude, that there are other areas of jurisdiction.

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In this sense, the following ideas are partly metapsychical. But they can claim to be less metapsychical and less metaphysical than most other ideas used in current psychology used as a theoretical explanation. Additionally, they are consciously metapsychical. They should only be considered as a possible reconstruction of psychology based on the previous analysis. They aim at making the conceptual distinction between the adaptation of the thoughts to the facts and the thoughts to each other easier. This I tried to do, based on a historical genetic analysis and a rigorous application of the economy of thought. From my current point of view, only three basic concepts are necessary for this reconstruction: sensation, gestalt and memory (meme). The other concepts are sub-processes (sub-gestalts) of these. This specific reconceptualization has the advantage, that one can much better distinguish between the empirical and the metapsychical (related to the psychological, in the sense of metaphysical as related to the physical) contents of psychological concepts. This conceptualization also provides for the main aspects of a genetic analysis. All these concepts already have a history in psychology, although they have never been synthesized in this form together. Nevertheless, the reconstruction should be regarded as only tentative and as such speculative. Other reconstructions are certainly possible when they are based on alternative conventions. Similar to this approach they should be based on a rigorous analysis: whichever are the basic concepts and which intuitive assumptions they are based upon. Intuitive assumptions equally need to be kept continuously genetically analyzable and not fixed a priori.

Sensations Mach in his ―Analysis‖ developed a more general concept of sensations. But it is not easy to change our intuitions of the concept of sensations in such a way that Mach‘s suggestion seems intuitively acceptable. As his intellectual successors in psychology Semon and von Ehrenfels note, one has to adapt the intuitive concept of sensations to Mach‘s concept by imagining the widest application of the concept. For Mach, sensations become a relation between the physical and the psychical. It is always seen as the whole relation, although temporary local analyses are possible. The only thing we know, the ―given‖ is, that there is a relation, although we do not know it a priori in its totality. In inquiry about colour we might intuitively begin at the body and not at the light source, in inquiry about the sound of a church bell we might start with the bell and not the bobbin and the bell ringer. When we become aware of our intuition that the body would have no colour without the light source, we become aware of the supposedly single sensation as actually an intricate cluster of many sensations. We become aware of its dependency on the physical and the understanding of the physical (i.e. metaphysical). Also the relation is not 81 always the same. The same physical facts can lead to different perceptual results. Different physical facts can lead to the same perceptions. For Mach, sensations can be analyzed into sensual elements, which are defined recursively (as gestalts building on each other). The most elemental is explicitly defined as such from current analytical perspective, not excluding that

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For conceptual purposes, ―perceptions‖ is here used in the sense in which many people use the concept of sensations: the psychical part of the psychophysical relation which we experience in ―conscious‖ introspection. The question of the relation of the concepts ―doing‖ and ―perceiving‖ shall not be further elaborated here, as it would require a more detailed analysis. It will be enough to say that for Mach, both are part of sensations.

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later the elements might become more detailed or change their conceptual meanings completely. As a result of the recursive definition, the same concept of sensations does not only concern the most elemental, but also complex constructed sensations. When one assumes therefore that the unconscious plays an important part in all thought processes on a general level, including the seemingly most conscious, rational or logical, can one also assume that unconscious thought is part of all ―levels‖ of thought? Is there really a ―gap‖ between ―high‖ and ―low‖ levels of thought or might this assumption be itself an illusion? What is the role of sensations in this? Do they belong (as many psychologists assumed) to the ―low‖ level psychological processes, while abstract scientific thought is a ―high‖ level process? Do these concepts still make sense after the observations from the prior investigations? These questions historically lead back to an intensively discussed question in psychology on the role of images in thought processes. The first psychological ―theory‖ we know of is probably the one from Aristotle, mostly written down in his De Anima (―On the Soul‖). It had and still has a profound influence on all theoretical thinking in psychology in Western culture. In it, Aristotle describes that before him ―Indeed the ancients go so far as to identify thinking and perceiving; e.g. Empedocles says 'For 'tis in respect of what is present that man's wit is increased', and again 'Whence it befalls them from time to time to think diverse thoughts', and Homer's phrase 'For suchlike is man's mind' means the same. They all look upon thinking as a bodily process like perceiving. 82 They hold that like is known as well as perceived by like , as I explained at the beginning of our discussion. Yet they ought at the same time to have accounted for error also; for it is more intimately connected with animal existence and the soul continues longer in the state of error than in that of truth. They cannot escape the dilemma: either (1) whatever seems is true (and there are some who accept this) or (2) error is contact with the unlike; for that is the opposite 83 of the knowing of like by like.‖ (Aristotle, book III, part 3) 82

As the concepts used here are not in common use anymore, but on the other hand I do not wish to adapt the translation, I will try to provide an interpretation: Aristotle‘s point is that his predecessors did not fundamentally distinguish between thinking and perceiving and therefore there is no possibility of error ―between‖ knowing and perceiving. ―Like‖ here is generalized from two meanings. On the one hand it is the humans themselves which are ―alike‖, including the observer who is also a human (in the sense of William James‘ question ―How Two Minds Can Know One Thing‖ from 1905c) in the sense of for instance (for Aristotle) an intelligent mind not belonging ―alike to all animals, and indeed not even to all human beings‖. On the other hand a person can perceive and know two things as alike (in the sense of William James‘ question ―The Knowing of Things Together‖ from 1895) in the sense of having at least one similar property. The non-intelligent mind for Aristotle errs more often and is not-like his own mind because of this difference, although he still assumes the perception to be similar. In the ―beginning of the discussion‖, Aristotle is referring to the question of monism and dualism: ―All, on the other hand, who looked to the fact that what has soul in it knows or perceives what is, identify soul with the principle or principles of Nature, according as they admit several such principles or one only. […] That is why […] all those who define the soul by its power of knowing make it either an element or constructed out of the elements. The language they all use is similar; like, they say, is known by like; as the soul knows everything, they construct it out of all the principles.‖ 83 As we saw before, is it not possible to make a consistent conceptual ―cut‖ between sensory perception and interpretation, unless one manages to distinguish between a visual and a tactile world view, which is scientifically not very consistent. The stick held into the water is neither bent nor straight for our sensations. The ―bent-ness‖ or ―straight-ness‖ depends on the reference system. Both are in this sense metaphysical, i.e. one adds experiential interpretations in the thoughts and the inconsistency of these naïve interpretations are the source of the error. Or a very small child, there is no inconsistency. Rousseau‘s Emile is already grown (Rousseau initially described this example of the stick in the water and the resulting epistemological question). In this sense, there is no absolute truth to be found in these different views, only consistency of the thoughts with the facts and consistency of the thoughts to each other. Then there is also no teleology in the sense of Darwin.

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From this perceived inconsistency, Aristotle (De Anima book III) starts to differentiate between perceiving, practical thinking, sensitive and deliberative imagining as well as judging. He sees them as a hierarchy of thought processes, beginning with the simplest animals (which can perceive and move) to the ―highest‖ form of logical judgement, which he observes only in humans. But he retains the idea of similarities between these concepts. ―Thinking both speculative and practical is regarded as akin to a form of perceiving; for in the one as well as the other the soul discriminates and is cognizant of something which is.‖ 84 In spite of this, Aristotle continues to drive an epistemological wedge between thinking and perceiving (De Anima, book III, part 3): ―Thinking is different from perceiving and is held to be in part imagination, in part judgement‖. ―For imagination is different from either perceiving or discursive thinking, though it is not found without sensation, or judgement without it. That this activity is not the same kind of thinking as judgement is obvious. For imagining lies within our own power whenever we wish (e.g. we can call up a picture, as in the practice of mnemonics by the use of mental images), but in forming opinions we are not free: we cannot escape the alternative of falsehood or truth.‖ Here, Aristotle has tacitly introduced a concept from logic/mathematics into psychology: the principle of the excluded third. As the intuitionists in mathematics have shown, this principle is a convention, i.e. it is not empirical, but a simplification, which makes calculation in mathematics easier. It is the introduction of a logical convention as a basis of a metapsychical concept. Aristotle has thereby inadvertently put logic (a specific form of it) before psychology in all psychological descriptions from him and his successors, which start from this assumption. As we saw from Mach‘s conceptual frame, this assumption is not a logical necessity resulting from the observed facts. It is an ―intuitive axiom of the excluded third‖ resulting probably from Aristotle‘s interest in logic more than from his empirical observations. Aristotle‘s other concepts, especially the concept of image, are then constructed from the assumption of the excluded third. ―To imagine is therefore (on this view) identical with the thinking of exactly the same as what one in the strictest sense perceives. But what we imagine is sometimes false though our contemporaneous judgement about it is true; e.g. we imagine the sun to be a foot in diameter though we are convinced that it is larger than the inhabited part of the earth, and the following dilemma presents itself. Either (a) while the fact has not changed and the observer has neither forgotten nor lost belief in the true opinion which he had, that opinion has disappeared, or (b) if he retains it then his opinion is at once true and false. A true opinion, however, becomes false only when the fact alters without being noticed.‖ (p. 38/39) When we apply this concept to Mach‘s example of the boy and the world as a blue sphere, its genetic limitations become clear. This leads us back to the question of teleology regarding what are illusions, what is metaphysics and to the question of the relation between knowledge and error. It is not by chance that Mach‘s most philosophical book was titled ―Knowledge and Error‖. Aristotle‘s interpretation is not an empirical necessity, but a convention. From the non-teleological perspective after Darwin applied by Mach to human and scientific thought, it even has to be considered an inconsistent convention. Aristotle mistakes the perspectives of the logikos and the psychologikos (instead of the mathematikos and the physikos). The facts of evolution are not consistent with the tacit teleology of the principle of the excluded third. As we saw from Mach‘s description of judgements, for 84

Mach in principle removes this wedge and instead introduces it as a differentiation between two types of thought: the adaptation of the thoughts to the facts (empiry) and the adaptation of thoughts to each other (metaphysics).

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children they follow intuition rather than logic. Thus they might be logically false and genetically (empirically) correct. Poincaré and Hadamard have shown that this is not only so for children, but also for adult top-level mathematical thought. One can see the same conceptual problem in Aristotle‘s concept of image. ―Sensitive imagination, as we have said, is found in all animals, deliberative imagination only in those that are calculative: for whether this or that shall be enacted is already a task requiring calculation; and there must be a single standard to measure by, for that is pursued which is greater. It follows that what acts in this way must be able to make a unity out of several images. This is the reason why imagination is held not to involve opinion, in that it does not involve opinion based on inference, though opinion involves imagination.‖ (p. 47) For Aristotle, the image is a basic psychical entity. But what if it is already constructed and dependent on his empirical experience as philosopher? Would he have thought the same, if he would have had the empirical experience of a physicist, such as Einstein? These questions came back into focus again at the time of the development of modern 85 86 scientific psychology. In the beginning of the 20th century, several researchers made experimental discoveries seemingly independent of each other. Their findings were not consistent with the dominant paradigm at the time, which was supposed to be ―associationism‖, i.e. that all thought processes could be described as associations. As an example, I will here quote the most famous of this development (see Beth & Piaget 1966), namely Marbe‘s (1901, p. 17) question of judgements: ―The experiments were therefore adequate to answer the question about the psychological conditions under which perceptual images (Wahrnehmungsvorstellungen) would become judgements.‖ In these experiments, the introspective observers could not discern basically any perception, memory or line of thought precluding the judgement. From this, Marbe (1901, p. 43) concluded that ―there are no psychological preconditions of judgement‖. Seen from our previous perspective, one could ask about the intuitive assumptions leading to the judgement, which are not consciously noticed and therefore not considered by Marbe. The Aristotelian true-false dichotomy (the principle of the excluded third) already presupposes a specific type of logic as well as language. Neither of the two are an empirical necessity. On the contrary, both presuppositions start the enquiry already at a relatively high level of concept formation in relation to sensual perception. What are considered judgements to be observed are a priori biased towards (Western) logic. Seen from the genesis process, Mach tries in his concept of sensation to gain a ―freer‖ position in psychology. First of all, it frees itself from Aristotle‘s logicistic assumption and thereby becomes consistent with the empirical facts of evolution. As a world view, it is insofar freer that – relatively independent of new physical and psychical findings – the 85

For instance it is also at the basis of Mach‘s criticism of Helmholtz‘s concept of unconscious inference (see Mach 1886; 1914 for instance p. 201). For Mach the concept is not consistent, because it assumes a logical process (inference) instead of a psychical (adaptive) process. According to Mach, thoughts are adapted to each other and not inferred from each other. What instead is often meant by ―inference‖ is an adaptation by analogy (see Mach 1905 or Siemsen 2010c). Inference thus mixes the concept of sensations with the concept of images, which is clearly inconsistent in the Machian sense of sensations. 86 These were the Würzburg school of psychology around Marbe in Germany, Binet in France and Woodworth in the USA (see Woodworth 1915, Beth & Piaget 1966). In a detailed genetic analysis, one could show here that the Aristotelian conceptual problem pervades the development of classical and modern psychology. Many of the assumed ―crises of psychology‖ are related to it. For the purposes of this article, I will only show it for the origins of the Würzburg school (Marbe). An example from modern psychology will be provided later.

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concept can remain the same. It is also relatively independent of metaphysical and metapsychical changes. The main problem is an intuitive one: In order to accept it, we have to ―learn to live with an incomplete world view‖ (Mach 1893a; 1960). Building on Mach‘s concept, Richard Semon in his synthesis is able to completely dissolve the psychological intuition of the Aristotelian distinction in De Anima (―On the Soul‖, book III) between perceiving, practical thinking, sensitive and deliberative imagining as well as judging. Aristotle‘s differentiation is oriented along the lines of conscious introspection and the observation of animals. By re-evaluating the concept of consciousness from a primary concept of psychology into a secondary concept of introspective description, the Aristotelian frame can finally lose the ―excessive authority‖ it had over psychological thought.

Meme As we have already seen, Mach‘s concept of sensations is more general than the usual use 87 of the concept. Semon built on this enlarged concept with his concept of the ―mneme‖ , distinguishing between actual sensations and memory. The origin of the concept can be traced 88 back to Ewald Hering, a psychologist who worked close with Mach at Charles University in Prague. Hering published an influential article about ―Memory as a General Function of Organized Matter‖ in 1870. In it he proposes that memory should be seen as a general function of evolution. Hering also mentions ―Gestalten‖: ―Who can hope to unravel the manifold and intricately intertwined tissues of the inner life by simply following the threads of consciousness? You may as well gather your information about the rich organic life of the oceanic world from those few forms [―Gestalten‖], which now and then emerge at the surface of the sea merely to disappear again into the depths of the ocean. Thus the cause which produces the unity of all single phenomena of consciousness must be looked for in unconscious life.‖ (Hering 1870; 1969, p. 10) Hering continues on developing his concept of unconscious memory: ―Our perceptive faculty would forever remain in its lowest stage, if we should consciously construct every single perception from the given single materials of sensation. Our voluntary motions would never surpass the awkwardness of a child, if in every case we should re-incite with conscious will the different single impulses and reproduce over again all our single conceptions; or, to state it briefly, if the nervous motor system were not endowed with memory, viz., an unconscious memory. […] But for the binding power of memory, consciousness would be dissolved into as many fragments as there are moments.‖ Most activities of the nervous system ―remain unconscious‖. (Hering 1870; 1897, p. 10/11) Thus, most of current sensational processes do not become part of consciousness, but can become part of memory. Memory can therefore be double-unconscious. This concerns concrete bodily processes as well as learnt abstract ideas. ―True, ideas are not inborn in an infant, but the ability of ready and precise crystallisation of ideas from a complex mixture of sensations, is due, not [mainly] to the labour of the child, but to the labour of innumerable ancestors.‖ (Hering 1870; 1897, p. 25) Nevertheless, the problem of inheritance remains largely unresolved by Hering. 87

As for English readers the spelling as ―meme‖ will be more familiar, I will retain this writing in the hope that it will not create confusion between the different epistemologies. 88 This concerns the theoretical concept. Mnemetic phenomena for plants have already been described by Sir Francis Darwin, as later Semon points out.

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In an article on ―Transformation and Adaptation in Scientific Thought‖ (1888), Mach describes knowledge as ―an expression of nature‖ and ideas thus having ―the properties of living organisms. And although ideas, as such, can not be treated in every respect as separate and distinct living beings, and although every forced comparison is to be avoided, […] the common trend of evolution and transformation is necessarily manifested in ideas also.‖ Semon (1923, p. 59) develops the meme concept further, based on Mach‘s concept of 89 sensation. ―[…] Mach himself does not recognize any such sharp contrast between bodies and sensations, for in another place he says: ―I see no contrast between the physical and the psychical, but only identity. In the sensory sphere of my consciousness every object is at one physical and psychical.‖ [Quoted from Mach‘s Analysis, 4th German edition] What we call a body is given to us first and immediately as a group of sensations, as a relatively, but not absolutely, permanent complex of colours, sounds, pressures, etc. This complex of sensations, not in the case indeed of the new-born babe in whom there is no concept of a body, but in that of every relatively more developed human being, is composed of original and mnemic sensations (under certain circumstances of the latter alone). Our concept of a body is therefore the result of a very intricate but simultaneously executed synthesis of sensations.‖ Semon‘s meme concept is based on a concept of sensations, which goes from the excitation (the ―skin‖) to the perception and even covers the after-effects of the immediate perception (such as after-images). We can also see from the quote, that Semon tentatively accepts the genetic world view of Mach as seen from a young child‘s perspective. Only this view tackles the problem of including genetically constructed psychical entities, such as the ―self‖ or ―consciousness‖ into one‘s a priori assumptions. Unfortunately, Semon speaks only of ―syntheses‖, but not how this process actually develops. He does not himself systematically research a genetic view which was attempted later by gestalt psychology. What Semon misses in Mach‘s concept of sensations is that it already includes more than what Semon calls the ―excitation‖, which is the physical. Mach‘s sensation of light does not 90 ―start at the skin‖. It is the whole relation from the light source, via the transmission medium (air) through the ocular lens, to the retina, via the optical nerves to the brain. It covers all the changes, transformations, reductions and interpretations in-between. It goes from the source of the sound to hearing the ringing of a bell (see Mach 1906a). The ―border‖ of the ―self‖ does not coincide with the border of the skin. The border of the skin does not coincide with the border between the physical and the psychical. Any epistemological ―cut‖ introduced here necessarily leads to inconsistencies in the empirical meanings of the concepts involved. As Helmholtz already found out, the sound does not ―traverse the skin‖ in the outer ear, but the sound waves are nevertheless changed by it. This, as well as the distinctions between excitation and conscious perception, is not consistent with the empirical facts. The Bergsonian differentiation between passive perceiving and active doing still prevalent in 89 90

Actually, Mach is by far the most quoted author in Semon‘s ―Mnemic Psychology‖. For Mach, the body sensations of the own body are not in principle different to the sensations concerning other bodies. The main difference is that they happen more frequently and thus after a while become the ―normal‖ point of reference when one grows older. The border of the skin is only approximate of this and often does not coincide with the border of the self (called by Mach the ―border U‖, which ―cuts right through consciousness‖; see Mach 1905). The border of the self in turn is culture-dependent. None of these concepts offers a safe, i.e. not anthropomorphic, basis for constructing a world view. Semon rejects the concept of body as something outside of sensation, but intuitively excludes the own human body from this conceptual change. Semon (1923, p.58) in the beginning proposes ―taking the word ―sensation‖ in its widest sense‖. Thus there is a wider sense of sensation than Semon is aware of.

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Hering‘s concept of memory does not exist for Mach. Perception cannot be consistently distinguished into active and passive. There are only clusters of sensory elements happening 91 at the same time. Semon was not aware of the gestalt concept. He died in 1918, before the main synthetic works on gestalt psychology were written by Wertheimer and Köhler. His own solution of the gestalt problem with his concepts of ―engram‖, ―acoluthic phase‖, ―ecphory‖ and ―homophony‖ seems complicated and his terminology archaic for the taste of a broader audience. Nevertheless, his synthesis as well as the gestalt concept are constructed from the same epistemological origin, namely Mach‘s concept of sensations. Thus, sensation and gestalt are consistent basic concepts. Both of them have mnemic and actual aspects in current thought. All other concepts describe sub-gestalts of these processes. One could assume that Semon‘s concept of mneme has little to do with James‘ critique on other world views and has not been very successful in its influence today, especially on psychology. But this impression would be mistaken as indeed there are (intuitive) influences of this idea to be found in psychology today and they are considered as challenging. In order to elaborate this, it will require a brief genetic historical analysis. Bertrand Russell confesses in his ―Analysis of Mind‖ that he changed his philosophical world view primarily because of James‘ question and its philosophical implications. But additionally, Russell includes Semon‘s concept of mneme. James and Semon are the most 92 quoted authors of Russell‘s book. Russell (1921; 1922, p. 25) partly follows James‘ successors (namely R. B. Perry and Edwin B. Holt) in postulating ―‖neutral‖ entities as the stuff out of which both mind and matter are constructed. […] But I should say that images belong only to the mental world, while those occurrences (if any) which do not form part of any ―experience‖ belong only to the physical world. There are, it seems to me, prima facie 93 different kinds of causal laws, one belonging to physics and the other to psychology.‖ Does Russell, by reducing Mach‘s concept of sensation even further than Semon, already ―cuts‖ or at least numbs one of the legs Mach contended we are standing on, so that we cannot sense the world through it anymore. Why does Russell reduce Mach‘s concept of sensation? Probably because as an advocate of the principle of the excluded third (in his Principia), he intuitively keeps Aristotle‘s assumption of a priori logical thoughts. But this of course is only an intuition and not based on genetic analysis. Nevertheless, Russell‘s reduction is important for the following historical genesis of the concept of meme.

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Semon was a student of Haeckel. The questions of inheritance are therefore close to his initial inquiries. Before Russell (1921; 1922, p. 22) ―goes further‖ into the ―revolutionary doctrine which [William James] advocated‖, he considers ―sensation‖ as the central concept for his shift in world view and Ernst Mach as the originator of the idea, whose ―‖Analysis of Sensations‖ [is] a book of fundamental importance in the present connection.‖ 93 Russell overlooks the dual dependency of causality. The causal concept is primarily used for investigations in physics, but it is a metaphysical concept according to Mach (1911). In the sense Russell is using it here, it becomes a highly metapsychical concept. Concerning the assumption of causality, Russell ignored his own warning (1921; 1922, p. 16): ―[T]here is no enemy to thinking so deadly as a false simplicity.‖ Mach had intensively warned against this solution of a ―third entity‖, as psychophysics thus loses its empirical meanings and becomes a purely metaphysical concept. 92

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For Russell (1921; 1922, p. 78), Semon‘s ―mnemic phenomena‖ are an important conceptual element missing in James‘ account. ―The essence of ―experience‖ is the modification of behaviour produced by what is experienced. We might, in fact, define one chain of experience, or one biography, as a series of occurrences linked by mnemic causation. I think it is this characteristic, more than any other, that distinguishes sciences dealing with living organisms from physics. The best writer on mnemic phenomena known to me is Richard Semon.‖ And further (Russell 1921; 1922, p. 84) ―Semon‘s applications of his fundamental ideas in various directions are interesting and ingenious.‖ For Russell, Semon‘s mneme account for the influence of ―past experiences‖ on behaviour. The mnemic phenomena open the way to the genetic account. James did not adequately include this direction, maybe as part of the difficulties he had answering genetic questions (cf. quote in footnote 9). Russell is struggling with the same difficulties, as he gives a rather behaviourist account of mnemic phenomena. He begins his observations similar to Semon (―excitations‖) 95 from the ―stimulus‖, but takes into account only the modification of behaviour. Both approaches (Semon‘s and Russel‘s) thus significantly reduce the possibilities for genetic analysis and understanding. The ―excitation‖ approach neglects much of the possible physical observation (i.e. everything that happens before it ―passes the skin‖. The criterion of behavioural modification excludes the observation of many intuitive learning processes. These as we have seen tend to be long-term and indirect, i.e. outside of most scientific observation periods. Consequently, most of the examples Russell uses for the concept of mneme are concerning remembering simple facts (adding them to memory). This corresponds best to his simplicity assumption of causal connections. Transformative (gestalt) memory events are not a priori excluded, but also not in detail considered. In Mach‘s sense, Russell might still use both feet to feel the earth, but standing only on the toes. Dawkins ―meme‖ concept is very close to Russell‘s interpretation of Semon‘s idea. Also Dawkins does not include the idea of transformative (gestalt) memory events. He focuses on the genesis properties of the concept, but by-and-large leaves out its sensational origins. He thereby abstracts from its genesis and does not apply the concept to itself. As an example, Dawkins (1978, p. 210) takes the understanding of Darwin‘s theory by different people. ―Yet, in spite of all this, there is something, some essence of Darwinism, which is present in the head of every individual who understands the theory. If this were not so, then almost any statement about two people agreeing with each other would be meaningless. An ‗idea-meme‘ might be defined as an entity which is capable of being transmitted from one brain to another. The meme of Darwin‘s theory is therefore that essential basis of the idea which is held in common by all brains who understand the theory. The differences in the ways that people represent the theory are then, by definition, not part of the meme.‖ The difficult part is of course the question of the meaning of ―understanding the theory‖ and what happens if the empirical meanings of the fundamental concepts shift. Dawkins unfortunately does not give any account on the origin of this idea, but it is rather unlikely that he did not have any either direct or indirect contact with Russell‘s influential 94

It is interesting to note that Russell changes Semon‘s terminology from ―sensations‖ to ―phenomena‖. On the one hand this change adds implications concerning the philosophy of science. On the other hand, it neglects the part of metapsychical from the dual dependency. 95 This conceptual shift is also slightly different as one puts the emphasis of observation on what happens to the ―outer side‖ versus what happens at the ―inner side‖ of the skin.

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book during his study time at Oxford. Because of his cultural closeness to Russell and his similarity in interpretation one can with a high likelihood assume that there has been some influence. This influence was enough to let the concept of the mneme suddenly re-emerge again by Dawkins more than 70 years after Semon‘s initial description. Seen from this perspective, Dawkins idea of ―replicators‖, i.e. self-replicating elements as the basis of all evolution, leading to ―the selfish gene‖ might be a result of Hering‘s idea of memory as a general function of evolution. Dawkins developed his idea of ―memes‖ after the idea of ―genes‖ as the centrepiece of evolution. Genetically, it was probably the idea of mneme, which led Dawkins to his idea of ―replicator genes‖. The idea of ―selfishness‖ thus becomes an anthropomorphic reintroduction of Descartes intuitive ―self‖. It thereby is a metapsychical concept and not an empirical (physical) one as Dawkins tacitly claims. As this development only serves as one example of the principles elaborated in this chapter, it shall be sufficient here to state the genetic likelihood of such a connection without showing it in all details. I will at this point also neither continue venturing into the details of Dawkins‘ intellectual influence on currently eminent psychologists (Daniel Dennett shall serve as the most prominent example) nor into showing that the conceptual adaptations which 96 were analyzed are still active with his intellectual successors. This account of the genesis of ideas from Mach via Hering, Semon and Russell to Dawkins provides a current example of the intuitive concept in science and how concepts can become more intuitive with time, while their foundational concepts might become more and 97 more ―hidden‖ through this intuitive process. This is a problem in science, as it reduces the possibility of fundamental reconstructions as well as the perpetuation of adaptive ―errors‖ over time. This phenomenon has always happened, but the number of such adaptive errors has increased through the turmoil of the World Wars. Unfortunately, the phenomenon causes its greatest problem in the area of learning science for students. In this area, the effects of the World Wars appears with a time-lag of about 2-3 generations (the literature used in education is mostly tertiary literature). The empirical evidence of this phenomenon will be briefly described at the end of this chapter.

Gestalt In his ―Analysis‖, Mach (1914, footnote p. 90) describes the origin of his idea of gestalt, which led to his last shift in world view.98 ―Some forty years ago […], in a society of physicists and physiologists, I proposed for discussion the question, why geometrically similar figures were also optically similar. I remember quite well the attitude taken with regard to this question, which was accounted not only superfluous, but even ludicrous. Nevertheless, I am now as strongly convinced as I was then that this question involves the 96

These details may be a subject for later research. I will again stress, that the account I gave I consider only one of several possible views. Especially the link between Russell and Dawkins is based only on probability of the ―meme‖ diffusion of prominent thinkers within the scientific culture (between Oxford and Cambridge). Nevertheless, the probability of fundamental ideas in science being reinvented (with similar foundational properties and – in this case – a similar and unusual name) is much more unlikely than their transmission through intuitive processes. The relation becomes even more likely, if the idea in question is not ―in the air‖, i.e. a mostly deductive result of previous new findings known to the scientific community. The meme/mneme concept does not seem to have been ―in the air‖ at the time of Dawkin‘s book as a logical necessity of the gene concept. 98 There were at least two more shifts in his world view (see Mach 1885; 1914, p. 30). 97

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whole problem of visual gestalts. That a problem cannot be solved which is not recognized as such is clear. In this non-recognition, however, is manifested, in my opinion, that one-sided mathematico-physical direction of thought […].‖99 These ideas of Mach had intuitive influences on physics and mathematics, but also on the development of psychology, for instance on the concept of gestalt and gestalt psychology.100 The article ―On Gestalt Qualities‖ from 1890 by von Ehrenfels was regarded by Wertheimer and Köhler as the foundational article of gestalt psychology (see Wertheimer 1924, Köhler 1920 and Ash 1995). In the beginning of this article, von Ehrenfels states that his ideas initiated from an intuition he had after reading Mach‘s Analysis. ―My starting point arose from several remarks and hints from E. Mach‘s ―Contributions to the Analysis of Sensations‖ (Jena 1886) practically by itself, which I owe a considerable strengthening of my opinions about the here described circumstances to, even though they seem to have originated in completely different circumstances. Mach sets up the, for some people certainly paradoxically sounding, hypothesis that we can immediately ―sense‖ [empfinden] spatial patterns [Gestalten] and even ―sound-patterns‖ or melodies. And indeed at least the second of these theses not only seemingly, but also from its contents should be undisputedly absurd101, if it would not be immediately intelligible, that ―sensation‖ here is used in a different than the usual sense. […] But if Mach, by using the term ―spatial and tonal gestalts‖, also wanted to stress its simplicity, it becomes clear that he […] viewed these ―gestalts‖ not as mere combination of elements, but as something new (relative to the elements on which they base) and up to a certain degree independent. […] I hope to be able to show in the following that Mach [in his reflections] has shown us the way of resolving the problem mentioned.― (von Ehrenfels 1890, pp. 249-251) The problem von Ehrenfels mentions is what William James called ―The knowing of things together‖ (1895). If one takes a ―regular‖ concept of sensation, it is a question of descriptive psychology. For Mach, it becomes a question of genetic psychology. What is ―simple‖ might therefore appear to be simple in its current sensational gestalt, but is actually a result of a ―complex‖ genetic process. Gestalts are not linear (additive), they are transformational.102 In order to genetically describe the gestalt concept, I will in the following deviate slightly from my method of quoting the status nascendi and use an example from one of the earliest articles of Wertheimer, because it concerns precisely the topic of the examples I mostly used in this chapter: the psychology of mathematics.103 ―It is in the psychological sense a fiction that everywhere any arbitrary partition can be considered equal, just discretionary; […] 99

This quotation also bears reference to the prior discussed question of methodological specialization in science and the (unintended) intuitive training of one‘s thoughts. 100 His other influences on for instance the development of genetic psychology (Siemsen 2010b) and Boring (1950), shall not be of concern here. 101 The German word used here is ―widersinning‖, which literally translates as ―counter-sensual‖. 102 Many gestalts, for instance, are not best recognized in reality, but in caricatures, i.e. when certain properties are overemphasized, while others are neglected. Greek statues in the ―classic‖ times are thus not just idealized bodies. They are (psychophysically) idealized beyond the point a body could look like (in the archeological museum in Athens, this phase is even called ―phychological realism‖). Egyptian obelisks are not built straight, but slightly curved. Equally, ―natural laws‖ cannot be observed in reality. They approximately describe many facts under idealized circumstances which can never be ―achieved‖ for each single fact. 103 Unfortunately, this article has never been translated into English, although it is from a genetic perspective one of the best articles from gestalt psychology. Wertheimer‘s most influential book ―Productive Thinking‖ is based on this article, i.e. the article provides the theory, the application of which Wertheimer demonstrates in the book. A reflection of the genesis of Wertheimer‘s own thought is unfortunately equally missing in the book.

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Operations are not in general initially given as arbitrary, but those operations suggest themselves, which are in the nature of entities, predetermined through their type or which lead to results, which have the character of wholes in the area concerned.‖ (Wertheimer 1912; 1925, p. 132) Contrary to Köhler‘s physicalistic interpretation later (see Ash 1995), Wertheimer (1912; 1925, p. 112) stresses that this ―nature‖ and ―predetermination‖ is not externally given and logical, but a genetic result of Mach‘s sensational relation: ―This is connected with the special way of thought, which does not grasp concepts according to discretionary logical operations, but according to their biological relevance.‖ This genetic concept has direct implications for the understanding of learning, for instance in the teaching of mathematics. ―So also the difficulty of teaching children the concept of generally transferrable numbers does not lie in their inability to think, but in the strength of the representation of these natural factors in thought.‖ (Wertheimer 1912; 1925, p. 134) ―The good mathematics teacher puts his main emphasis on the understanding (the general view) of the task and requires that the student for himself (approximately) forms a concept of what (roughly) will be the outcome – contrary to the mechanical mathematizing, where for instance a mistake in the setting of a decimal point can lead to claiming completely senseless results. Genetically it is probable that not primarily the counting, but natural groups and clusters develop within the real biological relationship coming into consideration; not concepts such as 1 and the continuous Plus One are probably what is primary, but the analogconceptual, more individual entities. Also probably not in the sense of a majority of similar, but initially as structured wholes.‖ (Wertheimer 1912; 1925, p. 143) ―The tendency of having the unity, the character as a whole does not – contrary to the substractive capturing of properties by our logic – let characteristic traits appear as logically addable parts, but in their being as a whole as constituents of a gestalt quality.‖ Abstraction therefore is not necessarily a ―higher development‖, but it is a specialization of thoughts. This specialization might be thought economical in some contexts, but hindering in others. What is ―higher‖ and ―lower‖ in a cultural sense cannot be judged anthropomorphically from the point of view of a specific culture.104 Such categories often make no sense in anthropology, as the whole conceptual frames (world views) are different. All concepts might be based on completely different sets of empirical meanings.105 Also logic and our current Western concept of number came out of practical requirements and needs. They can thus neither be considered universal nor culturally independent. Because of the expansion of modern science, they have just been developed by more people over longer time than any other similar conceptual systems from other cultures. The concept of gestalt also resolves the unproductive hen-egg type of questions regarding the initial primacy of ―nature or nurture‖. From a gestalt perspective it makes no sense to try to draw a triangle in one dimension and ask which of its sides has a larger share in its area. If

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Similar ideas have been developed by Franz Boas and have been very influential in US anthropological thinking until today (see Boas 1911; 1938 and Stocking 1968). On the closeness of the development of these ideas to Mach and their later influence on the initial ideas of Jerome Bruner, see Siemsen (2010b). 105 The difference in observed facts can be so intuitively fundamental that even with long training, one cannot observe them in principle. For instance Boas observed that he consistently heard phoneme in Inuit language one time as one sound, another time as a different sound. His interpretation was that psychophysically, the factual sound gestalt was in-between, but impossible for him to hear in the way the natives would hear it.

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one takes the concept of memory as a general function of evolution (see Hering 1870; 1969), the problem disappears as a pseudoquestion.106

An Example: Implications for the Concept of Construction One result of this genetic gestalt concept is a change of the empirical meaning of the concept of ―construction‖ in epistemology. The metaphor of construction in epistemology and the resulting constructivism have their origin in the question of the method of mathematical proofs. According to this approach, all mathematics is ―constructed‖ from as few initial elements (assumptions/axioms) as possible. This view was applied in mathematics for instance by Kronecker and Brouwer and voiced as an analogy by Poincaré: a house is constructed from stones (on the relation between Poincaré‘s analogy and Piaget, see Piaget 1984). From the theory of proofs, it became an epistemological assumption that all knowledge also in other sciences needs to be ―constructed‖ in order to be internally consistent. This idea was logically developed by Rudolf Carnap in his ―Aufbau‖ (The logical structure of the world) and then promoted by him, the members of the Vienna Circle, as well as Logical Positivists in general around the world. The central critique on this approach came from Eino Kaila, a gestalt psychologist and philosopher of science from Finland.107 According to Kaila, Poincaré‘s analogy of construction has one fundamental problem: it requires stones and a knowledgeable architect to begin with.108 Here the analogy ends, as stones are obviously not ―constructed‖ from ―basic elements‖, for instance from pieces of sand. Stones are gestalt wholes. Equally, the architect assumes to be conscious of the result of other people‘s thought processes, even though these depend mostly on the (in general not known) genetically pre-existent knowledge. Any ―basic elements‖ need another epistemology to be presupposable.109 Kaila‘s argument is founded on the results from his research in experimental psychology. It concerns the ―basic elements‖ of the relation between the logical and the psychological. Kaila‘s criticism led Carnap to re-evaluate the foundations of his ―Aufbau‖ towards physicalism. But this new approach still neglected Kaila‘s main arguments, which are psychological, or rather metapsychical.110 106

Dawkin‘s concept of ―meme‖ shows only superficial similarities to this. A more fitting account can be found in Semon‘s concept of ―mneme‖ (1911). Nevertheless, all these concepts are gestalts, i.e. they are constructed by our perception and the scientific process and do not exist outside of this process. No planet at any time moves exactly according to the laws of Newton. The laws are only an idealized approximation of planetary movement. Einstein used Minkowski‘s mathematics because it could best describe his ideas about relativity. It is not that Minkowski had found ―God‘s thoughts‖ with a mathematical description. As Mach (1886; 1919, p. 256) wrote, there is always the danger in specialized science to mistake the tools of a special science for the whole world. 107 Kaila was strongly influenced by Mach as were many members of the Vienna Circle (for details, see Siemsen & Siemsen 2009 and Siemsen 2010d). 108 It is important to note here that the Finnish words for building/constructing ―rakentaa‖, building ‖rakennus‖ and structure ―rakenne‖ do not exactly correspond to the English meaning implied in ―constructing‖. It does not require an ―architect‖ of construction. It can also be ―structured‖ without. ―Rakentaa‖ can signify developmental processes in nature, i.e. the structure and growth of plants. The empirical meaning of ―rakentaa‖ is therefore closer to a genetic (adaptive) understanding of the scientific knowledge process. 109 As we saw in Wittgenstein‘s ―Tractatus‖, metapsychical genesis must already have started before logic can be presupposed. 110 Kaila continued his critique, but because of the World Wars, it did not have an impact on Logical Empiricism anymore. Kaila‘s work though did have a long-term effect on Finnish Science education, which is ―documented‖ in the empirical results of the OECD PISA-study (see Siemsen & Siemsen 2009).

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Hayo Siemsen ―It follows from the extensional quasi-analytic method that any internal manifold of the basic elements must be left out of consideration. However, Carnap believes that his assumption that the ‗cross-sections of the stream of experience‘ are utterly simple qualia agrees with the views of modern psychology, in particular gestalt theory. He seems to assume that the rejection of the doctrine that experiences are composed of ‗mental elements‘ of some kind or another is equivalent to the statement that – apart from all ‗conceptual elaborations‘ – they are unstructured total impressions (without original internal manifold of their own). [...]

Quite generally, it has become clear at all points of the theory of perception that former psychology enormously overestimated the part played by learning, ‗experience‘ and custom in the formation of the perceptual world. Now these results of psychology surely are of significance for the construction theory inasmuch as this theory wants to be a ‗rational reconstruction‘ of the actual process of cognition. [...] And after all the construction theory itself is surely based on concepts which cannot have arisen according to the quasi-analytic schema – e.g., the concept of the past, without which this method would not be applicable. This implies that the quasi-analytic formation of concepts is only one among many others. What is more, this kind of concept formation is such as is possible only on a relatively high level of the actual cognitive process. Countless distinctions leaping forth from one single experience […] must precede before one can ‗abstract‘, e.g., the pitch of a tone. The reason why construction theory favours this particular kind of concept formation is, of course, that it can be formally represented in terms of classes and relations, the only constructional forms available to logistics. For this reason the theory absolutizes this method and introduces it epistemologically too soon, whereby the theory gets entangled in inner contradictions and does violence to the 'auto-mental objects' of experienced time and perceptual space.‖ (Kaila 1930) What does this story tell about constructivism? Constructivism is based on an unfitting metapsychical metaphor. This metaphor may be consistent from a metaphysical point of view, but not from a metapsychical one. Constructivism is not inherently genetic, but logicistic. For a consistent approach, one would have to include the genetic concept of gestalt (i.e. the one from Kaila, not the physicalistic one from Köhler).

The Metapsychical I hope that now the meaning of the concept of ―metapsychic‖ became clearer. The term distinguishes the process of the ―adaptation of thoughts to each other‖ from the empirical process of ―adapting the thoughts to the facts‖. As both processes are double-dependent, this distinction is never absolute. Nevertheless, an enquiry into it is a necessity in order to find the conventional parts of our intuitive assumptions and question them systematically. For an easier understanding of the concept, one can use the metaphor of origami. When the paper is folded, it assumes a different gestalt. In this gestalt, neither the shape of the initial sheet of paper, nor of what was written or depicted on the paper is apparent anymore. To the uninitiated (child), the folding appears as a given, a mystery. Only when we unfold the paper, and show it to the student, the connection with his or her prior experience becomes apparent to the student. When we slowly fold the paper again and then let the student repeatedly do the same, the mystery dissolves. The student can then after a while even develop his or her own adaptations of the gestalt. The origami gestalt has acquired its empirical meaning. Instead, the folded gestalt initially shown may be recognized as what it is meant to depict (an animal, a

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boat, etc.), but it cannot be fundamentally adapted. As such it is highly metapsychical. The image of it may lead to the assumption that it is not based on sensations, but ―senseless‖ images. The strong influence of logicism and its functionalist, operationalist, constructivist, etc. derivatives has probably unintentionally increased these phenomena of intuitive ―hiding‖ in science. As Hans Hahn111 summarized in another metaphor: ―If the mathematicians have, since the days of Euclid, already learnt to put themselves up with the fact that there is no royal road to their science, so on the other side the access to it must not lead over the longest and steepest high mountain paths, so that most people would have to fail underway, but the few who manage to pass, being exhausted to death, finding themselves not at the goal, but at the beginning, where true mathematics would be supposed to start.‖ Additionally, metapsychics is a methodological tool for the meta-analysis of science. Even though, metaphysics is dependent on physics for its construction, it has implications for all of science. All sensation depends on the physical. Equally, the metapsychical has implications for all of science. All sensation depends on the psychical as well. It is these implications, which can be systematically analyzed with the conceptual frame developed above.

5. GENERAL INTUITION The above view of course might not fit our intuitions about the concept of intuition. But precisely because we research the phenomena which might be related to intuition, we should know that one cannot be guided by intuition only. Intuition depends on developing a ―habit‖ of thought (alternatively one can of course use the physiological description that the synapses between neurons are strengthened so that the neurons become more likely to ―fire‖ together). This habituation does not distinguish between empirical habituation (when thoughts are adapted to the facts derived from sensual elements) and ―rational‖ habituation (the adaptation of thoughts to each other). As we saw in the quotation from James‘ before, most of the time (99% according to him) we do not have an empirical feedback, but intuitively regard the lack of a negative feedback as confirmation. Especially in science when one researches by thinking about a concept very intensively, the ―rational‖ part of habituation can become a strong part of the process of thought. Optimizing the process in terms of internal consistency – which in its extreme scientific form is seen as ―rational‖ or ―logical‖ deduction – does not have any relation to its empirical consistency (the consistency with the phenomena and the facts). Elaborate internally consistent (ratio/logical) systems, such as the Ptolemaic epicycles, can be completely speculative and considered ―erroneous‖ from the perspective of (often later developed) scientific theories which describe more facts or look at different circumstances of these facts. But, speculative systems can become practical tools for the economy of thought, like Minkowski‘s theorems for Einstein‘s relativity theory. A problem arises mostly when one does not handle them with appropriate empirical care, but regards ―toy models‖ as describing 111

Hahn provides an ―insider‘s perspective‖ in several ways. He was a student of Mach, a prominent member of logical positivism, an intuitionist mathematician and an inspiring mathematics teacher to Kurt Gödel, Rudolf Carnap, Karl Popper and Karl Menger.

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―reality‖. One may mistake some similarities in appearance between a mechanical model with ―knowing‖ the functions of a living being or a human brain. But up to now, no mechanist construction has ever produced a living being. It is not a thought experiment and certainly not a fact, but a (metaphysical) fiction. As Jerome Bruner (1962) stated: we have to be very careful in not mistaking the ―portrait‖ – even a very elaborate one – for the sitter. Therefore, the concepts and models derived mainly from adapting the thoughts to each other should be named metaphysical as opposed to empirical. This must be regardless of the thoughts being intuitive or conscious. The main problem with intuitive speculation is that many people in the sense of James do not notice that it is speculation. This intuitive metaphysical speculation should thus be counteracted by training empirical carefulness.

6. CONCLUSIONS How to Research Intuition with Intuition Shaping Research or the Erkenntnis-Theoretical Role of Psychology The psychological analysis of scientific (including psychological and philosophical) concepts is a necessity of scientific consistency. ―[It] is not enough to replace the instinctively acquired opinions of everyday life, which have crept into philosophy under different guises, by a purely scientific perspective. One has to lay bare their psychological roots; otherwise they will continue to tiller.‖ (Mach 1906a, pp. 598-599) But, psychology plays a double-role in this analysis of thought. On the one hand it provides the tools for the analysis of psychic phenomena, such as intuition. On the other hand it presupposes concepts, which depend on the meaning of the concept of knowledge. As knowledge in turn is part of psychic phenomena as well as a precondition of observing them, only a careful implementation of psychology and Erkenntnistheorie can help in unwinding these intricate relationships. In his erkenntnistheoretical inquiry into conceptual thinking in mathematics, Wittenberg112 (1957, p. 197) observed, ―This does not become evident in the usual psychological investigations, because these do not initially work with the goal of a total reduction of thought to the psychical. Instead, they will use for example the reality or perception or something similar as relational concepts defined in regard to their contents and then investigate, how, for instance in the psychogenesis, the concepts come about with which << we orient ourselves in reality >>. That means that the investigation of certain concepts accept a certain part of meaningful language as reasonable, respective defined in regard to their contents beforehand. A total goal would imply to include also these concepts themselves into the field of psychological research.― This cannot be done by psychology alone, but only in conjunction with an erkenntnis-theoretical philosophy of science. On the same terms then the physical and physiological views are involved as no empirically oriented Erkenntnis is possible without. Again, the Erkenntnistheorie is needed to distinguish between the empirical and the 112

Wittenberg studied mathematics in Zurich under George Polya, Wolfgang Pauli and Hermann Weyl. He was probably also influenced in his ideas by Rolf Nevanlinna (see Siemsen 2010). His doctoral advisors were Hilbert‘s former assistant Paul Bernays and Ferdinand Gonseth. Gonseth had a close affiliation to Piaget‘s thoughts. Wittenberg was a central person in developing the ideas of the OECD PISA study on the comparison of science education and in voicing the resistance of mathematicians to the ―New Maths‖ reforms in the USA and Canada. He unfortunately died very early.

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metaphysical or metapsychical aspects of concept formation. It might console the psychologist that as a result of the psychological analysis, also the fundamental meaning of Erkenntnistheorie changes. The concept of the metapsychical is one example of this. The insufficiently understood complexity of this process is probably the root of many assumptions of crisis in psychology (for instance by Külpe, Bühler, Stumpf, Lurija, etc.) as well as the often observed distance with which several other sciences view psychology and its results (for instance philosophy, physics or economics). As Wittenberg argues, the epistemological problems do not show as long as one remains within a locally defined world or system. The problem is that no world or ―reality‖ restricts itself to any previously defined human thought system. This is the real challenge of the empirical primacy before any metaphysical or metapsychical. There are many local empiricists, but few that even attempted this view on a total (monistic) level. Changing the concept of consciousness from the basis on which psychology is constructed, or which – as James claimed – ―takes for its domain precisely the filed of the facts of consciousness‖, to an epiphenomenon of thought is a rather far-reaching claim. The claim is not new, as it was already stated by James, and it has been restated for instance by the heterophenomenologists, such as Dennett. But these cases still lack consistency from an epistemological point of view. The argument for a total (really monistic) empirical view113 is clear: The choice for the local empiricists when to be empirical and when not, remains arbitrarily based for instance on conventions and little understood intuitions. This is a fundamental inconsistency for dualists as well as for other monists. The only problem is that this view can – by definition – never be finished. In the terms of Gödel, it is consistent, but incomplete. Or as Mach (1883; 1893a; 1902, p. 464) has put it: ―The highest philosophy of the scientific investigator is precisely this toleration of an incomplete conception of the world and the preference for it rather than an apparently perfect, but inadequate conception.‖114

Empirical Effects on Science Education Although the focus of this chapter lies certainly on the questions of science and especially psychology, one of the main empirical impacts of the questions elaborated can be found in science education.115 Also in science education, the epistemological inconsistencies mentioned are aggravated by the effects of the two World Wars. But here the effects show much stronger. On the one hand, genetic questions have an immediate effect on all children, who do not acquire a sufficient background in Western logical culture from their parents (leading often to high attrition rates for scientific subjects as a result). On the other hand, many science educators orient themselves on current science thinkers. This implies that any epistemological inconsistency tends to be not only replicated, but ―metastasized‖ in tertiary literature (e.g. school text books). If one assumes – as a hypothesis – that the main ―damage‖ was done during WWII on the main scientists, their direct students would retire one generation after, while the science educators taught by them would retire another generation after and the teachers these had trained a further generation later. Thus, following this line of 113

Here one can understand, what James probably meant with his term ―radical empiricism‖. Mach adds to this: ―Our religious opinions are always our own private affair, as long as we do not obtrude them upon others and do not apply them to things which come under the jurisdiction of a different tribunal.‖ 115 For the purposes of this article, only a very brief overview can be provided. Details can be found in Siemsen & Siemsen (2009) and Siemsen (2010b and 2010d). 114

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argument, the effects of the cultural ―rubble‖ left by the World Wars should empirically show in education roughly now, with a widening gap between low and high achieving students as well as a general decrease in science-related achievement. Both trends seem to be confirmed by most large-scale educational studies, such as the OECD PISA study (for instance OECD 2007).116 There should also be an empirical effect observable depending on the proportion of James‘ and Mach‘s epistemology implemented into the central ideas of science teaching. At least for Finland, i.e. the country consistently occupying the first rank among OECD PISAstudy countries, this can be shown.117 Their internationally most renowned Finnish mathematician Rolf Nevanlinna developed a specific synthesis of mathematics between intuitionism and formalism based on the epistemology of Ernst Mach. His colleague and friend Eino Kaila used this in turn for a unique synthesis with gestalt psychology and Erkenntnistheorie. Two generations after, a successor of Kaila, Kaarle Kurki-Suonio (2010) implemented the ideas in science education in an in-service teacher training course (see Lavonen et al. 2004). Through this course (and regular teacher training courses at Helsinki and other Finnish universities) about 20% of Finnish science teachers have been taught in an epistemology very similar to Mach‘s approach. As a result, the PISA-study average on student achievement in Finland is much higher, while the variance of low-achievers is much lower than in the rest of the OECD. Also the dependency of student grades on the parents‘ academic background is very low in Finland. This was achieved by changing the teachers‘ world view on science as well as education jointly and consistently (see Siemsen 2010d and Kurki-Suonio 2010). How the problem of erkenntnis-theoretical consistency is central to the question of science education has been found again and again in many educational debates. Unfortunately, the related teleological question as discussed in this chapter is often missed. As an example, one of the current participants of the so-called ―Math Wars‖, Schoenfeld118 (2004, p. 264/272) observes the already described empirical situation: ―The attrition rate from mathematics, from 9th grade on, was roughly 50% per year; worse still, the attrition rate for Latinos and African Americans was significantly larger.‖ On the analysis of the origins of this problem and the question of the remedy he mentions: ―When superficial aspects of reform are implemented without the underlying substance, students may not learn much at all. [For the teacher] this means knowing the mathematics well, having a sense of when to let students explore and when to tell them what they need to know, and knowing how to nudge them in 116

The PISA study also has a strong phenomenological background, which makes it a better proxy for the following purposes than more logicistically based studies, such as TIMSS (see Siemsen & Siemsen 2009). 117 See Siemsen & Siemsen (2009) and Siemsen (2010d). The empirical results in PISA for several other countries, such as Germany, the Netherlands, Denmark or the Czech Republic also fit this picture. The Asian countries as well as Canada are cases that still need to be researched. The situation in the USA seems to be historically mixed: while there have been several attempts at implementing such educational reforms, like James Conant‘s General Education program, these seem to have mostly failed in their broad implementation in the long run (i.e. for the whole country and not only for single university cities), probably because of a lack of epistemological consistency in the sense discussed in this chapter. The continuing debate on the ―Math Wars‖ seems to be a case in point, where the initial erkenntnis-theoretical questions have been watered down to the point where sensible empirical questions cannot be asked anymore within the given set of metapsychological metastases. 118 Schoenfeld should serve only as an example, because he is one of the few authors who at least tries to take a less radical perspective, although he clearly belongs to the reformist camp. Other descriptions of the ―Wars‖ from the traditionalist camp or of the older debate around the ―New Maths‖ show similar properties in the sense observed here.

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productive directions.‖ Thus, the main questions of good education (and this can similarly be found for the ―other side‖ of the ―Wars‖) remain vague and presupposed in the existing intuitions of the teachers. They are seemingly not explicitly provided in the (reform or nonreform) ideas of teaching. But what might give a teacher this magical ―teaching sense‖? Schoenfeld, for instance, regards cognitivism as the main basis for the reform ideas. Piaget is taken by many cognitivists such as Jerome Bruner as one of the founding fathers of their discipline. Piaget (1966 in his book with Beth, p. 141) states: ―We cannot oppose the search for connecting links between the mental mechanisms and logico-mathematical structures, since this is precisely our task.‖ Here we are squarely back at the topic of this chapter. But does this implicit Aristotelian assumption really comply with empirical evidence? Many educators have continuously thought so. But some of their greatest began to have empirical doubts at the end of their lives. Piaget, in spite of Bruner‘s earlier critique on the culture-dependency of his empirical results (Bruner et al. 1966), started to have doubts only in 1971/72 at his retirement, especially about the 11-15 year olds and their development in his conceptual terms: ―However, recent research has shown that subjects from other types of schools or different social environments sometimes give results differing more or less from the norms indicated; for the same experiments it is as though these subjects had stayed on the concrete operatory level of thinking.‖ (Piaget 1972; 2008, p. 43) Similarly, other great educators began to have late doubts about some of their initial assumptions. For instance Henry Edward Armstrong, the great British science education promoter and pioneer of the experimental approach (which was later implemented by the Nuffield approach), staggeringly noted at the end of his life that he had done a fundamental mistake for more than 30 years: He had been teaching mainly for the high-achieving students. ―The majority [of the students] proved incapable – it is not in us to be logical.‖ (Armstrong 1934) But at the point where Armstrong had resigned, more than 20 years earlier Alfred Binet – one of the greatest French psychologists and educationalists – had followed-up. He concluded his book on pedagogy, which became his scientific testament, with a humble metaphor as a guide for further inquiry: ―The old science of education is like an old-fashioned carriage: it squeaks but it can still serve a turn […] [Modern educational science] looks like a precision-made machine, but the parts do not hold together and it has one defect: it does not work.‖ (Binet 1975, p. 232) Following the line of Binet‘s thoughts, one could wonder if what he describes is actually the origin of such educational phenomena as the ―Math Wars‖: the ―new‖ approach destroys enough of the ―old‖ approach without being able to replace it with enough ―conscious‖ consistency (i.e. theoretically replicable by the average teacher). In the end, each well-meaning ―reform‖ or synthesis leads to a de facto (though unintended) deterioration of the overall intuitive knowledge of the teachers. The problem would then be that the ―old‖ as well as the ―new‖ approach are inherently inconsistent. Furthermore, all attempts of synthesis are thereby built on inconsistencies, which both approaches share to begin with. The result after several rounds of reform and counter-reform is erkenntnistheoretical gibberish.119 119

Both ―sides‖ in the ―Math Wars‖ for instance still introduce fundamental concepts logically, without basing them on the sensual experience of the students. In this case it is irrelevant, if the concept is introduced by a definition of the teacher or by group work or in an experiment of the students. In the latter cases, the concept is also implicitly introduced by the teacher by framing the problem, i.e. before the actual group work or experiment begins. The students would otherwise never arrive at the concept. As John Bradley, strongly influenced by Mach, working in the same school as the late Armstrong and a great critic of the Nuffield experimental approach,

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Unfortunately, these empirical insights came often at the very end of the careers of these educationalists, when their successors did not notice their change of mind anymore. Seemingly each of them did not build on these insights of their predecessors.120 Just like James‘s ―radical empiricism‖ idea, which has been but almost forgotten. But seen from the perspective of this late world view of James, much of what came afterwards seems to become erkenntnis-theoretically increasingly fuzzy rather than clarified. The newer thinkers do not necessarily provide a more consistent view.121 Nevertheless, their hindsight insight seems to remain mainly the same. Instead of repeating it, one should therefore start to treat it as a joint Erkenntnis to learn from such great educationalists and psychologists as Piaget, Armstrong, Binet, James and Mach122. All of them up to a degree had noticed that the erkenntnistheoretical analysis of the genesis of scientific thought cannot be based on logical premises, at least after Darwin had shown the principal way out of this Aristotelian circularity. Do we have to make the same mistake all over again and again? It is time to go back in time and to see these insights in a new erkenntnis-theoretical light.

REFERENCES Archimedes, (1972). Werke. Darmstadt: Wissenschaftliche Buchgesellschaft. Aristotle, (1994, 2000). On the Soul. Internet Classics Archive http://classics.mit.edu// Aristotle/soul.html, accessed 20/09/2009. Armstrong, H. E. (1934). The First Frankland Memorial Oration. The Lancastrian Frankland Society. Journal of the Society of Chemical Industry, 53/21. Ash, M. G. (1995). Gestalt Psychology in German Culture 1890-1967: Holism and the Quest for Objectivity. Cambridge: Cambridge University Press. Avenarius, R. (1891, 2005). Der menschliche Weltbegriff. Leipzig: Elibron Classics.

recognized in his retirement speech (1975, p. 9): ―Why have teachers […], including myself, failed so miserably? […] We have answered the question: Where does theory begin?: wrongly. […] So with good intentions, we have said to Robert: What matters is the atom, or the molecule or the equation. Poor Robert has been stranded; he resembles a child aged six given logarithms to multiply three by two or like David he is too small and weak to carry the armour of Mendeleeff and Cannizzaro [both eminent chemists, the concepts of whom Bradley had earlier suggested to teach to students]. I am convinced that almost all of us have answered the question wrongly. Where has been our mistake? We have forgotten that all thought is theory, and that classification is thought and therefore also theory.‖ 120 Luckily, though, they managed to document it. 121 With the exception maybe of Kaila, who made this change away from Aristotelian logicism much earlier in his life. 122 Mach had published an article in 1890 about this topic on the ―About the Logical and Psychological Moment in Science Education‖ in a teachers‘ journal, which unfortunately, like similar articles, has never been translated to English. ―[…] This view seems to be shared little in the circles of teachers, and even those, who agree with them theoretically, in practice abdicate from them again and again, which manifests itself in the overestimation of the logical and a disregard of the psychological moment in education. […] Criticism cannot begin where empirical meanings [konkrete Vorstellungen] are still lacking. […] If a teacher, who already knows all the subject matter, states a sentence adapted to his meanings and to his own satisfaction, this indicates if it happens unconsciously, an error of the person on whose satisfaction the effort should be focused upon. If it happens consciously, it is a didactical insincerity.― For Mach, this relation of the logical and the psychological moment in science education also explains the fact that many of the most prominent French mathematicians of the 18 th century had initially been technicians. ―The technician has to take care of many details; his abstractions appear later and therefore often stronger than at studying pure theory.‖ (Mach 1890, pp. 1/4)

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Perrott, D. A., Gentner, D. & Bodenhausen, G. von (2005). Resistance is futile: The unwitting insertion of analogical inferences in memory. Psychological Bulletin & Review, 12/4, 696-702. Perry, R. B. (1935). The Thought and Character of William James: Vol. I&II. London: Oxford University Press. Quoted page numbers are all taken from Vol. II. Pleh, C. (2003). Ernst Mach and Daniel Dennett: Two Evolutionary Models of Cognition. http://www.jate.u-szeged.hu/~pleh/articles/mach.html accessed 24/07/1999. Piaget, J. (1972/2008). Intellectual Evolution from Adolescence to Adulthood. Human Development 1972, reprint in Human Development 2008, 51, 40-47. Piaget, J. (1978, 1980). Das Weltbild des Kindes. Stuttgart: Ullstein. Piaget, J. & Garcia, R. (1983, 1989). Psychogenesis and the History of Science. New York: Columbia University Press. Pinker, S. (1997, 1999). How the Mind Works. New York: Norton. Poincaré, H. (1898). On the Foundations of Geometry. The Monist, IX. Poincaré, H. (1906). La relativité de l‘espace. L‟Année Psychologique, XIII, 1-17. Poincaré, H. (1908). L‘invention mathématique. L‟Année Psychologique, XV, 445-459 Poincaré, H. (1908; 2003). Science and Method. New York: Dover Publications. Ramachandran, V. S. & Blakeslee, S. (1998). Phantoms in the Brain – Probing the Mysteries of the Human Mind. New York: Harper. Ribot, Th. (1889). Psychology de l‟attention. Paris: Alcan. Ribot, Th. (1899). The Evolution of General Ideas. Chicago: Open Court. Schack, T. (2004). The cognitive architecture of complex movement. International Journal of Sport and Exercise Psychology, Special Issue Part II: The Construction of Action – New Perspectives in Movement Science, 2/4, 403-438. Semon, R. (1911, 1920). Die Mneme als erhaltendes Prinzip im Wechsel des organischen Geschehens. Leipzig: Engelmann. Semon, R. (1923). Mnemic Psychology. London: Allen & Unwin. Siemsen, K. H. (1981). Genetisch-adaptiv aufgebauter rechnergestützter Kleingruppenunterricht: Begründungen für einen genetischen Unterricht. Frankfurt (M.): Peter D. Lang. Siemsen, K. H. & Siemsen, H. (2008). Ideas of Ernst Mach Teaching Science. In: Gh. Asachi University, Cetex, Iasi, 5th Int. Seminar on Quality Management in Higher Education (QM 2006). Tulcea, Romania, June 2008. Siemsen, H. & Siemsen, K. H. (2009). Resettling the Thoughts of Ernst Mach and the Vienna Circle to Europe – The cases of Finland and Germany. Science & Education, 18/3, 299323. Siemsen, H. (2009a). Conceptual Adaptation: Bridging Spatial and Temporal Relations by Cognitive Wormholes. In: Albert, M. et al. (Eds.): Transnational Political Spaces. Agents – Structures – Encounters. Frankfurt (M.): Campus. Siemsen, H. (2010a). The Mach-Planck debate revisited: Democratization of science or elite knowledge? Journal of the Public Understanding of Science, forthcoming. Siemsen, H. (2010b). Alfred Binet and Ernst Mach. Conference paper November 2007, University of Nancy, Revue Recherches & Éducations, forthcoming. Siemsen, H. (2010c). Die psychophysiologische Fundierung des Analogiebegriffs bei Ernst Mach. In: K. Hentschel, (Ed.), Analogien in Naturwissenschaften, Medizin und Technik. Acta Historica Leopoldina, forthcoming. U

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Wilczek, F. (2004a). Total Relativity: Mach 2004. Physics Today, April 2004, 10-11. Wilczek, F. (2004b). Whence the Force of F = ma? Culture Shock, Physics today.org. Wittenberg, A. I. (1957). Vom Denken in Begriffen: Mathematik als Experiment des reinen Denkens. Basel: Birkhäuser. Wittenberg, A. I. (1962). May Philosophy of Science Preach Empiricism and Practice Apriorism? Dialectica, 16/1, presentation held in section 4 of the International Congress for the Philosophy of Science, Stanford 1960. Wittgenstein, L. (1922, 2003). Tractatus Logico-Philosophicus. Frankfurt (M.): Suhrkamp. Woodworth, R. S. (1915). A Revision of Imageless Thought. Psychological Review, 22, 1-27. Zilsel, E. (1976). Die sozialen Ursprünge der neuzeitlichen Wissenschaft. Krohn, W. (Ed.), Frankfurt (M.): Suhrkamp.123 Zoroaster (1900). The Gâthas. By L. H. Mills, (Ed., second edition), Leipzig: Brockhaus.

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The relevant articles have also been published in English, but, because of inconsistencies in the translation, not been used as sources:

a) 1931; 1940, ‗History and Biological Evolution I‘. In: Philosophy of Science, Vol. 7. b) 1941, ‗Problems of Empiricism‘. In: Neurath, O. et al. (eds.), Foundations of the Unity of Science. Towards an International Encyclopedia of Unified Science. Part II.

In: Advances in Psychology Research. Volume 72 Editor: Alexandra M. Columbus

ISSN: 1532-723X © 2011 Nova Science Publishers, Inc.

Chapter 2

EFFORTFUL CONTROL: LINKAGES TO REGULATION DISORDERS AND ATTENTIONDEFICIT/HYPERACTIVITY DISORDER Kimberly Renk*, Brea-Anne Lauer, Rebecca Weaver, L. Samantha Scott, Melissa Middleton and Rachel White University of Central Florida, Department of Psychology, Orlando, Florida All children are born with characteristic styles of expressing emotions and exhibiting behaviors. Generally, researchers refer to these characteristic styles using the term ‗temperament‘ (Thomas, Chess, & Birch, 1968). Although temperament is thought generally to include the relatively innate and consistent characteristics exhibited by children (Calkins, Hungerford, & Dedmon, 2004), the seminal work of Thomas and colleagues (1968) suggests that temperament can be shaped throughout development by the environment in which children are raised. For example, research suggests that there is a relationship between children‘s temperament characteristics and parenting behaviors exhibited by their mothers and fathers (Belsky, 2005). Further, children‘s temperament characteristics are related to the outcomes that children experience (e.g., any emotional and/or behavioral problems that they may exhibit; Aunola & Nurmi, 2005). Although the relationship between children‘s temperament and the experience of emotional and behavioral problems is documented, fewer researchers examine the relationship between children‘s temperament and their display of symptoms consistent with diagnoses described in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM; American Psychiatric Association, 2004), the most widely used psychiatric diagnostic system in the United States. The relative lack of examination of this relationship is curious, as there appears to be significant overlap between certain temperament characteristics and specific diagnoses in the DSM and in other diagnostic systems available *

Corresponding author: Kimberly Renk, Ph.D., University of Central Florida, Department of Psychology, P.O. Box 161390, Orlando, Florida 32816. E-mail: [email protected].

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for children (e.g., Diagnostic Classification: 0-3R; DC: 0-3R; Zero to Three, 2005). In particular, effortful control, a temperament characteristic that is characterized by difficulties with attentional focusing, inhibitory control, and perceptual sensitivity (Rothbart, Ahadi, Hershey, & Fisher, 2001), appears to overlap greatly with characteristics noted in children who are diagnosed with Regulation Disorders (i.e., a DC: 0-3R diagnosis) and in children who are diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD; i.e., a DSM diagnosis). Given these overlapping characteristics, these potential relationships deserve to be examined further. Thus, to examine these relationships and provide a foundation for future work, this chapter will examine a number of related constructs. First, this chapter will define ‗temperament‘ and examine the importance of temperament for children‘s relationships with their caregivers and their overall emotional and behavioral functioning throughout childhood. Next, this chapter will examine two disorders that may be of particular interest in terms of difficult temperament styles and effortful control (i.e., Regulation Disorders and ADHD). Throughout this discussion, this chapter will note the extant literature suggesting that having particular temperament styles (particularly difficulties with effortful control) may predispose children to exhibit behaviors consistent with these disorders. Finally, this chapter will outline the best course of assessment for determining whether children meet criteria for Regulation Disorders and ADHD (versus exhibiting difficult temperament style only) and will discuss potential treatment options for children who may benefit from improvements in managing their difficult temperament characteristics and behaviors consistent with these diagnoses.

TEMPERAMENT AND EFFORTFUL CONTROL After birth, one of the first processes that infants must master in order to survive is selfregulation. In particular, infants must learn to achieve a state of homeostasis so that they can regulate their sleep-wake cycle and their experience of hunger as well as their other activities. Thus, infants must learn to regulate their responses to sensory stimulation (DeGangi, 2000). In order to later develop the ability to build relationships, exhibit appropriate behaviors, and acquire appropriate affect, infants also must develop the ability to process and regulate their reactions to sensory stimuli from their environment while maintaining their attention and remaining in a state of calm (Greenspan, 2007). Children‘s competency in their development of self-regulation lies along a continuum, with some infants achieving more adaptive levels of self-regulation than others. Infants who are unable to achieve an adequate level of selfregulation tend to exhibit difficulties in a number of domains (e.g., sensory, attention, motor; Greenspan, 1992). As already noted, all children are born with characteristic styles of expressing their emotions and exhibiting behaviors that may help or hinder their acquisition of self-regulation abilities. Researchers typically refer to these characteristic styles using the term ‗temperament‘ (Thomas et al., 1968). Overall, temperament frequently is conceptualized as being a biologically based behavioral style or emotional disposition that is moderately consistent over time (Bates, 2001; Calkins et al., 2004). In general, research dichotomizes the temperament construct, such that children are viewed as having a difficult temperament or an easy temperament. For example, children who are viewed as having a difficult temperament are highly active, rigid, and unaffectionate. These children also experience difficulties with

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self-regulation. In contrast, children who are viewed as having an easy temperament are flexible, positive, and affectionate. These children also are better able to regulate their reactions to environmental stimuli (Billman & McDevitt, 1980; Rothbart & Bates, 1998). Thus, although temperament is conceptualized and studied in a variety of ways (for a review see Zentner & Bates, 2008), temperament generally is believed to be associated with children‘s individual differences in their emotional, motor, and attentional reactivity as well as their self-regulation (Bates, Maslin, & Frankel, 1985; Rothbart & Bates, 1998). Given that temperament is believed to be innate, individual differences in temperament are evident early in infancy. In fact, research often examines the duration and intensity of emotional reactivity and the regulation of those reactions when considering the earliest appearing aspects of temperament (Rothbart & Bates, 2006). In particular, research examines these early appearing temperament components (i.e., emotional reactivity and regulation) through the observation of emotional expressivity and orienting behaviors (e.g., Kagan, 1997; Rothbart, Derryberry, & Hershey, 2000). In this context, emotional expressivity includes the display of emotional reactions and is evident through behaviors such as laughing, crying, negative or positive vocalizations, and smiling or facial grimacing (Kagan, 1997). Infants who are prone to frequent crying, negative vocalizations, and facial grimacing are more likely to be viewed as having a difficult temperament, whereas infants who are prone to laughing, positive vocalizations, and smiling are more likely to be viewed as having an easy temperament. In contrast, infants‘ orienting behaviors are considered to be an early form of attentional regulation or control. These orienting behaviors include infant gaze aversion (i.e., the ability to avert attention away from stressful environmental stimuli) and object orientation (i.e., the ability to maintain a focused gaze on a non-stressful object; Rothbart et al., 2000). Accordingly, infants‘ object orienting behaviors allow them to disengage from stressful environmental stimuli and to refocus on neutral stimuli, thus serving as an early form of selfregulation. Taken together, these early temperament components are initial indicators of infant reactivity and regulation in the context of environmental stimuli. Further, these difficult temperament characteristics appear to resemble some of the diagnostic criteria used in diagnosing Regulation Disorders and ADHD. It is important to note that, although temperament is believed to be innate (e.g., Bates, 2001; Calkins et al., 2004), temperament also is believed to be influenced over time by environmental experiences (Rothbart & Bates, 2006; Thomas et al., 1968). For example, parenting behaviors (i.e., parents‘ power assertive behaviors) contribute to the developmental process of effortful control, one component of temperament (Kochanska & Knaack, 2003; Sprinrad et al., 2007). In addition, children who have a difficult temperament, including those with poor effortful control, evoke different reactions from their parents relative to children who have an easy temperament. For instance, research finds that children who have a difficult temperament display significantly less positive affect (Calkins et al., 2004) and increased crying and negative vocalizations (Kochanska, Coy, Tjebkes, & Husarek, 1998) when interacting with their parents relative to children who have an easy temperament. Thus, research suggests that, when compared to children who have an easy temperament, children who have a difficult temperament are more likely to interact adversely with others due to the way in which they respond to environmental stimuli (Billman & McDevitt, 1980; WebsterStratton & Eyberg, 1982). Consequently, children‘s temperament style is important for understanding how children interact with others in their environment, including their parents and other caregivers.

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Nonetheless, when examining the developmental progression of reactivity and regulation, effortful control, one component of temperament, may be particularly important. Effortful control is believed to emerge during the latter part of children‘s first year of life (Rothbart, Derryberry, & Posner, 1994) and to coincide with the development of more advanced cortical areas of the brain (Posner & Rothbart, 2000). Thus, effortful control is thought to develop rapidly in infancy and early childhood (e.g., Posner & Rothbart, 2000) and to become relatively consistent over time (e.g., Kochanska, Murray, Jacques, Koenig, & Vandegeest, 1996; Olson, Schilling, & Bates, 1999). In particular, effortful control is defined as ―the ability to suppress a dominant response in order to perform a subdominant response‖ (Rothbart & Bates, 1998, p. 137). Thus, effortful control includes children‘s ability to control impulsive reactions to environmental demands (Rothbart & Bates, 1998) and their ability to inhibit, activate, or change their attention and/or behavior (Eisenberg, Smith, Sadovsky, & Spinrad, 2004). As such, children‘s individual differences in effortful control are thought to underlie their development of emotional and behavioral self-regulation (Rothbart & Bates, 2006). Although more research is still needed, children‘s difficulties with effortful control also may be related to their development of symptoms consistent with Regulation Disorders and ADHD. For example, some research suggests that effortful control and reactive control are related, such that individuals who are impulsive are low in effortful control (Eisenberg et al., 1997). Further, given the connection between children‘s effortful control and self-regulation, it should not be a surprise that children with poor effortful control exhibit difficulties with attentional focusing and inhibitory control and experience perceptual sensitivity (Rothbart, Ahadi, Hershey, & Fisher, 2001). In fact, these relationships may be explained by an interaction between children‘s effortful control and their experience of guilt. Those young children who experience guilt in response to their actions will inhibit negative behaviors regardless of their effortful control, whereas those young children who do not experience guilt utilize their effortful control to inhibit their negative behaviors (or not; Kochanska, Barry, Jimenez, Hollatz, & Woodard, 2009). Thus, the temperament component of effortful control has important implications for understanding the origins of individual differences in children‘s emotional, behavioral, and social development (Kochanska, Murray, & Harlan, 2000; Posner & Rothbart, 2000). Given that effortful control includes the ability to regulate attention and inhibit or activate behavior when required by the environment (Rothbart & Bates, 2006), it is associated with children‘s behavior problems as well (e.g., Murray & Kochanska, 2002). For example, across several studies, poor effortful control (i.e., difficulties with attentional focusing, inhibitory control, and perceptual sensitivity) is associated with the presence of externalizing behavior problems in school-age children (Hughes, White, Sharpen, & Dunn, 2000; Spinrad et al., 2007) and clinic-referred children (Huey & Weisz, 1997). Such externalizing behavior problems are consistent with those problems exhibited by children who are diagnosed with Regulation Disorders (i.e., a diagnosis described in the DC: 0-3R; Zero to Three, 2005) and with ADHD (i.e., a diagnosis described in the DSM; APA, 2000). For example, shifting and focusing attention and inhibiting responses are main components of effortful control and allow children to regulate their reactions to environmental stimuli (Rothbart & Bates, 1998). These same components are prominent in Regulation Disorders and in ADHD (e.g., Barkley, 1997; Nigg, 2001). Given these overlapping characteristics, the relationship between effortful control and the development of children‘s emotional and behavioral problems should be

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examined further. In particular, gaining an understanding of young children‘s effortful control may provide valuable insight into the development of later psychological disorders involving symptoms of inattention, disinhibition, and perceptual sensitivity. As a result, the symptoms of Regulation Disorders and ADHD will be discussed next.

REGULATION DISORDERS As already noted, those children who are exhibiting difficulty in the components of effortful control and who are experiencing severe deficits in their ability to self-regulate may be diagnosed with a Regulation Disorder in their toddler and/or preschool years. According to the Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood (DC: 0-3R; Zero to Three, 2005), young children who exhibit difficulties in the realm of sensory processing are diagnosed typically with Regulation Disorders of Sensory Processing. By definition, these young children have difficulty regulating their emotions, behaviors, and motor abilities when they are required to process sensory stimulation. Typically, these difficulties impair young children‘s ability to develop appropriately and to interact with their surrounding environment. In order to be diagnosed with a Regulation Disorder, young children must exhibit a specific behavior pattern that is characterized by difficulties processing sensory information as well as difficulties with motor skills. Further, these difficulties must be apparent across multiple settings and within multiple relationships (Zero to Three, 2005). Three subtypes of Regulation Disorder are described in the DC: 0-3R. These subtypes are described as Hypersensitive (with Fearful/Cautious and Negative/Defiant patterns), Hyposensitive/Underresponsive, and Sensory Stimulation-Seeking/Impulsive (Zero to Three, 2005). Young children who fall in the Hypersenstive subtype find sensory stimulation to be overwhelming and unpleasant and tend to have extreme reactions to this stimulation, concomitant with significant difficulty in trying to manage their reactions. Young children‘s responses to environmental stimuli can be affected by a number of variables, including their level of emotional arousal before exposure to a stimulus and the type of stimulus to which they are exposed (e.g., its source, intensity, and duration; Zero to Three, 2005). For both the Fearful/Cautious and the Negative/Defiant patterns of Hypersensitive Regulation Disorder, young children‘s responses to sensory stimuli are characterized by a number of behaviors, including crying, attempting to escape, aggression, and a limited tolerance for particular stimuli (e.g., textures, smells). Further, these young children can develop motor deficits (e.g., difficulties with motor coordination and planning) due to their limited interaction with their environment. Young children who are classified as exhibiting behaviors consistent with the Fearful/Cautious subtype are inhibited extremely, exhibiting a lack of assertiveness, irritability, anxiety, and shyness. In contrast, young children who are classified as exhibiting behaviors consistent with the Negative/Defiant subtype tend to avoid, fuss, show defiance, and have difficulty adapting to changes when confronted with a variety of environmental stimuli (Zero to Three, 2005). In contrast, young children who exhibit behaviors consistent with the Hyposensitive/ Underresponsive subtype of Regulation Disorder require much higher levels of sensory stimulation in order to respond appropriately to their environments. As a result, the caregivers of these young children must exert more effort to engage them, as these young children often

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appear to be uninterested in their surrounding environment. Further, these young children often exhibit a limited response to sensory stimulation, do not explore their environments, are lethargic, withdraw, and are inattentive (Zero to Three, 2005). Finally, young children who exhibit behaviors consistent with the Sensory Stimulation-Seeking/Impulsive subtype of Regulation Disorders also require high levels of stimulation in order to respond to their surrounding environment. Unlike children who exhibit behaviors consistent with the Hyposensitive subtype and who have a tendency to withdraw, young children who are classified as Sensory-Stimulation Seeking/Impulsive seek out stimulation in order to satisfy their needs. Because of their need for stimulation, these children tend to engage in high-risk behaviors and often exhibit impulsivity, clumsiness, hyperactivity, and disorganized behavior. Further, these young children tend to seek out physical contact by often touching or hitting others and destroying property (Zero to Three, 2005). Thus, young children who meet criteria for each of the subtypes of Regulation Disorder experience difficulty in maintaining their attention, managing their interactions with their surrounding environment, and dealing with perceptual sensitivity. Given these diagnostic criteria, it seems likely that those young children who have difficulties in utilizing effortful control also would be at risk for a diagnosis of Regulation Disorder. In fact, Regulation Disorders are one of the most commonly diagnosed disorders in infancy, with a prevalence rate of approximately 7 percent in the general population (Skovgaard et al., 2007). In laboratory settings, infants who are classified as having Regulation Disorders exhibit deficits in several areas of physiological development, including eye movement control, visual-tactile integration, and motor response, as well as hypersensitivity to touch and intolerance for movement (DeGangi & Greenspan, 1989). These deficits are consistent with the common belief that young children who exhibit behaviors consistent with Regulation Disorders have underlying deficits in sensory processing as well as in self-regulation (DeGangi, Breinbauer, Roosevelt, Porges, & Greenspan, 2000). Further, if these deficits are not addressed through treatment, these young children will be at risk for the development of a number of difficulties later in childhood. For example, infants who exhibit moderate to severe symptoms of Regulation Disorders (i.e., three symptoms or more) are much more likely to receive a diagnosis at the age of 3-years, with the majority of these diagnoses being related to developmental delays (e.g., in regulation, motor abilities, cognitive abilities, or language) and parent-child relationship problems (DeGangi et al., 2000). Further, infants who exhibit behaviors consistent with Regulation Disorders are more likely to exhibit difficulties with their language development, sensory integration, and behavioral problems in preschool, including signs of emotional immaturity, hyperactivity, and inattention (DeGangi, Porges, Sickel, & Greenspan, 1993). Consistently, research indicates that early self-regulation difficulties are common in many children who exhibit behavioral problems in preschool (Rostad, Nyberg, & Sivberg, 2008). Finally, current research indicates that early problems with self-regulation may have a small but significant impact on cognitive development (Wolke, Schmid, Schrier, & Meyer, 2009).

Potential Etiology of Regulation Disorders Although it is clear that problems with effortful control appear related to the symptoms of Regulation Disorders and that Regulation Disorders appear to have many symptoms in common with ADHD (to be discussed next), understanding the potential underlying reasons

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for children‘s development of Regulation Disorders may be helpful in solidifying these connections. In this context, it is a common belief that self-regulation is influenced by the combination of a number of factors, including the temperament with which children are born (e.g., difficulties with effortful control), interactions between children and their parents and other caregivers, and children‘s physiological characteristics (DeGangi, 2000). In fact, current research suggests that young children‘s regulation problems are predicted by both environmental factors (e.g., having mothers who are depressed or anxious) and characteristics of the children themselves (e.g., having higher levels of emotionality or physical health problems; Mathiesen & Sanson, 2000). Further, other current research suggests that both young children‘s own neurological difficulties and their interactions with their parents are related to regulation problems (Wolke et al., 2009). Thus, both biological and environmental characteristics should be considered when trying to understand the development of Regulation Disorders in young children. Based on such findings, several theories are being developed to provide a cohesive understanding of Regulation Disorders. One relevant physiological theory of self-regulation is the Polyvagal Theory (Porges, 1996, 2007), which focuses on the management of stress through the vagal system. As part of the vagal system, the vagas nerve allows the brainstem to regulate and adjust cardiac and metabolic output so that individuals can interact most effectively with their surrounding environment. In particular, cardiac activity is increased or decreased when individuals emit the fight or flight mechanism or need to calm their bodies, respectively. In addition, the vagas nerve provides feedback as individuals engage with or disengage from their surrounding environment based on the sensory information that they are receiving. One major focus of this theory is the ‗vagal brake‘, a physiological mechanism that assists in the regulation of metabolic reactions as individuals interact with their environment on a psychological and behavioral level (Porges, Doussard-Rousevelt, Portales, & Greenspan, 1996). Release of the vagal brake allows individuals to react to stressful situations by increasing their metabolic output, whereas individuals‘ engagement of the vagal brake as they come into contact with novel stimuli allows for self-soothing and interaction with these stimuli to occur (Porges, 1996). Thus, greater reductions in vagal tone via the vagal brake during tasks that require focused attention are associated with individuals‘ better responsivity and fewer social problems. Further, young children‘s effective use of the vagal brake to manage their responses to novel stimuli is associated with fewer behavioral problems during toddlerhood. Thus, young children who are better able to regulate their vagal tone tend to be more engaged in their surrounding environment and better able to manage novel stimuli. Further, higher baseline vagal tone is related to fewer sleep and somatic problems as well as to greater awareness of and reactivity to the environment (Porges et al., 1996). In contrast, young children who exhibit behaviors consistent with Regulation Disorders may have more difficulty in using their ‗vagal break‘. In fact, research shows that young children who exhibit behaviors consistent with Regulation Disorders have a higher baseline vagal tone but have inconsistent regulation of their vagal tone across situations (DeGangi, DiPietro, Greenspan, & Porges, 1991). Further, young children who do not have regulatory issues and who have a higher vagal tone demonstrate more adaptive behavior, whereas young children who exhibit behaviors consistent with Regulation Disorder and who have higher vagal tone demonstrate behavioral difficulties (DeGangi et al., 1993). More recent research also suggests that children who

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exhibit a homogenous regulation of vagal tone across tasks tend to have a higher baseline vagal tone, possibly indicating that their initial reactivity to their environment may be related to their management of stressful situations (Calkins, 1997). In addition, children who have a higher baseline vagal tone demonstrate more positive responses and fewer negative responses to stimuli in their environment. Finally, children who are at a greater risk for externalizing disorders demonstrate less effective vagal regulation (Calkins, Graziano, & Keane, 2007). In summary, young children who exhibit behaviors consistent with Regulation Disorders are characterized by deficits in their ability to competently organize and regulate their responses to the stimulation that they receive from their surrounding environment. These children‘s inability to cope with this stimulation is exemplified by a range of behaviors that may include excessive fussinesss or crying, avoidance, withdrawal, a need for excessive stimulation, and impulsivity. If these young children are not treated for these difficulties, they may go on to develop delays in a number of developmental areas, including language, perception, and sensory processing, as well as behavior problems later in their childhoods. Based on research into the underlying etiologies for Regulation Disorders, these children may have great difficulty in regulating their physiological reactions to their environment, similar to the difficulties seen by young children who exhibit difficulties with effortful control as part of their temperament characteristics. By learning to regulate their physiological reactions to stress, these young children may be able to effectively control their reactions to sensory stimulation. If such improvements do not occur, these children may go on to be diagnosed with other disorders later in life. One such possible diagnosis is discussed next.

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by core symptoms of inattention, hyperactivity, and impulsivity (APA, 2000). A diagnosis of ADHD is given when six or more symptoms of inattention and/or hyperactivity and impulsivity are present for at least six months. These symptoms of inattention (e.g., making careless mistakes on school assignments, having difficulty sustaining attention, not following through on instructions), hyperactivity (e.g., fidgeting or squirming, running or climbing excessively, being ‗on the go‘), and/or impulsivity (e.g., blurting out answers before being called on, having difficulty waiting for a turn, interrupting or intruding on others) present as maladaptive and inconsistent with same-age children‘s typical developmental level. For a diagnosis to be made, the DSM (APA, 2000) specifies that these symptoms must cause clinically significant impairment in children‘s social and/or academic functioning. In addition, some impairment from these ADHD symptoms must be present for children in two or more settings, and the symptoms must be present before children are 7-years of age. Exclusionary criteria require that ADHD symptoms must not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or some other psychotic disorder and may not be better accounted for by another mental disorder (e.g., mood or anxiety disorders; APA, 2000). Further, based on the symptom profile that is present, children may be diagnosed with the Predominantly Inattentive Type (i.e., children experience six or more of the inattentive symptoms without significant hyperactivity-impulsivity), the Predominantly Hyperactive-Impulsive Type (i.e., children experience six or more of the hyperactive-impulsive symptoms without significant

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inattention), or the Combined Type (i.e., children have six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity; APA, 2000). Currently, the prevalence rate of ADHD in the U.S. population is estimated to be between 2 and 18 percent (Rowland, Lesesne, & Abramowitz, 2002). Many other young children are at-risk for this disorder as a result of their disruptive behaviors, particularly in their classroom settings (Campbell, 2002), although only approximately 2 percent of children who range in age from 3- to 5-years receive this diagnosis (Lavigne et al., 1996) . Further, ADHD often presents along with comorbid disorders. Estimates of comorbidity suggest that 10 percent of children who are diagnosed with ADHD also experience Reading Disabilities, 27 percent experience Anxiety Disorders, and 25 to 40 percent experience Oppositional Defiant Disorder or Conduct Disorder (Rowland et al., 2002). Thus, similar to the information on Regulation Disorders, children who are diagnosed with ADHD are likely to experience difficulties in multiple domains. Also of concern for ADHD, the course of this disorder is chronic, with an insidious onset. Although most symptoms may remit by adolescence, some symptoms may be lifelong (Rapport et al., 2008), and there can be increasing impairments (Hechtman, 1999). For example, DuPaul, McGoey, Eckert, and VanBrakle (2001) suggest that young children who are diagnosed with ADHD experience more problem behaviors, are less socially skilled, exhibit more noncompliance and inappropriate behavior in interactions with their parents, and exhibit more negative social behavior in interactions with their preschool classmates than children who do not have such a diagnosis. Further, parents of young children who are diagnosed with ADHD experience greater parenting stress and cope less adaptively relative to parents who have nonclinical young children (DuPaul et al., 2001). Although young children are being referred increasingly for issues related to inattention and hyperactivity-impulsivity, the diagnostic process can be difficult, particularly when young children exhibit signs of difficult temperament. For example, young children‘s temperament activity level may be related to symptoms of hyperactivity-impulsivity, whereas young children‘s effortful control may be related to symptoms of inattention (Bussing, Lehninger, & Eyberg, 2006). Research supports this assumption, in that young children who are inattentive and who have difficulty inhibiting their responses at 2-years of age are more likely to exhibit inattention, hyperactivity, and aggression at 4-years of age (Silverman & Ragusa, 1992). Children who exhibit such difficulties (i.e., inattention, oppositionality, and aggression) at 3.5-years of age also are more likely to experience comorbid ADHD and disruptive behavior disorders at 5.5-years of age (Shaw, Owens, Giovannelli, & Winslow, 2001). Further, Sanson, Smart, Prior, and Oberklaid (1993) suggest that hyperactivity emerges from poor self-regulation when children are faced with environmental demands. Thus, young children‘s temperament and their display of inattention and hyperactiveimpulsive symptoms are related highly and should be considered closely during assessments conducted with young children. Further, given these relationships, understanding the etiology of ADHD is of the utmost importance, as this information may shed light on the distinctions between difficult temperament and symptoms of ADHD.

Etiology of ADHD Generally, there are many reasons that young children may develop symptoms of ADHD. One such potential etiology involves the genetic inheritance of these symptoms. Overall, the field of behavioral genetics provides support for ADHD as a heritable and biologically based

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disorder (Rapport, Kofler, Alderson, & Raiker, 2008). For example, twin studies using parental rating scales find that genetic variation accounts for 73 to 76 percent of the individual differences noted in attention (Gjone, Stevenson, & Sundet, 1996) and 70 percent of the individual differences noted in impulsivity-hyperactivity (Sherman, Iacono, & McGue, 1997). In addition, studies of heritability estimates that use discrete diagnostic categories for ADHD provide estimates that are comparable to studies using continuous rating scales, with approximately 75 percent of the variation in ADHD being genetically based (Levy, Hay, McStephen, Wood, & Waldman, 1997). Further, heritability estimates of ADHD are similar whether ADHD is described in terms of categorical or continuous dimensions (Gjone et al., 1996; Levy et al., 1997). For example, familial genetic studies indicate that 10 to 35 percent of first degree relatives of individuals who are diagnosed with ADHD are likely to be diagnosed with the disorder (Biederman et al., 1992). Thus, consistent evidence has accumulated that the symptoms of ADHD are highly heritable. In addition to considering genetics, however, research suggests that symptoms of ADHD are likely related to underlying neurobiological factors as well. In particular, current research suggests that abnormalities in the development of the frontal-striatal-cerebellar regions of the brain are the cause of the specific neurological deficits underlying ADHD (Hendren, De Backer, & Pandina, 2000). For example, one neuroanatomical study reports that children who are diagnosed with ADHD have a significant delay (rather than deviation) in their cortical development by several years relative to children who are classified as nonclinical controls. This delay is particularly noticable in the lateral prefrontal cortex, which supports cognitive functions such as behavioral inhibition, executive control of attention, evaluation of reward contingencies, higher-order motor control, and working memory (Castellanos et al., 2001; Shaw et al., 2007). Magnetic Resonance Imaging (MRI) studies also suggest that there are size differences in the structure of certain brain regions in children who are diagnosed with ADHD relative to controls. For example, numerous studies note that the size of the basal ganglia and the right frontal lobe are correlated with the degree of impairment that children who are diagnosed with ADHD experience in inhibition and attention (Semrud-Clikeman et al., 2000). Further, the finding that those who are diagnosed with ADHD have smaller cerebellar volume, especially in the central region called the vermis, is consistent with deficits in executive functioning and the motor-related aspects of sensory perception that affect executive function (Durston et al., 2004). In addition to the findings that there may be structural differences in the brains of children who are diagnosed with ADHD, there may be differences in the function of their brains as well. For example, Functional Magnetic Resonance Imaging (FMRI) studies find that, during attention and inhibition tasks, children who are diagnosed with ADHD have differing patterns of activation in the right prefrontal region, the basal ganglia, and the cerebellum relative to children who are classified as typically developing controls (Yeo et al., 2003). Some research attempts to draw conclusions based on children‘s response to medications meant to treat the symptoms of ADHD. Positive response to medications (e.g., stimulants, dopamine and norepinepherine reuptake inhibitors and agonists), however, are not enough evidence to support neurotransmitter dsyfunction in these children, as children who are not diagnosed with ADHD also demonstrate a response to these treatments (e.g., stimulants; Rapoport et al., 1978). Further studies are necessary to confirm if neurotransmitter dysfunction is related to the difficulties that children experience in conjunction with an ADHD diagnosis (Bobb et al., 2005).

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In addition to the genetic and neurobiological findings noted above, other studies suggest that environmental factors may play a role in children‘s development of symptoms of ADHD. For example, studies assessing the influence of pregnancy and birth complications in the development of ADHD find consistently that low birth weight is associated with an increased risk of inattention, hyperactivity, disruptive behavior, and poor school adjustment, even after controlling for other factors (e.g., maternal smoking, alcohol use, and SES; Mick, Biederman, Faraone, Sayer, & Kleinman, 2002). Developmental theories based entirely on environmental and parental rearing factors, however, have little support in the literature, as the contribution of shared environment factors on the development of ADHD is quite small (0 to 13 percent; Sherman et al., 1997). Based on the research examining the etiology of ADHD, several models are being developed to explain the development of symptoms consistent with ADHD. For example, the DSM clinical model assumes that the core features of ADHD (i.e., inattention, hyperactivity, and impulsivity) are the result of biological factors (e.g., genetics; post-, pari-, and prenatal stressors), environmental characteristics, and cognitive demands, all of which subsequently may affect the functioning of neurobiological substrates (e.g., neurotransmission differences). Several other models also are described to explain the functional neurological deficits from which the core symptoms of ADHD arise. A major theoretical model described by Barkley (1997) proposes that a deficit in behavioral inhibition, the ability to inhibit a prepotent response, leads to secondary impairments in four executive neuropsychological functions. These four executive functions include working memory (i.e., the process of holding and manipulating events in the mind), self regulation (i.e., the control of affect, motivation, and arousal), internalization of speech (i.e., description, reflection, and rule-governed behavior), and reconstruction (i.e., the analysis and synthesis of behavior). These secondary impairments subsequently affect motor control. Thus, this theory states that the influence of a behavioral inhibition deficit on these four executive functions leads to the impairments seen in ADHD (i.e., effects on motor control, fluency, and syntax). Such an explanation appears similar in nature to theories proposed for Regulation Disorders. A recent meta-analysis evaluates the literature supporting the behavioral inhibition model, which is assessed primarily using the stop-signal paradigm. This meta-analysis suggests that the differences in stop-signal reaction time between children who are diagnosed with ADHD and children who are classified as typically developing controls reflect a more generalized deficit in attention and cognitive processes, rather than a deficit in behavioral inhibition (Alderson, Rapport, & Kofler, 2007). Thus, an alternate theoretical model posits that working memory deficits are at the core of ADHD etiology, with empirical studies showing that children who are diagnosed with ADHD are significantly deficient in their working memory processes relative to children who are classified as typically developing controls (Rapport et al., 2008). Further research also shows that a core deficit in working memory processes is related to the higher activity levels found in children who are diagnosed with ADHD and who show significantly higher rates of movement during tasks involving working memory (Rapport et al., 2009). Given these new findings, further research is warranted in understanding the underlying etiology of ADHD. Nonetheless, symptoms of ADHD still resemble some of the difficulties noted for children who exhibit difficulties in effortful control and who are diagnosed with Regulation Disorders.

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TYING IT ALL TOGETHER: THE DEVELOPMENT OF SELF-REGULATION Clearly, from the previously discussed research, it is clear that temperament difficulties in effortful control, Regulation Disorders, and some symptoms of ADHD have unique but also overlapping symptoms and potential etiologies. Nonetheless, young children‘s ability to selfregulate behavior appears to be an important underlying component of all these difficulties. For example, similar to a lack of effortful control in infants and toddlers and Regulation Disorders in young children, young children who are diagnosed with ADHD often have difficulties regulating their emotional states and their behaviors, particularly in response to situations where stimulation from the surrounding environment is not optimal. It would likely follow then that young children‘s difficulties in regulating their emotions and their behaviors would interfere with their ability to act and react in an effective and appropriate manner. Although many infants and toddlers who have early self-regulation difficulties (e.g., eating and sleeping disturbances) do not go on to present with behavior problems as young children, others do. Thus, reasons for the persistence of deficits in self-regulation require further examination.

Behavioral Inhibition Although the symptoms and course of children who have difficulties with effortful control, Regulation Disorders, and ADHD are described in current research, research that provides an understanding of the common deficits in self-regulation still is needed. One potential model that may provide insight is based largely on Gray‘s (1982) theory of anxiety. This model may provide one explanation for the inattentive, hyperactive, and impulsive symptoms of ADHD (Barkley, 1997). Based on this theory, these behaviors are the result of an underactive Behavioral Inhibition System (BIS). Gray (1982) posits that the BIS is responsible for responding to rewards, punishment, and fear, allowing for the inhibition of behaviors that create negative consequences (Gray, 1982; Quay, 1997). In other words, an underactive BIS prevents children from recognizing situations that should elicit fear and/or anxiety, subsequently leading to their engagement in or continuation of negative behaviors. In addition, the BIS affords children the ability to increase focused attention on relevant cues in their surrounding environment. As such, children with deficits in this system are less able to attend to environmental stimuli that signal punishment and, therefore, do not inhibit their behaviors accordingly (Gray, 1982; Quay, 1997). Consistently, research suggests that behavioral inhibition has a protective effect with regard to preventing the development of delinquent behaviors (Kerr, Tremblay, Pagani, & Vitaro, 1997). Based largely on Gray‘s (1982) and Quay‘s (1997) theory, Barkley (1997) proposes a new model describing ADHD that describes a deficit in behavioral inhibition. As noted earlier, behavioral inhibition leads to deficits in four neuropsychological functions (i.e., working memory, self-regulation of affect/motivation/arousal, internalization of speech, and reconstitution). These deficits in executive functioning then lead to decreases in control over behavior (e.g., inhibiting task-irrelevant responses, sensitivity to response feedback, task reengagement following directions, control of behavior by internally represented information). Although this model is described as an explanation for ADHD, it also may have some relevance for difficulties in effortful control and Regulation Disorders. For example,

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performance on computerized measures of executive attention is related to mothers‘ reports of their adolescents‘ effortful control (Ellis & Rothbart, 2002). Further, Barkley (1997) suggests that behavioral inhibition encompasses the ability to inhibit a response to an event, stop an ongoing response (i.e., affording more time to decide how to respond), and interference control (i.e., the ability to ignore external stimuli during the period of delay required to make a decision), difficulties that are apparent with difficulties in effortful control, Regulation Disorders, and ADHD. Barkley (1997) suggests, and subsequent research supports, that children who are diagnosed with ADHD have deficits in each of these areas associated with behavioral inhibition. Unique to this model is the assumption that deficits in behavioral inhibition disrupt executive functioning, thus influencing the ability to regulate behavior. Thus, behavioral inhibition is not related directly to executive functioning but allows the effective activation of the four executive functions considered important to self-regulation (Barkley, 1997). Studies demonstrate that children who are diagnosed with ADHD consistently perform more poorly on tasks measuring behavioral inhibition (e.g., the Stroop Color-Word Interference Test, the Change Task, the Stop-Signal Task, the Go-No-Go Discrimination task; Alderson et al., 2007; Quay, 1997), providing support for these assumptions. These tasks measure the ability to control and/or prevent motor responses by measuring reaction times. Difficulty with these tasks, specifically with slower reaction times, reflects children‘s difficulty with withholding or stopping an ongoing response. Given these findings, it may be valuable to examine the response of young children who demonstrate difficulties with effortful control and/or who are diagnosed with Regulation Disorders to determine if they exhibit a similar response pattern. In relation to Barkley‘s (1997) model, it is this deficit in behavioral inhibition that leads to deficits in the four executive functions. In turn, these deficits in the four executive functions lead to decreased control over motor behavior. Barkley (1997) further posits that deficits in behavioral inhibition disrupt emotion regulation processes as well. For example, when confronted with an emotionally charged situation, deficits in behavioral inhibition prevent children from delaying their emotional responses long enough to consider their social context. Thus, behavioral inhibition appears necessary for effective emotion regulation and the ability to behave appropriately. Consistently, research suggests that emotion regulation is related to disruptive behaviors (Cole, Zahn-Waxler, & Smith, 1994; Shields & Cicchetti, 2001). This relationship is noted in studies examining emotion dysregulation using frustrating tasks (e.g., Cole et al., 1994; Hinshaw & Melnick, 1995) as well as those that examine emotional dysregulation in conjunction with other constructs representing difficult temperament (e.g., social inflexibility and emotionally intensity in Sanson et al., 1993; reactivity and lability in Shields & Cicchetti, 2001). For example, Walcott and Landau (2004) report that school-aged boys (i.e., those who range in age from 6- to 11-years) who are diagnosed with ADHD are less effective than boys who are not diagnosed with ADHD at effectively regulating their emotion reactions when confronted with a frustrating task. This finding remains consistent, even when children are prompted to control their emotional reactions in front of a peer competitor. In other words, boys who are not diagnosed with ADHD, relative to those who are diagnosed with ADHD, demonstrate improvements in their emotion regulation following the prompt to do so. This finding suggests that emotion regulation is a skill that is developing during this time period and that children who are diagnosed with ADHD have specific deficits in this ability (Walcott & Landau, 2004). As it is likely that children who have difficulties with effortful control and

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who are diagnosed with Regulation Disorders would exhibit a similar pattern of responses, similar studies should be completed with these children. Further, deficits in behavioral inhibition are expected to interfere with relationships with peers and other individuals as well. First, impulsive behaviors often are disruptive and are perceived negatively by peers. Further, children‘s hyperactivity and impulsivity often result in children having difficulty engaging in reciprocal relationships with peers and other individuals. These children often interrupt others, have difficulty waiting their turn, blurt out answers in class, and are rejected subsequently by peers (Barkley, 1997). Second, deficits in behavioral inhibition prevent children from recognizing social cues that often guide typically developing children‘s behaviors and appropriate social skills. Such difficulties may be particularly apparent during frustrating situations, in which children who have deficits in behavioral inhibition are not able to effectively implement self-regulation strategies so that they may delay impulsive behaviors (Barkley, 1997; Walcott & Landau, 2004). Thus, difficulties with behavioral inhibition are likely to promote a variety of problematic occurrences for young children.

Evidence for Deficits in Executive Functioning In addition to the difficulties noted in behavioral inhibition, evidence of poor selfregulation strategies is found when examining deficits in specific executive functioning skills that are demonstrated by children with ADHD. Such findings also may be relevant to children who exhibit difficulties with effortful control and who are diagnosed with Regulation Disorders. In addition to the aforementioned executive functions (i.e., working memory, selfregulation of affect/motivation/arousal, internalization of speech, and reconstitution), other executive functions (e.g., attentional control, planning, and organizing) also may result from early difficulties controlling impulses (Campbell & von Stauffenberg, 2009). For example, children who are diagnosed with ADHD consistently perform more poorly on tasks of executive functioning relative to children who are not diagnosed with ADHD (for a review of specific tasks, see Pennington & Ozonoff, 1996). Further, a meta-analysis of 83 studies indicates that executive dysfunction appears to be an important aspect of ADHD (for metaanalytic review of specific executive functions, see Willcutt, Doyle, Nigg, Faraone, & Pennington, 2005). In addition, evidence of poor impulse control, behavior dysregulation, and deficits in delay of gratification are noted in young children who exhibit early symptoms of inattention, hyperactivity, and impulsivity in comparison to children who are not exhibiting symptoms consistent with ADHD (Sonuga-Barke, Dalen, Daley, & Remington, 2002; von Stauffenberg & Campbell, 2007). Other studies examining the executive functioning of children who are diagnosed with ADHD provide inconsistent results, however (Brocki & Bohlin, 2006). Variation in outcomes may reflect the inclusion of children who are diagnosed with the different subtypes of ADHD or who may be better diagnosed with a different disorder. For example, Campbell and von Stauffenberg (2009) compare Third Grade children who exhibit inattentive and hyperactive-impulsive behaviors to those who exhibit inattentive behaviors only on measures of delay capacity, attention, planning, and inhibitory control. When these groups of children are compared to children who do not exhibit either inattentive or hyperactive-impulsive symptoms, their early poor performance on these delay and central executive tasks predict their later ADHD diagnoses. In addition, membership in the group

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who exhibits both inattentive and hyperactive-impulsive is predicted uniquely by deficits in delay aversion. These children further present with greater planning deficits and impulsive errors. For those children who experience inattentive symptoms only, impulsive responding appears to be more related to poor attention and planning abilities (Campbell & von Stauffenberg, 2009). Overall, these findings support Barkley‘s (1997) model, suggesting that early deficits in executive functioning (i.e., delay aversion and deficits in planning) contribute to later symptomotology. Differential pathways may exist, however. It may be the case that delay aversion combined with impulse control deficits are a greater predictor of combined inattentive and hyperactive-impulsive symptoms, whereas delay aversion combined with deficits in attention are a greater predictor of inattentive symptoms only. If differential pathways do exist, variations in etiology and later symptom expression may exist (Campbell & von Stauffenberg, 2009). Variations in outcome also may reflect difficulty distinguishing developmentally expected problem behaviors versus clinically significant behavior problems. For example, in a longitudinal examination of young children displaying symptoms of ADHD, Campbell, Ewing, Breaux, and Szumowski (1986) indicate that, although the majority of children continue to demonstrate behavior problems over time, approximately one-half meet diagnostic criteria for ADHD in middle childhood. These results suggest that there is a great need for a biological explanation of behavior dysregulation in general and for ADHD in particular, as well as a great need to examine these results in the context of other difficulties that may promote behavior dysregulation (e.g., difficulties in effortful control and Regulation Disorders). Further, in the aforementioned study, those children who meet criteria for ADHD are more likely to demonstrate early deficits in resistance to temptation (Campbell et al., 1986), suggesting an additional manifestation of behavior dysregulation. von Stauffenberg and Campbell (2007) also provide evidence for early delay of gratification and inhibitory control deficits in the prediction of teachers‘ ratings of ADHD symptoms over time, even after controlling for the stability of children‘s symptoms (von Stauffenberg & Campbell, 2007). Thus, more studies examining specific deficits in behavioral inhibition in young children exhibiting behavior problems are warranted and may be crucial to the accurate identification of difficulties with effortful control, Regulation Disorders, and ADHD.

Behavioral Disinhibition Consideration of etiological factors related to self-regulation also should include a related construct, behavioral disinhibition. Behavioral disinhibition refers to difficulty inhibiting impulses that result in socially inappropriate behavior (Young et al., 2009). Children who exhibit behavioral disinhibition are able to recognize that their behavior may result in negative consequences but are unable to control their impulses to act in problematic ways. Thus, behavioral disinhibition reflects an overexcitement to stimuli resulting in impulsive decision making. Behavioral disinhibition also appears to be genetic in nature. For example, Young and colleagues (2000) suggest that behavioral disinhibition is related to response inhibition in a sample of twins; however, this relationship appears to be almost entirely genetic. This finding suggests that behavioral disinhibition appears to be related biologically to cognitive functioning, whereas behavioral inhibition may constitute an endophenotype of behavioral disorders (Young et al., 2009). Further, behavioral disinhibition is compared to a more difficult temperament style characterized by absence in restraint, sensation seeking,

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high approach behaviors, and a lack of inhibition (Hirshfeld-Becker, Biederman, Calltharp, Rosenbaum, & Rosenbaum, 2003), similar to effortful control. Evidence also supports a stable trend for behavioral disinhibition beginning in infancy and persisting into early childhood (Derryberry & Reed, 1994). In fact, behavioral disinhibition also may reflect Gray‘s (1982) behavioral inhibition system, such that children who experience behavioral disinhibition become overly aroused and are unable to inhibit their ongoing responses when they are presented with new or threatening situations. In addition, it may reflect a related system, the Behavioral Activation System (BAS; Gray, 1982), which is thought to regulate aggression and behaviors designed to obtain rewards or to escape punishment (Quay, 1997). Thus, children who experience behavioral disinhibition may have an overactive BAS and/or an underactive BIS (HirshfeldBecker et al., 2003). Behavioral disinhibition also may lead to greater sensation seeking as a result of these individuals‘ greater need for arousal. Consistently, underarousal is implicated in Regulation Disorders and ADHD. In fact, strong evidence links behavioral disinhibition to disruptive behavior disorders, particularly ADHD, and a variety of related problematic outcomes (e.g., behavior problems at school, lower overall functioning, higher rates of psychosocial treatment, participation in special education classes; Hirshfeld-Becker et al., 2002). For all young children, self-regulation is an ongoing developmental process, and all young children demonstrate increases in impulse control, problem solving, and sensitivity to feedback as part of normal development (Levin et al., 1991). In fact, Berwid and colleagues (2005) provide evidence for age-related developments in inhibitory control and sustained attention that take place between 3- and 7-years of age (Berwid, et al., 2005). Barkley (1997) further suggests that deficits in behavioral inhibition likely fall along a continuum and that the development of the related executive functions likely occurs at different times. Thus, the continued examination of young children‘s deficits in behavioral inhibition and disruptive behaviors related to behavioral disinhibition may be crucial to distinguishing age-appropriate behaviors from behaviors that warrant clinical attention, particularly as part of difficulties in effortful control, Regulation Disorders, and ADHD.

Environmental Factors Given this body of research, behavioral disinhibition may reflect a more temperamentally related construct that places children at risk for the development of future disruptive behavior disorders. The fact that not all children who exhibit behavioral disinhibition go on to develop such disorders may reflect a protective environmental factor. For example, goodness of fit, or the ability of parents to align their parenting and temperament style to that of their children may be related to children‘s behavior (Chess & Thomas, 1977). A large body of research exists to explain the role of temperament in the interactions between young children and their parents. Although temperament is thought to be relatively innate (Chess & Thomas, 1977), research suggests that the environment in which young children develop can provide a safehaven or a place of risk, depending on the temperament style of the children and their parents or caregivers. In other words, the notion of goodness-of-fit between children‘s temperament, parenting qualities, and the broader environmental context in which young children live all interact to determine the ultimate outcome of certain temperament characteristics (Chess & Thomas, 1977).

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Coercion theory provides a behavioral model that demonstrates what can go awry in the interactions that transpire between parents and their young children (Patterson, 2002; Patterson, Reid, & Dishion, 1992). At the heart of this theory is the idea that contingencies produced by both young children and their parents or caregivers set the stage for the relationship that will develop between them. One of the variables that Patterson and colleagues (1992) suggest is most likely associated with the commencement of a coercive process is the interaction between young children with difficult temperaments (i.e., difficulties with effortful control, intense reactivity and negative mood) and their ineffective parents. It should be noted that ineffective parenting can stem from a variety of situations (e.g., divorce, parental psychopathology, single parenting, distanced and uninvolved parenting style). In particular, coercion theory turns to operant conditioning principles to describe the processes that create coercive interactions. Young children are armed with a plethora of commanding contingencies (e.g., crying, fussing, temper tantrums), all of which are understandably aversive for parents and caregiver. Although all young children cry and fuss to some extent, a coercive process is thought to develop when the responsiveness of parents or caregivers to their young children is disproportionate. For example, if parents or caregivers respond to higher proportions of aversive behaviors (e.g., crying, fussing) and fail to respond to other behaviors exhibited by their young children (e.g., smiling, verbalizations, facial expressions), young children will learn that their aversive behaviors elicit more attention. Therefore, these aversive behaviors will increase in frequency. Patterson (2002) describes this process as a ―five-step dance‖ in which young children exhibit aversive behaviors (1). These behaviors are followed by parents or caregivers exhibiting aversive behaviors (2). Young children then escalate their aversive behaviors (3). Next, parents or caregivers correct their responses (4), and young children cease their aversive behaviors (5). Similar to the research of Patterson and colleagues (1992), Belsky‘s (2005) research also focuses on parenting styles and children‘s temperament. As part of the differential susceptibility hypothesis, Belsky posits that children vary in their susceptibility to rearing influences. This hypothesis is embedded in an evolutionary framework in which natural selection is at the center. Specifically, Belsky argues that parents bear children that vary in their susceptibility to rearing influence within a family, such that parents can ‗hedge their bets‘ that at least one of their children will fare positively within their family and greater environmental context and subsequently will be reproductively successful. Belsky‘s hypothesis is particularly relevant to this chapter, as there is a considerable amount of research demonstrating that young children who have difficult temperaments are especially susceptible to rearing influence. Their susceptibility places them at particularly high risk for negative outcomes related to their self-control and behavioral problems. For example, one study examines the predictive power of negative emotionality and parenting characteristics on young children‘s externalizing behavioral problems at 36-months of age. Results indicate that, relative to young children who do not have difficult temperaments, young children who have difficult temperaments are affected more strongly by parenting characteristics, in relation to their presentation of externalizing behaviors and inhibition (Belsky, Hsieh, & Crnic, 1998). A second study providing support for Belsky‘s hypothesis suggests that young children‘s emotional and behavioral dysregulation at 4-months of age and their experience of coercive parenting predicts their emotional and behavioral dysregulation at 9-months of age. This finding supports the idea that differential susceptibility to rearing influences indeed is

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related to self-regulation outcomes and suggests that these processes are already in effect before young children reach 1-year of age. Taken together, the research of Patterson and colleagues (1992) and Belsky (2005) regarding parent-child interactions and temperament suggests that, although temperament is biologically based, parenting characteristics will likely affect developmental outcomes in young children‘s self-regulation. Interestingly, parents‘ sensitivity and supportive care may not be the most effective parenting technique, depending on children‘s temperament. It seems that parents who are overly responsive to distress (such as in the context of Patterson‘s negative reinforcement) and/or exert indirect control over their young children who have difficult temperaments actually may reinforce these behaviors, leading to an overly inhibited child (Belsky et al., 1998). Further, research generally concludes that parents‘ negative control, harsh and inconsistent discipline, and rejection predict children‘s problematic behavior, including externalizing problems (Campbell, Pierce, Moore, Marakovitz, & Newby, 1996; Loeber & Southamer-Loeber, 1986; Rothbaum & Weisz, 1994). Nonetheless, it may be the case that young children‘s biologically based temperament interacts with the characteristics of their surrounding environment to promote some of the difficulties noted with Regulation Disorders and ADHD. More research is needed to examine these connections. More research also is needed to promote an understanding of the differing effects of mother-child interactions and father-child interactions in conjunction with children‘s developmental outcomes (Belsky et al., 1998; Phares & Compas, 1992). For example, Belsky and colleagues (1998) indicate that mothering more strongly predicts externalizing behaviors in infants who are highly negative. Negative mothering from the ages of 2- to 3-years appears to be the most predictive of these later outcomes for young children. Conversely, fathers‘ parenting during young children‘s second and third years of life is the most predictive of young children‘s inhibition. Specifically, less negative fathering from the ages of 2- to 3years and more positive fathering at the age of 2-years are associated with young children‘s inhibited behavior. Calzada, Eyberg, Rich, and Querido (2004) also examine parent-child interactions to better understand differences in mothers‘ and fathers‘ responsiveness to problematic behavior in preschool-aged children. In this study, children and their parents participate in a dyadic paradigm including child-directed play, parent-directed play, and clean up. Not surprisingly, referred mothers and fathers (i.e., mothers and fathers seeking treatment for their children who are disruptive) are more demanding and less responsive than their non-referred mother and father counterparts (Brestan, Eyberg, Algina, Johnson, & Boggs, 2003; Calzada et al., 2004). With regard to differences between mothers and fathers, this study suggests that mothers are generally more responsive than fathers; however, fathers gain higher levels of compliance from their young children. Results also suggest that fathers and mothers experience parenting stress uniquely, with fathers‘ parenting stress being a significant predictor of young children‘s disruptive behaviors despite lower reports of parenting stress. Furthermore, fathers‘ demandingness significantly predicts young children‘s compliance during young children‘s interactions with both their mothers and fathers. Calzada and colleagues (2004) suggest that fathers may adopt a more involved role when managing their young children who are noncompliant. When fathers are unsuccessful at managing their young children‘s noncompliance, fathers‘ demandingness and young children‘s disruptive behavior may develop into a coercive cycle (Patterson, 2002; Patterson et al., 1992). This

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pattern of interaction could easily spill over into the mother-young child relationship as well and subsequently promote some of the difficulties discussed in this chapter. In summary, research consistently demonstrates that, although temperament is considered innate, parenting characteristics will likely interact with children‘s characteristics to determine children‘s ultimate developmental outcomes. Differences in children‘s temperament may result from natural selection, with the ultimate goal being to create differential susceptibility in children born to the same family and to reassure that at least a portion of children in any one family will be reproductively successful or valuable. Therefore, the concept of goodness-of-fit becomes essential for young children who exhibit difficulties with their temperament generally and with effortful control in particular so that they may experience positive developmental outcomes (e.g., behavioral inhibition, self-regulation) rather than difficulties such as Regulation Disorders and ADHD. Environmental variables (e.g., parenting style) combined with children‘s temperament and neurobiology may interact to predict children‘s development outcomes, and it may be that different types of temperaments will respond differently to unique parenting styles. Finally, mothers‘ and fathers‘ interactions with their young children predict development uniquely.

ASSESSMENT Although the underlying etiologies for young children‘s difficulties with effortful control, Regulation Disorders, and ADHD still are being investigated, the symptoms of these difficulties are described specifically. Thus, such symptoms can be identified through careful assessment. To insure that such difficulties are examined thoroughly, the assessment of young children who are exhibiting dysregulation in their emotions and behaviors should be multifaceted. Such an approach may be difficult when assessing young children, however, as well-validated measures for identifying psychiatric difficulties in young children are lacking (Byrne, DeWolfe, & Bawden, 1998). As a result, when assessing young children for the difficulties discussed in this chapter, it is vitally important to utilize information from multiple informants (Bussing et al., 2006; Garrison, 1990; Renk, 2005) in the context of a multidimensional approach (Bussing et al., 2006). This multidimensional approach may include the use of clinical interviews (to assess the symptoms that children may be exhibiting), history taking (to understand the true progression of the symptoms noted), rating scales, psychoeducational test batteries, and direct observations (Rapport, 1993). Further, laboratory- and clinic-based assessment measures may be useful if these measures assess adequately the core deficits thought to underlie each of the disorders discussed in this chapter (e.g., ADHD; Rapport, Chung, Shore, Denney, & Isaacs, 2000). To insure that a thorough assessment is completed, it also is important to assess young children‘s functioning across a variety of emotional and behavioral functioning domains. As part of such an assessment, it would be helpful to include a standardized measure of young children‘s temperament (Bussing et al., 2006), so that some determination of the longevity of young children‘s difficulties can be made. Many such measures exist, with one example of a temperament measure being the Children‘s Behavior Questionnaire (Rothbart et al., 2001). This measure assesses three dimensions of temperament, Surgency/Extraversion (e.g., activity level, high-intensity pleasure, impulsivity, a negative loading for shyness), Negative Affectivity (e.g., anger, discomfort, fear, sadness, a negative loading for soothability), and

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Effortful Control (e.g., attentional focusing, inhibitory control, low-intensity pleasure, perceptual sensitivity). This measure also has an internal consistency reliability coefficient of .77, as well as good convergent validity, in a previous study (Rothbart et al., 2001). Further, reliable and valid measures of young children‘s current emotional and behavioral functioning should be included so that young children‘s temperament and their current emotional and behavioral functioning can be compared. Many of these domains will be assessed via rating scales completed by informants who are familiar with the young children being assessed. One example of a reliable and valid measure of young children‘s emotional and behavioral functioning is the Child Behavior Checklist (Achenbach & Rescorla, 2000, 2001). This measure assesses both broad-band and narrow-band symptoms of a variety of emotional and behavioral difficulties as well as DSM-oriented scales that group symptoms in a manner consistent with diagnoses found in the DSM. This measure also has accompanying measures that can be completed by caregivers and teachers as well (i.e., the CaregiverTeacher Report Form and the Teacher‘s Report Form), so that information from multiple informants can be collected. Generally, this measure has a strong history of being able to distinguish children who are experiencing clinically significant problems from those who are not experiencing such problems (Achenbach & Rescorla, 2000, 2001). It should be noted that parents are better reporters about the history of behavior relative to the quality of behavior (Wakschlag et al., 2005). As a result, it is likely that there will be discrepancies among different informants in their reports of children‘s behaviors as well as between parents‘ reports of young children‘s behaviors and those observed by clinicians (De Los Reyes & Kazdin, 2005; Duhig, Renk, Epstein, & Phares, 2000). Given such findings, using multiple informants is especially important in providing a complete understanding of young children‘s behaviors (Renk, 2005). In addition to including measures that assess young children‘s emotional and behavioral functioning broadly, it may be helpful to include measures specific to emotional and behavioral dysregulation and to the symptoms described in this chapter. Although some of the sensory sensitivities that are experienced by these young children may be best assessed by an occupational therapist, there are many measures available that assess symptoms of inattention, hyperactivity, and impulsivity (e.g., the Conners‘ Rating Scales; Conners, 1997). Further, in addition to assessing the behaviors that young children exhibit most prominently, it is important to assess associated problems, such as poor social behavior, parenting stress, difficulties in coping, preacademic skills, and functioning in the classroom setting (DuPaul et al., 2001). Intelligence tests, early achievement tests, memory tests, and neuropsychological tests also may be useful in delineating the performance of young children who are exhibiting difficulties consistent with those described in this chapter (Sattler & Hodge, 2006). In addition the measures already described, clinical observation may be particularly important for the sensitive diagnostic assessment of young children‘s development (American Academy of Child and Adolescent Psychiatry, 1997). In particular, it frequently is difficult to distinguish between normal variations in behavior and clinical problems in young children (Danis, Hill, & Wakschlag, 2009). As a result, being able to directly observe young children‘s display of disruptive behaviors may provide valuable information about the antecedents and consequences of the behavior as well as the quality (i.e., the intensity, organization, and flexibility) of the behavior (Wakschlag et al., 2007). In an effort to elicit disruptive behaviors in the context of the assessment session, Wakschlag, Hill, and colleagues (2008) describe an observational assessment paradigm, the Disruptive Behavior Diagnostic Observation

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Schedule (DB-DOS), that can be used to elicit disruptive behaviors from young children, provide a means of observation in multiple settings, and provide the examiner with a means of using their own attitudes and behaviors in the assessment setting (Danis et al., 2009). This assessment measure has good interrater and test-retest reliability (Wakschlag, Hill, et al., 2008) as well as evidence of validity (Wakschlag, Briggs-Gowan, et al., 2008). In particular, disruptive behavior in the context of the DB-DOS is related to significant increases in later impairment (Wakschlag, Briggs-Gowan, et al., 2008). Such measures used as part of a multidimensional assessment can prove useful in specifically identifying the difficulties of young children.

INTERVENTIONS Once a thorough assessment is completed, appropriate interventions can be outlined and implemented in an effort to help young children and their parents or caregivers to change their functioning. Although specific treatment interventions may be selected based on assessment finding, interventions generally should address young children‘s functioning across settings and over time (DuPaul et al., 2001). Further, there may be many angles for providing intervention to young children who exhibit the difficulties that are discussed in this chapter. In reviewing the research literature regarding interventions for young children who are at-risk for ADHD, McGoey, Eckert, and DuPaul (2002) note that parent training, stimulant medications, and classroom behavior management interventions are among the most frequently examined approaches, with each demonstrating some effectiveness in treating young children who are risk for ADHD. These interventions also may prove useful for addressing the difficulties of children who exhibit difficulties with effortful control and who are diagnosed with Regulation Disorders. Examples of these interventions will be described here. First, parenting interventions may be particularly useful to helping parents change their own behaviors as well as the behaviors exhibited by their young children. For example, in conjunction with the information provided earlier in the context of coercion theory (Patterson, 1982), research also documents that there is a strong relationship between parenting and young children‘s effortful control as well as between parenting and young children‘s regulatory strategies. In particular, with regard to effortful control, mothers‘ positive and negative caregiving strategies are related to the regulatory strategies used by 24-month old children in an emotion-eliciting task (Calkins, Smith, Gill, & Johnson, 1998). In addition, Kochanska and colleagues (2000) indicate that mothers‘ responsiveness to their toddlers‘ bids for attention are related to the effortful control that toddlers display at 22- and 33-months of age, whereas mothers‘ use of power-assertive discipline is related to these children‘s lack of effortful control. Further, with regard to inattentive behaviors, parenting that is warm and supportive when children are 1.5-years of age predicts children‘s ability to shift attention when they are frustrated at 3.5-years of age (Gilliom, Shaw, Beck, Schonberg, & Lukon, 2002). Mothers of children who are at-risk for developing ADHD also are more likely to adopt negative parenting behaviors, rather than positive strategies for child management (Cunningham & Boyle, 2002), and to experience higher levels of parenting stress and lower levels of parental coping (Keown & Woodward, 2002).

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Given findings such as these, parenting interventions may be a useful adjunct to any intervention program used to address the difficulties that are described in this chapter. Several parent training interventions are described and documented to be effective, although only two examples are described here. For example, Parent-Child Interaction Therapy (PCIT; Hembree-Kigin & McNeil, 1995) is a probably efficacious treatment program for young children (Eyberg, Nelson, & Boggs, 2008). Parents are taught to incorporate skills of responsive parenting to meet the needs of their young children, to positively attend to positive behaviors, and to actively ignore negative behaviors. To achieve these goals, parents participate in two treatment modules, Child-Directed Interaction (i.e., parents are coached in how to interact attentively to their young children) and Parent-Directed Interaction (i.e., parents are coached in effective contingency management skills that can be used to manage children‘s noncompliance; Hembree-Kigin & McNeil, 1995). As parents and their young children attend sessions together, parents are able to practice child behavior management skills with their young children while being provided feedback directly from a mental health professional (Brinkmeyer & Eyberg, 2003; Kazdin, 2005). So that these skills may generalize to the home setting, parents also are expected to continue practicing these skills at home (Capage, Foote, McNeil, & Eyberg, 1998). Another example of a parent training program that is effective is the Helping the Noncompliant Child program (HNC; Forehand & McMahon, 1981). HNC is also a probably efficacious treatment for managing the behavior of young children who range in age from 3to 8-years (Eyberg et al., 2008). HNC also uses two modules, Differential Attention (i.e., parents learn to increase the frequency and range of the social attention that they provide to their young children, decrease the frequency of their competing verbal behaviors, and ignore minor inappropriate behaviors) and Compliance Training (i.e., parents are coached in their use of appropriate commands to increase their young children‘s compliance; McMahon & Forehand, 2003). In general, studies provide support for the HNC program (e.g., Forehand & King, 1974, 1977). Although parenting interventions have a large research based for families who are raising young children, other interventions for young children are not as widely studied. Second, as already mentioned, medications are used commonly to treat inattentive and hyperactive-impulsive symptoms. The primary medications used to treat these symptoms are stimulant medications (DuPaul, McGoey, & Mautone, 2003). Generally, effectiveness rates for these medications range from 75 to 90 percent (Pennington, 2002), with some researchers estimating that approximately 80 percent of children who are diagnosed with ADHD will benefit from stimulant medications (Rowland et al., 2002). Children may experience mixed results from such medications, however, with there being some evidence of improvements in attention and concentration, decreases in disruptive and impulsive behaviors (Brodeur & Pond, 2001), improvements in peer relationships (Hoza et al., 2005), and minor positive effects on academic achievement (Ryan, Reid, Epstein, Ellis, & Evans, 2005). Unfortunately, the effects of medications disappear after they are discontinued (Brown, Carpenter, & Simerly, 2005). Further, 20 percent of children who are diagnosed with ADHD will not experience any benefits from these medications or will experience adverse effects (Rowland et al., 2002). Thus, stimulant medications are a well-accepted but controversial treatment for inattentive and hyperactive-impulsive symptoms (Barkley, 2003). Third, many individual intervention approaches for young children are based in the behavioral tradition. For example, many approaches include contingency management

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strategies (e.g., token economies, time out, and response cost; Nolan & Carr, 2000), all of which are considered evidence-based treatments (Hinshaw, Klein, & Abikoff, 2002). Research suggests that these interventions are effective, with contingency management strategies being more effective than other cognitive-behavioral interventions when used with children who are diagnosed with ADHD (DuPaul & Eckert, 1997). In particular, the recommended approach to treatment for school-age children consists of a combination of token reinforcement and response cost procedures (DuPaul & Stoner, 1994). Although this approach has not been studied thoroughly in young children, an initial single-subject withdrawal design suggests that this combination is effective with young children. Further, teachers rated this combination of treatments as highly acceptable for this small sample of young children, although teachers preferred the use of response cost (McGoey & DuPaul, 2000). Behavioral intervention approaches also may be helpful when young children are having difficulty managing their reactions, particularly with regard to sensory input. In these cases, young children‘s surrounding environment may need to be altered (in the context of stimulus control) to facilitate their experience of more positive responses. In particular, more sensory stimulation may be needed for those young children who are underreactive to stimulation, whereas less sensory stimulation with gradual, incremental exposure may be needed for those young children who are overreactive. Further, young children may benefit from having a structured routine that provides order but permits time for less structured activities as well (Barton & Robins, 2000). Although many of the individual interventions used with children who exhibit the difficulties described in this chapter are behavioral in nature, an additional cognitivebehavioral intervention also may be promising. Currently, many researchers are beginning to examine the merits of promoting emotionally competent functioning in conjunction with facilitating positive emotional and behavioral functioning (e.g., Suveg, Southam-Gerow, Goodman, & Kendall, 2007). Such interventions have a strong basis in affective neuroscience research and appear to be demonstrating positive effects in preliminary outcome studies (e.g., Suveg et al., 2007). One example, Emotion-Focused Cognitive-Behavioral Therapy, provides a more focused role for emotion in the context of therapeutic intervention for anxiety, with particular attention given to identifying emotional states, discussing emotion-related experiences, and understanding emotion regulation strategies (Suveg, Kendall, Comer, & Robin, 2006). The use of this intervention is related to improvements in self-control, enhanced ability to tolerate frustration, improved social skills, and decreases in internalizing and externalizing behavior problems (Denham & Burton, 1996; Greenberg, Kusche, Cook, & Quamma, 1995; Suveg et al., 2006). Similarly, Contextual Emotion-Regulation Therapy for childhood depression focuses on the self-regulation of dysphoria and distress so that children do not go on to experience future depressive episodes. In particular, one goal of this intervention is to identify the specific ways that children have responded to their experience of dysphoria in the past as well as the types of emotion regulatory responses that have been useful. An initial examination of this intervention suggests that 53 percent of the children who completed treatment experience full remission of dysthymic symptoms and that 13 percent experience partial remission. At 12-month follow-up, 92 percent of children who completed treatment experience full remission (Kovacs et al., 2006). Although these types of interventions have not been used with young children who show other types of self-regulation problems at this time, such interventions may prove helpful in furthering young children‘s

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development of self-regulation. Thus, the utility of these interventions for this purpose should be examined further. Ultimately, however, as multi-component interventions appear to be most effective for older children who exhibit symptoms of ADHD (MTA Cooperative Group, 1999), an intervention plan that offers a multi-component approach also may be best for young children. For example, Henry (1987) examines symbolic training and parent training in a small group of young children who are taking psychostimulant medications. This treatment combination is more effective than either the medications or symbolic modeling alone. McGoey, DuPaul, Eckert, Volpe, and Van Brakle (2005) more recently examine a comprehensive, multicomponent intervention approach for young children who are at-risk for ADHD. As part of their intervention approach, school-based consultation, parent training, and pharmacological interventions (when needed) are utilized. When compared to a community treatment control group, young children who receive this multi-component intervention approach experience improvements in their self-control and their social skills in both their home and preschool settings as well as a reduction in inappropriate behaviors and an increase in on-task performance. Further, parents exhibit moderate increases in positive parenting behaviors and reductions in their negative parenting behaviors across different types of situations, with overall improvements in family coping and knowledge of ADHD (McGoey et al., 2005). Such findings suggest that multi-component intervention programs ultimately will prove most effective for young children who exhibit the difficulties described in this chapter.

CONCLUSIONS Based on the current research literature, it is clear that young children who exhibit a difficult temperament, particularly difficulties with effortful control, are more likely to experience difficulties in their emotional and behavioral functioning. Given the commonalities in symptom presentation among difficulties in effortful control, Regulation Disorders, and ADHD, it appears likely that some young children may progress through a trajectory where they may move from exhibiting difficulties with effortful control to being identified as having a Regulation Disorder to receiving a later diagnosis of ADHD. Certainly, the overlap in symptoms across each of these difficulties as well as some of the similarities in the potential underlying etiology, the relationships among these difficulties would appear to be strong. This potential trajectory still must be examined in the research literature, however, as there are no studies that could be located that examine these difficulties collectively. Given the lack of information currently available on potential trajectories such as this, mental health professionals must conduct careful assessments that are multidimensional and include multiple informants so that an accurate diagnosis can be made. Once such an assessment is completed, it is likely that multi-component interventions will be successful in addressing at least some of young children‘s symptoms related to poor self-regulation. Currently, there is support in the research literature for parenting interventions, medications, and behaviorally-based interventions. Further, there appear to be some new treatments that address emotion regulation and that may prove to have utility for addressing young children‘s difficulties with self-regulation, no matter which level of difficulty that they may be experiencing. It is only by continuing to investigate the progression of young children‘s difficulties with self-regulation and targeting interventions accordingly that we may continue

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to foster the most positive outcomes for those young children who have the most difficulty in managing their responses to their surrounding environments.

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In: Advances in Psychology Research. Volume 72 ISSN: 1532-723X Editor: Alexandra M. Columbus © 2011 Nova Science Publishers, Inc.

Chapter 3

INTELLIGENT SOCIAL TUTORING SYSTEM FOR CHILDREN: APPLICATION OF INTERACTIVE SOFTWARE TECHNOLOGY TO THE ASSESSMENT AND DEVELOPMENT OF SOCIAL PROBLEM SOLVING Melissa E. DeRosier, Janey Sturtz McMillen and James M. Thomas 3-C Institute for Social Development.

OVERVIEW The quality of children‘s peer relations has a tremendous impact on their academic, behavioral, and emotional functioning. Children who are able to establish and maintain positive peer relations are more successful in school, more confident and happier, and better able to cope with stressful life events. In contrast, children who have difficulty navigating social relationships are substantially more likely to experience academic failure, behavioral problems, and emotional difficulties. A large body of research underscores the importance of social problem solving skills for helping children establish and maintain positive peer relations. This chapter describes initial development and testing of an innovative computerbased method to both engage children in social problem solving and assess their progress towards social skill development. Through grant funding from the National Institute of Mental Health (NIMH), 3-C ISD created an Intelligent Social Tutoring System (ISTS) through which children create a character to represent themselves (an avatar) and enter an interactive story world where they engage directly with pedagogical agents to solve plot-based social problems. The ISTS provides children with a safe place to practice various social problem solving skills and learn how to successfully navigate different types of social situations. As a child interacts with the ISTS, the software tracks his/her performance for each social situation in order to assess social skills levels and social learning trends over time. Performance indices are also used by

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the ISTS to adjust the difficulty level of subsequent social situations to provide self-paced learning with individualized adaptation and progression. In this chapter, we will first review the research literature regarding children‘s peer relations and their impact on adjustment. We will also summarize how social skills training can be used to effectively enhance children‘s social literacy, social behavior, and peer relations. Then, we will describe the development process for the initial version of the ISTS software, including the theoretical and empirical foundation for the ISTS‘ instructional methods. We will also present initial test results comparing performance on the ISTS social problem solving tasks with independent measures of children‘s social skills and behavior. In the last section of this chapter, we will explore the implications of this work for the measurement of social problem solving as well as the therapeutic potential of interactive computer models for enhancing the effectiveness of social skills training efforts with children.

IMPORTANCE OF PEER RELATIONSHIPS Children‘s relationships with other children are critically important for their sense of well-being and adjustment (see Kupersmidt & DeRosier, 2004 and Parker, Rubin, Erath, Wojslawowics, & Buskirk, 2006, for reviews). From the time children enter school, peers take on an increasingly meaningful and influential role, becoming key providers of support, advice, companionship, and affirmation as children mature through the elementary school years and into adolescence (Furman & Buhrmester, 1992). Positive social skills and relationships promote more positive emotional, behavioral, and academic functioning. Positive peer relations also operate as a protective factor, reducing the likelihood of negative outcomes in the face of stressful life events, such as poverty (Kazdin, 1991; Luthar, 1993; Parker et al., 2006). In contrast, social problems increase children‘s risk of poor adjustment across all areas of functioning. Children who experience peer problems tend to exhibit a wide variety of concurrent difficulties, including behavioral (e.g., disruptive, aggressive), psychological (e.g., low self-esteem, lonely, depressed), and academic (e.g., poor school performance, absenteeism) (see Kupersmidt & DeRosier, 2004 and Parker et al., 2006, for reviews). The developmental psychopathology literature underscores the insidious, damaging influence of peer problems which place children at heightened risk for development of numerous negative outcomes, including depression (Boivin & Hymel, 1997; Garber, 2006), anxiety disorders (Erath, Flanagan, & Bierman, 2007), suicide (Carney, 2000), delinquency and antisocial behavior (Brendgen, Vitaro, & Bukowski, 1998; Feinberg, Ridenour, & Greenberg, 2007), substance abuse (Hawkins, Catalano, & Miller, 1992; Spooner, 1999), educational underachievement (Fleming, et al., 2005; Woodward & Fergusson, 2000), and other mental health difficulties (Parker et al., 2006). Children can experience a variety of social difficulties within the peer group. Three common categories of peer problems are: Rejection (active dislike, avoidance, exclusion of a child by the majority peer group), Victimization (bullying, assault, intimidation, teasing, humiliation, rumor spreading), and Social Isolation (lack of stable, close positive friendships) (Asher, Parker, & Walker, 1996; Parker et al., 2006; Olweus 1993; Solberg, Olweus & Endresen, 2007). As children experience social failure, many become increasingly negative about themselves and anxious in social situations (Boivin & Hymel, 1997, Gazelle & Druhen,

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2009). They may withdraw, becoming more socially isolated, or they may act out their anger and frustration on others (Ladd, 2006). When children are rejected from the normative peer group, they tend to affiliate with other children also experiencing social difficulties with peers (Cairns et al., 1988; Pellegrini, Bartini & Brooks, 1999). When antisocial peers affiliate with one another more exclusively, negative behaviors and attitudes are compounded (Dishion, Andrews, & Crosby, 1995). In effect, a vicious cycle may develop in which poor social skills, social anxiety, and negative attitudes reinforce one another over time (Kupersmidt & DeRosier, 2004; Parker et al., 1995; Rubin, Bukowski, & Parker, 2006; Schwartz et al., 1997). While the particular adjustment difficulties a child exhibits vary depending on the specific peer problems experienced, as well as child and contextual factors, the research literature indicates that the quality of children‘s peer relationships directly influences their academic, behavioral, and emotional adjustment (DeRosier, Kupersmidt, & Patterson, 1994; Woodward & Fergusson, 2000). This influence is not simply an artifact of other associated behaviors, such as aggressiveness, nor environmental factors, such as poverty, but rather, peer problems contribute to the development of future problems with unique and independent prediction (see Kupersmidt & DeRosier, 2004, for review). As peer problems become more chronic or severe, children‘s risk for negative outcomes increases (e.g., DeRosier et al., 1994). A key to preventing the development of more serious maladjustment is to intervene with problematic social behaviors before they become chronic and intractable (Greenberg, Domitrovich, & Bumbarger, 2001; Parker et al., 2006). Early intervention is critical in the prevention of severe social skill deficits and entrenched negative peer interaction patterns (Coie, 1990; Odgers et al., 2008).

SOCIAL SKILLS TRAINING WITH CHILDREN While untreated peer problems tend to worsen over time, substantial research supports the effectiveness of social skills interventions for improving children‘s peer relationships and altering developmental paths towards more positive outcomes (Beidel, Turner, Young, & Paulson, 2005; Foster & Bussman, 2007; Greenberg et al., 2001; Joseph & Strain, 2003; Losel & Beelman, 2003). Targeted social skills interventions have been shown to not only significantly improve children‘s social skills and relations, but also directly and positively impact academic performance (e.g., test scores, attitudes toward school, classroom engagement and motivation), behavior at school and home (e.g., prosocial interactions, more positive parent and sibling relations), and emotional functioning (e.g., lower anxiety and depression, higher self esteem) (Hawker & Boulton, 2000). Effective social skills interventions target those social behaviors that either promote or interfere with the quality of children‘s peer relations (Asher & Renshaw, 1981; Coie, Dodge, & Kupersmidt, 1990; Dodge & Feldman, 1990; Merrell & Gimpel, 1997). For example, cooperative behavior promotes companionship, a key function of peer relations, whereas impulsive and domineering behaviors interfere. Empathy, or the ability to take another‘s perspective, promotes communication and mutual understanding, whereas blaming and disrespectful behaviors interfere. Through social skills training, children learn and practice those social skills that increase positive and/or inhibit negative social behaviors.

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A variety of social skills training programs, with differing sets of skills and teaching formats, have been developed over the years (see Asher et al., 1996; Greenberg, et al., 2001 for reviews). Social skills training may be directed towards children more generally as in school-based universal programs in which all children participate in the intervention regardless of social skills level. Other social skills training interventions are delivered in a small group therapeutic setting and focus on children who are identified as experiencing one or more social problems (i.e., indicated programs). While the research literature clearly supports the use of social skills training, universal or indicated programs that integrate social skills relating to behavior (what to do or not to do in a social situation), cognition (assumptions, evaluating consequences, goal setting), and emotions (feelings about/during a social situation) have been found to be most effective (Asher et al., 1996; Graczyk et al., 2000). This more integrative approach to social skills training helps children think through a given social situation, consider alternative social problem solving approaches, and evaluate the success of a selected approach for achieving a social goal. In other words, those interventions that build children‘s capacity to actively engage in social problem solving have the most significant and lasting impact on the quality of their peer relations (Greenberg, Kusché, & Riggs, 2004; Kam, Greenberg, & Kusché, 2004; Suveg et al., 2007).

INTELLIGENT TUTORING SYSTEMS While the treatment benefits of in-person social skills training interventions have been repeatedly demonstrated through empirical research, very little is known about how interactive software technology can be used to enhance children‘s social problem solving skills or peer relations. In developing 3-C‘s Intelligent Social Tutoring System (ISTS), we drew on the computer science research literature regarding use of Intelligent Tutoring Systems (ITS), which have been effectively applied to academic subjects, particularly in the areas of physics, math, and the sciences. For example, Dr. James Lester‘s Crystal Island ITS teaches microbiology concepts to 8th graders through an intelligent game-based learning environment that promotes problem solving (strategy use, divergent thinking, and collaboration) and engagement in science learning (motivation, situational interest, presence), as measured by both science content knowledge and transfer (Lester, Nietfeld & Spires, 2007). The core principle in designing an ITS is thoughtful consideration of how the tutorial system adapts to the different actions taken by individual learners (Kelso, Wehyrauch, & Bates, 1992; Loyall, 1997; Magerko & Laird, 2004; Magerko, Laird, Assanie, Kerfoot, & Stokes, 2004; Mateas & Stern, 2005; Sgouros, 1999; Weyhrauch, 1999). ITS employ logically consistent models of both the problem domain (i.e., content area that is the focus of tutorial instruction), and the child‘s dynamically evolving understanding of the problem domain, to guide children toward targeted learning goals. Problem domains can be represented in ITS through plain text descriptions, graphs, illustrations, or 3-Dimensional simulated environments that the learner can freely explore. Regardless of which of these forms of expression is used for the problem domain, ITS designers often describe the possible sequences of learner actions and outcomes through an abstracted hierarchy of causal links (e.g., one action may serve as a precondition for a subsequent action). An ITS can react and adapt to user input (e.g., providing more clues when a user has difficulty) to ensure that

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steady progress is made and global coherence of the story narrative is maintained. Pacing can be slowed or advanced in difficulty level so the user is continually and appropriately challenged. The ability to adjust presentation of events to fit the child‘s skill level means learning is individualized and the child can progress at his/her own pace. These interactive functions have been found to increase the user‘s sense of agency, level of engagement, and motivation for learning (Boyer, Phillips, Wallis, Vouk, & Lester, 2008; Murray, 1998). An underlying assumption of using ITS to teach and practice specific skills for a problem domain is that active engagement through interactivity of the child with the computer software will enhance learning and memory beyond more passive instructional methods (e.g., reading text, listening to a lecture). This assumption is consistent with the seminal work of Edgar Dale (1954; 1969) who described the ―Cone of Experience,‖ a visual depiction of the increased use of multiple sensory modes (hearing, seeing, touching) as learners move from passive to active learning environments (see Figure 1). Research has generally supported Dale‘s model, showing significant added learning benefit from, for example, adding visuals to verbal (text or auditory) information (e.g., Moreno & Valdez, 2005). Interactivity through discussions, simulation models, and direct practice has been found to augment learning beyond passive instructional methods, particularly for more complex skills (see Lee, 1999, and Rosen & Salomon, 2007, for meta-analyses). A further benefit of utilizing multiple sensory modes is the improved ability to reach different types of learners (Gardner, 1993; Keefe, 1987). As more sensory modes are engaged, instruction is better able to meet the needs of diverse learning styles (e.g., visual or auditory) for greater retention of presented information. Interactive computer models provide an innovative means to engage multiple senses for active learning and practice (Rydell et al., 2005). To date, research supports the potential benefits of using ITS to enhance learning, particularly for higher-order thinking of analysis, synthesis, and evaluation, which form the basis of planning and problem solving. Interactivity through participation in ITS has been found to enhance comprehension and recall of presented material compared to non-interactive training systems (Corbett, Koedinger, & Hadley, 2001; Gerrig, 1993; Graesser, Jeon, & Duffy, 2008; McQuiggan, Rowe, & Lester, 2008; VanLehn, et al., 2005). Engagement in learning through an ITS environment has also been found to increase generalization of acquired skills to real-life behavior (Gordon, 2004).While evidence supports use of ITS software technology for improved learning and memory of academic skills, no prior research has attempted to apply ITS training methods to the creation of an effective interactive social learning environment.

READ

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SEE

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Figure 1. Cone of Experience Pyramid.

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INTELLIGENT SOCIAL TUTORING SYSTEM Overview In 2007, the National Institute of Mental Health (NIMH) awarded 3-C ISD a grant entitled Extending Social Skills Training for Children through Interactive Technology. The purpose of this grant was to create a prototype of a computer-based social tutoring system for elementary age children and conduct initial ―proof of concept‖ testing of that system. 3-C‘s Intelligent Social Tutoring System (ISTS) was specifically designed to actively engage children in social problem solving tasks through interactive software technology. The overall design of the ISTS represents a unique collaboration between subject matter experts in child psychology and computer science, incorporating effective training strategies derived from research in education, intelligent tutoring systems, and social skills interventions. By combining what we know about effective training strategies across these disciplines, the ISTS represents a truly innovative computer-based social learning environment. The primary goal of the ISTS is to provide children with a safe and private social learning environment through which they can actively practice and build social problem solving skills through tailored interactive social challenges. First, the child uses the ISTS software to customize the visual features of the avatar that represents the child within the game. This avatar is then shown entering a story world where he/she needs to solve plot-based social challenges to progress through scenes and achieve plot-based goals. The child participates in the ISTS as an autonomous agent, navigating scenes independently and engaging directly with other characters. In addition to the child‘s avatar, the ISTS story world consists of a set of seven main characters, depicted with a palette of colors and artistic style intentionally similar to the choices available for the child‘s avatar. The narrative function of these characters is to be the child‘s companions in the story world, but the tutoring system also employs them as pedagogical agents to provide the child with feedback and other forms of assistance, as needed. The ISTS tracks children‘s interactions with the software and calculates performance indices, for each social problem solving task and for overall achievement. At appropriate times, the ISTS adjusts the difficulty level of subsequent social challenges in response to the child‘s performance on previous social problem solving tasks. A detailed description of each aspect of the ISTS is provided in the software development section below.

ISTS Social Learning Environment 3-C ISD‘s mission is to create and deliver research-based tools that promote positive social, emotional, and mental health for youth and families. We drew on 3-C‘s considerable clinical and research subject matter expertise regarding children‘s peer relations and effective treatment of peer problems to design the social learning environment for the ISTS. The instructional content of the ISTS social problem solving exercises (situations, dialogue, difficulty variations, non-verbal cues) was derived from decades of theory and research in children‘s social development (e.g., Bandura, 1977; Crick & Dodge, 1994; O‘Reilly et al., 2008; Parker, et al., 2006). We also incorporated 3-C‘s clinical research experience developing and testing a variety of universal and indicated interventions for use by schools and community mental health centers. In particular, 3-C has developed Social Skills GRoup INtervention (S.S.GRIN), a set of scientifically validated social skills training programs for children (DeRosier, 2007a, 2007b; Harrell & DeRosier, 2008; McMillen, DeRosier, Maxwell,

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& Ornstein-Davis, 2010). S.S.GRIN is an indicated small group in-person intervention, which provides structured, skill-based social skills training that (1) builds basic behavioral, cognitive, and emotional social skills (e.g., impulse control, cooperation, communication), (2) reinforces prosocial attitudes and behavior (e.g., respect, responsibility), and (3) increases adaptive coping strategies for social problems, such as being left out or teased. S.S.GRIN applies evidence-based social learning and cognitive-behavioral training techniques during group sessions through didactic instruction, practice (games, activities), modeling, role play, positive reinforcement, and cognitive re-framing (e.g., challenging negative assumptions). S.S.GRIN enhances the quality of children‘s peer relations by increasing their capacity to evaluate social situations (e.g., weigh consequences of different actions) and then respond in an adaptive, prosocial manner to achieve their social goals (e.g., make friends). S.S.GRIN has been repeatedly tested, starting with one elementary school in 1993 and progressing to longitudinal research within 45 elementary schools across the Wake County Public School System of North Carolina. Research supports the effectiveness of S.S.GRIN. For example, in a study of third graders, children with specific peer problems (high peer dislike, victimization by peers) and/or high social anxiety were identified and randomly assigned to Treatment (n=187) or no-treatment Control (n=194) (DeRosier, 2004). Trained school counselors administered S.S.GRIN in the school setting. Children who participated in S.S.GRIN showed improvement in peer liking, enhanced self-efficacy for dealing with social situations, lower social anxiety, and greater declines in aggressive behavior problems compared to controls (DeRosier, 2004). At one-year follow-up, all pre-post benefits were still present and additional benefits were evident, including lower victimization by peers, fewer negative nominations by peers, and more positive outcome expectancy for social situations (DeRosier & Marcus, 2005). Overall, results support the effectiveness of S.S.GRIN not only for enhancing children‘s social relationships, but also for improving social-cognitive, behavioral, and emotional functioning, both at immediate and one-year follow-up. In designing the ISTS virtual social problem solving situations, we incorporated specific training strategies and practice exercises used within the S.S.GRIN curriculum. The initial version of the ISTS focuses on tasks that require the social skill of impulse control, i.e., a child‘s ability to stop and think through possible consequences before acting. We selected impulse control because it is a basic behavioral social skill that provides the basis for many other more complex social skills, such as cooperation and communication, and impulse control is a necessary ingredient for effective social planning, problem solving, and evaluation (Merrell & Gimpel, 1997). The social problem solving tasks for impulse control within the ISTS prototype were constructed to parallel those that children would experience during S.S.GRIN social skills training sessions (see below for details).

ISTS Training Strategies Whether in-person or on the computer, whether social skills or science education, research consistently supports the training strategies of scaffolding, coaching and reinforcement, and practice for creating an effective learning environment for children. Therefore, in designing the ISTS, we incorporated each of these training strategies into the social problem solving tasks as well as children‘s overall experience with the software. Scaffolding. Scaffolding is the provision of sufficient supports to promote learning when concepts and skills are new or difficult (Hartman, 2002; Vygotsky, 1988). Supports are

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adjusted to fit the child‘s individual abilities and needs, being gradually removed (―faded‖) as mastery of skills and knowledge is achieved. Research shows that scaffolding dramatically enhances children‘s engagement and achievement (see Pea, 2004, for review). Boredom arises when tasks are too easy and frustration arises when tasks are too difficult; in both states, learning is negatively impacted. With scaffolding, the level of assistance and pace of learning are individualized so tasks are sufficiently challenging to maintain attention as well as motivation for continued effort, but not so difficult that uncertainty, confusion, and frustration undermine mastery. An example of scaffolding for the ISTS is the adjustment of difficulty for subsequent social problem solving tasks depending on the child‘s prior demonstrated level of social reasoning. Another example is the use of the pedagogical agents to provide hints and advice when children experience difficulty solving a social problem. Scaffolding is integrated into the ISTS to create an adaptive learning environment across social problem solving tasks. Coaching & Reinforcement. Feedback regarding progress and performance is a key instructional element (Hymel et al., 2006; Ladd, 2005; Oden & Asher, 1977). Constructive feedback helps children identify areas of difficulty and increases motivation for continued improvement. Positive feedback helps children understand their social strengths and reinforces adaptive problem solving. As children move through the ISTS, feedback is provided in a variety of ways ranging from more subtle cues (e.g., comments made by other characters) to performance progress reports (e.g., level of performance for each social task). The ISTS pedagogical agents act as coaches, reinforcing adaptive choices by children and providing suggestions for improvement, as appropriate. Research demonstrates that engaging with pedagogical agents through an ITS increases children‘s retention as well as effective internalization of problem solving skills (Atkinson, 2002; Lester et al., 2001; McQuiggan, Rowe, & Lester, 2008; Tartaro & Cassell, 2008). The ISTS is designed to be sufficiently challenging so that mastery is not expected the first time through and children have the opportunity to go back and try the social challenges again and again. Various reinforcers (e.g., praise, winning objects they can carry with them to subsequent scenes) are built into the software to encourage children to continue trying until mastery is achieved. Practice. Repeated exposure to practice opportunities is essential to achieve mastery in learning (Bloom, 1980; Merrell & Gimpel, 1997). The ISTS provides an innovative means for children to practice social skills and social problem solving strategies through interactive software technology. Computer-based methods for instruction, as well as entertainment, are increasingly prevalent in our society (Gee, 2003; Prensky, 2007). The ISTS builds on children‘s predilection for and familiarity with computers to provide an engaging, interactive platform for practice with social problem solving. Interaction with the ISTS also enables children to practice in ways that are not possible in real life. For example, children can experiment with different strategies for the same social situation, exploring alternative responses and consequences. In this way, the virtual world provides a safe place for children to try out social strategies before attempting them in real situations. As social learning theory suggests, witnessing different models for social behavior through the ISTS should influence children‘s real life choices (Bandura, 1977).

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ISTS SOFTWARE DEVELOPMENT Software Engine We created a modular software architecture that separates the general purpose software engine from the social problem solving instructional content. The ISTS software engine provides an underlying infrastructure that defines all core functionality (e.g., navigation and interaction styles) that is generally applicable across the interactive social learning environment. All instructional content is then built on the foundation of this flexible, reusable software platform. All programming of the ISTS software engine is built with Adobe Flash Creative Suite (CS) 4 with all software components written in the ActionScript 3.0 language of Adobe CS 4. We selected Flash as the software platform for a number of reasons. Flash is the gold standard for creating rich media and ActionScript is the most widely used programming language for the development of interactive technology on the Internet, actively used by over two million developers (Moltenbrey, 2006). We intend to deliver the ISTS over the Web to increase accessibility and decrease cost to consumers, thereby benefitting as broad a scope of children as possible. Flash is currently resident on more than 99% of all computers in the United States and Canada (Sarode, 2009). If a computer does not have Flash already installed, users can easily download the Flash Player for free. Flash can be deployed remotely through any standard web browser (Internet Explorer, Mozilla Firefox, Apple Safari) so that users do not need significant computer expertise or specialized software to run the ISTS.

Figure 2. ISTS Main Characters.

Graphic Design Visually engaging graphics have been found to increase children‘s attention to and engagement in interactive technology (Roussou, 2005; Vinayagamoorthy, Steed, & Slater, 2005). Detailed and complex story worlds with many different scenes and graphic elements (e.g., inclusion of ―Easter eggs‖ or hidden objects for fun interactivity) draw children in and increase their motivation to explore a virtual environment (Salzman et al., 1999). The ISTS story world, with its wide variety of locations, objects, and characters and its customizable avatar, is designed to be colorful and attractive for elementary school aged children. In order to guide the graphic design of the artwork to be used for the ISTS, we conducted a series of focus groups with children in our primary target age group of 8-12 years. We identified a set of seven core social skills and concepts that are taught in S.S.GRIN and universal to most effective social skills training programs: impulse control, respect and responsibility, cooperation, communication, emotion management, checking out assumptions,

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and goal setting. Then, we created three or four different characters of differing graphic styles for each of these core skills. We included both realistic and fanciful coloring for characters so we could assess differences in children‘s preferences. Through initial focus groups, children (n=16) were presented with the full array of graphic characters and colors. Characters that were highly rated (i.e., mean rating > 4 on 5-point Likert preference scale) by children of both genders and all ages were retained. This sub-set of characters was then presented to a second independent set of children (n=17) via focus groups. The preference ratings and rankings of characters were highly similar to those of the initial set of children. Figure 2 shows the final set of seven main characters. Each of these characters received a high overall liking score (mean = 4.8 on 5-point scale) by both boys and girls across the target age range with 100% of children recommending that character be included in the ISTS. These seven main characters provide visual cues to help children more easily associate the application of particular social problem solving strategies to particular social situations (e.g., ―Stop & Think Girl‖ reminds children to ‗Stop and Think‘ before reacting to teasing). The visual representation of each character is intended to help make social skills and concepts more concrete for children. Building on the graphic style of the seven main characters, the ISTS development team established artistic guidelines for development of all ISTS graphic elements. All scenery and other characters and objects in the scenes were then created in a graphic style consistent with that of the seven main characters. In addition to establishing a color palette and artistic style for the ISTS, these guidelines ensured that the visual presentation is appropriate for the interactive software medium (e.g., conversion of NTSC [television standard] colors and optimization of vector graphics for web-based deployment). In particular, we ensured our graphics would work on older computers so the ISTS would be accessible for families with limited access to recent technologies.

Story Narrative Compelling challenges and an interesting underlying plot are critically important for engaging children in instructional software (Mott & Lester, 2006a; Mott & Lester 2006b; Roussou, 2005). For the ISTS, the child actively participates in the story world as a crew member aboard the S.S.GRIN ship. Once the child creates a personal avatar (see below), the child enters the story world in his/her cabin on the ship. Soon after, the avatar receives an urgent incoming message via the Clam-A-Lator, a communication device for S.S.GRIN crew members (see Figure 3). Captain Coop communicates an urgent message that Action Plan Annie, a fellow crew member, has been captured by PirAnts. The PirAnts (Pirate Ants) function as antagonists in the ISTS story world, displaying negative social behaviors and creating negative social situations. Captain Coop (who herself escaped the PirAnts, but is now on the other side of the island and in need of the child‘s help to get back to the ship) asks the child to gather each of the crew members so they can set sail as quickly as possible to rescue Action Plan Annie. Captain Coop also provides a suggestion for where the child might find the first crew member, Stop & Think Girl. Much like any adventure game, this story narrative provides the child with an understanding of his/her mission and the steps needed to accomplish that mission as well as a sense of urgency and purpose.

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Figure 3. ISTS Screen Shot of Captain Coop Establishing Story Narrative

User Interface The ISTS user interface (UI) (e.g., graphic elements, interactive methods, navigation) reflects best practices for children‘s educational interactive software (e.g., Garris, Ahlers, & Driskell, 2002; Mathan & Koedinger, 2002; Lester et al., 2001; Lester, Stone, & Steling, 1998; Mott, Lee, & Lester, 2006; Roussou, 2005). To attain instructional goals, software must integrate educational components within a UI that is sufficiently interesting and engaging to maintain the child‘s attention (Lester et al., 2001; Lester, Stone, & Sterling, 1998; Mott & Lester, 2006a; Roussou, 2005). Too much of an educational focus and you lose the child, but too much of an entertainment focus and you lose the learning. We built on the ITS research literature and the expertise of our ITS computer science consultant, Dr. James Lester, to ensure that our ISTS environment strikes a balance in which children find the UI appealing and engaging, but also find the social problem solving situations challenging and meaningful so learning can be demonstrated. The ISTS software engine deploys 2.5D technology on which our software developers build custom algorithms to render 2D graphics with 3D dynamic perspective (e.g., things get smaller as they move toward the top of the scene) and dimensional perspective (e.g., characters can move behind objects in the foreground, shadowing and lighting effects). Modern animated cartoons, such as SpongeBob SquarePants™, commonly use 2.5D technology to maintain a cartoon feel without the flattened picture effect of older cartoons. A 2.5D UI was selected for the ISTS to provide children with an interesting and familiar cartoon graphic style without being visually distracting or overwhelming. In contrast, a 3D UI involves complex mechanics for movement (e.g., requires child to move character in three dimensions) that are visually intensive (Roussou, 2005). We chose a 2.5D UI because we did not want to visually or cognitively overload children while they navigate the ISTS nor distract them from the social problem solving focus of the environment (particularly for children with attention problems).

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Figure 4. ISTS Screen Shot of Avatar Builder.

Avatar Builder Before social training begins, the child is able to customize his/her avatar, the visual representation of the child throughout the ISTS story world. Being able to customize the avatar‘s gender and appearance enhances children‘s identification with their character, which in turn increases their engagement and learning (Chung & Lee, 2008; Schroeder, 2002). The child customizes the avatar‘s gender, clothes, hair color and style, and skin color (see Figure 4). A variety of fun and naturalistic options are available through a quick and easy selection process. Once avatar creation is completed, the software engine tracks and renders the avatar‘s location, directional orientation, locomotion, facial expression, and hand/body position throughout the ISTS.

Training Ground Once avatar customization is complete, the child‘s avatar is located in his/her cabin on the SSGRIN. This room and several other scenes aboard the ship are provided to acquaint the child with how to navigate and interact with the ISTS user interface (UI) in the following ways: Movement. To provide as much sense of agency (control and engagement) as possible, children can explore nearly any spot in each scene by clicking on that spot. ―Click-to-move‖ navigation was selected for the ISTS based on research demonstrating its superior usability (e.g., faster and fewer error clicks) as well as children‘s preference for this navigation style (Inkpen, 2001). A modified A* algorithm is used to plan the path the avatar will walk from one spot to another. This algorithm defines the map for each scene‘s geometrically-defined ―walkable area‖ to avoid collisions between the avatar and objects in the scene. Mapping also defines pathway(s) from one scene to another scene and the child learns that available paths from one scene to another are indicated by the cursor changing to an arrow. While the child might not consciously notice, dynamic perspective is emulated through shadowing, lighting, and perspective changes that alter the avatar‘s size and shading depending on its location in the scene. The software also emulates dimensional perspective: the avatar can move in front

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of or behind objects and the size of objects changes relative to the avatar‘s location within a scene (see Figure 5). Interaction with Objects. The ISTS software engine defines the set of rules for how the avatar can interact with the surrounding environment, including objects that are clickable, tools that can be used, and communication modes with pedagogical agents and other external characters. Within the training ground, children learn that the cursor changes color or shape when it moves over clickable objects. Clicking on an object makes the avatar move to interact with it. Some objects are tools that can be picked up and used in future scenes, such as the Clam-A-Lator (see lower right corner of Figure 5). Interaction with Other Characters. In the training ground, children learn how to communicate with another character, the Pelican, who initiates conversation with the avatar. Speech by another character appears within a nearby talk bubble. Based on our initial testing with children, this dialog is set at a 2nd grade reading level (Knobel, 1999) and the speed with which text is presented is equal to the length of text * 1/10 second. Children communicate with other characters by selecting from a menu of dialog and/or behavioral options that appear near the avatar (see Figure 6).

Figure 5. ISTS Screen Shot of Movement Training Area on Ship.

Figure 6. ISTS Screen Shot of Interaction Training Area on Ship.

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An innovative element, as well as a key instructional component of the ISTS, is the association of facial expressions (e.g., scared, angry, sad) with action choices by the child. As children move the cursor over each menu option, the avatar‘s facial expression changes to reflect the emotional intent of that choice. Non-verbal cues are critically important for communication (Graphe & Bernieri, 1999). Any verbal communication can mean very different things depending on the accompanying non-verbal cues. For example, ―It‘s your turn‖ would convey something different if delivered with a pleasant facial expression versus an angry one. Therefore, we have integrated facial expressions with each menu option to help children recognize visual cues associated with non-verbal communication. We built the avatar‘s facial expressions on the work of Dr. Paul Ekman and colleagues who identified facial muscular changes associated with distinct emotional states (e.g., Ekman & Rosenberg, 2005). Figure 7 shows this correspondence with side-by-side comparisons of avatar and human expressions. This social interactive element is unique to the ISTS and is expected to significantly aid children‘s social learning through consistent emotional feedback.

Figure 7. Comparison of ISTS Avatar and Human Expression of Emotions.

Script Management System Generating distinct paths through the social learning environment based on a child‘s choices provides more realistic exchanges and tailored social problem solving instruction (Roussou et al., 2005). For the ISTS, a user-friendly script management system (SMS) was developed so content experts on the ISTS development team can easily create and modify all dialog and behavioral menu choices, including associated facial expressions and responses by the system (e.g., response by external character). The SMS generates separate editable XML (eXtensible Markup Language) files that are then read by the ISTS software engine. When the ISTS presents a child with a menu of options for dialog and/or behaviors, unique paths emerge, branching from each possible option. For example, a series of three menus with three options each yields 27 unique paths of dialog/behavior. However, menu selections are only one factor that influences a child‘s course through a scene. The way a child interacts with a scene (where they move, what they click on, and sequence of these actions) also influences what is presented to the child (e.g., what a character says to them). For each scene, the SMS is used to define the rules for how ISTS responses are triggered by a child‘s menu selections and interaction pattern within a scene.

Calibration Scene The purpose of a calibration scene is to determine the difficulty level at which a child will enter the subsequent social problem solving tasks, i.e., low, medium, or high. A common, yet moderately difficult social situation was used for calibration, i.e., the wharf rats are attempting to bully the avatar (see Figure 8). During this interaction, each menu presents the

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child with a choice of three response styles: withdraw (passive response), escalate the conflict (aggressive response), or manage the situation in a non-aggressive, yet assertive manner (assertive response). Over the course of three exchanges with the rats, the child‘s responses are tracked by the software and scored according to both type (passive, aggressive, or assertive) and sequence. For example, a child who continues to escalate the conflict through aggressive responses at each choice point demonstrates lower social reasoning than a child who adapts from aggressive or passive to more assertive responses over the course of the interaction.

Figure 8. ISTS Screen Shot of Calibration Scene.

Impulse Control Social Problem Solving Tasks The ISTS prototype focuses on social problem solving tasks for the skill of ―Stop & Think‖ or impulse control. The S.S.GRIN intervention curriculum stresses the value of using impulse control across a variety of situations. During in-person group therapy sessions, children practice Stop & Think via role plays of interpersonal situations (e.g., initiating a conversation, resolving a conflict, compromising) and through behaviorally focused problem solving exercises (e.g., working through a logic puzzle, following instructions to ensure accurate responses). In this way, S.S.GRIN demonstrates the importance of inhibiting impulsive responses more broadly and provides practice in the application of impulse control specifically for social situations. Therefore, the ISTS prototype includes two different types of social problem solving tasks for impulse control: one that requires impulse control to navigate an interpersonal situation and one that requires impulse control to solve a behavioral puzzle. Interpersonal Task: “Jet Ski Scene”. In this scene, the child must successfully negotiate with another character, the ―fishing kid,‖ to borrow a jet ski in order to get to crew member Stop & Think Girl on an island across the bay (see Figure 9). However, the scene includes elements designed to interfere with impulse control and encourage the child to impulsively take the jet ski without asking. These elements are more or less difficult depending on how the child performed on the Calibration Scene: (a) at the easiest level, the fishing kid initiates conversation to signal that the child needs to talk with him first; (b) at the moderate level, the fishing kid no longer initiates conversation and a key is prominently

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displayed as an added temptation to take the jet ski; or (c) at the highest difficulty, an element of ―peer‖ pressure is added by which a monkey actively encourages the child to ignore the fishing kid and take the jet ski. Performance on this task is measured by a combination of the number of times the child ignores the fishing kid and attempts to take the jet ski without permission plus the quality of the child‘s negotiation with the fishing kid (i.e., demanding/impatient vs. cooperative/polite menu choices).

Figure 9. ISTS Screen Shot of Jet Ski Scene.

Behavioral Task: “Bridge Puzzle”. This scene focuses on the need to think before acting. In this scene, the child must pay attention to details and carefully follow instructions to cross the bridge to Stop & Think Girl (see Figure 10). This scene pulls for impulsive responding with several red herrings (e.g., cart of bananas, large ―Push for Bridge‖ button) and uncommon twists to the solution (e.g., the monkey does not like bananas). To be successful, the child must inhibit impulsive responding and carefully follow instructions. Performance is based on the order, number, and timing of impulsive responses (e.g., clicking button before reading note, failure to sequence responses correctly).

Figure 10. ISTS Screen Shot of Bridge Puzzle Scene.

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Travel Log Following completion of social problem solving tasks, children receive feedback regarding their performance via their Travel Log (see Figure 11). Similar to a passport, Travel Log pages are added as the child journeys through the ISTS story world, providing a record of accomplishments. The Travel Log provides children with both positive and constructive feedback to help them identify areas of strength as well as areas of difficulty completing each specific social situation. Children can then select to ―Try Again‖ to improve performance for a task or ―Continue‖ on to the next set of tasks.

Figure 11. ISTS Screen Shot of Travel Log.

Mini-Game Once a child has successfully completed a social problem solving skill area (e.g., at least two stars for both impulse control tasks), he/she is rewarded with a mini-game for that skill area. Mini-games provide fun, short activities focused on a specific social skill area. For the ISTS prototype, the child receives the ―Crab-Grab‖ game in which the skill of Stop & Think is needed to successfully complete increasingly difficult levels (see Figure 12). Once collected, mini-games can be accessed by the child at any time via the Clam-A-Lator to provide added practice with a specific skill and positive reinforcement for skill development.

Figure 12. ISTS Screen Shot of Crab-Grab Mini-game.

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Performance Tracking Because quantifying social interactions for interactive software technology has never been done before, we relied heavily on the research and clinical expertise of 3-C‘s content subject matter experts in designing the social problem solving tasks and performance metrics for the ISTS prototype. Each social task was based on what we know from theory and research in social learning as well as clinical experience with social skills training. We then modeled several social situations using the ISTS avatar and other characters to simulate social problem solving in which the social skill of impulse control would be needed to successfully navigate the situation. The sequence of actions and dialog for a social problem solving task were scripted by the first author and other experienced psychologists at 3-C ISD in order to trace paths of varying success through the social situation (e.g., escalating aggressive behavior in a bullying situation). We then assigned a score to each selection made by the child for each menu of dialog/action choices and, depending on the situation, measured other actions during the task (e.g., sequence of clicks through a scene). During the course of completing the ISTS, all interactions between the child and the ISTS are tracked by the software and this data is stored on 3-C ISD‘s secure, encrypted web server. The software engine calculates performance indices for each social problem solving task as well as systemic indices regarding the child‘s overall interaction pattern with the software (see details below). The software engine uses this data to adjust the difficulty level of subsequent scenes in response to the child‘s performance in prior scenes (as in Calibration Scene) as well as to modulate the amount of pedagogical assistance (e.g., level of advice provided by pedagogical agents). These calculations also form the basis of positive reinforcement and constructive feedback provided to the child during the course of completing the ISTS (e.g., pedagogical comments, Travel Log summary). In this way, the ISTS adapts training to the child‘s skill level for more individualized learning. In addition, the software can generate detailed reports regarding a child‘s achieved social problem solving skill levels, including learning curves across different trials and over time. Performance for each skill area can be summarized in terms of speed and proficiency of performance, number and type of errors, and areas of particular strengths and weaknesses.

INITIAL TEST RESULTS Study Design Sample Characteristics. Once the ISTS prototype was designed and created, we tested use of the software with children. To recruit families, flyers were sent to all elementary schools and pediatrician offices in the central North Carolina area and advertisements were posted on local parenting list servs and publications. Families were accepted on a ―first come first served‖ basis (n=37). Children were primarily male (59%) with an average age of 10 years. Families represented the full range of socioeconomic status with a racial/ethnic distribution of 73% White (5% of Hispanic/Latino ethnicity), 22% African American, and 5% Asian American. Participating parents were primarily female (67%) with a bachelor‘s degree or other college experience (53%) and an average age of 40 years. All families reported having a computer with an Internet connection (98% with high-speed) available to the child at home.

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Data Collection Procedures. Six groups of parent-child pairs attended a two-hour scheduled work group at 3-C ISD in Cary, NC. Each child was assigned a private kiosk where he/she could interact with the ISTS on a computer (all kiosks had identical set-ups) while the parent observed. Trained research assistants led the groups through a semi-structured threepart data collection process. First, following parental consent and child assent procedures, parents and children completed demographic and social skills questionnaires. Research assistants gave instructions, read questions aloud for children, and assisted with completion, as needed. Second, following the project introduction and computer orientation, children were given 30 minutes of free time to interact with the ISTS. Children were asked to go through the ISTS twice (i.e., click ―Try Again‖ at least once). Parents were asked to observe only, without providing assistance. Trained observers monitored and recorded children‘s level of attention, areas of difficulty, and responses to ISTS tasks. Computer logs tracked the location and time of each mouse click so children‘s interactivity could be mapped and examined (e.g., for software usability). Third, the first author led group discussions with parents and children to gather additional comments and suggestions. Measures. The software engine generated performance indices regarding children‘s interactions with the ISTS, as described in the results sections below. In addition, prior to interacting with the ISTS, the child‘s social functioning was assessed using an independent, standardized measure, the Social Skills Rating Scale (SSRS) (Gresham & Elliot, 1990). Children and parents separately completed SSRS rating forms. The parent and child reportforms include questions about the child‘s social behavior plus the parent form includes additional items rating problem behavior for the child (55 items for parents; 34 items for children). Each item includes a behavioral description (e.g., ―I make friends easily‖) to which the respondent indicated how often that description was true for the child (0=Never; 1=Sometimes; or 2=Very Often). Factor analysis of the parent-report (P-R) form supported four social behavior scales: Cooperative (e.g., ―Volunteers to help‖), Responsible (e.g., ―Asks permission before using another‘s property‖), Assertive (e.g., ―Is self-confident in social situations‖), and Self-control (e.g., ―Receives criticism well‖). Factor analyses also supported three problem behavior scales according to parents: Internalizing (e.g., ―Appears lonely‖), Externalizing (e.g., ―Fights with others‖), and Hyperactivity (e.g., ―Acts impulsively‖). Each P-R scale showed good internal consistency (mean Cronbach‘s alpha = .79). Factor analysis for the child-report (C-R) form supported four social behavior scales: Friendly (e.g., ―I smile, wave, or nod at others.‖), Polite (e.g., ―I ask before using other people‘s things.‖), Communication (e.g., ―I tell others when I am upset with them.‖), and Impulse control (e.g., ―I ignore others when they tease me.‖). Each C-R scale also showed good internal consistency (mean Cronbach‘s alpha = .71).

Avatar Builder Test Results As expected, children selected avatars that matched their own gender (X 2(1)=33.03, p<.0001). There was also a high correspondence between the child‘s racial/ethnic group and their selection of avatar skin tone (X 2(12)=32.94, p<.001). For example, 100% of African American children chose one of the two darker skin tones and 88% of White children chose one of the two lighter skin tones. Children used the full range of clothing color and hair style options with a strong tendency to select options that reflected their own appearance. During the work groups, children were observed looking at their own clothing and then selecting

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colors for the avatar‘s clothes to match. During follow-up discussion, children reported that being able to customize their avatar made the ISTS more fun and interesting (e.g., ―I like seeing me on the screen‖).

Calibration Scene Results The content and scoring algorithm for the calibration scene (CS) were developed by the first author based on theory and research in children‘s social development. Therefore, an important goal of the work groups was to examine the degree to which performance on the CS was related to an external measure of children‘s social skills and behavior. Given that children with poor social problem solving skills tend to respond in maladaptive ways to social challenges (e.g., first response of aggressive children is typically to be aggressive; Dodge, 1985), we first conducted Analyses of Variance (ANOVA) to examine whether a child‘s immediate response to the social challenge (bullying) by the wharf rats (aggressive n=11; passive n=9; assertive n=17) was related to his/her social skills on the SSRS. Contrast statements were included in the ANOVA models to directly test for differences between groups. Table 1 displays the means and mean contrast results for significant effects (means with different letters within a row were significantly different from one another). Because of the low power to detect differences due to the small sample size, contrast results that were significant at the p<.10 level are included. Child-reported polite behavior and parent-reported responsible behavior were higher for children whose first response was assertive compared to passive. Initially aggressive children displayed more hyperactive and externalizing behavior problems and lower self-control compared to assertive or passive children. Table 1. Mean Contrast Results for SSRS Scores by Children‟s Initial Response Style to the Calibration Scene.

SSRS Scale

Initial Response Style Passive B

Aggressive 1.61

Assertive

AB

1.77 A

Polite (C-R)*

1.43

Responsibility (P-R)*

1.21 B

1.32 AB

1.52 A

Self-control (P-R)t

1.30A

1.05 B

1.33 A

Hyperactivity (P-R)*

.66B

1.10 A

.68B

Externalizing Beh (P-R)*

.54 B

1.00 A

.55 B

Note. t p<.10; * p<.05; ** p<.001. P-R stands for parent-report SSRS. C-R stands for child-report SSRS. Means with different letters within a row were significantly different from one another.

Next, children‘s overall performance on the CS was categorized as low (n=10), medium (n=11), or high (n=16) social reasoning (SR). To test whether children‘s social skills differed according to CS performance, ANOVAs were conducted with SR level predicting SSRS scale scores. Table 2 displays means and contrast results by SR level. Child-reported levels of polite behavior, communication, and impulse control were significantly higher for children at

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the medium and high SR levels. Parents reported that children at the highest SR level were significantly higher on cooperative behavior, marginally higher on self-control, and marginally lower on externalizing behavior compared to the other levels. Table 2. Mean Contrast Results for SSRS Scores by Children‟s Social Reasoning Level on the Calibration Scene.

SSRS Scale

Social Reasoning Level Low B

Medium 1.80

High

A

1.67 A

Polite (C-R)*

1.44

Communication (C-R)*

1.25 B

1.56 A

1.55 A

Impulse Control (C-R)**

1.04 B

1.45 A

1.46 A

Cooperative (P-R)*

.97 B

.98 B

1.19 A

Self Control (P-R)t

1.12B

1.21 AB

1.38 A

Externalizing Beh (P-R)t

.81 A

.77 A

.48 B

Note. t p<.10; * p<.05; ** p<.001. P-R stands for parent-report SSRS. C-R stands for child-report SSRS. Means with different letters within a row were significantly different from one another.

A third set of ANOVAs examined the relation between children‘s level of SR on the CS and performance on the two subsequent social problem solving tasks. Table 3 displays the means and mean contrast results for this analysis. Because a child‘s performance on the CS directly determined the difficulty level at which the child entered the Jet Ski Scene (i.e., number of elements encouraging impulsive responding varied by CS level), error clicks for this scene were expected to be equal across SR groups. As expected, performance on the Jet Ski Scene did not show differences by SR level in the number of errors children made on this task. However, difficulty level for the Bridge Scene was not calibrated by SR level (i.e., difficulty on this scene was the same for all children), such that, as expected, children who demonstrated poorer social reasoning on the CS also showed more impulsive error clicks for the Bridge Scene. Also as expected, children‘s overall performance scores on both the Jet Ski and Bridge tasks showed a similar pattern of better performance for children with higher SR. Table 3. Mean Contrast Results for Performance Scores on Impulse Control Social Problem Solving Tasks by Children‟s Social Reasoning Level on the Calibration Scene.

Mean Performance Score

Social Reasoning Level Low

Medium

High

# error clicks JS ns Overall Performance JS *

1.46 A 1.68 B

2.13 A 1.82 AB

1.91 A 2.23 A

# error clicks BP *

16.27 A

8.55 AB

6.40 B

Overall Performance BP*

1.09 B

2.18 A

2.47 A

Note. * p<.05; ns=non-significant. JS stands for Jet Ski Scene. BP stands for Bridge Puzzle Scene. Means with different letters within a row were significantly different from one another.

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Social Problem Solving Tasks Results There was a significant positive correlation between performance scores for the two impulse control social problem solving tasks (Jet Ski Scene & Bridge Puzzle: r =.35, p<.05) indicating consistency in children‘s ability to solve these tasks. Children also demonstrated an ability to learn from repeated exposure to these tasks with an 80% drop in error clicks and a 72% increase in overall performance scores from the first to second attempts to solve these social problem solving tasks. Correlations were run to examine the inter-relations between children‘s performance on the impulse control social problem solving tasks and their social skills levels on the SSRS (due to limited power, correlations greater than .20 are reported). Overall, the pattern of correlations was consistent with expectations and revealed meaningful patterns of relations. More appropriate negotiation skills during the Jet Ski Scene were associated with being more polite (r =.50, p<.001) and responsible (r =.26, p<.10) and with higher communication skills (r =.34, p<.05) on the SSRS. Inhibiting impulsive responses and carefully following instructions on the Bridge Puzzle were associated with greater impulse control (r =.31, p<.05) and lower hyperactivity (r =-.29, p<.10) as reported on the SSRS.

Systemic metric results In addition to performance scores for social problem solving tasks, three systemic metrics were calculated to reflect the child‘s overall behavioral tendencies when interacting with the ISTS. First, dialog speed (DS) is the mean number of times a child clicked to exit a dialog window before the allotted time. Higher dialog speed indicates the child quickly clicked to remove a dialog display before he/she had time to fully read the presented text. Second, processing time (PT) equals the amount of time spent within each social problem solving scene minus the number of error clicks made during that time period. Higher processing time indicates the child took more time to process or think about a situation and what to do next before acting, i.e., clicking on the mouse. Last, exploration (EX) is the amount of time a child spent exploring the areas of the ISTS that are not part of a social problem solving scene (e.g., cabin on the ship, connecting scenes). Higher exploration scores indicate greater curiosity about or interest in the ISTS environment more generally as opposed to focused attention on solving presented social challenges. Correlational analyses showed that quickly moving through dialog with other characters (DS) was negatively correlated with performance on the Jet Ski Scene (r =-.25, p<.10) such that children who clicked to exit a dialog window prematurely were more likely to perform poorly when negotiating with the fishing kid. In addition, DS was associated with lower communication (r =-.35, p<.05) and cooperation (r =-.33, p<.05) skills, lower impulse control (r =-.32, p<.05), and more externalizing behavior problems (r =.37, p<.05) on the SSRS. As we would expect, rushing through dialog without taking the time to read/understand the other person or the situation interferes with social problem solving and reflects more maladaptive social skills and behavior. Spending more time processing a task without excessive or random clicking (PT) was positively correlated with performance on both social problem solving tasks (Jet Ski Scene r =.55, p<.001; Bridge Puzzle r =.29, p<.10), suggesting that PT is associated with greater problem solving ability. Higher PT was also modestly associated with higher internalizing

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behavior problems (r =.24, p<.10) according to parents, suggesting that children who tend to be more internally focused also tend to take more time processing situations before acting. Children who explored the ISTS environment more and were more investigative throughout the ISTS (EX) performed better on the Jet Ski task (r =.40, p<.01) indicating that this systemic metric is related to better communication skills with other characters in the ISTS. Consistent with this finding, higher EX was also found to be associated with higher communication skills (r =.33, p<.05) and greater friendliness (r =.25, p<.10) as well as lower hyperactive behavior problems (r =-.26, p<.10) on the SSRS, again suggesting that children who are more explorative on the ISTS are able to engage in prosocial behavior and problem solving. Sub-group differences. Though the number of subjects per cell was too low to test for sub-group differences statistically, examination of the various findings from these analyses across different genders and racial/ethnic groups indicated that the patterns of results held consistently across different sub-groups.

DISCUSSION Summary of Results The ―proof of concept‖ for implementing a social tutoring system via interactive software technology was strongly supported through this research. As expected, performance on the social problem solving tasks was related to children‘s social skills and behavior, as assessed through an independent standardized instrument, and these inter-relations were meaningfully linked to the intended content of each task (e.g., externalizing behavior problems associated with aggressive responding on the CS). Further, the ways in which children more generally interacted with the ISTS prototype (systemic metrics) corresponded with their performance on each ISTS social problem solving task as well as their social behavior with peers (as measured by the SSRS). Initial test results also showed that interactive software technology can be designed in such a way that social problem solving tasks are sufficiently difficult to challenge children (e.g., variance in response patterns) and repeated exposure to computerbased social challenges results in significant learning. In addition, relations between the calibration scene and subsequent social tasks support our ability to effectively modulate difficulty level of presented social tasks by altering social cues within a scene to fit the child‘s social reasoning level. This initial test of the ISTS prototype provided substantial evidence for the construct validity of our instructional content as a social learning environment. In particular, the pattern of inter-relations between ISTS performance scores and independently assessed SSRS social behaviors indicates both convergent and discriminate validity of our theoretically derived underlying performance indices. These findings are remarkable given the ISTS prototype included only a small set of social problem solving situations and the study sample size was relatively small. Overall, findings from this research show that it is possible to create an effective social learning environment through interactive software technology. We can apply what is known from theory and research in children‘s peer relations and social skills training to this new computer-based medium in such a way that the social problem solving challenges are both

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meaningful and related to real world social behavior. This study underscores the potential value of using interactive software technology as a social learning agent and clearly supports continued development and testing of the ISTS software.

Implications for Assessment While there are a multitude of paper-and-pencil and direct observational measures that can be used to assess social functioning, children‘s social skill level and social problem solving ability have never been quantified via interactive software technology. This research indicates that computer-based social tutoring models provide a viable way to assess children‘s social skills, social literacy, and social behavior. In effect, this study shows that it is possible to translate children‘s action choices within an interactive social learning environment into meaningful performance indices. Being able to reliably and validly assess social functioning through software offers a number of advantages over traditional assessment methods. First, assessing social skills through interactions with a computer game provides less obvious measurement and more objective data than is possible with other assessment methods. For example, questionnaire responses are always skewed by the respondent‘s subjective perspective. Measures with good face validity commonly suffer from a social desirability bias in which respondents answer questions in a manner that they think is the desired response, e.g., over reporting good behavior or under reporting bad behavior (King & Bruner, 2000; Nederhof, 1985). While it is possible for children to ―game the system‖ or purposefully respond incorrectly on the ISTS, this is possible with any assessment tool. Further, the ISTS calculates systemic measures that can provide insight into whether a child‘s poor performance reflects random or rushed responding versus misunderstanding of the social concepts. Second, while changes in social functioning over time can be tracked through repeated completion of traditional assessment tools (e.g., administering a measure before and after an intervention), the ISTS continually tracks children‘s performance as they engage in social tutoring. Thus, children‘s progress and performance can be easily monitored in real time, including changes in skill levels over time. An advantage of continual measurement is the ability to track developmental trends as a function of exposure to the ISTS and/or engagement in another social skills training intervention. This information could be used to inform treatment (e.g., identify need for additional practice in a particular skill area) as treatment is being delivered. In effect, providers could use this data to tailor intervention strategies to better meet the needs of a given child and thereby increase the overall effectiveness of an intervention. Third, the ISTS performance indices provide a unique means to quantify achievement in the area of social problem solving. Existing measures typically assess social skill level in terms of rating scales regarding the frequency with which a child exhibits particular prosocial and antisocial behaviors. Very few tools attempt to directly assess children‘s social problem solving skills through more experiential methods. One such example is Dodge and colleagues‘ Social Problem Solving measure (SPS; Dodge, Bates, & Pettit, 1998), which presents a child with drawings depicting various social situations (e.g., a child being laughed at by other children on the playground) and asks the child to generate as many alternative strategies as possible for how he/she could successfully cope with each situation. Each response is coded according to social competency criteria as aggressive, competent,

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authority/punish, authority/intervene, or passive/inept. Both the number and quality of strategies generated for the SPS measure have been shown to be associated with higher social competence (Dodge & Feldman, 1990). However, this measure is time consuming to administer and children‘s responses can be influenced by social desirability biases to respond in ways that please the examiner. The ISTS collects data regarding social problem solving skills as the child independently interacts with the software, providing a more time efficient and cost effective method for collecting assessment data. In addition, collecting data through a game environment is less apparent to the child than other assessment methods which may generate more accurate results regarding children‘s social skill levels.

Implications for Treatment While the ISTS represents a powerful assessment tool, the software is also potentially a powerful intervention strategy. During the work groups, the interactive nature of the ISTS with its familiar computer game interface clearly drew children in so that they were highly motivated to engage in and successfully complete the social challenges. Remarks made by children and parents during the work groups underscored the quality of the ISTS game play. Representative comments made by children included ―I liked figuring out the puzzles that were tricky,‖ ―I liked the whole thing,‖ and ―When can I play the rest?‖ Representative comments made by parents included ―Clever puzzles forced my child to think about situations‖ and ―The characters‘ actions clearly modeled social skills.‖ In development of the ISTS, we intentionally integrated the training strategies of scaffolding, coaching and reinforcement, and practice to create an effective interactive social learning environment for children. The ISTS provides a safe, private place where children can experiment with different strategies for the same social situation, explore alternative responses and consequences, and practice key social skills. Children can also garner constructive feedback about their social strengths and weaknesses in private without fear of embarrassment or retribution. Tailoring social challenges to the child‘s social reasoning level and adjusting pedagogical assistance to meet the child‘s learning needs are all included to enhance children‘s engagement and social learning through the ISTS. Given that the ISTS prototype social situations were sufficiently challenging to engage children in social learning and that children demonstrated learning gains with repeat exposure, the potential of this interactive software technology for social tutoring is significant. In addition, the interactive nature of the ISTS may enhance learning beyond traditional social skills training methods. As Dale‘s theoretical model suggests, interventions that incorporate multiple modes of teaching (e.g., auditory, visual, kinesthetic, experiential) have been found to be more effective for learning and memory than those that do not (Gardner, 1993; Tabbers, Martens, & van Merrienboer, 2004; Vincent & Ross, 2001). We would expect active engagement in the interactive social world of the ISTS to yield greater learning gains for children compared to more passive instructional methods. In addition, by utilizing multiple sensory modes, we would expect the ISTS software to better meet the needs of learners of diverse learning styles than less interactive instructional methods (Gardner, 1993; Keefe, 1987; Rydell et al., 2005). In addition to its potential as a social learning environment in its own right, the ISTS also provides an innovative means of extending in-person social skills training into the home. We know that multi-component intervention strategies that provide children with practice

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opportunities outside the intervention setting (e.g., homework) enhance the treatment benefits of programs (Foster & Bussman, 2007; Greenberg et al, 2001). For example, generalization of skill acquisition can be particularly difficult to achieve through in-person social skills training (Greco & Morris, 2001; Gresham, 1985; Kazdin, 1990). Children may demonstrate enhanced skills during the group, but then fail to generalize that skill across settings (e.g., on the playground) or to new social situations. Training strategies that bridge training into the home environment have been found to result in greater generalization and maintenance of skill acquisition (Greenberg et al., 2001). Home-based activities, videos, and web-based materials have each been used to successfully extend training outside of the group setting (Kazdin & Weisz, 2003). We would expect inclusion of the ISTS along with in-person social skills training to significantly increase the effectiveness of that intervention beyond provision of the in-person social skills training program alone.

Future Directions This initial test of the ISTS prototype provided considerable support for the continued development and testing of the full ISTS software. Next steps include creation of the full set of social challenges representing all seven of the core social skills and concepts represented by the main characters. We expect a total of 21 different social challenges with variations to modulate the difficulty of each challenge for children of different social reasoning levels. Systematic psychometric testing will be incorporated into this development to ensure that all social challenges are related to children‘s social skills and behavior as expected and all underlying performance indices measure what they should measure. Once development of the full ISTS software is complete, a primary goal for future research will be to directly test the impact of participating in the ISTS for helping children achieve social learning goals, including positive changes in social problem solving skills and peer relations. We plan to implement a large-scale, longitudinal investigation of the efficacy of the ISTS to directly test its impact on children‘s social functioning (e.g., social skill acquisition, generalization across settings, changes in peer relations, changes in social behavior). Through a randomized experimental design, we will compare outcomes for children who participate in the ISTS alone, S.S.GRIN alone, both interventions, or neither intervention (i.e., control). We expect to find that the ISTS alone significantly benefits children‘s social literacy and functioning compared to the control group. We also expect the combination of ISTS and S.S.GRIN to result in significant added benefit for treatment outcomes compared to S.S.GRIN alone. This first study of the ISTS provides an excellent foundation upon which to build future development and testing efforts. In particular, several limitations of the current study will need to be addressed through future studies. First, this study involved a small sample size which limited the statistical power to detect significant differences when present. Future research should include a larger subject pool. Second, several measures of children‘s social behavior and social problem solving skills should be included so that future psychometric analyses do not depend solely on relations with one measure when evaluating the construct validity of the ISTS social situations and performance indices. Third, this initial test did not permit examination of changes in social literacy or peer relations over time as a function of participating in the ISTS social tutoring. Future research should directly examine the extent to which the ISTS impacts these therapeutic outcomes. Despite these limitations, the robust

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findings from this small study are remarkable and underscore the potential for applying ITS interactive software technology in the service of social learning. Our future research will benefit from the research findings and experience gathered through this initial testing.

CONCLUSION The ISTS represents an innovative means of providing effective social tutoring for children, combined with simultaneous assessment of learning trends in social skill gains. This software gives schools, parents, and mental health providers a novel, powerful tool to engage children in social skills training. The ISTS provides children with a fun, engaging, interactive means to actively learn and practice key social problem solving strategies. While the treatment benefits of in-person social skills training interventions have been repeatedly demonstrated through empirical research, we need to know more about how interactive software technology can be used to enhance children‘s social problem solving skills and peer relations. Innovative computer-based social learning environments, such as the ISTS, not only add to the intervention strategies that can be used to help children build positive peer relations, but also open the door to novel research questions investigating social problem solving processes and the impact of interactive software technology for the treatment of children‘s social difficulties.

AUTHOR‟S NOTE The authors wish to thank the many people who helped make this project a success. We greatly appreciate the expert advice, guidance, and feedback provided by our ITS consultant, Dr. James Lester, throughout development of the ISTS prototype. For his patient guidance and skillful project management with the difficult task of combining the skills and opinions of computer scientists and psychologists into the design of the ISTS software, we give much thanks to Chris Hehman. We also wish to thank Matt Habel for all his hard work and creativity programming the ISTS software, creating colorful graphics, and integrating the graphics and animations into a fun, engaging game for children. The authors are grateful for the tremendous efforts of Laura Brightwood who conceptualized and created the ISTS main characters who provided the basis for the artistic design of the ISTS story world. We would also like to thank Jeremiah Weatherley for his artistic creation of the graphic assets used throughout the ISTS and for his help bringing these graphics to life through animation. Finally, we wish to thank all the children and parents who participated in our work groups to test the ISTS software. We greatly appreciate their time, enthusiasm, and willingness to help. This research was funded, in part, by an SBIR Phase I grant (1R43MH081385-01; PI DeRosier) awarded to 3-C ISD from the National Institute of Mental Health.

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In: Advances in Psychology Research. Volume 72 ISSN: 1532-723X Editor: Alexandra M. Columbus © 2011 Nova Science Publishers, Inc.

Chapter 4

CHILDREN AND ADVERTISING: WHAT DO THEY THINK ABOUT ADVERTISEMENTS, HOW ARE THEY AFFECTED BY ADVERTISEMENTS? Arzu Şener, Seval Güven and Ayfer Aydıner Boylu Hacettepe University, Samanpazar , Ankara, Turkey.

ABSTRACT In all circumstances television advertisements affect children of different age and gender groups in terms of consumption. Because of the ease to affect and lead children, advertisers consider them as the target audience. Today, since television advertisements have an important and effective role in the conscious raising of children who will be socialized as the consumers of the future, we are confronted by the imperative to focus on television ads. For this reason, this study has been planned and conducted with the aim of determining the effects of television advertisements on primary school age children and understanding their attitude towards advertisements. The sample of this research is constituted by 225 students, who are selected by random sampling method from the 6 th, 7th and 8th grades of 5 primary schools within Ankara city territories. The results of the research show that girls watch more television advertisements than boys do (p<.05) and that the ratio of those who ―always‖ watch television advertisements, decline with the increase in education level. Furthermore, at the end of the research it was found that children, be it a girl or a boy at any education level, want to possess the goods and services that they see on television advertisements. However, it was also seen that there is a high ratio of those who think that goods and services that they purchase sometimes carry the characteristics stated in the advertisements. Moreover, the findings of the research also indicate that while most of the children agree with the fact that advertisements are ―entertaining‖ and ―effective in shopping,‖ a considerable number of children think that advertisements cause prodigality. More critical than that, findings pinpoint that the ratio of those who think that advertisements are ―honest and real‖ decline while the ratio (p<.05) of those who think that advertisements are ―misguiding and deceptive‖ increase with the increase in grade level.

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INTRODUCTION Change and progress are experienced in all areas around the world. Especially, the increase in literacy rate that came along with industrialization and the growing importance of media in our lives lead to changes in the society‘s needs and values (Güven, 1996). This structural change in the society and developments in the world have been influential in the economic sector as well. As the basic elements of economic life, managements have various goals like increasing sales, introducing products and services, informing the consumer, enabling the consumer to purchase goods or services in line with their desires and needs, creating and strengthening a brand or a brand image (Bayraktaroğlu 1999; Bir and Maviş, 1988). It is evident that managements want to fulfill these goals. Nevertheless, the eventual increase in goods and services parallel with the changes and developments in economy and technology increased the gap between the producer and the consumer and also perpetuated the competition among producers (Bir and Maviş, 1988). Together with the increased competition, reasons like raising consumer awareness, evaluation of the consumers‘ time and money, the need to inform the consumers in the internal and foreign markets augment the importance of communication in marketing (Bayraktaroğlu, 1999; Dalbudak and Zorman, 2000). Marketing communication carries the goal to publicize the company, product, idea or service of the company to the consumer, customer or to the public (Budak, 2001). If the consumer does not know the product, its price or where that product can be bought, it is not possible for the company to sell it. Therefore, the costumer should be informed about the product, price and distribution channels. This can be realized by promotion efforts within marketing communication methods (Bayraktaroğlu, 1999). Promotion efforts can be explained as a function informing and persuading the consumer as well as affecting their decision in buying (Kurtz and Boone, 1987). Advertisement as a promotion effort is preferred since it provides mass communication (Bayraktaroğlu, 1999; Güzel, 2001). Although many people perceive advertising as new and immature, within the dynamism of free market it has become a significant sector which can use aesthetic elements to motivate the consumer and form communication in a shorter way (Çetinkaya, 1993). Equipped with such functions, today advertising is one of the most crucial cultural factors shaping and reflecting our lives. It is an inevitable part of everybody‘s lives at all places. Even if newspapers are not read, or television is not watched it is not possible to escape images that dominate the urban space. Therefore, today advertising has an autonomous superstructure which encompasses the media and which has no limits (Yulafçı, 2000). The beginning of exchange among people coincides with the same historical process in which advertising is born. Advertising in our country first appeared in newspapers and magazines that came out in the second half of the 18th century. However, advertising through newspapers and magazines did not grasp much attraction due to low literacy rate among the public (Suna, 1963). While advertisements became widespread in radio broadcasting in the 1950s, their most active and influential form appeared in the 1970s when television entered into our lives (Öztürk, 1996; Özyurt, 2004; RTÜK, 2004; Ünsal, 2000).

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Regardless of the short history of advertising in Turkey, on a general scale advertising fulfills functions like creating demand for a product or service, increasing that demand or performing other demand methods. Since advertising carries out these goals on a large scale with its ability to reach great masses, it is also called ―mass sale.‖ Advertisement, as a communication tool, informs people about the benefits of a product or service and persuades them. These constitute the functions of advertising (Bayraktaroğlu, 1999; Dalbudak and Zorman, 2000; Güven, 1996). The first and the most important function of advertisement is ―to inform individuals.‖ The assumption that all consumers in the market have the whole and real knowledge of products and services in the market is an invalid assumption. The rational consumer starts to seek information on the product and service when she decides to meet her wishes and needs. This search for information requires time and energy for the consumer. In such a case, the individual tries to reduce the cost for gaining information and leans towards advertisements which can give information with low costs (Dalbudak and Zorman, 2000; Filizer, 1999). In fact, modern marketing -the father of advertising- aims at understanding and determining customer wishes and needs. Accordingly, it also aspires to develop products in line with these needs and to present the product by announcing the product‘s availability through advertisements (Dalbudak and Zorman, 2000). The second function of advertising is to ―persuade the consumer‖, i.e. to try to make the consumer choose the product which have been advertised. The function of persuasion is the main goal of contemporary modern advertising (Dalbudak and Zorman 2000; Filizer, 1999). Advertisers benefit from the persuasion power of advertisement in the light of social values, because consumers give importance not only to rational and objective criteria like price, quality, and endurance, but also to emotional criteria like color, prestige, fashionability. As a result, there can appear problems such as introducing groundless assertions about the product, directing the consumer to purchase products that are not needed and misusing the consumer‘s inexperience and lack of knowledge (Brettman, 1979; Kavas, 1985). Each and every individual living in the society is a ―consumer.‖ In order to maintain their lives, people have to meet some needs like nutrition, clothing, sheltering, leisure and entertainment. As a result of this, consumption appears as a mere economic concept. According to our contemporary value judgments, consumption is seen to be one of the most vital ways of existence. Thus, everything becomes meaningful in terms of consumption. However, every product and service starts to dissatisfy people at the very moment they are consumed. In turn, people lean towards more consumption. Therefore, consumption oriented life style is being set down and societies transform into consumption societies. In due course, consumers cannot only behave like homo economicus. They also give importance to emotional criteria (color, prestige, fashionability and etc.) along with objective criteria (price, quality, endurance and etc.). The significance attributed to emotional criteria as well as objective criteria and the constant instinct to consume oblige advertisers to use the power of persuasion in the light of social value judgments (Dalbudak and Zorman, 2000; Fromm, 1982; Kavas, 1998). In line with the fact that consumption is not a mere economic concept, today advertising sector concentrates on perpetuating the attitude and behavior of consumer towards a product, service or idea by using creative ability rather than merely informing and entertaining the consumers (Budak, 2001; Dalbudak and Zorman, 2000; Mattelard, 1992).

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Within this consumption society, it is evident that the consumer contribution and dominance in the modern economy are increasing everyday. This dominance becomes more visible with the increase of consumer income level and at the same time with the increase of goods and services in quantity and quality. In the first place, the aim of producers and sellers is to make consumers purchase their goods and services. In order to persuade consumers, these producers develop methods like advertising, individual sales, exhibitions, free samples, coupons, flyers, trade fairs and packaging products. These methods have been utilized in order to transform the society into a consumer society, to shape and settle this consumer society. Still, the most effective method is advertising, especially advertising through mass communication (Gönen and Özgen, 1988; Mattelard, 1992; Pira and Sohodol, 2004). Means of mass communication can be in written, visual or auditory format. While they may contain all these characteristics by themselves, sometimes they may have only a few of these characteristics. As television provides both visual and auditory stimulus (message), it is the most effective means of mass communication (Atay and Öncü, 2003). Along with this, the existence of at least one colored television at each home regardless of its socio-economic level and an average of 5-6 hours spent for watching television caused advertisers to use television effectively for introducing and selling products or services (Aksoy and Batmaz, 1995; Dalbudak and Zorman, 2000; Filizer, 1999; Kulen, 1990; Mete, 2004; Özgen, 1989; Öztürk, 1996; Suna, 1963; Turan, 1996; Yengin, 1994). Thus, despite the short history of television in Turkey, it has become widely used and indispensible for various sections of the society within a short period of time. Television has the power of affecting individuals as a whole. This influence is seen the most in individual's behavior concerning consumption (Öztürk, 1996). "Mass culture,‖ which is pioneered by television, became a mass culture that is known, embraced and used by all world societies at the end of the 20th century. Television is more effective on individuals especially in consumption societies, because of the fact that individuals are interested in televisions and broadcasting due to economic, social and cultural reasons (Cereci, 1996). When we look at general ratings of television broadcastings, it is evident that although the ratings of television advertisements are the lowest, their immediate affectivity is high. Television advertisements have the purpose of creating change in the attitude of target audience towards the products or services produced by companies. Thus, mostly the focus is on "introduction and selling" (Bovee and Arens, 1986; Cereci, 1996; Dalbudak and Zorman, 2000; Kocabaş, Elden and Yurdakul, 2000; Rutherford, 1998). The reactions given by an adult or a child to television advertisements reflect what that individual feels about the instinct to purchase that product (Devrez, 1979; Kocabaş, Elden and Yurdakul, 2000). Such reactions are not caused by methods of pressure but rather by the method of enticement. This enticement, which cannot be realized in the beginning, becomes more visible and faster as the ages of individuals get younger (Çiğdem and Dikeçligil, 1991; Özdiker, 2004). To put in other words, since children are more vulnerable to deception and orientation due to their inexperience, they cannot evaluate advertisements objectively (Akbulut, 2004; Aker, 1978; Kocabaş and Kocabaş, 2004). For this reason advertisements affect children more easily. Besides, teenagers and children have more determinate roles in giving decisions about consumption (Buckingham, 1993). Hence, most of the new consumption tools conduct market researches and activities oriented towards children and teenagers (Akçalı, 2004; Özgen, 1995), because now more teenagers and children are included in the economy as

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consumers. In our contemporary society, children can give decisions on and perform the process of purchasing. Today, not only can children express their desires and needs clearly, but also they can be very insistent on their parents in the process of buying. Therefore, unlike their coevals before they direct consumption behaviors of families even if they do not purchase by themselves. As a matter of fact, some studies underline an increase in the consumption expenditures of 82% of families who go shopping with their children (Gürel, 2004; Kaner, 1989). As for the children‘s decision in buying, mostly advertisements are used as a source of information. Thus, advertisements can influence children to a large extend (Dalbudak and Zorman, 2000; Halloran et al., 1973; Kapferer, 1991; Kocabaş, Elden and Yurdakul, 2000; Pira and Sohodol, 2004; Tokgöz, 1982). Children are constantly confronted with materialist values through television advertisements; thus, advertisements have great effects on the children's thought systems. It is a fact that children gain basic categories that shape social experiences through advertisements. By exploiting children‘s curiosities through wrong and deceiving methods, television advertisements increase consumption of various products. Therefore, it is plausible to suggest that specific techniques used in advertisements can be deceiving and misguiding for the children who cannot evaluate advertisements adequately. Confrontation with television advertisements for a long time can cause changes in children‘s values, attitude and behaviors. According to some observations, when a child sees another child, just like himself, praising a product or service, his instinct of imitation gets stronger. Therefore, he can be easily influenced by the advertisement and wants to possess the products in that advertisement (Öztürk, 1996; Kaner, 1989). In fact, the findings of Tokgöz‘s (1980) research show that children are pushed toward consumption through the effects of advertisements. Similarly, in a study conducted by Robinson et.al. (2001), a special program was organized for some children of 8-9 years. This program, which also included parents, aimed at reducing the time children spend for watching television. In due course, children's watching television was restricted incrementally under the control of their families and they were encouraged to engage with other activities. After this procedure, a 70% decline was found in children‘s demands for toys. In order for the children to be influenced by advertisements, first of all they have to get some information from advertisements and then they have to evaluate and interpret them. Self characteristics like age and gender, social atmosphere and the way the advertisement is presented are of the important factors guiding this process (Turan, 1996). Beginning from the age of 2, children can comprehend everything in their environments (Aksoy and Batmaz, 1995). In between the age range of 0-4, the child leads his family towards consumption covertly. This concealed force becomes visible in his behaviors as he gets older (Filizer, 1999). Moreover, while children of 4-5 years undertake the role of consumers, at the ages of 9-10 they start to differentiate between television programs and advertisements and thus, they become conscious consumers. At the age of 12, they join the society as consumers (Aksoy and Batmaz, 1995; Filizer, 1999). However, the effects of advertisements on children vary not only according to age, but also in relation with gender. Children in the same age group can show differences in consumption behavior in relation to their gender differences (Rutherford, 1998). Tokgöz‘s (1982) study point out that there are gender differences in learning consumption skills of the children in the same age group. For instance, girls like the music and dances in the advertisements. On the other hand, boys remember television advertisements more than the

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girls do. In addition to that, there are also differences between the kinds of advertisements watched by girls and boys. To be more specific, while girls watch advertisements about cleaning and banks, boys watch advertisements about toys more. Regardless of age and gender differences, advertisements affect children in terms of consumption behaviors. Because of the ease to affect and lead children in the consumption society, advertisers consider them as the target audience (Aksoy and Batmaz, 1995; Uebert, Meare and Davidson, 1973). Television advertisements constitute a new dimension for experience and socialization in Turkey and in the world for everyone regardless of their ages. It is evident that in Turkey television is very effective for accepting and forming new social values in the newly emerging generation. Accordingly, since television advertisements have an important and effective role in the conscious raising of children who will be socialized as the consumers of the future, today we are confronted by the imperative to focus on television advertisements. Another reason for the specific focus on television advertisements stems from the fact that among the mass communication tools, children use mostly television. Advertisements squeezed within television programs lead children to consume more by affecting them in terms of both quality and quantity. Here, it should be kept in mind that children begin to participate actively in consumption starting from the age of 12 and they also guide their families‘ consumption patterns. Thus, more studies that investigate the effects of advertisements on children and how children regard this issue should be conducted. Following this need, this study has been planned and conducted with the aim of determining the effects of television advertisements on primary school age children and understanding their attitude towards advertisements.

METHODOLOGY Sample The 6th, 7th and 8th grade students constitute the universe of this research. As the research area, 5 primary schools were chosen from the districts of Bahçelievler, Dikmen, Elvankent, Natoyolu and İncirli within Ankara city borders. 45 students were chosen from the 6th, 7th and 8th grades of each of these five schools within the research scope. Therefore, N=225 has been reached (Çıngı, 1994). Research data were gathered through face-to-face interviews basing on a survey form.

Evaluation and Analysis of the Data The evaluation of the data gathered at the end of the research was done through X2 analysis in the SPSS 12 program. When there are values less than 5 within the expected frequency in the crosstabs, the value of Likelihood Ratio is taken into consideration (Çıngı, 1994).

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FINDINGS AND DISCUSSION General Information on Children More than the half of the children (52%) within the scope of the study is boys, whereas 48% of the children consist of girls. In this sample, while children in the ―13 age‖ group occupy the first rank with a ratio of 32.9%, the ratio of students continuing in the 6th,7th,8th grades is the same (33.3%).

The Situation of Children‟s Watching Television Television is the most widely used means of mass communications. When it is recognized that rural or urban, rich or poor, more or less educated, everyone has a television, then the effects of television on children‘s lives are better understood (Lindstrom and Seybold, 2003; Arslan, 2004). In fact, television may become the most crucial tool that brings the external world into the home for the children, especially during infancy period and the years after (Güler, 1989). For example, according to a study conducted by the International Children‘s Center, children of 2 ages know how to turn on the television and when they turn into the age of 3, they start to stare at television everyday (Revue, 1998). More than the half of the children in the scope of this research (56.9%) stated that they ―always‖ watch television. While 41.3% of the children expressed that they ―sometimes‖ watch television, the ratio of those who said that they ―never‖ watch television (%1.8) is quite low (Table 1). In a research carried out in 15 countries in the continents of Europe, Asia and South America along with the USA, it was found that children watch television almost everyday (Lindstrom and Seybold, 2003). As for Turkey, the ratio of watching television is increasing gradually. Thanks to the new wave of series and soap operas, Turkey caught up with the USA and now she is in the first rank in terms of the ratio of watching television. Furthermore, the high ratio of those children who stated that they "always" watch television in this research signifies the high frequency of watching television among primary school age children. When this issue is analyzed on the basis of gender difference, it is seen that the ratio of boys who state that they "always" watch television (59.0%) is higher than the ratio of the girls who ―always‖ watch television (54.6%) (Table 1). This finding reflects upon the judgment that boys watch television more than the girls do. Regarded the issue on the basis of education level, it is found that in each of the three grades more than the half of the children expressed that they ―always‖ watch television (6th grade: 56.0%, 7th grade: 61.3%, 8th grade: 53.3%) (Table 1)

The Average Time Children Spend Everyday for Watching Television As the most widely used means of mass communication which provides both visual and auditory stimuli, television has penetrated into children‘s lives. As a matter of fact, a child spends more time in front of the television than he spends for reading or playing games (Atay and Öncü, 2003; Doğan, 2003). 45.8 % of the children within the scope of the study watch television for ―3-4 hours‖ in average a day, whereas 37.3% watch television for ―0-2 hours‖ in average. Only 16.4%

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expressed that they watch television for ―5-6 hours‖ in average. At the same time, the ratio of those who watch television ―0-2 hours‖ and ―3-4 hours‖ a day (81.3%) cannot be undervalued (Table 2). When the length of the advertisements seen during this period of watching television, it can be argued that advertisements can affect children in shaping and guiding their consumption behaviors. In a study carried out by Revue (1998) in France, it was found that 30% of the children watch television for 3 hours and 28 minutes a day. Table 1. The Case of Children‟s Watching Television.

Explanatory Variables

Gender

Female Male Total

The Situation of Watching Television Always Sometimes Never n % n % n % 59 54.6 48 44.4 1 0.9 69 59.0 45 38.5 3 2.6 128 56.9 93 41.3 4 1.8

Total n 108 117 225

% 100.0 100.0 100.0

75 75 75 225

100.0 100.0 100.0 100.0

LR = 1.565 p>.05 df= 2

Grade

6th grade 7th grade 8th grade Total

42 46 40 128

56.0 61.3 53.3 56.9

33 28 32 93

44.0 37.3 42.7 41.3

1 3 4

13.0 4.0 1.8

LR = 5.552 p>.05 df= 4 Table 2. The Average Time Children Spend Everyday for Watching Television. Explanatory Variables

Gender

Female Male Total

Time spent for Watching Television 0 – 2 hours 3-4 hours 5-6 hours n % n % n % 38 35.2 53 49.1 17 15.7 46 39.3 50 42.7 20 17.9 84 37.3 103 45.8 37 16.4

7+ hours N % - 1 0.9 1 0.4

Total n 108 117 225

% 100.0 100.0 100.0

1 1

75 75 75 225

100.0 100.0 100.0 100.0

LR = 2.120 p>.05 df= 3

Grade

6th grade 7th grade 8th grade Total

29 24 31 84

38.7 32.0 41.3 37.3

35 36 32 103

46.7 48.0 42.7 45.8

10 15 12 37

13.3 20.0 16.0 16.4

1.3 0.4

LR = 5.175 p>.05 df= 6 When the issue is examined in terms of gender difference, it is observed that about half of the girls (49.1%) and 42.7% of boys watch television for ―3-4 hours‖ a day in average (Table 2). This finding is also illuminated by a research conducted by Saatçiler (1997). The research pointed out that 40% of boys watch television for more than 3 hours, whereas 40% of girls watch television for only 2-3 hours.

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Analyzed in terms of grades in which children continue their education, in all grades those who watch television for "3-4 hours" a day in average occupy the first rank (6th grade: 46.7%; 7th grade: 48.0 %, 8th grade: 42.7%). Those who express watching television for ―0-2 hours‖ a day in average (6th grade: 38.7%, 7th grade: 32.0%, 8th grade: 41.3%) follow the first rank (Table 2). On the other hand, in a study conducted by Revue (1998) in France, it is found that children of 11-14 ages watch television for 2 hours 1 minute. This difference between research findings might be stemming from the fact that these researches were conducted at different times in different cultures.

The Situation of Children's Watching Television Advertise-ments Children start to watch television almost at the time of birth. Since grasping ideas from television does not require any skills, they became a significant part of the advertising watchers at early ages. Considering the role that television has in extending the limits of consumption, children turn into a crucial target for advertising industry. In the light of this goal, children are exposed to thousands of advertisements every year (Unnikrishnan and Baipai, 1996; Leonhardt and Kathleen, 1997; Moore and Lutz, 2000, Kunkel et al., 2004). According to a study carried out in England, a child watches around 140.000 advertisements until he turns into 18 (Lindstorm and Seybold, 2003). In our study, it is seen that those who ―sometimes‖ watch advertisements (66.7 %) are predominant, while the ratio of those who "always" watch advertisements is 27.1 % (Table 3). Being the most important factor affecting the family's decision in buying, children gradually became the focus for advertisers (Mengü and Karadogan, 2003). As mentioned before, while children are related to products about themselves, now they watch around twenty thousand advertisements in a year (Gürel, 2004). As such, they became the target of a wide array of products. By using action, music, cartoon heroes, rhymed mottos and child heroes, advertisers have actually found the ways to attract children‘s attention more (Cesur and Paker, 2007). It can be argued that such attempts of advertisers are successful, because as our study also indicates the ratio of those who "never" watch television are only 6.2% and; thus, the tendency of children to watch television advertisements are necessarily high. The ratio of girls who ―sometimes‖ watch television advertisements are higher than those of boys (female: 73.2% male: 60.7 %). While the ratio of girls who "never" watch television advertisements is 1.9 %, this ratio is found to be 10.3 % for boys (P < .05) (Table 3). When the issue is analyzed in terms of grades in which children receive education, it is seen that more than the half of the 6th graders (58.7%), 62.7 % of 7th graders and majority of the 8th graders (78.7 %) ―sometimes‖ watch television advertisements. Children who express watching television ―always‖ declines with the level of education, whereas the ratio of those who ―sometimes‖ watch television increases with the increase in education level (always: 6th grads: 33.3 %, 7th grade: 29.3 %, 8th grade: 18.7 %; sometimes: 6th grade: 58.7 %, 7th grade: 62.7 %, 8th grade: 78.7 %) (Table 3). This situation might be interpreted as children are less interested in television advertisements as they grow up due to socialization as consumers. As a matter of fact, there have been studies which showed that children‘s behavior concerning television advertisements are connected to the development of their perceptive skills. Therefore, these studies pinpoint that as children become capable of differentiating the reality from imaginary, they start to be less attentive to advertisements (Van Evra, 1998).

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Types of Advertisements that Children Watch the Most Marketers use television as a means of communication which can reach to children at an earlier age than printed media can reach. Around 80 % of children oriented advertisements concentrate on toys, breakfast cereals, candies and fast food restaurants (Kunkel and Gantz, 1992). Therefore, most of the advertisements created for children are about food. On the contrary, in this research more than the half of the children in question (52.9 %) pinpointed ―car advertisements‖ as the most viewed kind of advertisement. The reason for that lies in the fact that 52.0 % of the children within the scope of the research consists of male students. Furthermore, this study has also underlined the finding that the ratio of those who stated watching "advertisements on personal care products" (44.4 %) and the ratio of those who expressed watching ―advertisements on food‖ (44.0 %) are equal and in the second place. The least viewed advertisement among children is ―technological products‖ (5.3 %) which is preceded by advertisements about toys (19.1 %) (Table 4). Koç et.al. (1998) conducted a research which investigated how students of different socio-economic levels are affected by television advertisements. The findings of this study suggested that children remember advertisements related to "food" and ―personal care products‖ the most. This might stem from the fact that these advertisements are watched more. Table 3. The Case of Children's Watching Television Advertisements. Explanatory Variables

Gender

Female Male Total

The Case of Watching Television Advertisements Always Sometimes Never Total n % n % n % n % 27 25.0 79 73.2 2 1.9 108 100.0 34 29.1 71 60.7 12 10.3 117 100.0 61 27.1 150 66.7 14 6.2 225 100.0

X2 = 8.026 p<.05 df= 2

Grades

6th grade 7th grade 8th grade Total

25 22 14 61

33.3 29.3 18.7 27.1

44 47 59 150

58.7 62.7 78.7 66.7

6 6 2 14

8.0 8.0 2.7 6.2

75 75 75 225

100.0 100.0 100.0 100.0

LR = 8.849 p>.05 df= 4 Among girls, the most watched advertisement type is ―personal care advertisements‖ with a ratio of 72.2 %, whereas this ratio is found to be 18.8 % for boys. The majority of the boys (82.9 %) stated "car advertisements‖ as the most watched advertisement type. Besides, the fact that 43.6 % of the boys and only 17.6 % of the girls watch ―credit card advertisements‖ might be interpreted as boys‘ being more interested in advertisements about services (Table 4). Thus, it has been detected that there is a significant statistical relationship between gender and watching different types of advertisements like car, bank, clothing, personal care products and credit cards (P<.05).

Table 4. Types of Advertisements that Children Watch the Most. Types of Advertisements that Children Watch the Most Explanatory Variables

Gender

Toys Advertisements

Car Advertisements

Bank Advertisements

Clothings Advertisements

Food Advertisements

Personal Care Products Advertisements

Credit Card Advertisements

Technological products like mobile phones, computers etc.

n

%

n

%

N

%

n

%

n

%

n

%

n

%

n

%

Female (n=108)

24

22.2

22

20.4

25

23.1

58

53.7

52

48.1

78

72.2

19

17.6

6

5.6

Male (n=117)

19

16.2

97

82.9

45

38.5

34

29.1

47

40.2

22

18.8

51

43.6

6

5.1

Total (n=225)

43

19.1

119

52.9

70

31.1

92

40.9

99

44.0

100

44.4

70

31.1

12

5.3

X =1.300 p>.05 df= 1 X =88.144 p<.05 df= 1X =6.145 p<.05 df= 1 p<.05 df= 1 X2=0.020 p>.05 df= 1 2

Grade

2

2

X =14.111 p<.05 df= 1 2

X =1.450 p>.05 df=1 2

X = 64.904 p<.05 df=1 2

X2=17.710

6th grade (n=75)

24

32.0

36

48.0

20

26.7

33

44.0

38

50.7

31

41.3

19

25.3

3

4.0

7th grade (n=75)

12

16.0

42

56.0

27

36.0

27

36.0

32

42.7

29

38.7

23

30.7

8

10.7

8 grade (n=75)

7

9.3

41

54.7

23

30.7

32

42.7

29

38.7

40

53.3

28

37.3

1

1.3

Total (n=225)

43

19.1

119

52.9

70

31.1

92

40.9

99

44.0

100

44.4

70

31.1

12

5.3

th

X2=13.442 p<.05 df= 2 X2=1.451 p>.05 df= 2 X2 =2.012 p>.05 df=23 p>.05 df= 2 LR =6.710 p<.05 df= 2

X2=0.982 p>.05 df=23

X2=2.705 p>.05 df= 2

X2= 3.769 p>.05 df= 2

X2=3.138

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Arzu Şener, Seval Güven and Ayfer Aydıner Boylu

When the subject is analyzed in relation to the grades levels, the findings show that around the half of the 6th graders (50.7%) state ―food advertisements‖ as the most watched advertisements type. On the other hand, students of 7th and 8th grades mentioned ―car advertisements‖ as the most viewed advertisement kind (7th grade: 56.0 %, 8th grade: 54.7 %). As the grade level increases the ratio of those who state watching "toys advertisements" and ―food advertisements‖ decline (P<.05) (toys advertisements: 6th grade: 32.0 %, 7th grade: 16.0 %, 8th grade: 9.3 %; food advertisements: 6th grade: 50.7%, 7th grade: 42.7 %, 8th grade: 38.7 %) (Table 4). This finding indicates that as the children grow up, their interest in toys and attractive foods decrease.

Elements in Advertisements which Children Find Attractive The results of the research point out that the children within the scope of this study find ―music‖ (49.8 %) as the most attractive element in television advertisements. This ratio is followed by "images" with 46.7 % and ―advertisement actors‖ with a ratio of 40.0 %. While 39.1 % of children affirm that they find ―every‖ element in television advertisements attractive, the ratio of those who state that they find ―none‖ of the advertisements attractive is quite low (2.2%). In other words, majority of the children find at least one element of advertisements attractive (Table 5). In Koç et.al‘s (1988) study, the forms of presenting advertisements (elements, music, song, dance) are effective in making the recollection of advertisements easier. Similarly, Karaca et.al's (2007) study findings show that children are most affected by advertisements in which movie-cartoon heroes and children take part and which has good music. In our study, among girls, the most attractive element in television advertisements is ―music‖ (63.0%) (P<.05). Although among boys, ―image‖ (45.3 %) takes the first rank as the most attractive element, still the ratio of girls stating image as the most attractive element (48.1 %) is higher than boys (45.3 %). This result arouses an impression of girls giving more importance to image and music than the boys do. When the issue is analyzed in terms of grade levels in which children continue their education, the findings of the research pinpoint that students in the 6th grades (54.7 %) and 7th grades (50.7%) who indicate ―music‖ is the most attractive element in advertising take the lead. This is followed by those who give the answer of ―image‖ (6th grads: 45.3 %, 7th grade: 48.0%). In the 8th grade, while the ratio of students who find "image" (46.7 %) as the most attractive element occupies the first rank, the second place belongs to those stating ―music‖ (44.4%) as the most attractive element. As it can be seen in Table 7, as the education level increases, children's attention on advertisement actors, music (P<.05), voice and text starts to decay gradually. This situation might be caused by the fact that as children grow up, there is also an increase in their ability to differentiate between the constructed image and the people who try to impose these images on them.

Table 5. Elements in Advertisements which Children Find Attractive. Elements Which are Found to be Attractive in Advertisements Explanatory Variables

Gender

Female (n=108) Male (n=117) Total (n=225)

N

%

n

%

n

%

Advertisement Actors n %

68

63.0

26

24.1

52

48.1

48

44

37.6

41

35.0

53

45.3

112

49.8

67

29.8

105

46.7

Music

Voice

Image

Text

Effects

All

N

%

n

%

n

%

n

%

44.4

33

30.6

1

0.9

45

41.7

1

0.9

42

35.9

27

23.1

3

2.7

43

36.8

4

3.4

90

40.0

60

26.7

4

1.8

88

39.1

5

2.2

X2=13.442 p<.05 df= 2 X2=1.451 p>.05 df= 2 X2 =2.012 p>.05 df=23 X2=0.982 p>.05 df=23 X2= 3.769 p>.05 df= 2 LR =3.138 p>.05 df= 2 LR =6.710 p<.05 df= 2 6th grade 41 (n=75)

Grade

7th grade 38 (n=75) th 8 grade 33 (n=75) Total 112 (n=225)

None

X2=2.705 p>.05 df= 2

54.7

26

34.7

34

45.3

32

42.7

22

29.3

1

1.3

27

36.0

1

1.3

50.7

21

28.0

36

48.0

30

40.0

20

26.7

3

4.0

31

41.3

2

2.7

44.0

20

26.7

35

46.7

28

37.3

18

24.0

-

-

30

40.0

2

2.7

5.3

67

29.8

105

4.7

90

40.0

60

26.7

4

1.8

88

39.1

5

2.2

X2=13.442 p<.05 df= 2 X2=1.451 p>.05 df= 2 X2 =2.012 p>.05 df=23 X2=0.982 p>.05 df=23 df= 2 X2= 3.769 p>.05 df= 2 LR =3.138 p>.05 df= 2 LR =6.710 p<.05 df= 2

X2=2.705 p>.05

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Arzu Şener, Seval Güven and Ayfer Aydıner Boylu

The Situation of Children Wanting to Possess the Goods and Services Seen on Advertisements Being presented to the children with amazing visual and audio effects, advertisements arouse consumptions instincts of children and thus activate their feeling of possession. This situation increases children‘s tendency to consume, so it transforms children into consumption slaves. Children of all families, regardless of their education and cultural levels, get their share from the ruthless concussions of television advertisements (Arslan, 2004). The majority of the children (72.0 %) "sometimes" want to have the goods or services seen on television advertisements. On the other hand, the ratio of those who "always" want to possess the goods or services seen on television advertisements is 24.0 % (Table 6). As a matter of fact, Koç et.al‘s (1988) study found that 38.0% of children absolutely believe in the need to buy the thing on television advertisements, whereas 52% stated that some of these could be bought. Still, 10.0 % of children expressed that everything seen on television advertisements could be bought. Many studies point out that advertisements constitute an important source of children demands on products (Robinson et al., 2001; Robertson et. al., 1989; Devrez, 1979; AC Nielsen Zet, 1999; Buijzen and Valkenburg, 2003a; Caron and Ward, 1975; Robertson and Rossiter, 1973; Goldberg,1990; Gorn and Goldberg ,1977; Yavas and Abdul-Gader, 1993; Elden and Ulukök, 2006; Arslan, 2004; Jensen, 1995; Williams and Veeck, 1998; Holdert and Antonides, 1997; Ahuja and Stinson, 1993.; Dunne, 1999). For instance, in a research conducted by Robinson et.al (2001), the findings indicate that the frequency of children‘s toys demands is 70 % less in children who watch television and advertisements less. In another study carried out by Robertson et.al. (1989) it was found that television advertisements enhance unnecessary consumption desires of children. Likewise, Devrez‘s (1979) study showed that advertisements create a desire for buying the products that are seen on advertisements. In addition to these, AC Nielsen Zet (1999) organized a research in order to determine to what extend the advertisements are effective in children‘s and teenagers‘ buying and decisions on brands. In this study, which included 2000 families, it was shown that 82.0% of families who go shopping with their children increase their spending in line with the wishes of their children. Thus, it was found that children constitute a leading force in buying. Gender also has an important role affecting the demand of the product which is advertised. While majority of the girls (80.6 %) "sometimes‖ want to have to goods seen on television advertisements, this ratio is 64.1 % for boys. In line with this finding, it can be asserted that girls want to possess the good or services they see on television advertisements more than the boys do. This situation makes us think that girls use television advertisements as means of socialization more and they are more affected by these advertisements. Moreover, it can also be argued that their great interest in personal care products, due to their ages, lead advertisers to create more advertisements on these products. On the other hand, studies show that boys are more insistent on buying products seen on television advertisements more than the girls (Ward and Wackamn, 1972; Sheikh ad Moleski, 1977). The divergence between research findings might stem from cultural and historical differences of researches' scopes. Still, a statistically significant relationship was found between the situation of wanting to possess the goods or services seen on television advertisements and gender (P<.05).

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Table 6. The Situation of Children Wanting to Possess the Goods and Services Seen On Advertisements.

Explanatory Variables

Gender

The Situation of Children Wanting to Possess the Goods and Services Seen On Advertisements Always

Sometimes

Never

Total

N

%

n

%

n

%

N

%

Female

20

18.5

87

80.6

1

0.9

108

100.0

Male

34

29.1

75

64.1

8

6.8

117

100.0

Total

54

24.0

162

72.0

9

4.0

225

100.0

18

24.0

56

74.7

1

1.3

75

100.0

7 grade

17

22.7

54

72.0

4

5.3

75

100.0

8th grade

19

25.3

52

69.3

4

5.3

75

100.0

Total

54

24.0

162

72.0

9

4.0

225

100.0

LR = 10.399 p<.05 df= 2 6th grade th

Grade

LR = 2.659 p>.05 df= 4

Table 7. Reasons Behind Children‟s Wanting to Possess the Goods or Services Seen on Advertisements. Reasons for Wanting to Possess the Goods or Services Seen on Advertisements Explanatory Variables

Gender

Liking the product or services seen on advertisements

Liking the advertisements of product or services

Only curiosity

Wanting to be like actors seen on advertisements

Wanting to possess just because other friends possess.

N

%

n

%

n

%

n

%

n

%

Femal (n=108)

68

63.0

27

25.0

47

43.5

20

18.5

1

0.9

Male (n=117)

71

60.7

40

34.2

59

50.4

16

13.7

4

3.4

Total (n=225)

139

61.8

67

29.8

106

47.1

36

16.0

5

2.2

X2=0.124 p>.05 df=1 p>.05 df= 1 6th grade (n=75)

X2=2.267 p>.05 df= 1

X2= 1.076 p>.05 df= 1

X2 =0.980 p>.05 df= 1

LR =1.731

45

60.0

22

29.3

37

49.3

20

26.7

3

4.0

7 grade (n=75)

45

60.0

23

30.7

34

45.3

8

10.7

-

-

8th grade (n=75)

49

65.3

22

29.3

35

46.7

8

10.7

2

3.7

Total (n=225)

139

61.8

67

29.8

106

47.1

36

16.0

5

2.2

th

Grade

X2=0.751 p>.05 df=2 p>.05 df= 2

X2=0.179 p>.05 df= 2

X2= 0.268 p>.05 df= 2

X2 =9.092 p<.05 df= 2

LR =4.348

Other than gender difference education level is also poignant in determining the demand of the product seen on television advertisements. Generally speaking, it was found that as the grade level in which children receive education increase, children‘s demand on products or services seen on television advertisements decreases (always: 6th grade: 24.0%, 7th grade: 22.7 %, 8th grade: 25.3 %; sometimes: 6th grade: 74.7 %, 8th grade: 69.3 %) (Table 6). This

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Arzu Şener, Seval Güven and Ayfer Aydıner Boylu

result might signify that the ratio of children affected by advertisements decline as they grow up. Thus, being exposed to advertisements is a necessary precondition for developing a cognitive defense against the persuasive influence of advertisements. This argument can also backed by the results of many studies which show that the effects of advertisements on children decrease as children grow up and; thus, the demands of children for advertised products decline as well (Buijzen and Valkenburg, 2003b; Ward and Wackman, 1972; Robertson and Rossiter, 1974; Ward, Wackman and Wartella, 1977; Barry and Hansen, 1973; Bever et al., 1975; Mitchell, 1986; Galst and White, 1976; Lewis and Hill, 1998; Moore and Lutz, 2000; Valkenburg, 2000; Young, 2003; North and Kotze, 2001). For example, in a study conducted by Robertson and Rossiter (1974) it was found that demanding the advertised products decline with the increase in grade level.

Reasons Behind Children‟s Wanting to Possess the Goods or Services Seen on Advertisements Among the reasons of children‘s wanting to possess the goods or services seen on advertisements, "liking the product or services seen on advertisements" lead the first place with a ratio of 61.8 %. On the other hand, ―only curiosity‖ follows the first rank with a ratio of 47.1 % and ―liking the advertisements of products and services‖ take the third place with a ratio of 29.8 % (Table 7). As it can be seen in Table 7, this issue shows similarities in terms of both gender and grade. ―Liking the product or services seen on advertisements‖ and ―only curiosity‖ take the lead as the reasons for the desire to possess products or services seen on advertisements.

The Situation of Children‟s Unnecessary Consumption Due to Advertisements Being frequently confronted with television advertisements, children regard advertisements as the primary source of information. By informing children about the external world, advertisements contribute to the socialization of children. Yet, at the same time they might have negative effects like encouraging children for unnecessary consumption (Doğan, 2003). As a matter of fact, one of the criticisms directed against advertisements is that television advertisements lead children for needless consumption (Savran, 2000). In the scope of this study, children were asked whether ―advertisements cause purchasing products or services that are not needed.‖ While 59.6% answered ―sometimes‖ and 23.6% answered ―always‖ (Table 8). In accordance with this finding, Devrez‘s (1979) study found that advertisements creates a desire for buying and this desire manifests itself in the purchasing of products seen on television advertisements. Similarly, Tokgöz (1982) conducted a study in order to find the effects of advertisements on children in Turkey. The results showed that children are led to extreme consumption through the effects of television advertisements. Likewise, Karaca et.al's (2007) study also determined that 87.6 % of the families complained about advertisements‘ ―directing children towards purchasing goods that are not needed.‖ As it can be seen Table 8 as well, in both gender groups and all grade levels those who think that advertisements ―sometimes‖ lead to unnecessary consumption are in the first place (P<.05).

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The Situation of Whether Products and Services Carry the Characteristics Stated in Advertisements 68.8 % of the children answered the question ―Do the products and services that you purchased by being affected by advertisements carry the characteristics stated in advertisements?‖ as ―sometimes.‖ On the other hand, only 6.0 % of the children expressed that the good and services they purchase "always" carry the characteristics stated in advertisements (Table 9). When this subject is investigated in relation to gender; it is found that whereas 72.1 % of girls state that the goods and services that they buy "sometimes" have the characteristics stated in advertisements, this ratio is 65.8 % for boys. The ratio of those who affirm that purchased goods and services ―always‖ carry the characteristics stated in advertisements is the same for girls (2.0 %) and boys (10.0 %) (Table 9). Therefore, findings indicate that girls are less satisfied with the purchased products and services seen on advertisements than boys are. In due course, a statistically significant relationship between this issue and gender was found (P<.05). When the subject matter is analyzed in terms of the grades in which children continue their education, it is seen that the ratio of those who state that goods or services ―sometimes‖ have the characteristics stated in advertisements increases with the increase in grade level (6th grade: 66.7 %, 7th grade: 68.0 %, 8th grade: 72.0 %). The ratio of those who suggest that goods or services "never" have the characteristics stated in advertisements decline with the increase in grade level (6th grade: 30.7 %; 7th grade: 24.0 %, 8th grade: 20.0 %). On the other hand, the ratio of those who answer the question ―always‖ increase with the increase in grade level (6th grade: 2.7 %, 7th grade: 8.0 %, 8th grade: 8.0 %) (Table 9). According to these findings, it can be concluded that as the grade level increases, children start to act more rationally in their choice of goods and services; therefore, the goods and services they purchase meet their expectancies more. Table 8. The Situation of Children‟s Unnecessary Consumption due to Advertisements.

Explanatory Variables

Gender

Female Male Total

The Situation of Children‘s Unnecessary Consumption due to Advertisements Always Sometimes Never Total n % n % N % n % 31 28.7 63 58.3 14 13.0 108 100.0 22 18.8 71 60.7 24 20.5 117 100.0 53 23.6 134 59.6 38 16.9 225 100.0

X2 = 4.284 p<.05 df= 2

Grade

6th grade 7th grade 8th grade Total

18 16 19 53

X2 = 2.840 p<.05 df= 4

24.0 21.3 25.3 23.6

48 43 43 134

64.0 57.3 57.3 59.6

9 16 13 38

12.0 21.3 17.3 16.9

75 75 75 225

100.0 100.0 100.0 100.0

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150

Table 9. Children‟s Views on Whether Products and Services Carry the Characteristics Stated in Advertisements. The Case of Whether Products and Services Carry the characteristics Stated in Advertisements

Explanatory Variables

Gender

Always

Sometimes

Never

n

%

n

%

N

%

Total n

%

Female

2

2.0

78

72.1

28

25.9

108

100.0

Male

12

10.0

77

65.8

28

23.9

117

100.0

Total

14

6.0

155

68.8

56

24.9

225

100.0

6th grade

2

2.7

50

66.7

23

30.7

75

100.0

7th grade

6

8.0

51

68.0

18

24.0

75

100.0

8th grade

6

8.0

54

72.0

15

20.0

75

100.0

Total

14

6.2

155

68.9

56

24.9

225

100.0

X2 = 6.800 p<.05 df= 2

Grade

LR = 2.798 p>.05 df= 4

Children‟s Views on Advertisements The most debated issues in advertising studies are focused upon encouraging people for unnecessary consumption, misguiding people by giving wrong information about the characteristics of the product or the service, exaggerating the benefits of the product or the service, exploiting the emotions of consumers in trying to make them purchase (Elden and Ulukök, 2006). Table 10. Children‟s Views on Advertisements. Views on Advertisements

Explanatory Variables

Gender

It is entertaining

It is informing and useful

It is misguiding and deceptive

It is honest and it believable

It causes prodigality

It is effective in shopping

n

%

n

%

N

%

n

%

n

%

n

%

Female (n=108)

I agree

93

86.1

54

50.0

63

58.9

47

43.5

67

62.6

87

80.6

I disagree

15

13.9

54

50.0

44

41.1

61

56.5

40

37.4

21

19.4

Male (n=117)

I agree

91

77.8

78

66.7

53

45.3

68

58.1

69

59.0

92

78.6

I disagree

26

22.2

39

33.3

64

54.7

49

41.9

48

41.0

25

21.4

Total (n=225)

I agree

184

81.8

132

58.7

116

51.8

115

51.1

136

60.7

179

79.6

I disagree

41

18.2

93

41.3

108

48.2

110

48.9

88

39.3

46

20.4

I agree

62

82.7

49

65.3

30

40.5

44

58.7

38

50.7

60

80.0

I disagree

13

17.3

26

34.7

44

59.5

31

41.3

38

49.3

15

20.0

I agree

60

80.0

45

60.0

40

53.3

37

49.3

47

62.7

58

77.3

I disagree

15

20.0

30

40.0

35

46.7

38

50.7

27

37.3

17

22.7

8 grade (n=75)

I agree

62

82.7

38

50.7

46

61.3

34

45.3

51

68.9

61

81.3

I disagree

13

17.3

37

49.3

29

38.7

41

54.7

23

31.1

14

18.7

Total (n=225)

I agree

184

84.8

132

58.7

116

51.8

115

51.1

136

60.7

179

79.6

I disagree

41

18.2

93

41.3

108

48.2

110

48.9

88

39.3

46

20.4

X2 = 10.580 p<.05 df= 3 6th grade (n=75) th

Grade

7 grade (n=75) th

X2 = 10.580 p<.05 df= 3

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In this research, while the majority of the children (81.8 %) found advertisements "entertaining," 60.7 % stated that advertisement ―causes prodigality‖ (Table 10). Analyzing the issue in relation to gender, it is shown that majority of the girls (86.1 %) stated that advertisements are ―entertaining,‖ while 80.6 % thought that advertisements are ―effective in shopping.‖ Furthermore, 62.6 % of the girls expressed that television advertising ―causes prodigality.‖ On the other hand, while 77.8 % of boys said that advertisements are ―effective in shopping,‖ 77.8 % find advertisements ―entertaining.‖ These are followed by those boys who think that advertisements are "informing and useful" (P<.05) (Table 10). When the issue is analyzed in relation to the grade level, it is discovered that the ratio of those who find advertisements as ―misguiding and deceptive‖ (6th grade: 40.5 %, 7th grade: 53.3%, 8th grade: 61.3 %), ―leading to prodigality‖ (6th grade: 50.7 %, 7th grade: 62.7 %, 8th grade: 68.9 %) raise with the increase in grade level. At the same time, it is also observed that the ratio of those who think that advertisements are ―informing and useful‖ (6th grade: 65.3 %, 7th grade: 60.0 %, 8th grade: 50.7 %), ―honest and believable‖ (6th grade: 58.7 %, 49.3 %, 8th grade: 45.3%) decrease with the increase in grade level. Moreover, at all grade levels, the ratios of those who find advertisements ―entertaining‖ are close to each other (6th grade: 82.7 %, 7th grade: 80.7 %, 8th grade: 82.7 %) (P<.05) (Table 10). In line with these findings, in a study conducted by Robertson and Rossiter‘s (1974) it was found that the ratio of those who believe in all advertisements decline with the increase in grade level. The findings of this study suggests that as children grow up, they become more aware of the bias and deception in advertisements as well as the persuasive character of advertisements. In fact, many studies shed light upon the fact that as children grow up, their ability to recognize the deceptive, biased and persuasive character of advertisements also develop (John, 1999). Therefore, many studies found a positive relationship between age and understanding the goals of advertisements. To put in other words, as children grow older, their positive feelings towards advertisements turn into negative ones. They even start to doubt and be skeptical of advertisements (Boush, Friestad and Rose, 1994; Ward, Reale and Levinson,1972; Barling and Fullagar, 1983; Elden and Ulukök, 2006; Martin, 1997). For example, in some studies it was shown that starting from the age of 12, children can see advertisements from a critical perspective and understand the intension of producers (Martin, 1997; Peterson and Lewis, 1988; Peterson et al,1984). More than that, it was also found that they can be skeptical and feel insecurity towards advertisements (Boush, 2001; Van Evra, 1998).

Children‟s Views Concerning the Necessity of Advertisements It is observed that 58.2 % of the children within the scope of this study gave the answer ―it does not matter‖ concerning the necessity of advertisements (Table 11). This result indicates that children do not regard advertisements that necessary. In both gender groups, the ratio of those who stated "it does not matter" is the highest, although the ratio is higher for girls (64.8 %) than for boys (52.1%). In addition to that, the ratios of those, who think that advertisements are ―very necessary,‖ are higher in boys (26.5 %) than in girls (18.5 %) (Table 11). When the issue is analyzed in relation to grade levels, it is observed that the ratio of those who find television advertisements ―very necessary‖ decreases with the increase in education level (6th grade: 32.0 %, 7th grade: 21.3 %, 8th grade: 14.7 %). Moreover, the ratio of those who express ―it does not matter‖ concerning the necessity of advertisements‘ existence raise

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152

with the increase in education level (6th grade: 48.0 %, 7th grade: 61.3 %, 8th grade: 65.3 %) (Table 11). This result might stem from the decrease in the ratios of watching television and television advertisements in line with children‘s growing up. Table 11. Children‟s Views Concerning the Necessity of Advertisements.

Explanatory Variables

Gender

Views Concerning the Necessity of Advertisements Very Necessary N %

It does not matter n %

Not necessary n %

Female

20

18.5

70

64.8

16

14.8

Male Total

31 51

26.5 22.7

61 131

52.1 58.2

24 40

6th grade

24

32.0

36

48.0

7th grade 8th grade

16 11

21.3 14.7

46 49

61.3 65.3

Total

51

22.7

131

58.2

No idea

Total

n

%

n

%

2

1.9

108

100.0

20.5 17.8

1 3

0.9 1.3

117 225

100.0 100.0

13

17.3

2

2.7

75

100.0

13 14

17.3 18.7

1

1.3

75 75

100.0 100.0

40

17.8

3

1.3

225

100.0

X2 4.601 p>.05 df= 3

Grade

X2 = 9.390 p>.05 df= 6

Table 12. The Situation whereby Children Tend to Choose Products or Services that are More Used or More Liked Although They are not Different in terms of Price or Quality.

Explanatory Variables

Gender

The Situation whereby Children Tend to Choose Products or Services that are More Used or More Liked Although They are not Different in terms of Price or Quality Always

Sometimes

Never

Total

Female Male

N 33 41

% 30.6 35.0

n 66 61

% 61.1 52.1

n 9 15

% 8.3 12.8

n 108 117

% 100.0 100.0

Total

74

32.9

127

56.4

24

10.7

225

100.0

46.7 24.0 28.0 32.9

34 49 44 127

45.3 65.3 58.7 56.4

6 8 10 24

8.0 10.7 13.3 10.7

75 75 75 225

100.0 100.0 100.0 100.0

2

X = 2.205 p>.05 df= 2

Grade

6th grade 7th grade 8th grade Total

35 18 21 74

X2 = 10.432 p<.05 df= 4

The Situation whereby Children Tend to Choose Products or Services that are More Used or More Liked Although They are not Different in terms of Price or Quality

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Most of the children within the scope of this research (89.3 %) stated that when they are confronted with two products or services of no difference in quality or price, they "sometimes" (56.4 %) or ―always‖ (32.9%) tend to choose the one which is more advertised or the one with better advertisements. On the other hand, the ratio of those who "never" (10.7 %) choose the one which is more or better advertised. Generally speaking, this finding indicates that children tend to prefer goods or services seen on television advertisements. As a matter of fact, Özgen (1989) conducted a research on 300 children in order to understand children‘s consumption behaviors. In this study, it was found that almost every children (97.0 %) consider television advertisements while doing shopping; thus, television was found to be one of the three information sources that determine children's purchasing behaviors. Similarly, in a study conducted by North and Kotze (2001) results showed that more than one third of the children want to possess the product which is more advertised. In line with these, in researches carried out by Singh (1998) and Jensen (1995) it was underlined that children‘s choice of products are highly aroused by advertisements. Analyzing the issue in terms of gender difference, it is seen that the ratio of boys who ―sometimes‖ choose the product or service which is more or better advertised take the lead (female: 61.1 %, male: 52.1 %). This is followed by the ratio of those who ―always‖ choose products or services which are more advertised or which have better advertisements (female: 30.6 %, male 35.5 %) (Table 12). When the subject is analyzed in terms of grade levels, it is understood that the ratio of those who ―always‖ choose the product or service that is better and more advertised takes the lead in 6th grade with a ratio of 46.7 %. On the other hand, the first ranks belong to those who ―sometimes‖ choose such products in the 7th (65.3%) and 8th (58.7%) grades. As the level of education increases, the ratio of those who state that they do not choose products and services with better and more advertisements also increases (P<.05) (Table 12). This situation gives the idea that children start to be more impartial in choosing products and services as they grow; therefore, it seems that children start to make their decisions in the light of objective criteria.

CONCLUSION Children are very crucial for young populated countries like Turkey, because they form a vital market. Therefore, as it can be seen from research findings, they form an important target for advertisers. Various producers and distributers of national or foreign branded products are in a constant attempt to influence this target through advertisements. Yet, when research findings are analyzed in detail with reference to children‘s abilities to perceive, gather information and be affected, it becomes evident that advertisements might contain various problems concerning children. On the other hand, being totally against advertisements is inconceivable as well. Advertisements have many useful functions: not only can television play an important role in socialization of children as consumers, but also television advertisements can inform little children about their external worlds. They enable children to enter into the world of objects, specially the world of objects oriented towards adults. In a way, advertisements contribute to the social development of the children as they bring them closer to new objects (Doğan, 2003). With the help of some advertisements, the child remembers once again that he should

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brush his teeth and that milk is healthy and he should drink it. Therefore, seen from this perspective advertisements are educating and monitory (Karaca, Pekyaman and Güney, 2007). In due course, society is not reactive against the activities of advertising, rather it opposes to the methods used to enhance the effects of advertisements. Deceptive and misguiding applications are the most important methods among these (Akan, 1995). Since children are vulnerable and in need of protection; controlling, limiting and prohibiting advertisements will be for societal good. However, advertisements still continue to affect children despite the limitations and in fact children are more affected by advertisements than adults are. Thus, public forces have to take action around two alternatives: either marketing stimuli (advertisement) will be controlled or variables that change the effects of these stimuli will be reorganized. The first one refers to auditing, while the second one refers to an education strategy. The effects of advertisements are not the same on every child. They can be either high or low in accordance with parent attention, inter familial relationships and education level. This influence also differs in relation to child‘s ―advertisement consciousness.‖ In that case, some of these variables can be targeted in order to educate the children about advertisements. As these factors ease the effects of advertisement on the child, it is more appropriate to develop these factors in the child and in his environment. These should be organized around two axes. On the one hand, critical capacity of the child should be developed in the face of the messages stemming from the means of advertising and communication. On the other hand, skills to make him a good buyer should be built up. Distancing the child from the message through developing his critical capacity would teach him to understand the images better. Furthermore, it would also enable him to distinguish technique of highlighting techniques through images and voice. In this way, he would learn the persuasive intention of advertisement. As a second goal, education oriented towards equipping the child with skills to make rational choices in buying can decrease the effects of marketing stimuli in the short run. In the long run, this goal is important for the children, as the adults of the future, to develop models for health decision making (Kapferer, 1991). Educating children are necessary, yet not sufficient. Parents also should try to quit their habits of sitting in front of the television whole day. As parents can quit such habit, they can also save their children and secure them against advertisements to some extend. Being exemplary through action is the most efficient method of education. Besides educating children and self control of parents, advertising agencies should take responsibilities. They should consider the side effects of advertisements and take action accordingly. Children start to make more demands with the effects of advertisements. Yet, families with low income levels find it extremely hard to meet these demands. In addition to that, families with adequate income levels might refuse these demands on the grounds that buying whatever the child wants is not right. This situation might form a feeling of deprivation and offense for the child. Advertisements, which are also called as the online form of consumption capitalism, bring such difficulties with itself (Karaçoşkun, 2009). For this reason, advertisers or advertising agencies should act with social responsibility rather than with a mere focus on the product sales. More specifically, considering that children of young ages are more vulnerable and more affected, advertisements should not include messages that are deceptive, misguiding and encouraging consumption.

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In due course, having both positive and negative effects advertisements should be processed and controlled in line with basic principles that will be considered in advertisements oriented towards children. Along with this, educating children and people around them about advertisements is of significance.

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In: Advances in Psychology Research. Volume 72 ISSN: 1532-723X Editor: Alexandra M. Columbus © 2011 Nova Science Publishers, Inc.

Chapter 5

VERBAL AGITATION IN DEMENTIA: A MANIFESTATION OF A NEED FOR COMFORT? Marianne Lemay and Philippe Landreville School of Psychology, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Université Laval, Québec (Québec), Canada, G1V 0A6.

ABSTRACT Verbal agitation (VA) is a problem frequently observed among people suffering from dementia. Although several researchers have suggested that VA conveys a need for comfort, few studies have actually examined the relationship between these variables. The goals of the study reported in this chapter are a) to verify whether physical pain, depression and sleep disturbances are associated with discomfort, b) to identify which variables among physical pain, depression and sleep disturbances are related to VA, and c) to determine which VA manifestations are related to discomfort, physical pain, depression and sleep disturbances. Sixty-four people suffering from dementia were recruited from two long-term care facilities participating in the study. The results, based on correlational analyses, demonstrate no association between discomfort and VA, pain, depression, or sleep disturbances. Furthermore, pain and depression significantly contribute to VA, beyond cognitive functioning, disabilities and medication. Some specific manifestations of VA, such as negativism and complaining, seem equally related to pain and depression. The relationships between the variables studied and other agitation subtypes are also analysed for exploratory purposes. This information furthers our understanding of VA and potential for reducing behavioral problems.

Keywords: dementia, verbal agitation, discomfort, pain, depression, sleep.

INTRODUCTION The behavioral and psychological symptoms of dementia are now recognized as significant manifestations beyond the deterioration of cognitive functioning (Finkel, 2000). Verbal agitation (VA) appears to be one of the most common and disturbing form of these

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symptoms. It refers to a group of verbal or vocal behaviors which are either repetitive, disruptive or inappropriate in terms of intensity, frequency, duration or the context in which they occur. VA takes several forms such as screaming, aggressive language, swearing, complaining, repetition of phrases or demands, moaning, incoherent speech or speaking to someone who is not there (Cohen-Mansfield & Werner, 1994). It is found in 10 to 52% of people suffering from dementia, both within institutional settings and in the community (Cohen-Mansfield & Werner, 1994; Lai, 1999; Shahar, Snow, Souchek, Ashton, & Kunik, 2004). Without treatment, VA becomes a chronic problem that occurs several times per day and takes up a considerable proportion of nursing home residents‘ days. It may also be associated with feelings of powerlessness, anxiety and anger in other patients and caregivers. Caregivers tend to distance themselves from people who demonstrate VA, to isolate them and to over medicate them, thus diminishing their quality of care (Beck & Vogelpohl, 1999; Burgio & Bourgeois, 1992; Burgio, Scilley, Hardin, Hsu, & Yancey, 1996; Cohen-Mansfield, Werner, & Marx, 1990). Two major categories of determinants are associated with VA: personal variables and environmental variables. Looking at personal variables, VA has been associated with being female, severity of cognitive problems, loss of independence in activities of daily living, pain, poor health, depression, and sleep disturbances. Among environmental variables, VA has been related to social isolation, physical restraint and time of day. Over the last few years, several researchers have used the Need-Driven DementiaCompromised Behavior Model (Algase et al., 1996) to explain VA. According to this model, VA is a means of expressing unmet needs that a person suffering from dementia cannot communicate otherwise. Predisposing factors make the appearance of VA more likely while other more easily changeable factors precipitate it. Predisposing factors refer to psychosocial characteristics and an altered neurological, cognitive and health functioning. Precipitating factors include changing needs, the psychological and physiological state of the person and some elements of the physical and social environment. Various authors suggest that VA may be an expression of a need for comfort. A physically unpleasant condition, such as a cold shower, may lead to VA (for example, screaming, swearing or complaining), which may serve to attract the attention of a caregiver to the discomfort of the situation. To clarify the relationship, Kovach and collaborators (2001) have indicated that unmet needs, be they physiological or not, cause physical or psychological discomfort which lead to a change in behavior. Discomfort has been defined as an affect or negative physical state that may vary in intensity in response to internal and environmental conditions (Hurley, Volicer, Hanrahan, Houde, & Volicer, 1992). As such, this concept includes somatic and psychological sources of discomfort. Few researchers have directly studied the link between discomfort and behavioral problems associated with dementia. Buffum and collaborators (2001) recruited 33 older adults who had a diagnosis of dementia, lived in the same care home, had at least one painful condition noted in their medical file (e.g. progressive degenerative joint disease, osteoporosis), and demonstrated at least one agitated behavior per day. Their results show a significant positive relationship between agitation and discomfort while controlling for the severity of dementia. More specifically, their results show that discomfort and agitation share a common variance of 14%. However, the authors limited their study to general agitation (GA) without taking subtypes into account. In fact, various researchers have distinguished VA from physically aggressive agitation (PAA; e.g., hitting) and nonaggressive physical

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agitation (NAPA; e.g., pacing) and the literature supports the idea that various subtypes of agitation may express different needs and be related to different factors. Buffum and collaborators (2001) do not specify whether discomfort is more strongly related to some subtypes of agitation than others. Young (2001) has explored the relationship between discomfort agitation subtypes among 104 persons with dementia aged 59 to 100 and living in a long-term care facility. In spite of a significant positive correlation between GA and discomfort, a multivariate analysis of variance, controlling for cognitive functioning, revealed no significant relationship between the two variables. As for subtypes of agitation, only PAA was shown to be positively associated with discomfort. Unfortunately, these results are difficult to interpret due to a lack of precision regarding the version of the measure of agitation and the scale used to score items. In addition, the exact items used for calculating the score for each of the subtypes of agitation is not reported. Pelletier and Landreville (2007) arrive at different conclusions regarding the relationship between subtypes of agitation and discomfort in their sample of older persons with dementia. Hierarchical multiple regression analyses controlling for various participant characteristics (severity of dementia, loss of independence in daily activities and gender) showed that discomfort explains a significant portion of GA, VA and NAPA. The link between discomfort and PAA was not significant. However, no further clarification is available regarding the determinants of discomfort and specific forms of VA implicated in the association between discomfort and VA. Although previous research has provided important information, knowledge regarding VA and discomfort is limited. First, studies of the determinants of VA often measure several variables at the same time and because no statistical control is performed, it is impossible to know the real contribution of each variable to VA. Second, studies by Buffum and collaborators (2001) and those of Pelletier and Landreville (2007) provide no clarification regarding the sources or manifestations of discomfort associated with VA. The shared variance between VA and discomfort may be better explained by variables associated with VA, such as pain, feelings of depression and sleep disturbances, which may also be considered determinants or manifestations of discomfort. Third, Pelletier and Landreville‘s (2007) study does not specify which manifestations of VA are most strongly related to discomfort. Although these researchers have found that VA is globally associated with discomfort, this association may in fact be explained by certain specific forms of VA. Discomfort may, for example, lead to complaints and negativism rather than repetitive questioning. The identification of specific aspects of VA and discomfort implicated in their association would provide useful information for the prevention and management of VA. The main objective of this chapter is to specify the relation between discomfort and VA among people with dementia. The specific objectives are (a) to verify whether physical pain, depression and sleep disturbances are associated with discomfort, (b) to identify which variables among physical pain, depression and sleep disturbances are related to VA, and (c) to determine which manifestations of VA are related to discomfort, physical pain, depression and sleep disturbances. To ensure greater precision of the results, cognitive functioning, disabilities in activities of daily living and use of certain types of medication will be measured for statistical control purposes because these variables are related to VA. Further, the relations between the different variables and other subtypes of agitation (PAA and NAPA) and GA will be analysed for exploratory purposes.

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METHOD Participants Sixty-four participants were recruited from two residential and long-term care facilities. Participants were identified by the directors of these centres according to the following criteria: a) be over the age of 65, b) having lived in the same facility for at least three months, and c) having a diagnosis of dementia. Residents with a premorbid diagnosis of psychotic problems (preceeding dementia) in their medical records were excluded because this condition may confound the etiology of agitation. The sample size is much larger than that estimated by a multiple regression power analysis using the G*Power software, version 2.0 (Erdfelder, Faul, & Buchner, 1996), and performed before the data was gathered. This estimation of a sample size (N=40) was calculated with a statistical power of .80, an alpha threshold of .05, 6 predictors and an effect size of .54 corresponding to the significant correlation between discomfort and VA reported by Pelletier and Landreville (2007).

Variables and measures Descriptive characteristics. The descriptive characteristics of participants and caregivers were recorded. For participants, we noted age, gender, length of stay in the facility, medical diagnoses and daily medication. Types of medication noted were neuroleptics, antidepressants, benzodiazepines, other psychotropics, opiates and other analgesics. These medications were considered because of their possible effects on both VA and the other variables. For correlational analyses, taking medication was treated as a dichotomic variable, meaning that each medication was scored 0 or 1 depending on its absence or presence in the medical file. Caregivers‘ age, gender, level of education, job title, work schedule and number of years of experience working with the elderly were compiled. Comorbidity. The Charlson Comorbidity Index (CCI; Charlson, Pompei, Ales, & MacKenzie, 1987) estimates the risk of death according to comorbid diagnoses and the participant‘s age. In all, 19 comorbid conditions are evaluated and weighted according to their degree of severity. The total score, which also takes age into account, reflects higher comorbidity and ranges from 0 to 43. Various studies have demonstrated this tool‘s validity. Cognitive functioning and dementia. Cognitive functioning was evaluated using the second version of the Dementia Rating Scale (DRS-2; Jurica, Leitten, & Mattis, 2001) which differs from the original DRS (Mattis, 1988) because norms for age and education are available. This tool measures the cognitive functioning of persons with dementia in five areas: attention, initiation and perseverance, construction, conceptualization and memory. A higher score indicates better cognitive functioning. In addition, a total score equal to or lower than 123 out of a maximum 144 points suggests the presence of dementia. Several studies have shown the reliability and validity of the original DRS.

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Functional disability. The degree of disability in performing activities of daily living was assessed using a subscale of the revised Functional Autonomy Measurement System (SMAF; Desrosiers, Bravo, Hébert, & Dubuc, 1995). This subscale includes seven items measuring different activities including feeding, cleaning, washing, dressing, toileting, using the washroom independently as well as urinary and fecal incontinence. Each item is scored on a Likert-type scale comprised of five response levels (0, -0.5, -1, -2, -3), where 0 corresponds to total independence and -3 to complete dependence. A total score was obtained by adding the result for each item without taking the negative sign into account (ex: a score of -14 was entered as 14). A higher score reflects greater disability. The construct and concomitant validity of the original SMAF as well as the reliability of the section on activities of daily living of the revised SMAF have been established. Agitation. Agitation was evaluated using the Cohen-Mansfield Agitation Inventory (CMAI; CohenMansfield, Marx, & Rosenthal, 1989). The CMAI is comprised of 29 items measuring the frequency of disruptive behaviors over the previous two weeks using a seven-point scale ranging from 1 (never) to 7 (several times per day). This instrument is completed by a member of the care team who knows the person well. The total score for the 29 items is indicative of GA and a higher score indicates more frequent agitation. In earlier work, we found three factors, or subscales, of the French version of the CMAI which were used in this study: VA (6 items; e.g., complaining, repetition of phrases or questions), PAA (6 items; e.g., hitting, kicking) and NAPA (6 items; e.g., pacing, inappropriate dressing and undressing). Discomfort. This variable was measured using the Discomfort Scale-Dementia of the Alzheimer Type (DS-DAT; Hurley et al., 1992). The DS-DAT includes nine behavioral discomfort indicators (e.g., noisy breathing) accompanied by a list of observable behaviors that more specifically describe what they include (e.g., negative sounding noise on inspiration or expiration; episodic bursts of rapid breaths or hyperventilation). Over a period of five minutes, a trained evaluator scores the frequency (between 0 and  3), the intensity (low or high) and the duration (long or short) of each indicator. The level of discomfort is then found using the value attributed to each of the three components. Each of the nine behavioral discomfort indicators was evaluated independently on a scale ranging from 0 (no discomfort) to 3 (extreme discomfort). The discomfort score for each of the indicators was then added to obtain the final score. The reliability of the DS-DAT, including inter-rater agreement, has been demonstrated. Pain. The Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC; Fuchs-Lacelle & Hadjistavropoulos, 2004) was used to measure pain. This tool is designed specifically for persons with dementia with limited language abilities and is comprised of a list of 60 observable behaviors grouped in four subscales: 1) facial expressions, 2) activities and body movements, 3) behaviors, personality and mood, 4) other behaviors (physiological changes, changes in eating or sleep habits, and vocal behaviors).

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This instrument was designed to be administered by caregivers and takes approximately five minutes to complete. The caregiver must check the observed behaviors and add the number of identified behaviors within each subscale to generate a total pain score. The greater the pain, the higher the score. The PACSLAC has been shown to be valid and reliable (Fuchs-Lacelle & Hadjistavropoulos, 2004).

Depressive symptoms. Symptoms of depression were evaluated using the Depression/Dysphoria subscale of the Neuropsychiatric Inventory (NPI-D; Cummings et al., 1994). This subscale is completed on the basis of an interview with a person familiar with the patient. After verification of the presence of depressive symptoms, both the frequency (ranging from rarely to frequently) and the severity (ranging from minor to significant) are assessed. The total score is obtained by multiplying the frequency score by the severity score with a higher score indicating more significant depressive symptoms. The validity and reliability of NPI-D has been demonstrated. Sleep disturbances. Sleep disturbances were measured using the Sleep Disorders Inventory (SDI; Tractenberg, Singer, Cummings, & Thal, 2003), an improved version of the NPI Sleep Subscale. The SDI provides an assessment of sleep difficulties over the two previous weeks. Both the frequency (ranging from absent to once or more per night) and the severity (ranging from absent to significant) of each of the eight items are rated. The total SDI score is obtained by multiplying the average frequency score by the average severity score. A higher score indicates a more disrupted sleep. The convergent validity of the SDI is documented (Tractenberg et al., 2003). Procedure The nursing assistant most familiar with each participant was contacted by the first author (M.L.) to present the study and ask for collaboration in collecting data. If no regular nursing assistant was assigned to the resident (n=10) or a nursing assistant declined participation (n=2), an auxiliary nurse or the unit‘s head nurse was solicited. The nursing assistant had two weeks to observe the participant‘s behavior, check sleep disruptions daily by asking nighttime staff members, and complete the measure of pain. Nursing assistants were given specific instructions to collect data. In the case of the PACSLAC, for example, the nursing assistant had to select a situation in which the patient was either sitting or laying down to proceed with the pain evaluation. The first author could be contacted by the caregiver if he or she had questions regarding the procedure or the measurement tool. Within the same two-week period, the first author administered the DS-DAT and the DRS-2 and consulted the participant‘s medical file to obtain descriptive characteristics. If a score for the FIMS was already recorded in the resident‘s file, this score was taken directly. Otherwise the unit‘s head nurse completed the FIMS. At the end of two weeks, the first author met the nursing assistant to complete the CMAI, the NPI-D, the SDI and to collect descriptive characteristics. To complete the various tools during the interview, the nursing assistant referred to the two weeks during which the PACSLAC was completed and he or she gathered information on sleep disturbances.

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To verify the reliability of the data for the instruments completed by the first author, the data was also collected by a research assistant. The assistant completed the DS-DAT independently at the same time as the first author for 42 successive participants (65% of the sample). In addition, interviews with nursing assistants were recorded and the research assistant completed the CMAI, the NPI-D and the SDI a second time based on these recordings. This data was collected for 16 randomly selected participants (25% of the sample).

Data analysis SPSS software, version 13.0 for Windows, was used to analyse the data. Descriptive statistics (number, percentage, mean, standard deviation and minimum and maximum values) were calculated. The reliability of some measures was examined. The inter-rater agreement for the DS-DAT was evaluated by calculating an intra-class correlation coefficient between the two independent evaluations and by performing a paired t-test between the evaluations. Intra-class correlation was chosen because it allows inter-rater agreement to be tested on a continuous variable while controlling for the variance between raters. In addition, percent agreement on the total score of each of the two CMAI, NPI-D and SDI evaluations was calculated. Percent agreement was preferred to estimate inter-rater reliability because these evaluations were of the same interview and the information provided by the nursing assistants allowed for little variability. Subsequent analyses served to meet the objectives of the chapter. The relations between the variables were first examined. In the case of certain asymmetrical distributions, Spearman rather than Pearson correlations were calculated. Using the ranks of the variable values rather than the variables themselves, Spearman correlations correct the asymmetrical effect of the data. In the case of significant correlations between agitation and the other main variables (discomfort, pain, depression, sleep disturbances), hierarchical multiple regression analyses, controlling for cognitive functioning, disability, and medication, were performed to evaluate the specific contribution of the variables to each model. The latter three variables were first introduced together in the first step of the regression followed by the variable to be added to the model. If more than one variable was selected for a regression model (e.g., pain, depression and sleep disturbance), the analysis was done in two stages: one of these variables (e.g,, pain) was entered in the third stage after the other variables (e.g., depression and sleep disturbance) had been previously introduced in the second stage. The order of entry of the variables in the model was then modified to determine the contribution of each variable. The variance explained by the model (R2) and the variance added at each step (increment R2) was calculated. Other statistics reported were the unstandardized regression coefficients (B), the standard error of regression coefficients (SE B), and the standardised beta regression coefficients (ß) which indicate the relative contribution of each variable in the model. Graphs of the residuals were examined to verify assumptions of multiple regression analysis. A logarithmic transformation of VA and a type 1/y3 type transformation of PAA were performed to improve the linearity and homogeneity of variances of these variables. Finally, the relations between manifestations of agitation and the main variables studied were examined using Spearman correlations. For all analyses, the significance threshold was set at p<.05.

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RESULTS Descriptive analyses As shown in Table 1, the sample is made up mainly of women. On average, participants were 83 years of age, had lived in the long-term care facility for 47 months and presented several health problems and a relatively elevated comorbidity level. In addition, participants presented significant difficulties in terms of cognitive functioning and performing activities of daily living. More than half of participants had prescriptions for neuroleptics and analgesics (opiates and others) while slightly less than half took antidepressants and benzodiazepines. Thirty-one members of the caregiving staff participated in the data collection. They had on average 20 years of experience working with the elderly and most of them were women working as nursing assistants.

Reliability of measures An intra-class correlation of .94 was obtained between both judges‘ DS-DAT scores. The t test shows that their scores do not differ significantly from one another, t(41) = 1.62, p = .11. Perfect agreement was observed between the judges for the CMAI, NPI-D and SDI scores.

Main analyses Table 2 shows the correlations between the different variables. It can be seen that pain, depression, and sleep disturbances are not correlated with discomfort. In fact, looking at the various subtypes of agitation, it can be seen that PAA is the only one for which a significant correlation with discomfort is observed and this correlation is positive. The results show that VA is positively associated with cognitive functioning, pain, depression, taking antidepressants and opiates, and to PAA, NAPA and GA. On the other hand, more disability is significantly correlated with less VA. NAPA is positively related to cognitive functioning, taking antidepressants, VA, and GA. Greater disability is associated with significantly less NAPA. In addition to being associated with discomfort, PAA is also positively correlated with disability, sleep disturbances, taking neuroleptics, VA and GA. A lower level of cognitive functioning is associated with more PAA. Finally, GA is positively correlated with pain, depression, taking neuroleptics and antidepressants, and to VA, NAPA and PAA. The results also show that disability in activities of daily living is negatively associated with GA. Two multiple hierarchical regression analyses were performed to evaluate the respective contributions of pain and depression to VA while controlling for cognitive functioning, disability, and medication. R2 explained by variables introduced in step 1 in each analysis is 14%, F(3,60) = 3.32, p < .05. In the first analysis, adding depression at the second step explains an additional variance of 19%, F(1,59) = 16.37, p < .01 while introducing pain at the third step adds an additional variance of 9%, F(1,58) = 8.61, p < .01. Reversing the order these variables in the second analysis shows that they still explain a substantial part of the variance: adding pain at the second step explains an additional variance of 23%, F(1,59) = 21.52, p < .01, while introducing depression at the third step increases the variance explained by 4%, F(1,58) = 4.35, p < .05. As shown in Table 3, only pain and depression carry significant weight in the regression equations. The total variance explained by each model is 42%, F(5,58) = 8.24, p < .01.

Table 1 Characteristics of participants and caregivers Characteristics

Number (%)

M

SD

Min, Max

83.40 47.40 8.05 7.30

7.40 32.80 3.68 1.80

65, 100 4, 189 2, 20 4, 12

35.86 14.29

34.11 6.03

0, 116 1, 21

13.39 8.45 10.89 46.67

8.59 5.36 7.58 17.45

6, 36 6, 36 6, 40 29, 97

Characteristics of participants (n = 64) Gender Male Female Age (years) Months in long-term care facility Number of medical diagnoses Comorbidity Daily medication Neuroleptics Antidepressants Benzodiazepines Other psychotropics Opioids Other analgesics Cognitive functioning Disability in activities of daily living Agitation VA PAA NAPA GA

15 (23.44) 49 (76.56)

46 (71.88) 28 (43.75) 29 (45.31) 1 (1.56) 5 (7.81) 32 (50.00)

Table 1 (Continued)

Characteristics

Number (%)

Discomfort Pain Depression Sleep disturbances

M 5.17 6.65 1.84 3.80

SD 3.85 6.03 2.96 4.27

Min, Max 0, 19 0, 28 0, 12 0, 12

46.81 12.61

7.17 2.54

27, 58 7, 18

20.71

8.49

5, 43

Characteristics of caregivers (n = 31) Gender Male Female Age (years) Education (years) Job title Nursing assistant Auxiliary nurse Nurse Work experience with the elderly (years)

7 (22.58) 24 (77.42)

22 (70.97) 5 (16.13) 4 (12.90)

Note. VA=Verbal agitation; PAA= Physically agressive agitation; NAPA=Nonagressive physical agitation; GA=General agitation.

Table 2 Correlations between agitation and other variables Disability Cognitive functioning Disability Neuroleptics Antidepressants Benzodiazepines Other psychotropics Opioids Other analgesics Discomfort Pain Depression

-.79**

Neuroleptics

Antidepressants

Benzodiazepines

Other psychotropics

Opioids

Other analgesics

Discomfort

Pain

Depres -sion

Sleep disturbances

VA

NAPA

PAA

GA

.26*

-.31*

.21

.29*

-.32*

.08

.25

.05

.07

.03

-.07

-.37**

-.08

.02

-.28*

.28*

-.08

-.21

-.16

-.10

-.07

-.08

.33**

-.02

-.15

.35**

-.31*

.13

.08

.08

.05

-.07

-.12

.06

.07

-.06

.24

.11

.29*

.31*

.15

-.11

.10

-.06

-.001

.17

.31*

-.01

.25*

.35**

.07

.32*

-.12

.09

.16

-.19

.06

.21

-.13

.06

.05

-.14

-.01

-.04

-.13

.04

-.19

-.09

-.15

-.16

-.11

-.09

-.18

.18

.09

.20

.37**

-.08

.32*

.10

.04

.22

-.10

.01

-.01

.15

.21

.17

.08

.25

.20

-.05

.01

-.05

-.06

.29*

.04

.57**

-.10

.50**

.16

.21

.47**

.10

.52**

.15

.11

.36**

-.05

-.14

.33**

-.01

.40**

.28*

.83**

.12

.71**

Sleep disturbances VA NAPA PAA

Note. VA=Verbal agitation; PAA= Physically agressive agitation; NAPA=Nonagressive physical agitation; GA=General agitation.; * p < .05; ** p < .01.

-0.51**

.50**

Table 3 Summary of hierarchical multiple regression analyses (N=64) Variable

B

SE B

ß

Verbal agitation

a

Cognitive functioning Disability Medicationa Pain Depression

0.00 -0.01 0.08 0.04 0.05 Physically agressive agitation

0.00 0.01 0.13 0.01 0.03

.23 -.06 .07 .36** .28*

Cognitive functioning Disability Medicationb Sleep disturbances Discomfort

0.00 -0.00 -0.00 0.00 -0.00 General agitation

0.00 0.00 0.00 0.00 0.00

.14 -.04 -.34** -.30* -.19

Cognitive functioning Disability Medicationc

-0.00 -0.47 6.73

0.08 0.47 5.04

-0.00 -.16 .15

Depression Pain

1.28 0.86

0.81 0.39

.22 .30*

Both antidepressants and opioids were associated with VA and were combined in a single dichotomous variable; Only neuroleptics were associated with PAA; c Both antidepressants and opioids were associated with GA and were combined in a single dichotomous variable; * p < .05; ** p < .01. b

Table 4 Correlations between manifestations of agitation, discomfort, pain, depression and sleep disturbances Discomfort

Pain

Depression

Sleep disturbances

Verbal agitation Cursing /verbal aggression Request for attention Repetitive sentence or questions Screaming Complaining Negativism

.21 -.08 -.20 -.02 -.12 -.03

.30* .32* .27* .13 .39** .52**

.05 .42** .41** .06 .57** .49**

.03 -.13 -.09 -.02 -.17 .07

Non aggressive physical agitation Pace Trying to get to a different place General restlessness Handling things inappropriately Hiding things Hoarding things

-.13 -.05 -.08 -.02 .08 .06

.15 .08 .10 -.02 .05 .03

.17 .09 .28* .11 .18 -.01

-.08 .09 .04 .03 -.06 -.12

Physically aggressive agitation Spitting Hitting Kicking Grabbingo nto people Pushing Scratching

.25 .27* .25* .06 .14 .20

.19 .17 .11 .21 .16 .15

-.17 .14 .10 .01 .15 -.09

.05 .30* .37** .24 .12 .30*

Table 4 (Continued) Other forms of general agitation Strange noises Verbally sexual advances Inappropriate dressing or disrobing Tearing things or destroying property Performing repetitious mannerisms Making physically sexual advances Intentional falling Throwing things Biting Eating/drinking inappropriate substances Hurt self

Note. * p < .05; ** p < .01

.23 .00 -.21 -.03 -.01 .00 .10 .00 .14 .00 .00

-.03 .00 .13 .21 .35** .00 -.19 .00 .18 -.19 .00

.06 .00 .24 .29* .32** .00 -.09 .00 -.09 .03 .00

.12 .00 -.02 .13 -.16 .00 -.15 .00 .19 .25* .00

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The same procedure was used to evaluate the contributions of discomfort and sleep disturbances to PAA and pain and depression to GA. For PAA, R2 explained by variables introduced in step 1 is 21%, F(3,60) = 5.32, p < .01. In the first analysis, adding sleep disturbances to the second step explains and additional variance of 6%, F(1,59) = 4.61, p < .05, while adding discomfort at the third step does not significantly increase the variance explained (increment R2 = 0.03, F(1,58) = 2.61, p > .05). Reversing the order of the variables in the second analysis shows similar results: adding discomfort at the second step does not explain a significant share of the variance (increment R2 = 0.02, F(1,59) = 1.52, p > .05) while introducing sleep disturbances at the third step explains an additional 7% variance (F(1,58) = 5.70, p < .01). As shown in Table 3, only sleep disturbances and neuroleptics significantly contribute to the regression model. The total variance explained by each model is 55%, F(5,58) = 4.95, p < .01. Finally, for GA, R2 explained by variables controlled in step 1 was not significant (R2 = 0.12, F(3,60) = 2.64, p > .05). Adding depression at the second step of the first analysis explains an additional variance of 13%, F(1,59) = 10.33, p < .01, while introducing pain at the third step introduces an additional variance of 6%, F(1,58) = 4.89, p < .05. Reversing the order of the variables entered in the second analysis shows that only pain significantly contributes to the variance of the model: adding pain at the second step explains an additional variance of 16%, F(1,59) = 13.08, p < .01, while adding depression at the third step does not significantly increase the variance explained (increment R2 = 0.03, F(1,58) = 2.49, p > .05). As shown in Table 3, only pain carries significant weight in the regression equations. The total variance explained by each model is 31%, F(5,58) = 5.13, p < .01. Table 4 demonstrates the relationships between the variables studied and the various manifestations of agitation. For VA, pain and depression are significantly and positively correlated with demands for attention, complaints and negativism. Pain is also associated with swearing and verbal aggression. For NAPA, only depression appears to be positively correlated with general restlessness. As for PAA, discomfort and sleep disturbances are both significantly and positively related with hitting and kicking. In addition, sleep disturbances are related to scratching. Finally, among other agitated behaviors, pain and depression are significantly and positively related to repetitive mannerisms. Depression is also related to tearing or destroying things while sleep disturbances are associated with eating inappropriate substances.

CONCLUSION The main objective of this chapter was to clarify the relationship between discomfort and VA among people suffering from dementia. While several authors have suggested that VA may be a manifestation of an unmet need, our results show no relation between VA and discomfort. While this conclusion is contrary to results obtained by Pelletier and Landreville (2007), it is consistent with the findings of Young (2001). One of the three specific objectives of this chapter was to verify whether physical pain, depression or sleep disturbances are associated with discomfort. Again, the results obtained show no significant relation between these variables.

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Some explanations may be formulated to explain the results obtained concerning the first two specific objectives. First, from a methodological point of view, the DS-DAT has often been criticized because it is difficult to administer and score, particularly with regard to the intensity and duration of the behaviors observed (Herr, Bjoro, & Decker, 2006; Smith, 2005; Young, 2001). Evaluators must be very familiar with the tool to complete it correctly and provide an acceptable inter-rater agreement. In our study, however, the reliability of the DS-DAT has been verified and the average score (5.17) is within the range of scores (4.2 to 7.7) reported in the literature (Miller et al., 1996; Pelletier & Landreville, 2007; Young, 2001). The DS-DAT must be administered when the individual is at rest. Because some indicators of discomfort may be visible only in motion, it is possible that the level of discomfort of some participants is underestimated. This criticism reflects the possible lack of sensitivity of the DS-DAT as well as the limitation of observational measures in general. Indeed, since these measures do not allow one to know with certainty the internal state of an individual, they may present a more important risk of error than self-report measures. However, observational tools are sometimes the only possible way to evaluate certain variables, especially among people who cannot communicate their internal state. From a theoretical standpoint, the lack of relations between discomfort and pain, depression, and sleep disturbance suggests that these variables are actually independent from discomfort rather than sources of discomfort. This explanation, however, seems difficult to conceive. It is also possible that the construct of discomfort is not specific enough to accurately predict and measure this variable. Hurley et al.‘s (1992) definition (« an affect or negative physical state that may vary in intensity in response to internal and environmental conditions») illustrates this problem well. In this context, the construct validity of the DS-DAT may be limited. A second specific objective was to identify which variables among pain, depression, and sleep disturbances are related to VA. The results show that pain and depression may play an important role in VA beyond the contribution of cognitive impairment, functional disability, and medication. These results support those of other researchers. Overall, these results suggest that VA is a manifestation of underlying pain and depression. In terms of clinical practice, these findings underscore the importance of systematically examining the physical and psychological state of a person manifesting VA, as in the Serial Trial Intervention. The last specific objective was to determine which forms of VA are related to discomfort, physical pain, depression and sleep disturbances. Results show that swearing and verbal aggression are associated with pain. Furthermore, constant requests for attention, repetition of sentences and questions, complaining and negativism are positively correlated with pain and depression. Other authors have noted the importance of pain and depression in the etiology of VA and our results confirm that caregivers should consider the possibility of these factors for patients manifesting VA (Cohen-Mansfield, 2000). Although there are many studies on the determinants of VA, only two have reported how these variables are related to specific forms of VA. Cohen-Mansfield and collaborators‘ (1990) found screaming to be associated with pain, depressed affect and sleep problems. Cohen-Mansfield and Marx (1990) have also showed that screaming, constant requests for attention, repetition of sentences and questions, complaining and negativism are associated with more sleep difficulties. Our own results show that sleep problems are not associated with VA but rather with PAA. This study also explored the associations between different variables and NAPA, PAA, and GA. Results show the absence of link between NAPA and discomfort. Those results differ from those of Pelletier et Landreville (2007) but consistent with those of Young (2001).

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Also, no relation was found between NAPA and pain, depressed affect and sleep disturbances. Globally, those results are concordant with the literature (Cohen-Mansfield, Billig, Lipson, Rosenthal, & Pawlson, 1990; Cohen-Mansfield & Libin, 2005; CohenMansfield & Marx, 1988, 1990; Cohen-Mansfield & Werner, 1999). NAPA could occur in response to needs other than comfort. Concerning PAA, ours results are in line with those of Pelletier et Landreville (2007) and show that discomfort is not related to this type of agitation when other variables are taken into account. Sleep disturbances are positively associated to PAA which is also concordant with other studies. Therefore, sleep disturbances, or consequent tiredness, could be manifested more by PAA than by VA, particularly by hitting, kicking, and scratching behaviors. Finally, the absence of a relation between GA and discomfort is not concordant with previous work but positive relations with pain and depressed does agree with the literature. However, our analyses show that only pain is a significant predictor of GA when individual characteristics are controlled for. Note that pain is positively associated to repetitious mannerisms. Therefore, when those behaviors are manifested, nursing staff should investigate the presence of a painful condition. This chapter adds to current knowledge about the relation between discomfort and VA and other forms of agitation associated with dementia. To our knowledge, this is the first study to examine those relations while controlling for the potential influence of certain characteristics of the individual. It is also the first study to shed light on the relations between discomfort and related variables and specific manifestations of different types of agitation. However, the generalization of our results must be qualified because of the small sample size, the fact that participants were recruited in only two long-term care facilities, and limitations inherent to the cross-sectional design, in particular the fact that data was collected at a specific moment in time. The accumulation of data obtained at various time points or continuous observation over a twenty-four hour period would provide a more representative measure of discomfort and the other variables under study. Furthermore, the results of this study may reflect not so much the absence of relations between discomfort and the other variables but rather the limitations of the DS-DAT. The use of other measures of discomfort, such as the Assessment of Discomfort in Dementia Protocol (Kovach, Weissman, Griffie, Matson, & Muchka, 1999) or the Discomfort Behavior Scale (Stevenson, Brown, Dahl, Ward, & Brown, 2006), may shed some light on this issue. If these tools do show significant and coherent relations with measures of agitation, the usefulness of the DS-DAT could be questioned. Otherwise, we could be more confident about the absence of relations and call into question the concept of discomfort and how it is measured. Although our results do not support relations between discomfort, VA, and the other variables, they clearly show that depression and pain are both associated with VA. As these states are likely to significantly alter the well-being of the person, the idea that VA is the manifestation of an unmet need for comfort remains relevant. It is hoped that this chapter contributes to a better understanding of the variables associated with VA and other forms of agitation and, ultimately, to improved care for persons with dementia.

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REFERENCES Algase, D. L., Beck, C., Kolanowski, A., Whall, A., Berent, S., Richards, K., et al. (1996). Need-driven dementia compromised behavior: An alternative view of disruptive behavior. American Journal of Alzheimer's Disease and Other Dementias, 11, 10-19. Beck, C., & Vogelpohl, T. S. (1999). Problematic vocalizations in institutionalized individuals with dementia. Journal of Gerontological Nursing, 25, 17-26. Buffum, M. D., Miaskowski, C., Sands, L., & Brod, M. (2001). A pilot study of the relationship between discomfort and agitation in patients with dementia. Geriatric Nursing, 22, 80-85. Burgio, L. D., & Bourgeois, M. (1992). Treating severe behavioral disorders in geriatric residential settings. Behavioral Residential Treatment, 7, 145-162. Burgio, L. D., Scilley, K., Hardin, J. M., Hsu, C., & Yancey, J. (1996). Environmental "white noise": an intervention for verbally agitated nursing home residents. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 51B, 364-373. Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, R. (1987). A new method of classifying pronostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40(5), 373-383. Cohen-Mansfield, J. (2000). Nonpharmacological management of behavioral problems in persons with dementia: The TREA Model. Alzheimer's Care Quarterly, 1(4), 22-34. Cohen-Mansfield, J., Billig, N., Lipson, S., Rosenthal, A. S., & Pawlson, L. (1990). Medical correlates of agitation in nursing home residents. Gerontology, 36, 150-158. Cohen-Mansfield, J., & Libin, A. (2005). Verbal and physical non-aggressive agitated behaviors in elderly persons with dementia: robustness of syndromes. Journal of Psychiatric Research, 39, 325-332. Cohen-Mansfield, J., & Marx, M. S. (1988). The relationship between depression and agitation in nursing home residents. Comprehensive Gerontology. Section A, Clinical and Laboratory Sciences, 2, 141-146. Cohen-Mansfield, J., & Marx, M. S. (1990). The relationship between sleep disturbances and agitation in a nursing home. Journal of Aging and Health, 2, 42-57. Cohen-Mansfield, J., Marx, M. S., & Rosenthal, A. S. (1989). A description of agitation in a nursing home. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 44, M77-M84. Cohen-Mansfield, J., & Werner, P. (1994). Verbally disruptive behaviors in elderly persons: a review. In A. J. Vellas BJ, Garry PJ (Ed.), Facts and research in gerontology: Dementia and cognitive impairments (pp. 73-89). New york: Springer. Cohen-Mansfield, J., & Werner, P. (1999). Longitudinal predictors of non-aggressive agitated behaviors in the elderly. International Journal of Geriatric Psychiatry, 14, 831-844. Cohen-Mansfield, J., Werner, P., & Marx, M. S. (1990). Screaming in nursing home residents. Journal of the American Geriatrics Society, 38, 785-792. Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308-2314.

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Desrosiers, J., Bravo, G., Hébert, R., & Dubuc, N. (1995). Reliability of the revised Functional Autonomy Measurement System (SMAF) for epidemiological research. Age and Ageing, 24, 402-406. Erdfelder, E., Faul, F., & Buchner, A. (1996). GPower: A general power analysis program. Behavior Research Methods, Instruments, and Computers, 28, 1-11. Finkel, S. (2000). Introduction to behavioural and psychological symptoms of dementia (BPSD). International Journal of Geriatric Psychiatry, 15, S2-S4. Fuchs-Lacelle, S., & Hadjistavropoulos, T. (2004). Development and preliminary validation of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC). Pain Management Nursing, 5, 37-49. Herr, K., Bjoro, K., & Decker, S. (2006). Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review. Journal of Pain and Symptom Management, 31(2), 170-192. Hurley, A. C., Volicer, B. J., Hanrahan, P. A., Houde, S., & Volicer, L. (1992). Assessment of discomfort in advanced Alzheimer patients. Research in Nursing and Health, 15, 369-377. Jurica, P. J., Leitten, C. L., & Mattis, S. (2001). Dementia Rating Scale-2: Professionnal manual. Lutz: Psychological Assessment Resources. Kovach, C. R., Noonan, P. E., Griffie, J., Muchka, S., & Weissman, D. E. (2001). Use of the assessment of discomfort in dementia protocol. Applied Nursing Research, 14, 193200. Kovach, C. R., Weissman, D. E., Griffie, J., Matson, S., & Muchka, S. (1999). Assessment and treatment of discomfort for people with late-stage dementia. Journal of Pain and Symptom Management, 18, 412-419. Lai, C. K. Y. (1999). Vocally disruptive behaviors in people with cognitive impairment: current knowledge and future research directions. American Journal of Alzheimer's disease, 14, 172-180. Mattis, S. (1988). Dementia Rating Scale: Professionnal manual. Odessa, FL: Psychological Assessment Resources. Miller, J., Neelon, V., Dalton, J., Ng'andu, N., Bailey, D., Layman, E., et al. (1996). The assessment of discomfort in elderly confused patients: A preliminary study. The Journal of Neuroscience Nursing, 28, 175-182. Pelletier, I. C., & Landreville, L. (2007). Discomfort and agitation in older adults with dementia. BMC Geriatrics, 7(27), 1-24. Shahar, K., Snow, A. L., Souchek, J., Ashton, A. M., & Kunik, M. E. (2004). Cut-point definition of agitation. Clinical Gerontologist, 27, 15-23. Smith, M. (2005). Pain assessment in nonverbal older adults with advanced dementia. Perspectives in Psychiatric Care, 41(3), 99-113. Stevenson, K. M., Brown, R. L., Dahl, J. L., Ward, S. E., & Brown, M. S. (2006). The Discomfort Behavior Scale: a measure od discomfort in the cognitively impaired based on the Minimum Data Set 2.0. Research in Nursing and Health, 29, 576-587. Tractenberg, R. E., Singer, C. M., Cummings, J. L., & Thal, L. J. (2003). The Sleep Disorders Inventory: an instrument for studies of sleep disturbance in persons with Alzheimer's disease. Journal of Sleep Research, 12, 331-337. Young, D. M. (2001). Pain in institutionalized elders with chronic dementia. The University of Iowa, Iowa City.

In: Advances in Psychology Research. Volume 72 ISSN: 1532-723X Editor: Alexandra M. Columbus © 2011 Nova Science Publishers, Inc.

Chapter 6

I CAN SEE FOR MILES AND MILES: SERENITY AND SELF-REPORTED EXTRA-SENSORY PERCEPTIONS Belinda M. Boyd-Wilson1* and Frank H. Walkey2 1

Open Polytechnic Kuratini Tuwhera Victoria University of Wellington Te Whare Wananga o te Upoko o te Ika a Maui

2

ABSTRACT A growing body of evidence suggests that extra-sensory perception (ESP) is relatively common. Generally, ESP may produce some degree of apprehension in the perceiver initially but it tends to be a positive experience. Several authors (e.g., Wolman, 2001) have noted an association between ESP and spiritual well-being. Serenity is a form of spiritual well-being, and is characterized not by feelings of happiness so much as a sense of inner wholeness, security, and peace. Boyd-Wilson, Walkey, and McClure (2004, 2007) found a unidimensional and improved structure for a 20-item measure of serenity, derived directly from Roberts and Aspy‘s (1993) multi-factorial 40-item Serenity Scale. In the present exploratory research, an association between serenity scores on the 20-item measure and self-reported ESPs was sought. The results showed, as predicted, that the serenity scores of participants who reported ESPs were higher than the serenity scores of participants who did not report ESPs. Almost a third of the entire group reported ESPs, with women more likely to than men. The results suggest that ESP is an indicator of spiritual well-being, and support the concurrent validity of the 20-item measure. They were discussed in terms of social exigencies and the limitations of a narrow science. She kept her gaze to the ground, on her feet, stepping on the gray stone path. She was aware of the presence of people in the garden, murmuring, stepping aside, as she and Jalil walked past. She sensed the weight of eyes on her [italics added], looking down from the windows upstairs. - Hosseini

*

Corresponding author: Email: [email protected] Tel: 64 4 913 5932 Fax: 64 4 913 5727

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Keywords: extra-sensory perception (ESP), spirituality, serenity, well-being.

INTRODUCTION A variety of descriptive terms is used for a subset of human experiences that appear not to involve the five senses and that cannot currently be fully explained by science, including ‗sixth sense‘, ‗seventh sense‘, ‗paranormal‘, „parapsychological‘, „psychic‘ or ‗psi‘, and ‗extra-sensory perception‘ (ESP). The different terms can be confusing. For practical purposes rather than to make any particular argument for accuracy, we mostly use the term ‗ESP‘ in this paper. This term was coined in 1934 by one of the pioneers in the field, Joseph Rhine. In 1937 the Journal of Parapsychology was founded to mark the fast-emerging ESP research endeavour; however, after 1940, although research continued, the field ran into a great deal of opposition which held up further expansion (Mauskopf & McVaugh, 1981). Today, although research has picked up again to some extent, there is still division in the scientific community about whether ESP is a valid subject for study, with debate about the issue becoming heated at times. Further, there is a lack of consensus in the ‗pro-ESP‘ camp as to what precisely causes ESP, making it difficult to come up with an adequate terminology. The excerpt from Hosseini‘s (2007) A thousand splendid suns quoted above reflects the not uncommon experience of many laypeople, who often accept such experiences without questioning them unduly. Scientists, on the other hand, require proof. In the various research fields of psychological science, a body of evidence based on probability is regarded as satisfactory proof. Nevertheless, there is often debate about findings and, as noted, this tendency is perhaps stronger for ESP research. However, if the same scientific criteria applied to other fields are applied to the study of ESP, it can be said that satisfactory proof of ESP exists. Evidence for the commonly reported ESPs, such as telepathy, clairvoyance, and precognition, for example, is now strong (Radin & Rae, 2000; Sheldrake, 2003). A comprehensive discussion about the validity of ESP findings to date and of explanations of ESP is beyond the scope of this paper (for excellent reviews see Griffin, 1997; Radin, 1997; Sheldrake, 2003; Tart, 1997; and Ullman, Krippner, & Vaughan, 1989). Our aims were to build on research findings that suggest that ESP is a relatively common phenomenon, and to show an association between ESP and well-being, specifically, spiritual well-being, characterized as serenity. The concept of serenity has been discussed at length in previous papers (e.g., Boyd-Wilson, Walkey, & McClure, 2004, 2007; Roberts & Aspy, 1993). For those readers new to the concept, however, serenity is essentially a way of being that tends to develop for people who start relinquishing false poses and empty striving, and instead develop their ability to live in the moment and their capacity for inner peace and inner wholeness. Once accessed, serenity tends to grow stronger and be experienced more frequently, although it comes and goes initially. It can therefore be distinguished from more materialistic types of ‗happiness‘ that perennially come and go and that are accompanied by standard forays into negativity (e.g., Oishi, Diener, D.-W. Choi, Kim-Prieto, & I. Choi, 2007). Serenity and related concepts are attracting more and more attention in the academic arena as psychological science ―grows up‖ (Emmons, 1999), that is, loses its materialistic, narrow focus. Over a decade ago, Griffin (1997) noted that such states were particularly salient at that time, confronted as the world was by major ecological, socio-political, economic, and spiritual challenges which called for radical rather than narrow, short-term

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solutions. How much more so this applies today, following the traumatic global events of the 2000s! Before discussing ESP and serenity, and in order to introduce the topic as one worthy of in-depth study, we provide some examples of systematic research on ESP, out of the thousands of studies that have been conducted. We cite examples of human ESP only although animal ESP has also been studied extensively. For example, in his broad and very readable review, Sheldrake (2003) argued that humans and animals have extra-sensory abilities in common such as telepathy, precognition, and the sense of being stared at – in the absence of actually looking to see who is staring (see also Smith, 2005).

ESP Research In the late 19th and early 20th centuries, over four million trials were conducted that involved participants‘ attempts to ascertain patterns on cards which were out of sight. Overwhelmingly, the results showed responses a little better than chance, with certain individuals extraordinarily successful at stating the content of the cards (Radin, 1997). Similarly, in a series of well-controlled studies using ‗Zener‘ cards, conducted by Rhine over several years at Duke University, guessing the content of cards was just over chance (Mauskopf & McVaugh, 1981). Such findings may actually greatly underestimate typical ESP ability because they involve trivial rather than meaningful stimuli, and strangers rather than people known to each other (Sheldrake, 2003). At the University of Nevada, in trials in which photographs that elicited emotional responses were displayed on a computer screen, Radin and Rae (2000) found that in the fivesecond interval after an unseen photograph had been randomly selected by participants with a mouse click, and before the photograph appeared, participants registered an emotional response (measured as electrodermal activity) relevant to the type of photograph, whether it was of a calm or shocking scene. These results, suggestive of precognitive ability, were later replicated several times (Bierman & Radin, 1997). The relatively new concept of ‗biofield‘ (Rubik, 2002) may explain various ESP phenomena. It is thought to comprise vital energy fields, perhaps electromagnetic, that interpenetrate the body and extend beyond it for enormous distances. The fields may be behavioural, social, mental, or morphogenetic (shaping the development of animals and plants; Sheldrake, 2003), taking in and passing on various kinds of information, supporting the body‘s self-healing capacity, and responding to intention, attention, touch, and compassion (Pierce, 2007; Rein, 2004; Sheldrake, 2003). Thus, ‗mind‘ may not be restricted to the brain but extend into these energy fields, linking organisms to one another and to their environment. Sheldrake suggested that mind extended in space is apparent in telepathy, whereas mind extended in time is apparent in precognition. Research has been conducted into energy fields. For example, Nelson and Schwartz (2005) tested the biofield awareness of university (college) students. In a series of wellcontrolled studies, the often blindfolded participants performed proximal and distal tasks, such as judging whether an experimenter was placing their hand above the participant‘s hand. If the experimenter was actually present, he or she would be three feet behind the participant. In this and several similar studies, accuracy of responses tended to be above chance (in the range 54-66%; Nelson & Schwartz, 2005; Schwartz & Russek, 1999; Schwartz, Russek, &

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Beltran, 1995). These results, especially those involving distal detection, are indicative of ESP. In an even more remarkable study, since replicated (Radin, Hayssen, Emoto, & Kizu, 2006), Emoto (2004) exposed hundreds of samples of water to various stimuli for some hours, and then examined the crystals that formed after the water was subsequently frozen. The results mirrored the type of stimuli used. For example, the crystals that formed in a glass vial of distilled water, after the vial was wrapped in paper on which the words ‗Thank You‘ were written (in Japanese), took on a beautiful symmetrical appearance, whereas the same water wrapped in the words ‗You Fool‘ formed only crystal fragments. These results can also be explained in terms of ESP via a biofield. A relatively startling type of ESP involves the sighting of apparitions. Apparitions are usually, although not always, people who have passed on. They have sometimes provided information, subsequently verified, to the people to whom they appeared. These have sometimes been groups of people (Griffin, 1997). The well-known researcher of death and dying, Elisabeth Kübler-Ross (1991), reported that she was at first reluctant to accept her own sighting of a female acquaintance who had died 10 months earlier. Dr Ross related how Mrs Schwarz walked with her to her office and opened the office door for her. The apparition told Dr Ross that she had come back in order to thank her and a colleague, and to tell her to continue her work. When Dr Ross asked her to write a note to the colleague (so that she had some evidence of the sighting), Mrs Schwarz obliged. Subsequently, Dr Ross wrote that she had been inspired by the apparition to the realization that her real work was not with dying patients but to help humankind reach the understanding that death is fundamentally an illusion. Recently, numerous data have been gathered on ‗near-death experiences‘ (NDEs) which have been reported to occur for certain individuals who either nearly die or who are pronounced dead but recover. Greyson (2006) proposed that NDEs contain four components, two of which are paranormal features, like ESP, and transcendental features, like the perception of spirits of the deceased. (The remaining two components are cognitive features, such as a life review, and affective features, such as perception of a brilliant light.)

ESP and Serenity Serenity is a form of spiritual well-being (e.g., Boyd-Wilson, Walkey, & McClure, 2004, 2007; Roberts & Aspy, 1993). The term ‗spiritual‘ evokes a wide range of different belief systems, concepts, principles, and states, from a theistic being concerning whom there exists a complicated set of rules and instructions for future improvement, to simply what gives human lives meaning (Emmons, 1999), wholeness, peace, and joy now (Tolle, 2005). We use the term ‗spirituality‘ in the latter sense. Mainstream psychology has only relatively recently included spirituality as a subject of systematic study (Emmons, 1999). For example, research-based clinical strategies to cope with and resolve various disorders such as depression and anxiety now widely include ‗mindfulness‘, which involves an individual‘s attentiveness to their sense perceptions, and simple awareness or sense of aliveness (Kabat-Zinn, 2005). Mindfulness essentially involves accessing the inner dimension - as opposed to the material - and in doing so, keeping the intellect in balance. The title of a recent book (Hayes & Smith, 2005) expresses the principle succinctly: Get out of your mind and into your life.

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Spiritual well-being contrasts with materialistic well-being in distinct ways (BoydWilson, Walkey, & McClure, 2007). For example, the former concerns sensory and extrasensory ability whereas the latter tends to involve only the five senses (Kumar, 2004). Tolle (2000, 2005) distinguishes between the ‗formless‘ and ‗form‘, suggesting that spiritual essence, the formless, underlies all form. The formless cannot be transmitted in words but is a kind of universal intelligent consciousness – one that is not necessarily recognized as such or fully accessed. Another difference is that whereas spiritual well-being models concern an absence of thought or thought that is non-negative and integrated, traditional well-being models regard cognition as powerful in its own right (e.g., Greenberger & Padesky, 1995), and hold that a balance of positive and negative cognitions is normal (e.g., Oishi, Diener, D.W. Choi, Kim-Prieto, & I. Choi, 2007). Spiritual well-being also involves living in the moment (Boyd-Wilson, Walkey, & McClure, 2002), inner peace, and acceptance of what is as well as sometimes taking action to change things (e.g., Frankl, 1964; Tolle, 2000, 2005), as opposed to the endlessly unsatisfying westernized ―quest for adoration, money, and power‖ (Dyer, 2007, p. 57) – essentially, material success (see Csikszentmihalyi, 1999). This cannot be relied on because by definition the form of things is subject to endless change. Only that which informs form is constant (Tolle, 2000, 2005). As Kumar (2004) noted, spiritual well-being involves some degree of ESP. Others have also commented on this association (Chopra, 2003; Emmons, 1999; Levin, 1993; Wilde, 2000; Wolman, 2001). Wolman, for example, defined spirituality as the ability to investigate the meaning of life and at the same time to experience connectedness with others and the world. He suggested that ESP is one of seven factors that make up spiritual intelligence. The other factors are divinity, mindfulness, intellectuality, community, childhood spirituality, and trauma. Wolman proposed that spiritual intelligence is universal and that working with it improves well-being. In a similar vein, Emmons proposed that spirituality is central to wellbeing for many individuals for whom it reflects those matters with which they are most deeply concerned. He suggested that spirituality should, and soon will, play a central role in personality theory, stating: ―The psychological sciences are on the verge of a spiritual revolution‖ (p. 8). To measure spiritual well-being, Roberts and Aspy (1993) developed a 40-item Serenity Scale. The scale has nine factors: Inner Haven, Acceptance, Belonging, Trust, Perspective, Contentment, Present Centred, Beneficence, and Cognitive Restructuring. In three studies using large participant groups, Boyd-Wilson, Walkey, and McClure (2004, 2007) obtained a unidimensional 20-item version for the scale, with a more robust structure. Higher scores on this shorter scale reflect an individual who has achieved a sure direction for spiritual growth and self-fulfilment. Such an individual tends to be trusting, have inner strength and inner peace, forgive themselves and others, take action to change things where indicated and accept what cannot be changed, share their talents with others, live in the moment, and cope well with any remaining negative emotions that threaten to obscure inner wholeness. According to theories that spirituality and ESP are linked (Chopra, 2003; Emmons, 1999; Kumar, 2004; Levin, 1993; Wilde, 2000; Wolman, 2001), we set out to find an association between serenity and ESP. It was predicted that participants who reported having experienced ESPs would have higher scores on the 20-item serenity measure than participants who did not report ESPs.

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METHOD Participants Participants were 200 students who were approached on the Victoria University of Wellington campus. Of the 200, 106 were female and 94 were male. Ages ranged from 17 to 76 years old, with seven participants over 35 years old. The mean age of participants was 22.5 years.

Materials Materials consisted of a four-page questionnaire. The first page was an information sheet which participants took away with them. It contained general information about the research as well as the main researcher‘s contact details so that participants could learn of the results later if they wished to. The information sheet stated that individual responses were confidential. Participants were asked: ―Please be open and honest in your responses. There are no ‗right‘ answers, only ones that apply to you. Don‘t ponder your responses for too long; first impressions are welcomed‖. The second page was a consent form, which stated that participants could withdraw at any time without penalty, and that only group responses would be analysed. The third page of the questionnaire contained serenity items. The fourth page contained an interview question and was used by the researcher to write down participants‘ responses. Presentation of serenity items and the interview question was counterbalanced. The 20-item measure of serenity (see Appendix; Boyd-Wilson, Walkey, & McClure, 2004, 2007) was derived from Roberts and Aspy‘s (1993) Serenity Scale. Items were presented in the same order as in Roberts and Aspy. Above the serenity items were instructions to participants: ―Please indicate how much each statement below usually applies to you by putting a circle around the relevant number on the scale‖. Beside each item was a 5-point scale, with ‗1‘ indicating ‗rarely if ever‘,‘ 2‘ indicating ‗occasionally‘, ‗3‘ indicating ‗some of the time‘, ‗4‘ indicating ‗often‘, and ‗5‘ indicating ‗always or nearly always‘. The interview question requested information about participants‘ ESP experiences. ESPs were defined as events that appear to lie outside the normal sensory range, and that mainstream science cannot currently fully explain. Examples were provided, such as hearing a voice when there is no-one within earshot, and seeing a family member after they have passed over. Participants who stated that they had had an ESP were asked to consider carefully whether any cues had been present that would have made the ESP in fact a normal (non-ESP) event. This was not an attempt to negate participants‘ reports of ESP but to be conservative about their identification. Where there was doubt about the validity of a reported ESP, it was excluded from the analysis. Clarification of ESP reports was sought where necessary.

Procedure Participants were approached on the university campus and asked if they would like to take part in research on well-being and ESP conducted by researchers from the Open Polytechnic and Victoria University. Participants were led to a room in the Psychology Department or to a quiet spot on campus, and were then given the questionnaire. They

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proceeded to read the introductory information, and any questions they had were answered. Next participants filled in the serenity items and answered the interview questions on ESPs (or vice versa). Following completion of the research, each participant was thanked and debriefed as to its nature, and was given a small incentive payment of $5.

RESULTS Serenity The mean response on the 20-item serenity measure was 58.26 (SD = 12.06). The range of scores was 30-88 (possible top score = 100). Females‘ mean serenity score was 57.84 (SD = 11.36) whereas males‘ was 58.72 (SD = 12.85). There were no gender differences on the serenity scores, t(198) = .52, ns. We obtained an alpha of .88 for the 20-item measure and a corrected split-half alpha of .88 also, indicating good internal consistency.

Categorisation of ESPs ESPs were grouped into categories or types with some reference to Morse (2004). Eight categories were created: Déjà-Vu, Precognition, Apparition, Clairsentience, Clairvoyance, Spiritual Experience, Psychokinesis, and Telepathy. Déjà-vu experiences involved participants‘ feeling that they had experienced or dreamt a current event at some point in the past: For example, ―Every couple of months or so I have a déjà-vu experience where I feel I‘ve dreamt about what‘s currently happening‖; and, ―I quite often have a déjà-vu experience where I feel I‘ve been somewhere before‖. Precognition involved feelings that events were going to happen that subsequently did: For example, ―I dreamt I would have a son with blonde hair and my partner‘s eyes. This turned out to be so‖; and, ―Last year, travelling in a car, I felt a car accident would happen and it did, in front of me, not just once but three times‖. Apparitions involved seeing the forms of people and animals who had passed on: For example, ―Often I‘m woken by ghosts who sit on my bed. They say nothing but they touch me‖; and, ―At dawn I saw a person in profile rocking at the end of my bed‖. Clairsentience involved sensing, hearing, and smelling things through ESP: For example, ―At a gravesite a chilly breeze that no-one else felt swept through the area‖; and, ―I felt scared when I felt something touch my head like a book hitting me, but there was no-one there‖. Clairvoyance involved the acquisition of knowledge through ESP: For example, ―In the bathroom in a pub a stranger walked in and I felt she‘d had an abortion. I discovered later that this was true‖; and, ―A few times I‘ve known who was on the phone or at the door before they let me know‖. Spiritual Experiences involved transcendent or mystical feelings: For example, ―I felt an aura and a deep connection when standing in a dark forest‖. Psychokinesis involved manipulation of physical objects without the involvement of anyone physically present: For example, ―I lived in a house that was known to be haunted. Doors opened on their own, channels on the TV skipped on their own, and I‘d come back into a room and an object would have moved even though I was the only person in the house at the time‖. Telepathy involved a person sensing what another was thinking or feeling: For example, ―I and my boyfriend sense each other‘s thoughts and emotions‖.

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ESPs by Frequency Of the 200 participants, 62 (31%) reported ESPs and 138 (69%) reported none. Eleven instances of ESP reports were treated as ‗no-ESP‘ reports because of doubts about their validity. There were a total of 77 reports of ESP by type, of which 31 involved a single instance, two involved two instances, 12 involved three instances, and 32 involved more than three instances (see Table 1). No participants reported experiencing more than two types of ESP. There were a relatively large number of ESPs involving loved ones and pets: 26 reports by type. Of these 26, 11 were Clairsentience, 10 were Precognition, two were Telepathy, and the remaining three were one each of Déjà-Vu, Clairvoyance, and Apparition.

Serenity and ESP As predicted, a one-tailed t-test showed that the serenity score of the group of participants who reported ESPs (M = 60.68, SD = 10.35) was significantly higher than the serenity score of the group who did not report ESPs (M = 57.17, SD = 12.64), t(198) = 1.92, p<.05. Table 1. Frequency of Self-Reported Extra-Sensory Perceptions by Type and Instance per Type ESP Type Déjà-Vu Precognition Apparition Clairsentience Clairvoyance Spiritual Experience Psychokinesis Telepathy

Frequency 13 16 12 23 4 2 4 3

Once 1 7 6 10 3 2 1 1

Instance per Type Twice Thrice >Thrice 12 1 5 3 1 5 4 9 1 1 1

2 1

As an additional test, we also examined the relationship between the serenity score of each of the eight ESP groups by type and the serenity score of the non-ESP participants. We did not test for significance because of very small numbers in some of the ESP groups, but in six out of eight cases, the serenity score of the ESP groups showed a trend to be higher than the serenity score of the non-ESP group. In one of the remaining two cases, the serenity scores of the ESP group (Déjà-Vu) and non-ESP group were equal; and in the other case, the serenity score was very slightly lower in the ESP group (Apparition) than in the non-ESP group.

ESP and Gender Of the 106 female participants, 40.6% reported ESPs; this compared with 20.2% of the 94 males. Thus, twice as many females as males reported ESPs. A chi-square difference test showed that the difference was significant, X2(1) = 17.11, p<.001.

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DISCUSSION The results supported the prediction that participants who reported ESPs would have higher serenity scores than non-ESP participants. The results thus support the proposed association between ESP and spiritual well-being, in this case, serenity. When an individual opens up to and becomes cognizant of their inner self, as opposed to their material self, they also tend to access their ESP ability, and become more ―tuned in‖ to paranormal phenomena (Chopra, 2003; Wilde, 2000; Wolman, 2001). Paranormal events tend to have a more or less immediate beneficial effect, and to matter in people‘s lives (Lancaster, 1999). For example, the sighting of a loved one after their passing may bring solace; or precognition may give a sense of empowerment. However, it is important to note that ESP may not bring about spiritual well-being but simply be an indicator of it (e.g., Wilde, 2000). As perhaps the wisest person of the 20th century, Sri Ramana Maharshi (1982) claimed, ESP per se is not synonymous with wisdom (http://www.arunachala-ramana.org/whoami.htm). Just under a third of the entire group of participants reported experiencing one or more ESPs. This pattern is similar to that found by other researchers. For example, using national survey data collected in the U.S. in 1973, Greeley (1975) found that about a quarter of participants reported clairvoyance, another quarter reported contact with individuals who had passed on, and nearly two-thirds reported déjà vu. Levin (1993), who also used U.S. survey data, this time collected in 1988, found, for example, that about a third of participants reported déjà vu, about 17% reported clairvoyance, and about 18% reported a numinous experience. These data suggest that ESP is not uncommon in the population. Indeed, our finding that about a third of participants reported ESPs may have been conservative. Not only were participants asked to consider carefully whether cues had been present at the time that might have explained the experience in more banal terms but also, instead of asking participants if they had had ESPs that fitted a given category, we simply asked if they had experienced ESPs at all. Prompting for ESPs by category may stimulate memory and clarify definitions of ESP, resulting in a greater number being reported. Future study should perhaps include exhaustive questions to the participant as to whether they had experienced each ESP type. There need to be further investigations into how much the different ESP types predict spirituality. There may be a demarcation between the more and the less striking types. For example, telepathy and clairsentience for spiritually-oriented people who are intimate with each other may occur relatively frequently whereas sighting apparitions and seeing objects move of their own volition may not: The more striking ESP experiences may be relatively uncommon (Levin, 1993). Although our results did not clearly indicate such a demarcation, this may be partly because the more common experiences, such as knowing who is calling on the phone, and sensing that someone is looking at you from behind (Sheldrake, 2003) were under-reported, being considered mundane or not particularly memorable. In our test of the relationship between ESP and serenity, it may have been more useful to use a participant group that included more highly serene individuals. Although our entire group‘s mean serenity score was similar to serenity scores obtained in previous studies using a variety of samples (Boyd-Wilson, Walkey, & McClure, 2004, 2007), it was still relatively low (58.26 out of a possible 100). When we formed a group of participants (N = 40) who had

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a serenity score of over 75, the percentage of those in the group who reported ESPs rose somewhat (from 31% to 35%), lending support to this suggestion. The results showed that women were twice as likely to report ESPs as men. It is not clear whether this finding is explained by women‘s greater sensitivity to their spirituality (Bryant, 2007; Wilde, 2000), a greater interest on their part in the spirit world (Bryant, 2007; Scheitle, 2004-2005; Wilde, 2000), or to some other unknown factor. The relationship we found between serenity and ESP supports the concurrent validity of the 20-item serenity measure (Boyd-Wilson, Walkey, & McClure, 2004, 2007), which was derived from Roberts and Aspy (1993). However, more evidence of validity is needed before firm conclusions about the utility of the measure can be made. Investigations into spiritual well-being may do better to use a measure of enlightenment rather than serenity - unless of course researchers explicitly wish to capture the state of serenity that an individual tends to reach as they progress towards enlightenment. Enlightenment, although it develops and changes, is the ‗end-state‘ for spiritual growth. Although like serenity, it may come and go initially, unlike serenity, it involves no negativity. An enlightened individual experiences inner wholeness and is in balance constantly (Tolle, 2000, 2005), even when experiencing pain (Foster, 2007). We did not attempt to obtain independent verification for the reported ESPs. Are there reasonable alternative explanations for the data? First, it is unlikely that the ESPs were simple hallucinations since this would mean that about a third of the 200 university student participants suffered from psychological disorders. Second, the possibility that demand characteristics affected the results is unlikely because the research assistant who collected the data was a skeptic rather than a ‗believer‘ – or he at least started out that way. Third, the majority of people are skeptical about ESP, and are likely to under- rather than over-report it (Schmeidler & McConnell, 1958, cited in Sheldrake, 2003). Fourth, participants used in ESP research may under-report paranormal experiences because they are embarrassed or do not wish to confide such information to a stranger. Fifth is the less straightforward issue of whether people who say that they have experienced ESP actually attributed chance phenomena to paranormal events at the time (Esgate & Groome, 2001). However, although this may seem a likely explanation to some, it is not a plausible one, because it involves closed reasoning. We examined the data carefully, and we judged that the large majority of self-reported ESPs were just that, extra-sensory experiences. Critics often explain systematic ESP results away in terms of ―error some place‖, as in ―I can‘t quite find it but I know there is an error in there somewhere‖ (Morris, 2001, p. 46), but do not provide plausible alternative explanations for the data (Palmer, 2003). According to Bird (2003), ―the explaining away of this sort of awkward fact is an example of special pleading so bald that it could be an object lesson on how not to conduct a scientific enquiry‖ (p. 258). The title of Cromer‘s (2005) interview with Sheldrake, ―Science is a method, not a position‖, indicates the neutrality that scientists should hold to, until there is irrefutable proof. And in the search for proof, ESP study need not confine itself to rigid experimentation. Anecdotal evidence is also useful, comprising of information that would otherwise be lost (Sheldrake, 2003). Psychological science focuses less on areas, such as the study of ESP, that do not fit its materialistic paradigm (Bird, 2003), but in fact the promulgation of information about ESP would contribute to positive changes in society (Radin & Rae, 2000). It would, for example, help people face death, and foster a sense of fairness instead of perceptions of a random and cruel world (Griffin, 1997).

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For things to change, people primarily need to get in touch with their inner strength and spirit (Kübler-Ross, 1991). Boyd (2006) illustrated the kind of change in attitude that is needed. The author reported that Harvard anthropologist Michael Jackson, after returning from a trip to Africa, noted that ―life in Western society is increasingly seen as a personal project, in which everyone can single-handedly achieve great things and if they don‘t they‘re a failure…: In Africa, life is much more unambitious. People dedicate all their energy to the enjoyment of being with others‖. Serenity (Roberts & Whall, 1996) and other spiritual concepts such as forgiveness (Exline, Baumeister, Zell, Kraft, & Witvliet, 2008), gratitude (McCullough, Tsang, & Emmons, 2004), resilience (Kelley, 2005), mindfulness (Kabat-Zinn, 2005), and acceptance and commitment (Hayes & Smith, 2005) are becoming increasingly prominent in various clinical arenas as more and more practitioners, researchers, and laypeople realize that ultimately, only strength derived from an inner source is helpful. States that depend on positive external events can never be robust because contrast is a natural and inevitable part of living; life events can never be wholly predicted and controlled. Any life situation contains ups and downs because the forms of life contain inherent limitations and are in a process of constant flux. However, the ups and downs do not need to result in joy followed inevitably by disappointment and despair. Inner serenity can be attained (Singer, 2007; Tolle, 2000, 2005).

CONCLUSIONS This exploratory research investigated the relationship between serenity as a measure of spiritual well-being and ESP. The results showed that research participants who reported ESPs had higher serenity scores than those who did not report ESPs. About a third of participants reported ESPs: Women were more likely to do so than men. The results suggest that the relationship between spirituality and paranormal phenomena warrants further investigation.

REFERENCES Alcock, J. E. (2003). Give the null hypothesis a chance: Reasons to remain doubtful about the existence of psi. In J. E., Alcock, J. E. Burns, & A. Freeman, (Eds.), Psi wars: Getting to grips with the paranormal, (29-50). Exeter, UK: Imprint Academic. Bierman, D. J. & Radin, D. I. (1997). Anomalous anticipatory response on randomized future conditions. Perceptual and Motor Skills, 84, 689-690.

Bird, R. J. (2003). Chaos and life: Complexity and order in evolution and thought. Columbia University Press: New York. Boyd, S. (2006, May 27). A man of many people. The Dominion Post, B5. Boyd-Wilson, B. M., Walkey, F. H. & McClure, J. (2002). Present and correct: We kid ourselves less when we live in the moment. Personality and Individual Differences, 33, 691-702. Boyd-Wilson, B. M., Walkey, F. H. & McClure, J. (2004). Serenity: Much more than just feeling calm. Advances in Psychology Research, 29, 35-55. Nova Science: New York.

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Boyd-Wilson, B. M., Walkey, F. H. & McClure, J. (2007). A measure of serenity: A fresh look at well-being. Advances in Psychology Research, 48, 233-245. Nova Science: New York. Bryant, A. (2007). Gender differences in spiritual development during the college years. Sex Roles, 56, 835-846. Chopra, D. (2003). Synchrodestiny: Harnessing the infinite power of coincidence to create miracles. London: Rider. Cromer, M. (2005, November). Science is a method, not a position. Tracking experiments and observations that shine light on the blind spots of reductionistic materialism: Matthew Cromer interviews Rupert Sheldrake. Retrieved January 15, 2007, from http://www.sheldrake.org/interviews/AMNAP.html Csikszentmihalyi, M. (1999). If we are so rich, why aren‘t we happy? American Psychologist, 54, 821-827. Dyer, W. (2007). Change your thoughts – change your life. Carlsbad, CA: Hay House. Emmons, R. A. (1999). The psychology of ultimate concerns: Motivation and spirituality in personality. Guilford: New York. Emoto, M. (2004). Photoessay: Healing with water. The Journal of Alternative & Complementary Medicine, 10, 19-21. Esgate, A. E. & Groome, D. (2001). Probability and coincidence. In R. Roberts & D. Groome (Eds.), Parapsychology: The science of unusual experience (19-34). Oxford University Press: New York. Exline, J. J., Baumeister, R. F., Zell, A. L., Kraft, A. J. & Witvliet, C. V. O. (2008). Not so innocent: Does seeing one‘s own capability for wrongdoing predict forgiveness? Journal of Personality and Social Psychology, 94, 495-515. Foster, J. (2007). Beyond awakening: The end of the spiritual search. Salisbury, UK: NonDuality Press. Frankl, V. E. (1964). Man‟s search for meaning: An introduction to logotherapy. London: Hodder & Stoughton. Greeley, A. M. (1975). The sociology of the paranormal: A reconnaissance. Beverly Hills, CA: Sage Publications. Greenberger, D. & Padesky, C. A. (1995). Mind over mood: A cognitive therapy treatment manual for clients. New York: Guilford Press. Greyson, B. (2006). Near-death experiences and spirituality. Journal of Religion and Science, 41, 393-414. Griffin, D. R. (1997). Parapsychology, philosophy, and spirituality: A postmodern exploration. Albany, NY: State University of New York Press. Hayes, S. & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. Oakland, CA: New Harbinger. Hosseini, K. (2007). A thousand splendid suns. London: Bloomsbury Publishing. Kabat-Zinn, J. (2005). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness: Fifteenth anniversary edition. New York: Delta Trade Paperback/Bantam Dell. Kelley, T. M. (2005). Natural resilience and innate mental health. American Psychologist, 60, 265. Kübler-Ross, E. (1991). On life after death. Berkeley, CA: Celestial Arts.

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Kumar, R. (2004). Living beyond sixth sense. The Academy of Religion and Psychical Research, Annual Conference Proceedings, 56-65. Lancaster, B. (1999, March 12). Why I am researching meditation, telepathy and ESP. Times Higher Education Supplement, 1375, 16. Levin, J. S. (1993). Age differences in mystical experience. The Gerontologist, 33, 507-513. Mauskopf, S. & McVaugh, M. (1981). Obituary: Joseph Banks Rhine (1895-1980). American Psychologist, 36, 310-311. McCullough, M. E., Tsang, J. A. & Emmons, R. A. (2004). Gratitude in intermediate affective terrain: Links of grateful moods to individual differences and daily emotional experience. Journal of Personality and Social Psychology, 86, 295-309. Morris, R. (2001, March 3). Tales of the paranormal. New Scientist, 2280, 46-49. Morse, D. R. (2004). The sixth sense and beyond. The Academy of Religion and Psychical Research, Annual Conference Proceedings, 5-19. Nelson, L. A. & Schwartz, G. E. (2005). Human biofield and intention detection: Individual differences. The Journal of Alternative & Complementary Medicine, 11, 93-101. Oishi, S., Diener, E., Choi, D. W., Kim-Prieto, C. & Choi, I. (2007). The dynamics of daily events and well-being across cultures: When less is more. Journal of Personality and Social Psychology, 93, 685-698. Palmer, J. (2003). ESP in the Ganzfeld: Analysis of a debate. In J. E., Alcock, J. E. Burns, & A. Freeman, (Eds.), Psi wars: Getting to grips with the paranormal (51-68). Exeter, UK: Imprint Academic. Pierce, B. (2007). The use of biofield therapies in cancer care. Clinical Journal of Oncology Nursing, 11, 253-258. Radin, D. I. (1997). The conscious universe: The scientific truth of psychic phenomena. San Francisco: Harper Edge. Radin, D. I., Hayssen, G., Emoto, M. & Kizu, T. (2006). Double-blind test of the effects of distant intention on water crystal formation. Explore: The Journal of Science and Healing, 2, 408-411. Radin, D. I. & Rae, C. (2000). Is there a sixth sense? Psychology Today, 33, 44-51. Rein, G. (2004). Bioinformation within the biofield: Beyond bioelectromagnetics. The Journal of Alternative and Complementary Medicine, 10, 59-68. Roberts, K. T. & Aspy, C. B. (1993). Development of the Serenity Scale. Journal of Nursing Measurement, 1, 145-164. Roberts, K. T. & Whall, A. (1996). Serenity as a goal for nursing practice. Journal of Nursing Scholarship, 28, 359-364. Rubik, B. (2002). The biofield hypothesis: Its biophysical basis and role in medicine. The Journal of Alternative and Complementary Medicine, 8, 703-717. Scheitle, C. P. (2004-2005). Bringing out the dead: Gender and historical cycles of spiritualism. Omega: Journal of Death and Dying, 50, 237-253. Schwartz, G. E. R. & Russek, L. G. S. (1999). Registration of actual and intended eye gaze: Correlation with spiritual beliefs and experiences. Journal of Scientific Exploration, 13, 213-230. Schwartz, G. E., Russek, L. G. & Beltran, J. (1995). Interpersonal hand-energy registration: Evidence for implicit performance and perception. Subtle Energies & Energy Medicine, 6, 183-200.

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Sheldrake, R. (2003). The sense of being stared at and other aspects of the extended mind. London: Hutchinson. Singer, M. A. (2007). The untethered soul: The journey beyond yourself. Oakland, CA: New Harbinger. Smith, J. (2005, September 1). Telepathy: A new way of seeing. The Ecologist, 052-056. Sri Ramana Maharshi, (1982). Who am I? (Nan Yar?) The teachings of Bhagavan Sri Ramana Maharshi (T. M. P. Mahadevan, Trans.). Tiruvannamalai, S. India: Board of Trustees, Ramanasramam. (Original work written 1902) Retrieved June 10, 2008, from http://www.arunachala-ramana.org/whoami.htm C. T. Tart, (Ed.). (1997). Body mind spirit: Exploring the parapsychology of spirituality. Charlottesville, VA: Hampton Roads. Tolle, E. (2000). The power of now: A guide to spiritual enlightenment. Sydney, Australia: Hodder. Tolle, E. (2005). A new earth: Awakening to your life‟s purpose. New York: Dutton. Ullman, M., Krippner, S. & Vaughan, A. (1989). Dream telepathy: Experiments in nocturnal ESP (2nd ed.). Jefferson, NC: McFarland. Wilde, S. (2000). Sixth sense: Including the secrets of the etheric subtle body. Brighton-LeSands, NSW: Hay House. Wolman, R. N. (2001). Thinking with your soul: Spiritual intelligence and why it matters. New York: Harmony Books.

APPENDIX 20-item Serenity Scale* (Boyd-Wilson, Walkey, & McClure, 2004, 2007), based on Roberts and Aspy‘s (1993) Serenity Scale. 1. I am aware of an inner source of comfort, strength, and security. 2. During troubled times, I experience an inner source of strength. 3. I trust that life events happen to fit a plan which is larger and more gentle than I can know. 4. I see the good in painful events that have happened to me. 5. I experience peace of mind. 6. I am forgiving of myself for past mistakes. 7. In problem situations, I do what I am able to do and then accept whatever happens even if I dislike it. 8. I accept situations that I cannot change. 9. I am aware of an inner peace. 10. I experience an inner quiet that does not depend on events. 11. I find ways to share my talents with others. 12. When I get upset, I become peaceful by getting in touch with my inner self. 13. I attempt to deal with what is, rather than what was, or what will be. 14. Even though I do not understand, I trust in the ultimate goodness of the plan of things. 15. I experience an inner calm even when I am under pressure.

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16. I can feel angry and observe my feelings of anger and separate myself from them and still feel an inner peace. 17. I trust that everything happens as it should. 18. I feel forgiving of those who have harmed me. 19. When I remember people who have caused me pain, I hope that good things will happen to them. 20. I feel serene. *Numbered consecutively rather than according to Roberts and Aspy

In: Advances in Psychology Research. Volume 72 ISSN: 1532-723X Editor: Alexandra M. Columbus © 2011 Nova Science Publishers, Inc.

Chapter 7

“MANAGING DISRUPTIVE BEHAVIORS IN THE HEALTH CARE SETTING: PROCESS, POLICY, PREVENTION AND INTERVENTION” Alan H. Rosenstein* Medical Director Physician Wellness Services, San Francisco, California

ABSTRACT Disruptive behavior in the healthcare environment can have a significant impact on staff relationships, communication efficiency, and patient outcomes of care. The ever increasing introduction of new research, knowledge, and medical technology has made health care an increasingly complex industry which is becoming more and more dependent on mutual understanding and respect of individual roles and responsibilities with the need for more interactive team collaboration to assure effective information flow and task accountability. Despite the noted impact of human factor issues affecting quality and safety of patient care, until recently, the health care industry has been reluctant to address the issue of disruptive behavior head on. Much of has to do with the history and autonomy of physician practice. The call for action is here. What health care organizations need to do is to get a better understanding of the dynamics related to the cause and effect and ramifications of disruptive behaviors and take a proactive approach toward preventing such episodes from occurring, mitigating the acute and down steam effects if they do, and have policies in place to address chronic offenders. This is what we are trying to do.

INTRODUCTION What is disruptive behavior? We have defined disruptive behavior as ―any inappropriate behavior, confrontation or conflict ranging from verbal abuse to physical or sexual harassment‖. [1] There are several other working definitions out there, but they all lead to the *

Cooresponding autor: Email: [email protected].

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same universal conclusion, people acting badly and negatively impacting those who are the target of the behavior. [2, 3] it‘s a serious situation, and when it occurs in the health care environment, it can have serious consequences on staff working relationships, communication efficiency, and patient outcomes of care. Disruptive behavior is not a new phenomenon. In many industries disruptive behavior has been shown to adversely affect productivity and efficiency and they have taken a heavy handed approach in dealing with disruptive behaviors in the workplace. This is not quite the case in the health care industry. Up until recently, many organizations were reluctant to address the issue, particularly if it involved a prominent physician, because of the imbedded hierarchy of physician stature and the fear that if they approached the physician that he or she would bring their patients to the hospital next door. The issue was further compounded by potential conflicts of interest, personal resistance to intervene, and a general lack of skill set or training in behavioral interventions. Fortunately, things have changed. Concerns about staff turnover, noted negative impacts on patient care, a tarnished hospital reputation, increasing liability, and the new accreditation mandate from The Joint Commission requiring hospitals to have a disruptive behavior policy in place as part of its new 2009 leadership standard, have forced the issue to the forefront. [4] Hospitals can no longer afford to look the other way.

BACKGROUND We originally began our work on disruptive behaviors in 2001 during the first signs of the nursing shortage. Working through our VHA West Coast member physician network, every year we would query our hospital Medical Directors to find out what were the key issues they were facing in their jobs. Starting in 1996, disruptive behavior was always one of the top issues on their radar screen. Then in early 2000 we first noticed that the nursing shortage appeared as a concern for the Medical Directors. They realized that without a full complement of nurses the hospital had to cancel scheduled surgeries, close programs or medical units, go on divert status for Emergency Room visits, and worry about patient care. At this point we went to the literature to assess if there was a relationship between physician disruptive behaviors, nurse satisfaction, and nurse turnover. Other than noting a few anecdotal stories of physicians yelling at nurses and making them feel bad, there weren‘t any real studies or objective data that addressed this topic, so we decided to develop our own survey. What we found was striking! More than 90% of the 2500 respondents (which included physicians, nurses and senior level administrators from more than 100 acute care hospitals across the United States) reported that they witnessed disruptive behavior in a physician. More than one third of respondents said that they knew of a nurse who had left the hospital specifically because of experiences with a disruptive physician.[1, 5] What was truly worrisome was that it was occurring so frequently, and nobody was doing anything about it. We learned a lot from this first phase of the survey. Disruptive physician behavior occurred much more frequently than ever realized, there was a big difference in perception of seriousness of the episodes between nurses, physicians and administrators, and it had a profoundly negative impact on staff relationships, satisfaction and morale. Based on comments received from phase I, we developed phase II of the survey to address disruptive

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behaviors in other disciplines, particularly in nursing, and looked to see if there was a correlation between disruptive behaviors and patient outcomes of care.

We again went to the literature to see if we could find any studies linking disruptive behaviors with any ill effects on job performance and outcomes of patient care. Once again we came up empty handed. We could find good reference support for the benefits of strong team collaboration in improving outcomes, particularly in the intensive care and emergency room setting, but couldn‘t find anything on the results of disruptive behaviors, or poor teamwork and collaboration and its effect on clinical care. Once again we had to develop our own survey. Phase II survey results were reported in 2005 summarizing input from more than 5000 survey respondents from over 150 hospitals across the nation. [6] Overall, more than three quarters of the respondents reported that they had witnessed disruptive behavior in a physician. Interestingly, more than two thirds of the respondents reported that they had witnessed disruptive behavior in a nurse, with the bulk of that being nurses seeing it in other nurses. (Figures I, II). We found a strong linkage between disruptive behaviors and elevated levels of stress, frustration, loss of concentration, impaired communication, collaboration and information transfer, all which led to gaps in task fulfillment and patient care. There was a strong correlation between disruptive behaviors and a negative impact on patient outcomes of

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care including the occurrence of adverse events, medical errors, compromises in quality and patient safety, and even patient mortality. (Figures III, IV). Many of these perceptions were reinforced through a series on comments made by survey participants (Table I). Table I. Selected Comments  

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Most nurses are afraid to call Dr. X when they need to, and frequently won‘t call. Their patient‘s medical safety is always in jeopardy because of this. Staff was afraid to approach MD despite fact order was clearly incorrect. Disruptive behavior policy ―wildly ineffective‖ Complaints delivered to a ―black hole:‖ Cardiologist upset by phone calls and refused to come in. RN told it was not her job to think, just to follow orders. Rx delayed. MI extended MD became angry when RN reported decline in patient‘s condition and did not act on information. Patient required emergency intubation and was transferred to ICU. This caused the family much unnecessary heartache and disruption in family grieving process Poor communication post-op because of disruptive reputation resulted in delayed treatment, aspiration and eventual demise The disruptive behavior from nurses is much more upsetting because I expect that behavior from the surgeons NOT the nurses b/c I rely on them as my peers (RN) When patient brought to unit for GI bleeding patient saw MD yelling at nurses. Patient asked if that was his doctor. Yes. Patient refused treatment and was transferred to another hospital. I am retiring early and never recommend someone becoming a nurse Disruptive behavior results in medication errors, slow response times and treatment errors! Specific group of MDs with poor communication habits which adversely affect patient care and nurse role. Dr. X is so condescending to nurses that we are very reluctant to call him on patient‘s behalf. My concern is that the new nurses are afraid to call about patient problems and issues that truly need to be addressed in a timely manner impacting outcomes. It seems there is an increasing lack of respect by nurses and other ancillary caregivers toward practicing clinicians in the hospital environment. Decisions by clinicians are frequently challenged and some orders are flatly disobeyed or at least not carried thru with almost reflexive propensity, and with little or no forethought ―Are you aware of any specific adverse events ….?‖ Yes. Death as a result of disruptive behavior. Staff nurses advocated for better patient care but MD would not willing to listen to reason. As a result patient died. The doctor chose to undo all the help that various staff had been working on for weeks to get this patient the help so badly needed.

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Phase III of the survey focused on the impact of disruptive behaviors in high intensity areas such as Peri-operative Unit, Neurosciences, and the Emergency Department. [7-9] Phase IV of the survey focused more specifically on the impact of disruptive behavior on communication gaps and compromises in patient safety.[10] Results were similar to the previous studies.

PRECIPITATING EVENTS Now that we had the data to support the cause, the next step was to try to assess why these episodes occur. I don‘t think anyone starts the day out planning to be disruptive. In some cases the individuals are totally unaware of the way they are behaving and its impact on others (―emotional intelligence/ situational awareness‖). Others may have subconsciously (or consciously) learned that acting disruptively gets you want you want and people tend to leave you alone and there are a few who probably do it intentionally. [11] The goal is to get a better understanding of the factors that may precipitate a disruptive event and see if something could be done to prevent it from occurring. [12] None of these categories are

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mutually exclusive and they all contribute to individual behavioral tendencies and communication styles. (Table II). Generational Differences: There has been a lot of research done on the attitudes, styles, preferences, and behavioral tendencies related to a person‘s age. A set of age based generational cohorts links common experiences, attitudes and preferences of each generation which were influenced by the current events of the time affecting societal, family and individual values. The Veteran generation (1900-1945) who experienced the depression and First World War, are focused on job security as a way to provide for their family. They will stay at one job forever and do whatever is asked of them. The Baby Boomer generation (1946-1964) was brought up during the good times of the 50s, 60s and 70s. They also remain loyal to their organization, pride themselves in putting in whatever time is necessary to see a task completed, and appreciate being recognized for all their hard work. The Generation Xers (1965-1980) and Generation Yers (1981-1999) are brought up on technology. If it‘s not electronic, it‘s archaic. They want to feel like they‘re part of the team and have a participative team approach to authority. Their primary focus is work life balance. When their shift is done, they‘re out of there. Many find it normal to move from job to job rather than staying with one organization for a long period of time. All of these traits impact the perception of workplace performance and commitment. It‘s not that any one generation is any better than any other, but with the generation gap in the workplace now being extended, understanding each other‘s values, preferences and ways of doing business will provide for a much more efficient and satisfying workplace environment. This is particularly true for nurses and physicians. Gender Differences: in his book ―Men are from Venus Woman are from Mars‖ John Grey provides a classic description of gender based tendencies.[13] Men are task oriented, prefer to work independently, pride themselves on competency, and tend to be domineering. Women are much more gregarious, prefer the social contact, enjoy listening and sharing and look for group consensus. One can see how under stress males may become more bullying or independent while woman will look for group support from their peers. This too is particularly relevant in the health care environment. Culture and Ethnicity: The health care market is becoming increasingly diverse. In some areas of the country more than 50% of the health care workers were either not born in or not trained in the United States. Beyond language based difficulties in communication, cultural and ethnic views toward power, hierarchy, gender, wealth, religious beliefs and relational behaviors all impact communication style and reactions. Personality traits: There are many different types of personality classifications used to describe a set of common traits attributed to a particular personality type. Using the MyersBriggs classification, the ―Beavers‖ are usually Directors who are hard working, independent, domineering, task driven individuals who are driven toward high achievement and don‘t like to be thwarted from their course. The ―Dolphins‖ are the socializers who more gregarious, sharing, and collaborative types who are more apt to listen and share and look for group input to support their cause. The ―Owls‖ are the deep thinking intellectuals who thrust for supporting information to support their views. The ―Foxes‖ are on the surface the easy going relaters who go with the flow, but deep down may undermine efforts through behind the

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scenes passive aggressive tendencies. Each of these personality types plays a significant role in the group process. During crisis time, one can see how these groups may adversely interact with each other. This is particularly true in the discipline specific hierarchy structure common in medical organizations. Family/ Life experiences: Many of our attitudes are molded in early childhood and reflect the values and attitudes of family upbringing, schooling and life experiences. Training: Beliefs, attitudes and preferences are modeled by ones training experience. This is particularly true for physicians. To start off with, certain specialties draw certain personality types. The physical get it done quickly types are drawn to the surgical specialties. The more people oriented information processors are drawn to the primary care specialties. The more psychosocial behaviorists are drawn to the psychiatric specialties and so on. Next is the way we are trained. On day one in medical school you learn that you know nothing and it quickly becomes obvious from the way people treat you. This results in a sense of isolation which perpetuates feelings of low self confidence and self esteem. You learn on your own. As a result you become very independent and autocratic. Your skills are based on technical and knowledge competency. When you need to make a critical decision your reaction is to bark out orders and direct people on what to do. There is little if any training in communication and team collaboration and in today‘s complex health care environment, this can turn out to be a liability. External forces: On top of these deep seated values are the more acute or sub-acute external influences. Problems resulting from growing stress, frustration, burnout, fatigue, depression, or substance abuse can all affect ones demeanor and performance.[14, 15] Many of these factors can be easily triggered or provoked by an acute event that sets the mood for the day all of which may consciously or unconsciously affect one‘s attitude and actions. Table II. Precipitating Events Deep seated values: 1. Age 2. Gender 3. Culture and ethnicity 4. Family‘ life experiences 5. Training 6. Personality Contributing factors: 1. Stress/ Frustration 2. Burnout/ Fatigue 3. Depression 4. Substance abuse External influences: 1. ―Bad day‖ 2. Provoked response

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Organizational leadership Awareness and Accountability Education Special Education Communication/ Collaboration tools Clinical Champion(s) Policies and Procedures Reporting process Intervention process Support or organizations patient safety/ quality/ risk management programs

Disruptive behavior can occur anywhere. In the health care environment it tends to occur in more frequently in the high stress acute settings such as the Peri-operative area, Emergency Department, Intensive Care Unit, Labor and Delivery, or general Medical/ Surgical Units. It may involve a direct face to face interaction, it may occur over the phone, or it may take a more indirect path through written correspondence or behind the scenes gossip and communication. It may be overt, or it may be passive aggressive. When it involves physicians it‘s usually direct, obvious, right in front of you. When you look at nurses, it‘s usually more insidious, more passive aggressive, undermining a person from behind. [17] In any event, it is a detrimental force that needs to be addressed.

CALL TO ACTION Disruptive behavior in the health care environment is nothing new. The problem is that organizations have been reluctant to address it in the past. This was particularly true if it involved a very prominent physician who was technically adept and ―voluntarily‖ brought lots of patients and revenue into the organization. One overriding concern was the fear of antagonizing the physician and the threat that he or she would bring their patients to a different facility. A second concern focused on who would do the intervention and what the resulting outcome might be. Issues related to overall willingness to address a colleague on non- clinical matters, potential conflicts of interest, and possessing the necessary skill set to effectively address these types may impede a successful intervention. Physicians are competent in addressing other physicians on technical and knowledge competency, but have never been taught how to effectively address problems related to behavioral issues.[18] Things have changed. Recent events have highlighted the concerns about disruptive behaviors to the point where you can no longer afford to look the other way. First is the negative impact on nurse satisfaction and turnover. Second is the negative impact on quality and patient safety. Third is the growing liability for not addressing the issue. Fourth is the impact on reputation. And fifth is the need to comply with the new Joint Commission standard requiring hospitals to have a disruptive behavior policy in place and provide appropriate education as one of their accreditation requirements. The risks of not addressing disruptive behaviors are much greater than the risk of avoidance. The call to action is there. So here‘s what you need to do. (Table III).

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Organizational Leadership: To effectively address disruptive behaviors it is crucial that the organization be committed to making it happen. The commitment needs to come from top level governing and leadership bodies which includes the Board and senior level administrative and clinical leadership and extend through to middle management and front line staff. The organization needs to endorse a non tolerance approach toward disruptive behaviors and be willing to take action when individuals refuse to comply with expected behavioral standards. Awareness, Recognition and Accountability: Many of the individuals who act disruptively are truly unaware of their actions and its impact on the surroundings. In order to get a better picture of what‘s going on at the organization, we recommend performing a confidential internal self-assessment. This can be done either though individual interviews, focus groups or survey assessment. Presenting organization specific results to the medical staff and employees will raise levels of awareness. Discussing contributing factors and individual roles and responsibilities will heighten accountability. When addressing these issues we recommend that the organization take the positive route of using this information as an opportunity for improvement rather than a punitive approach of identifying bad apples. Education: Education can occur at several different levels. First would be the high level overview of what disruptive behavior is, what it does, and why it‘s important to address it. These sessions should focus on reaching a multidisciplinary audience which includes Administration, Human Resources, Risk Management, Nursing, Medical Staff, and when appropriate, students in training. Educational sessions can be presented at a number of different venues including Grand Rounds, Departmental meetings or special sessions. Having your own data helps to make a more compelling case for action. Special education: More in-depth educational sessions can focus on such topics as diversity training, sensitivity training, assertiveness training, linguistics, conflict management or any other topic germane to the organization‘s individual needs. Communication and Team Collaboration Training: Extending the boundaries beyond just addressing disruptive behavior opens up the opportunity to improve overall efficiency in communication and collaboration. Whereas 3-5% of the staff overtly exhibit disruptive behaviors, another 30-50% are ineffective communicators. One way to improve communication is to create an opportunity for individuals to get to know each other. Informal get togethers, career days, community days, cultural celebration days, town hall meetings, focus groups and/ or multidisciplinary task forces can be put together to discuss roles, responsibilities, assumptions and perceptions. These events will do a lot to promote mutual understanding and respect. The next level is to provide programs that directly enhance communication efficiency. Several new tools have been introduced that enable an individual to better organize their thoughts and presentation style though a structured format or script designed to enhance information flow. One such tool is the SBAR tool (Situation/ Background/ Assessment/ Recommendation). The tool provides consistent process for organizing thoughts and presentation flow that will enable the receiver to better understand the information being

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presented and then be able to better provide the appropriate advice or recommendation that is being requested. Whereas the SBAR tool is effective in enhancing one on one communication efficiency several new techniques have been successfully introduced to enhance team communication. Based on the same principles utilized in the airline industry (crew resource management), racing industry (pit crew management), and nuclear plant safety, these tools focus on the importance of team collaboration by fostering a better understanding of purpose, expectations, roles and responsibilities, and actions required by each team member. These team building techniques are particularly effective in the Peri-operative, Intensive Care, Emergency Department, and Obstetrical/ Newborn setting. Clinical Champion(s): Having a program sponsor is often a key to success. Key characteristics are passion and enthusiasm for the cause, peer group respect, and the necessary communication and persuasiveness skills to make things happen. It‘s helpful if the champion is a clinician. You never know where and how the champions may surface so always look for an opportunity to stimulate and cultivate candidates who have expressed an interest in the topic. Sometimes added value is gained if they are not part of the paid executive staff. Policies and Procedures: Policies and procedures are necessary to set the standards, guidelines, criteria, and expectations for appropriate behavior. These standards need to be incorporated and adopted as part of the standard operating procedure for the organization. Paid employees need to agree to follow these standards as part of their employee agreement. For non- salaried medical staff, the standards need to be supported by the medical staff bylaws and physicians need to agree to comply with these standards as part of the credentialing and re-credentialing process. As mentioned previously, in 2009 the Joint Commission introduced a new requirement that hospitals must have a disruptive behavior policy in place and provide appropriate supporting services as part of the hospital accreditation process. Having a guideline or policy by itself is not enough. The two biggest barriers to policy success are lack of consistency in application and lack of follow through. One of the most frequent complaints we heard from our survey respondents was the inequity between the way the policies were applied and reinforced particularly when it came to the physicians. One representative comment we heard was ―if a nurse did this she would be fired. If a physician did this the organization looked the other way‖. The second barrier was lack of notable change. ―We report and report and nothing ever changes. It‘s like our report goes into a deep black hole‖.[6] The obvious recommendation is to have one universal disruptive behavior policy which needs to be consistently applied and reinforced across all levels of the organization. In regard to feedback, it is a confidential manner and discussing specifics of follow up action need to be held in that regard, but thanking the person for bringing it to your attention and letting them know that the issue will be addressed is essential to maintain faith in the process. Reporting process and follow through: Similar to the issues raised in regard to the implementation and follow through process for the disruptive behavior policy, there needs to be consistency in both the front end and back end of the reporting process. In order to assure success our recommendation is that the organization outlines a formal process for event

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reporting and event review. Having all complaints forwarded to one designated reviewing entity rather than a casual report to a supervisor or colleague will assure that each incident will be handled in a consistent fashion. Having a multidisciplinary group review each complaint and make the appropriate recommendation for follow up will help assure equity by avoiding any individual bias or conflicts of interest. The review committee should also take responsibility to monitor follow up actions and outcomes. Not everyone has the right skill set to deal with these issues. If an event is referred to a Department Chief or Unit Supervisor, one needs to make sure that they are able to effectively address the situation and facilitate the desired outcome. Intervention process: Once a disruptive event occurs, it is essential for the organization to take the necessary steps to address the issue. Similar to the process outlined for reporting, it is crucial to have a consistent process of evaluation and follow through. Our recommendation is that all events be reviewed by a core multidisciplinary team of skilled individuals who conduct the necessary interviews and make appropriate recommendations for follow up action. There are several possible outcomes from the intervention process. As mentioned previously, most of the time the individuals involved are unaware of their actions and the impact it has on their colleagues. Part of this may be related to ―emotional intelligence‖ and/ or their understanding of the definition of disruptive behaviors. In many cases individuals may think that disruptive behavior is defined by actions constituting sexual harassment or physical abuse. While these types of behaviors are the most serious types of disruptive behaviors, they occur relatively infrequently. Most of the disruptive behaviors cite intimidating, condescending, disrespectful, berating behaviors as the most frequent types of disruptive behaviors reported by survey respondents. [1,6,7,19 ] In the majority of cases, once an individual is made aware of their actions and its down steam consequences, they make the necessary adjustments to avoid further episodes. In the middle of the spectrum are individuals who need more intensive services. Many of the individuals in this group are chronic offenders. These individuals may require a more comprehensive program which may include special courses in diversity training, sensitivity training, conflict management or the like. Some individuals may require more in-depth psychological or psychiatric consultation. Always be aware of the possibility of underlying drug or alcohol abuse and be able to offer these services when appropriate. At the end of the spectrum is the individual who refuses to make any changes. On the employee side, the only choice may be termination. On the physician side, the only choice may be to curtail privileges or suspend the individual from the medical staff. The greatest potential for success in the intervention process is to intervene before a disruptive event actually occurs.[20] Once an event occurs the damage is already done and the intervention takes on more of a confrontational punitive nature. The goal should be to focus efforts on preventing such events from occurring. On one side is raising levels of awareness and sensitivities about factors contributing to values, attitudes and perceptions that set the framework for individual communication styles and preferences and provide appropriate training programs designed to enhance understanding and improve interactions that affect working relationships. On the other side is to identify individuals at high risk for a disruptive event and provide supporting services to lessen the likelihood of occurrence. On the physician side, this is a particularly important consideration.

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Today‘s health care environment has placed a lot of stress on physicians. Growing intervention by outside parties, greater accountability, increasing complexity, higher expenses, and lower reimbursement are just a few of the issues that have significantly changed traditional practice settings. Physicians are not only frustrated and dissatisfied, there is a greater degree of burnout and depression which is significantly impacting their behaviors. Some physicians have retired early and others are beginning to leave practice in search of other employment opportunities. There is a growing concern about future physician shortages particularly in the areas of primary care and general surgery. The goal is to treat the physician as a valued resource and support him or her with services that will increase physician satisfaction, productivity and enhance working relationships. While the intent is admirable, the crucial step is to get the physician to recognize the problem and be willing to do something about it. Most physicians are not aware that they are working under increasing levels of stress and even if they are aware, feel that they have been working under stress all their life and are able to handle it by themselves. Several organizations are beginning to develop programs specifically designed to assist physicians under stress or duress with the prime goal of increasing physician satisfaction. Working through a physician comfortable convenient peer to peer coaching/ counseling format, physicians are able to confidentially share their concerns and work toward solutions that improve personal satisfaction which will help reduce stress, improve productivity and efficiency, and improve personal and staff relationships. [20, 21] Patient Safety/ Risk Management program support: All of the strategies described above should be integrated in with all the other organizational strategies designed to enhance patient safety and quality management. In addition to reducing the frequency and impact of disruptive events is the opportunity to increase communication and information flow between all components of the health care team which will enhance collaboration and coordination which ultimately improve patient outcomes of care.

CONCLUSION Disruptive behavior is a difficult issue to address. The problem is compounded by a history of tolerance, a complex hierarchal based medical care system, and an economic structure where most physicians are not salaried employees and have multiple allegiances and priorities. Recognizing the negative impact these behaviors have on staff relationships and patient outcomes of care, we can‘t afford to look the other way. Organizations need to provide, support and enforce the necessary policies and procedures to address the issue head on. Most individuals pride themselves on their desire and ability to provide best patient care. Taking a positive supportive approach to identify potential problem areas early on and implementing appropriate programs to not only address disruptive behaviors but also to enhance opportunities to improve satisfaction, communication and collaboration will provide the best opportunities for success.

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REFERENCES [1] [2]

[3] [4]

[5] [6]

[7]

[8] [9] [10]

[11] [12]

[13] [14]

[15] [16]

[17]

Rosenstein, A. "The Impact of Nurse-Physician Relationships on Nurse Satisfaction and Retention" American Journal of Nursing, June 2002, Vol.102 No.6, 26-34. Model Medical Staff Code of Conduct American Medical Association 2009 http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groupssections/organized-medical-staff-section/helpful-resources/disruptive-behavior.shtml Joint Commission Sentinel Alert Vol. 40 July 9, 2008 http://www.jointcommission.org/ SentinelEvents/ SentinelEventAlert/sea_40.htm Joint Commission Hospital Accreditation 2009 Leadership Standard http://www.joint commission.org/NewsRoom/PressKits/Behaviors+that+Undermine+a+Culture+of+Safe ty/app_stds.htm Rosenstein, A; Lauve, R; Russell. H. "Disruptive Physician Behavior Contributes to Nursing Shortage" The Physician Executive, November-December 2002, 8-11. Rosenstein, A; O‘Daniel, M. "Disruptive Behavior and Clinical Outcomes: Perceptions of Nurses and Physicians" American Journal of Nursing, January 2005, Vol. 105 No.1, 54-64. Rosenstein, A; O‘Daniel, M. ―Impact and Implications of Disruptive Behavior in the Peri-Operative Arena‖ Journal of American College of Surgery, July 2006, Vol.203 No.1 96-105. Rosenstein, A; O‘Daniel, M. ―Impact of Disruptive Behaviors on Clinical Outcomes of Care‖ Journal of Neurology, 2008, Vol.70 No.17 April 24, 1564-1570. Rosenstein, A; Naylor, B; O‘Daniel, M. ―Impact of Disruptive Behaviors in the Emergency Department‖ The Journal of Emergency Medicine In review. Rosenstein, A; O‘Daniel, M. ―A Survey of the Impact of Disruptive Behaviors and Communication Defects on Patient Safety‖ Joint Commission Journal on Quality and Patient Safety, August 2008, Vol 34 No8, 464-471. Tarkan, Laurie ―Arrogant, Abusive and Disruptive- and a Doctor‖ NY Times, December 2, 2008 D1, 6. Rosenstein, A; O‘Daniel, M. ―Nurse- Physician Communication: The Impact of Disruptive Behaviors on Factors Affecting Decision Making Affecting Patient Outcomes of Care‖ Chapter VII The Psychology of Decision Making, Nova Science Publishers, New York 2007. Gray, J. Men are from Mars: Woman are from Venus HarperCollins publishers New York 2004. Krasner, M; Epstein, R; Beckman, H; Suchman, L. et. Al. ―Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians‖ Journal of the American Medical association, September 23.30 2009, Vol.302 No.12, 1294-1300. Chen, Pauline ―When the Doctor is Distressed‖ nytimes.com October 1, 2009. Shanafelt, T; Balch, M; Bechamps, G; Russell, T. et. Al. ―Burnout and Career Satisfaction Among American Surgeons‖ Annals of Surgery, September 2009, Vo.250 No.3, 463-471. Bartholemew, K. Ending Nurse to Nurse Hostility: Why Nurses Eat Their Young and Each Other HC Pro Inc., Publishers Marblehead, MA 2006.

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[18] Leape, L; Fromson, J. ―Problem Doctors: Is There a System Level Solution?‖ Annals of Internal Medicine, February 2006, Vol.144 No.2, 107-115. [19] Johnson, C. ―Bad Blood: Doctor-Nurse Behavior Problems Impact Patient Care‖ The Physician Executive Journal of Medical Management, Vol.35 No.6 November/ December 2009, 6-11. [20] Rosenstein, A. ―Early Intervention Can Help Prevent Disruptive Behavior‖ The Physician Executive Journal of Medical Management, Vol.35 No.6 November/ December 2009, 14-15. [21] Darves, Bonnie “Physician Wellness” The New England Journal of Medicine http://www.nejmjobs.org/career-resources/physician-wellness.aspx

In: Advances in Psychology Research. Volume 72 ISSN: 1532-723X Editor: Alexandra M. Columbus © 2011 Nova Science Publishers, Inc.

Chapter 8

HUMAN-CENTRED DESIGNED INTERFACE IN PROBLEM-SOLVING ACTIVITIES: THE EXAMPLE OF COMPUTERISED MEDICAL REGULATION William Guessard1, Alain Puidupin1, Richard Besses1 and Paul-Olivier Miloche1 Service de Sante des Armees, Ministere de la Defense, Versailles, France.

ABSTRACT Medical regulation consists in matching the needs of the patient or casualty with the most appropriate medical capabilities, whether in terms of equipment, personnel or technical support centre. According to the severity of the wounds, the tactical and logistical situation, the physician in charge of the regulation has to choose the right medical team to drive the casualties to the right medical and surgical capacities. Therefore, he makes his decision based on what he imagines of the patient's situation and of the capacities of the rescue teams, that are both unstable. Medical regulation is part of problem-solving processes, at the "knowledge-based level" of the Rasmussen's model. According to J. Reason's description of human error production, especially during problem-solving processes, we think that Human-Computer interfaces have to be ecologically designed. This Human centred design is the best way to improve the resilience of the system (the capacity to resist to Human error). Quantitative and qualitative factors combined with the time factor determine the critical character of situations (need to make choices), decisions having to be made by vulnerable, stressable 1

Service de santé des armées Ministère de la Défense Section technique de l'armée de terre Avenue Gribeauval – Satory CS 90701 78013 Versailles France [email protected]

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William Guessard, Alain Puidupin, Richard Besses et al. and fatigable men. This design implies the analysis of the activities observed during medical regulation (both for the physician in charge of the regulation and the teams caring for casualties) to understand how they co-operate and the nature of the shared representation of the situation. The purpose of this paper was to share our thoughts on the design of an operatorcentred software program, based on the cognitive mechanisms of problem solving, decision making and human error. Human decision in medicine cannot be replaced but the level of human performance is fluctuating, both naturally circadian and likely to be rapidly degraded under constraint. Man has thus to be employed for what he is irreplaceable, his abilities have to be conserved and he must be released from what only concerns automatism. In order to avoid the pitfall of a software program imposing an action not desired by the operator, we have thus wanted to put him in the centre of the system. To that end, we consider that situation awareness is one of the key points. We aim to support him to create a shared representation of the situation, both with the medical team in charge of the casualties and the operational structures in charge of the military actions.

Keywords: medical regulation, problem-solving, human error, human reliability, human centred design, resilience, situation awareness.

INTRODUCTION Medical regulation consists in matching the needs of the patient or casualty with the most appropriate medical capabilities, whether in terms of equipment, personnel or technical support centre. The design of a computerised regulation system shall provide the physician in charge of medical regulation with the relevant information that will help him to make the best decisions concerning the referral of the patient(s). To that end, it is first necessary to ask the question of what medical regulation is: a situation in which the physician in charge of regulation has to solve a problem (refer the patient to appropriate structures). It is then necessary to develop a reflection about the consequences it entails in terms of cognitive processes implemented and error risks associated. The core of medical regulation lies at the level of information gathering, processing and integration required to its implementation. Quantitative and qualitative factors combined with the time factor determine the critical character of situations (need to make choices), decisions having to be made by vulnerable, stressable and fatigable men. Human decision in medicine cannot be replaced but the level of human performance is fluctuating, both naturally circadian and likely to be rapidly degraded under constraint. Man has thus to be employed for what he is irreplaceable, his abilities have to be conserved and he must be released from what only concerns automatism. In order to avoid the pitfall of a software program imposing an action not desired by the operator, we have thus wanted to put him in the centre of the system. To that end, we have searched for the information relevant to such a regulation and the links between them in order to propose consistent information to the physician in charge of regulation. This reflection must allow the development of a medical regulation interface adapted to the cognitive process actually implemented, that is to say an "ecological" interface presenting the relevant information in a manner which is appropriate to the forms of perception of the human operator.

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MEDICAL REGULATION Medical regulation is part of problem-solving processes. The physician in charge of regulation has to make a decision in view of the coordination of the patient management means, based on data available to him, which is necessarily fragmentary and changes as the patient condition evolves. There are very few books that study the cognitive processes implemented during medical regulation. However, it can be considered as a specific aspect of medical diagnosis. In a book describing the cognitive processes used to make a medical diagnosis, whether by medical students or experienced physicians, Elstein, Shulman and Sprafka [3] showed how the generation of hypotheses was involved early in this mechanism and how cognitive reasoning aimed at testing this hypothesis. The main difference between students and experts lies in the capacity for the latter to generate a higher number of concurrent hypotheses and to confront them over a longer period of time, before deciding on their diagnosis and propose the corresponding heath care actions. It can be explained by the fact that experts have a greater knowledge of the various possible diagnoses, but also a lesser propensity to select the information confirming the most probable hypothesis, to the detriment of information aiming at infirming it. The medical regulation process can also be compared with that implemented by the operators in charge of supervision and management of systems at risk (air traffic control, power plants, to name a few). The physician in charge of regulation has to be able, from the moment when an alarm sounds (here, the incoming of a "message" indicating the presence of casualties in the field) to carry out corrective actions (send medical teams to manage the casualty(ies), and refer them to the technical support centres that are best suited to their clinical statuses and to the availability of evacuation means) in order for the system to return to a normal operating state (in our case, the management of patients by health care structures). We will also use the knowledge derived from studies on cognitive mechanisms implemented during the management of systems at risk and, in particular, during air traffic control operations.

COGNITIVE BASES OF DECISION-MAKING The problem-solving process can be defined as an action aiming at achieving a result (the management of the patient), without knowing the solution or the appropriate procedure (which medical structure and which means). This process involves a variety of cognitive mechanisms: the physician in charge of regulation has to reason, that is to say make a probable conclusion based on a set of statements, assess (make a probabilistic judgment about the most probable hypothesis of action) and decide, in other words choose the action he considers the best adapted. This latter process shows the superiority of Man over machine. We have the capacity to make a decision despite a lack of information that does not allow us to develop all the possible hypotheses (which anyway would not be possible in view of our limited cognitive capacities, in particular mnestic capacities). Man is able to make bets and to act without having all the information. However, as we will see in next chapter, the system has to be designed so as to not cause interpretation errors, it has to display the information required for a good representation of the situation.

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Rasmussen [6] described three levels of operator action: the skill-based level, the rulebased level and the knowledge-based level. The level concerned here is the rule-based level (assuming an experienced operator and a "simple" case: rescue organisation complies with specific rules based on the patient's condition), but most often, actions are based on the implementation of declarative knowledge: the physician in charge of regulation makes his decision based on what he imagines of the patient's situation and of the capacities of the rescue teams. As we have seen in the framework of medical diagnosis, to which medical regulation can be related (the practitioner makes a diagnosis of the patient's condition in order to propose an appropriate treatment, his referral to the health care structure corresponding to his condition), the works of Elstein, Shulman and Sprafka [3] have highlighted applied reasoning. These authors showed that the practitioner very quickly develops a diagnostic hypothesis then tests it towards the information available to him. In other words, the operator will switch from the knowledge-based level (the generation of diagnostic hypotheses) to the rule-based level (the application of a known treatment procedure, adapted to the diagnosis). To that end, he will use the information available to him to test his diagnosis, that is to say to confirm or invalidate his hypothesis. As part of medical regulation, in addition to "medical diagnosis", the physician in charge of regulation will also have to consider other factors such as the operational situation to cite only this example. This situation is close to that observed for air traffic controllers by Anne Isaac and Bert Ruitenberg [5]. They describe how the air traffic controllers build a threedimensional picture of the relative situation of the various aircraft and its evolution over time. This picture is then used to make regulation and traffic management decisions in order to avoid potential conflicts. This mental picture, as was shown by Gibson, is built on the basis of collected sensory information (in particular, sight and hearing are the prevailing sensory pathways for air traffic control and also medical regulation). It contains all the characteristics, that is to say the operator is able to "see" or "hear" the information used to develop it. This mental representation is built from the transfer of sensory information, stored in the shortterm memory, to the working memory, at the level of which the cognitive processing operations make it possible to create this picture of the situation. The information processing model proposed by Norman and Shallice [9] in 1980 reminds us of the mechanisms involved in the sensory information processing. Information is received by sensory organs then processed, that is to say merged, rejected or highlighted, by data base trigger and psychological processing structures, via a schemata and contention scheduling system, itself under control of the supervisory attentional system. Thus, raw sensory information is modified, some pieces increase in importance, others are dropped, yet others are altered, in order to result in a more or less accurate conscious representation of the situation. This representation is the starting point of the action carried out by the operator. The figure below is a schematic representation of this information processing model. These various information processing and decision-making mechanisms generate risks of errors by the physician in charge of regulation. These errors can be fatal to the patient but also, on a theatre of operations, to the rescue teams.

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Supervisory attentional system

Sensory information Sensory perceptual structures

Data base trigger

Schemata / contention scheduling

Psychological processing structures

Effector system

Figure 1. Norman and Shallice's information processing model. Sensory information triggers an action after processing by psychological processing structures. These structures are activated by the schemata and contention scheduling system and the data base trigger. The supervisory attentional system handles the activation of these processing structures.

ERROR-PRODUCTION MECHANISMS Reason [8] showed how a system could allow or limit the production of errors by operators. So, in civil aviation for example, it is frequently said that 80% of errors are of human origin. However, Daniel Maurino, in the foreword of the book by Isaac and Ruitenberg [5], explains how this number is finally under evaluated since the man is involved at all system levels, in its management and design as well as in the building of machines used for its production or logistics. The human error rate is consequently closer to 100% when considering the whole system. Thus, as is shown by Reason [8] and, after him, by Amalberti [2], not only the first level of management of the system shall be considered (that is to say the interface with the physician in charge of regulation as far as we are concerned), but also the whole medical regulation process, from the prior collection of medical history data and its storage in a computerised folder, to the management of the casualty by a medical team, to include the availability of information concerning the tactical and logistical situation (availability and follow-up of medical evacuation means, for example). In the specific case of problem-solving, errors can be due to the application of erroneous rules (the rule used by the operator is incomplete or incorrect: get a psychological casualty to a surgical structure for example) or to the erroneous application of right rules (the operator chooses to implement a solution that, although it works in other situations, is not adapted to the particular case of the current problem: it may be disastrous for a casualty suffering lung damage to be evacuated by air because although aeromedical evacuation is much faster, it may worsen the problem). According to Amalberti [2], these errors are linked to bounded rationality phenomena: an individual cannot apprehend all the environment information, and all the consequences of current actions. The operator has to make choices based on his fragmentary perception of information and consequences of his actions. To that must be added the time constraint, as in many other situations, that forces the physician in charge of regulation to act "under

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emergency" and not wait for the situation to stabilize. Another approach of this phenomenon is the one observed during the study of air traffic controllers' activity. Under certain circumstances, when they are not provided with all the pieces of information (for example a change in an aircraft performance due to a technical failure) or they are not able to process all the pieces of information (in case of fatigue, stress, overload of mental work, among others), these air traffic controllers "loose the image, the awareness of the situation". They have thus, at the expense of an important cognitive effort, to recreate this picture. This operation requires the new piece of information gathered and transitorily stored in the short-term memory to be moved into the working memory. These operations may be disturbed by the stress generated by this loss of representation of the situation and by environing stimulations (visual and sound in particular) that mix up with the truly useful information (the need for recreating a mental representation of the situation generally arises during potentially dangerous situations that cause stress for operators and result in a larger information flow). However, in spite of his weaknesses, the human operator makes the decision-making process more flexible. Indeed, he is able to make choices, bets, in spite of fragmentary and even erroneous information, while a computer system, more rigid, will request complementary information before proposing a solution. Besides, error is necessary for learning and it is as illusory and, above all, dangerous, to want to suppress human error as it is to want to suppress pain. Just like the latter enables us not to expose ourselves to a situation likely to result in irreversible damage (pain prevents us for example from staying near a heating source for too long and causes immediate removal of the limb from the source of the injury, which reduces the risk of burn injury), error allows us, when it is accepted, to adopt a less risky behaviour, even if is means temporarily reducing our performance (for example, when typing errors increase, the author decreases his typing speed in order to increase control and locomotor coordination). As was shown by Amalberti [2], the operator needs to be in a "turbulent area", that is to say an operating mode in which there is a risk of error that he can manage, in other words the detection of which is easy and for which there are correction possibilities without jeopardizing the system safety. Beyond this area, error detection or correction is more delicate and safety is jeopardized. Below this area, the operator has an under-load of work and his attentional abilities, thus his performance and power of recovery in case of a sudden failure of the system are affected. However, it is to be noted that this "turbulent area" varies from an individual to another. It can be very low, very far from the area of loss of system control, in particular for an inexperienced operator who will have first to get to know the system's reactions before testing its limits. Sometimes, for some operators "seeking sensations", this turbulent area will already be beyond the acceptable limits of security and could result in a loss of system control (this is for example the case of a driver seeking a sensation of speed but driving on an icy road). However, in this particular context, it is possible to bring the "turbulent area" into the system's acceptable limits through an increase of warning information on the risks of loosing control, and through the setting of additional tasks that (reasonably) increase the workload, to name a few. For example, in the case of our driver, information on the activation of the antiskid system, associated to a reminder of speed limits (displayed on the dashboard or, better, on a head-up display) and safety distances, will, in most cases, bring him to his senses. Thus, to quote Cicero, we can affirm that "to err is human" and that error is an adaptive mechanism necessary to the security of human activities (insofar as the system allows errors to be detected early and corrected).

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We thus propose a few avenues for action to design a resilient medical regulation system, that is to say tolerant to human error.

THE DESIGN OF A MEDICAL REGULATION SYSTEM IN PRACTICE Like Kenneth Allard [1], in his book on digitization in the US army, we support the hypothesis that information systems, and in particular a computerised medical regulation system, are a simple aid that will allow the various actors to create a mental representation of the situation that is as accurate and close to reality as possible, in order to carry out the actions incumbent upon them: "Information systems are helpful only to the extent that they reduce the fog of war (…) The command structure must be capable of winning even after the computer dies." In other words, digitization expands the distribution of information that is required for the activity of each of the actors and allows them to have a shared representation, an awareness of the situation, so that each one can make decisions that are best suited to the situation. We will cite Pr. Snyder, quoted by Kenneth Allard [1]: "…More important than doing things the best way is doing them the same way." For us, rule making does not consist in forcing the physician in charge of regulation to follow a pre-established algorithm but in assisting him to balance entities he will have to use to make his decision. Balance the relevance of upstream information, balance the useful availability of deployed means, balance the risk-taking calculated based on known elements. Rules can also be considered as automatisms that must trigger some safety actions, by subsidiarity, when human capacities are exceeded or also when the burden of choice is no longer accepted. However, the information automatic processing by systems can only be based on a structured (form) and well formed (e. g.: XML format) piece of information corresponding to a pre-established meaning (codes). The use of metadata does enable automatic cross-check and interpretation actions that offset the lack of consistence or the gaps and fuzzy logic techniques make the algorithmic process more flexible but Man maintains an edge on computer systems. He is able to exploit the implicit information contained in any communication and to use his metaknowledge (the knowledge of his own abilities). This exploitation is immediate, even if the interpretation entails risks. It has the advantage of saving time even if the postponement of a rational decision would not necessarily be better since only built on explicit information that is incomplete and sometimes wrong. Thus, designing a medical regulation system as we imagine it does not aim at developing a software program imposing ready-made solutions to an operator who will just be a mere executant. It aims at implementing an information system that lets Man carry out the noblest tasks (genesis of information and decision-making process). Everything else is just organisation and automatism, whether the transmission of messages themselves, their addressing in structured data bases or their processing via cross-checks in view of a relevant contextual graphical presentation. In this, we are in line with the definition of human factors and ergonomics proposed by Edwards (1988) and quoted by Isaac and Ruitenberg [5]: "Human factors (or ergonomics) may be defined as the technology concerned to optimize the relationship between people and their activities by the systematic application of human sciences, integrated within the framework of systems engineering."

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Following Gibson (1979), quoted by Hoc [4] and Amalberti [2], we will define such a concept as an ecological system. In this system, cybernetics takes on intangible automatisms, and Man takes on the contact with the patient and the critical decision making. It shall present the deep system operating structure, in a manner which is appropriate to the operator's perception abilities. So, somewhat similar to what is done in civil aviation (in particular concerning the design of cockpits, but also for air traffic control) or for the supervision of power plants, these aspects of "human factor" have to be considered all through the medical regulation system design. However, this engineering cannot simply be satisfied with the implementation of standards or general recommendations on ergonomics, but as specified by Rasmussen, Peterjen and Goodstein [7] and, after them, Isaac and Ruitenberg [5], it has to resort to the expertise and analysis of specialists trained in this field. This expertise will define: - which pieces of information participate in the creation of the mental representation of the situation by the physician in charge of regulation - which pieces of information are shared between this practitioner and the teams working in the field and the mechanisms that result in a shared representation of the situation, - which sensory pathways are involved in these mental representation mechanisms and which disruptions are possible (by competing stimuli that are useless, even disruptive to the building of the situation picture). It is also important to be noted that, as part of medical regulation, as in many other supervision systems (in particular air traffic control), several levels of control can be defined: local (the teams managing several casualties), regional (the physician in charge of regulation is responsible for the medical supervision of a somewhat important area) or national, even multinational. The interface will have to allow each operator to adjust the desired "level of granularity", depending on the extent of the area to be considered (relevant information is not necessarily the same for a local regulation and a national regulation). Moreover, as is noted by Rasmussen, Peterjen and Goodstein [7], the information used to create the mental representation of the situation varies according to the operators' expertise level. So, an inexperienced physician in charge of regulation will be more likely to use many pieces of information (at the risk of not being able to make a distinction between relevant stimuli and those from the "background noise"), while an expert operator, who builds an "a priori" diagnostic hypothesis and confronts it to the real world information, will look for an interface that enables him to search for the information he wants to get, according to what he knows of the system operation. All these elements are essential to determine the information architecture required to manage a patient or a casualty, or, in more practical terms, to decide on the organisation of data on the screens of the medical regulation system. The aim is to design an information system that allows the physician in charge of regulation to get a very good picture of the situation in order to make the decision that seems the most adapted to him based on his knowledge of tactical data, teams present in the field and their skills.

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CONCLUSION The purpose of this paper was to share our thoughts on the design of an operator-centred medical regulation software program, which aims at enabling him to have a "situation awareness". He will then be in a position to make a decision he will be able to follow and modify over time, based on the representation of the situation he has built, but which also takes account of his own abilities. This software program shall also enable all the operators involved in the management of a casualty in the field or remotely, to create a shared representation of the situation. This design compels us to reuse decision-making and error-production theoretical bases, in order to accurately identify the pitfalls we may encounter that will be challenges to be addressed by the end user. Thus, the software program that will be designed will have to include an ecological interface making the representation of the situation easier, proposing a decision support for the physician in charge of regulation but not imposing a rigid solution that could be a source of difficulty for the operator and entailing a risk of causing him to lose control of the situation. Sensory information provided to the operator will enable him to know, at all times, "the internal operating status of the system", that is to say, as far as medical regulation is concerned, the patients' situation, condition and geographical location, but also the availability of medical structures and means, the superadded risks, linked to environment, to name a few. This analysis will have to be faced with the field reality all through the design process in order to evaluate a prototype that will be validated by future users during different exercises simulating various and realistic employment conditions.

ACKNOWLEDGMENTS The authors wish to thank Anne-Lise BEUGNET for her translation.

REFERENCES [1] [2] [3] [4]

[5] [6]

Allard, K. Command, control and the common defense. Rev. Ed., Yale Univesity Press, 1996. Amalberti, R. La conduite des systèmes à risques. Paris : Presses universitaires de France, 2002. Elstein, AS; Shulman, LS; et Sprafka, SA. Medical problem solving: an analysis of clinical reasoning. Cambridge: Harvard University Press, 1979. Hoc, JM. Conditions méthodologiques d'une recherche fondamentale en psychologie ergonomique et validité des résultats. Le travail humain, tome 56, n° 2-3, 1993, 171184. Isaac, AR; et Ruitenberg, B. Air traffic control: human performance factors. Aldershot: Ashgate, 1999. Rasmussen, J; et Jensen, A. Mental procedures in real-life tasks: A case study of electronic troubleshooting. Ergonomics, 1974, 17, 293-307.

220 [7] [8] [9]

William Guessard, Alain Puidupin, Richard Besses et al. Rasmussen, J; Peterjen, AM; et Goodstein, LP. Cognitve systems engineering. NewYork: Willey-Interscience, 1994. Reason, J. L'erreur humaine. Paris: Presses universitaires de France, 1993. Shallice, T. Symptômes et modèles en neuropsychologie. Des schémas aux réseaux. Paris : Presses universitaires de France, 1995.

In: Advances in Psychology Research. Volume 72 ISSN: 1532-723X Editor: Alexandra M. Columbus © 2011 Nova Science Publishers, Inc.

Chapter 9

SELF-EXPANSION AS AN AID IN SMOKING ABSTINENCE AND CESSATION Xiaomeng Xua*, Anna H. L. Floydb, J. Lee Westmaasc and Arthur Arona a

Stony Brook University, Psychology Dept., Stony Brook, NY 11794-2500, U.S.A. b Klein Buendel, 1667 Cole Boulevard, Suite No. 225, Golden, CO 80401, U.S.A. c American Cancer Society, 250 Williams St., Atlanta, GA 30303, U.S.A. * Corresponding Author: [email protected]

ABSTRACT Health complications from smoking are the number one preventable cause of death in the US. Although there are effective treatments available, none have proven to be completely successful, and it is important to explore novel methods of helping smokers abstain from cigarettes for good. Particularly valuable would be smoking abstinence aids that are cost-effective, easily accessible, and likely to be implemented and sustained. We review one such potential aid which has not been discussed in prior smoking abstinence/cessation literature: self-expansion. Self-expanding (novel, exciting, and/or challenging) activities/events activate the mesolimbic dopamine reward system associated with pleasure and motivation. We review the theory and evidence for the idea that the reward from self-expanding activities/events can supplant the reward and reinforcement from smoking cigarettes. We propose that self-expanding activities/events have the potential to be useful in aiding smoking abstinence and cessation, and that they should be given more attention in both research and treatment practices. This is particularly important as self-expansion is accessible to most, cost-effective, easily added to/used in conjunction with smoking cessation treatments, and may elicit lower levels of relapse. Finally, we give an example of what a self-expansion intervention might look like and outline some future directions in this new and exciting area of research.

The World Health Organization has projected that 175 million deaths globally will be attributed to smoking worldwide by 2030 (WHO, 2008). In the United States, cigarette smoking leads to 438,000 (one in five) deaths per year, and is the number one preventable

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cause of death (Centers for Disease Control and Prevention [CDC], 2005). Some of the health consequences of smoking include coronary heart disease, lung disease, chronic bronchitis, stroke, emphysema, acute myeloid leukemia, gastric ulcers, cerebrovascular disease, and 15 cancers (CDC, 2005; USDH HS, 2004). There are roughly 45.3 million smokers in the United States (21% of the population; CDC, 2006), however, the majority of smokers report a desire to quit smoking completely (CDC, 2002). For smokers who seek to quit smoking, there are several smoking cessation programs and treatments available. Pharmacological and clinical treatments include antidepressants (for review see Hughes, Stead, & Lancaster, 2004), nicotine replacement therapy (for review see Silagy, Lancaster, Stead, Mant, & Fowler, 2004), behavioral support (for review see Lancaster & Stead, 2002), and clinical therapy (for review see Fiore et al., 2008). Although these treatments can be effective, many are costly and/or time-intensive and thus potentially inaccessible to some smokers seeking to quit. It would therefore be valuable to develop easily accessible, cost- and time-effective strategies to aid smokers who are attempting to quit smoking, particularly strategies that are enjoyable and easily continued after successfully quitting (to reduce susceptibility to relapse), as well as approaches that could be used either alone or in conjunction with existing treatments for a potentially synergistic effect. One potential aid for smokers seeking to quit is the use of self-expansion. The selfexpansion model (Aron & Aron, 1986) is based on the idea that people are motivated to expand their potential efficacy and identities through increasing their skill, knowledge, or resource base (often, but not necessarily, by including another person into the identity of the self such as in a close relationship), and that when this expansion occurs at a rapid pace, it generates high levels of aroused positive affect (see Strong & Aron, 2006). The association between positive affect and rapid self-expansion was first shown in the context of romantic relationships (e.g., Aron, Paris, & Aron, 1995). Participation in shared and novel activities with others, a cornerstone of new romantic relationships, creates a sense of rapid selfexpansion that contributes to intense positive affect, feelings of closeness, and increased relational satisfaction (e.g., Aron, Norman, Aron, McKenna, & Heyman, 2000; Graham, 2008; Tsapelas, Aron, & Orbuch, 2009). Although self-expansion has been studied mostly in the context of close relationships, self-expansion can also occur on an independent level, such as when a person begins a new hobby, sport, religious practice, or travel. Basically any event or experience that is exciting, novel, and/or challenging and that leads to an increase in the concept of self can be considered a form of self-expansion. Because there are so many opportunities for self-expansion, both in the context of a relationship or individually, capitalizing on these experiences to help smokers quit may prove to be very fruitful. Why might self-expansion be a useful aid in smoking cessation? People are naturally motivated to pursue and continue to engage in self-expanding events and experiences due to the rewarding nature of those events and experiences. This is neurologically based. The reward and motivation experienced may stem from self-expansion being associated with activation of the mesolimbic dopaminergic system of the brain that include the ventral tegmental area, caudate, and ventral striatum/nucleus accumbens (e.g., Aron et al., 2005; Xu et al., in press). Activation in these brain regions is especially relevant since these are the same brain regions involved in responses to, and the reward from/motivation for, addictive substances such as nicotine (e.g., Ikemoto, Qin, & Liu, 2006; Laviolette, Lauzon, Bishop, Sun, & Tan 2008; Sziraki, Sershen, Hashim, & Lajtha, 2002). Activation of these regions reflect reward from addictive substances like nicotine because these regions of the brain are

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rich in dopamine, one of the neurochemicals responsible for the hedonic response that people experience when smoking (e.g. Barrett, Boileau, Okker, Pihl, & Dagher, A., 2004; for review see Volkow, Fowler, Wang, Swanson, & Telang, 2007). Because the reward/motivation neural systems underlying both smoking and selfexpansion are the same, it is theoretically possible that the reward elicited by self-expansion could (at least in part) supplant or act as a substitute for the reward elicited by smoking. If so, then engaging in self-expansion would make abstaining from smoking more bearable, and thus increase the likelihood of a successful quit attempt. The idea of a substitution effect, where one rewarding stimulus or experience is substituted for another, is not new. Clinicians have long known that addictions can covary due to similarities in their reward value, and that this can lead to cross-addiction, where decrease (or cessation) of the use of one addictive substance or behavior is followed (or cooccurs) with initiation or increase in usage of another addictive substance or behavior (e.g. Donovan, 1988; Haylett, Stephenson, & Lefever, 2004; Marks, 1990). Addiction researchers have also documented this phenomenon of substitution with various substances in both animal and human models. In the animal literature, Carr (2007) found that chronic food restriction (decrease in reward from food) led to increased behavioral sensitivity to drugs of abuse. Wellman, Nation, and Davis (2007) observed that rats that were given access to a high-fat diet (compared to a low-fat diet) decreased their acquisition of cocaine selfadministration. In humans, Simon et al. (2006) found that obese people (who seek reward from food) are 25% less likely to develop a substance abuse problem. Alter, Lohrmann, and Greene (2006) and DiNardo and Lemieux (2001) found that when American youths were faced with a decrease in accessibility of alcohol, they exhibited a decrease in alcohol consumption but a sharp increase in usage of marijuana. Regarding smoking specifically, Wilson, Sayette, Delgado, and Fiez (2008) found decreased activation of the caudate in response to monetary reward among smokers who were able to smoke during the study (thus had access to reward from smoking) as opposed to those who were not allowed to smoke during the study. Although it is very understandable that substitution would occur when one is attempting to quit an addiction, it is unfortunate that people may end up substituting one addiction for another. But what about substitutions that do not involve taking another chemical substance or engaging in another negative behavior (e.g. binge eating)? Couldn‘t smokers seeking to quit replace the reward they used to get from cigarettes with reward from self-expanding activities/experiences? Since self-expanding activities/experiences tend not to be detrimental to one‘s health, and sometimes are even health-promoting (e.g. taking up a sport, improving one‘s social network), smokers could reap the benefits of substitution without the costs associated with taking up a new health-detrimental addiction. Findings from a few preliminary studies support this possibility. A study by Vaillant (1983) suggests that this sort of positive substitution involving self-expansion may occur naturally. They found that among a group of male alcoholics participating in their intervention, almost one-third of those who experienced a period of abstinence also happened to be in the process of beginning a new romantic relationship – an extremely intense and rapid form of self-expansion. The Vaillant (1983) finding was a bit serendipitous. In terms of research involving smokers, only one study so far has looked intentionally at the idea of self-expansion aiding smoking abstinence and cessation. Xu, Floyd, Westmaas, and Aron (2010) recruited a group of former smokers and a group of current smokers who had experienced a serious quit attempt

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in the past. Former smokers were asked to recall the time immediately prior to their successful quitting, and to report on how many self-expanding experiences (from a checklist) they engaged in during that period, as well as how helpful those experiences were for their quitting. Current smokers were asked the same questions but in terms of their most successful quit attempt (the quit attempt that yielded the longest length of cigarette abstinence). Former smokers reported significantly more self-expanding experiences, and found these experiences significantly more helpful to their quit attempt than did current smokers. However, even among current smokers, self-expansion was helpful such that the more self-expanding experiences current smokers reported the longer they were able to abstain from smoking. These results were still significant after controlling for age, level of nicotine dependence, measures of personality, and depressive symptoms. Although participants reported on many different kinds of self-expanding experiences, both former smokers and current smokers found positive and voluntary self-expanding events to be the most helpful. This finding is particularly useful since it indicates that one need not wait for a self-expanding experience to occur but can create or seek an experience. Potential self-expansion based interventions (perhaps in conjunction with nicotine replacement and other therapies) would then involve steering smokers seeking to quit towards positive and voluntary self-expanding experiences that would help to replace some of the reward smokers used to get from cigarettes and lessen the burden of smoking cessation. What might one such intervention look like? Smokers seeking to quit would be asked to think of exciting, novel, and/or challenging experiences/activities that they personally would like to participate in, perhaps something they‘ve always wanted to do but never got around to. The intervention would therefore be tailored to meet the smoker‘s own idea of what is self-expanding, as well as the smoker‘s need for self-expansion (e.g. a long list of many different experiences that smokers would go through vs. one experience that they would focus on), to maximize the program‘s effectiveness. For example, let‘s say a smoker seeking to quit expressed a passion for tennis, and indicated that this activity was highly exciting, challenging and novel in the sense that they had never devoted much time to it in the past. The smoker would then be encouraged to really engage in pursuit of this self-expanding activity, as often as possible, and particularly in times when they might be craving a cigarette. This does not mean that the smoker would need to play a game of tennis every few hours –self-expansion could also occur during various activities associated with the main experience of tennis. The smoker could play tennis, practice her/his swing, read up on the sport, watch video clips of exciting matches, go see a game in person, browse through various gear available to help improve performance, talk about the sport to someone else interested in it, exercise to improve general fitness and stamina to thus improve play performance, meet and develop friendships with other tennis fans either in person (e.g. a club) or online (e.g. forums), the list goes on and on. With so many possible activities (many of which are highly enjoyable and may lead to further self-expansion, especially the socially-oriented ones), the potential for self-expansion is limitless, and the activity need not get stale or boring. Smokers would be reminded to keep to the level of self-expansion that they find most helpful (i.e. enough to be exciting, not enough to be overwhelming), that they should feel free to move on to a different form of selfexpansion if the current one no longer interests them, and that they can always add on a second, third, fourth etc self-expansion activity/experience if they feel the need for more selfexpansion.

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Self-expansion is a potentially viable aid in smoking abstinence and cessation. Because of its probable cost-effectiveness (it is essentially free for the individual), and its potential to, if effective, not only help people quit smoking but also be life-enriching, it would be extremely valuable to continue further research on this topic. Questions that future research should address include: Can self-expansion be useful in the context of a structured smoking cessation program? Are there certain people for whom self-expansion will be more helpful than others, and why? Will self-expansion work synergistically with other treatment programs? Could including self-expanding activities decrease attrition in other treatment programs? Will continued experiences of self-expansion after successful treatment help to reduce the rate of relapse? These, and many other questions, need to be answered and provide a unique opportunity for collaboration among addiction researchers and clinicians. We feel strongly that this exciting and novel field of inquiry will provide rich and useful data and will be fruitful in terms of teaching us about the nature of smoking, and the mechanisms through which abstinence and cessation occur. Above all, it is a promising area that may really help to improve the success rates of smokers seeking to quit, particularly smokers who may not have the resources to partake in traditional treatment programs.

REFERENCES Alter, R. J., Lohrmann, D. K. & Greene, R. (2006). Substitution of marijuana for alcohol: The role of perceived access and harm. J. Drug Education, 36(4), 335-355. Aron, A. & Aron, E. (1986). Love and the expansion of self: Understanding attraction and satisfaction. New York: Hemisphere. Aron, A., Fisher, H., Mashek, D. J., Strong, G., Li, H. & Brown, L. L. (2005). Reward, motivation, and emotion systems associated with early stage intense romantic love. Journal of Neurophysiology, 94, 327-337. Aron, A., Norman, C. C., Aron, E. N., McKenna, C. & Heyman, R. (2000). Couples shared participation in novel and arousing activities and experienced relationship quality. Journal of Personality and Social Psychology, 78, 273-283. Aron, A., Paris, M. & Aron, E. N. (1995). Falling in love: Prospective studies of self-concept change. Journal of Personality and Social Psychology, 69, 1102-1112. Barrett, S. P., Boileau, I., Okker, J., Pihl, R. O. & Dagher, A. (2004). The hedonic response to cigarette smoking is proportional to dopamine release in the human striatum as measured by positron emission tomography and [11C]Raclopride. Synapse, 54, 65-71. Biener, L. & Abrams, D. B. (1991). The contemplation ladder: Validation of a measure of readiness to consider smoking cessation. Health Psychology, 10, 360-365. Blaney, P. H. (1986). Affect and memory: A review. Psychological Bulletin, 99, 229-246. Carr, K. D. (2007). Chronic food restriction: Enhancing effects on drug reward and striatal cell signaling. Physiological Behavior, 91, 459-472. Centers for Disease Control and Prevention (2002). Cigarette smoking among adults—United States, 2000. Morbidity and Mortality Weekly Report, 51(29), 642-645. Centers for Disease Control and Prevention (2005). Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 1997-2001. Morbidity and Mortality Weekly Report, 54.

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INDEX A abortion, 187 abstraction, 16, 17, 46 abuse, 100, 126, 129, 132, 197, 203, 207, 223 academic performance, 101 accessibility, 107, 223 accountability, x, 197, 205, 208 accounting, 14 accreditation, 198, 204, 206 accuracy, 25, 182, 183 achievement test, 82 acquaintance, 184 acquisition of knowledge, 187 activity level, 71, 73, 81 acute myeloid leukemia, 222 adaptation, 2, 3, 7, 18, 23, 29, 32, 33, 34, 36, 38, 39, 48, 49, 100, 131 adaptations, 11, 18, 44, 48 adjustment, viii, 73, 90, 96, 100, 101, 106, 126, 127, 129, 131 administrators, 198 adolescent behavior, 127 adolescents, 75, 88, 90, 92, 93, 94, 127, 128, 129, 130, 131, 158, 226 adulthood, 129 advantages, 26, 122 adverse event, 200 advertisements, viii, 116, 133, 134, 135, 136, 137, 138, 140, 141, 142, 144, 146, 147, 148, 149, 151, 153, 154, 155, 158 Africa, 191 African Americans, 52 agencies, 154 aggression, 67, 71, 78, 91, 95, 173, 175, 176 aggressive behavior, 105, 116, 126

aggressiveness, 101 Akan, 154, 155 alcohol abuse, 207 alcohol consumption, 223 alcohol use, 73, 93 alcoholics, 223 alcoholism, 227 algorithm, 110, 118, 217 alters, 29, 38 American Psychiatric Association, 63, 87 American Psychological Association, 93, 95 anger, 81, 101, 162, 195 animations, 125 annual review, 93 ANOVA, 118 anthropology, 2, 5, 46 antisocial behavior, 92, 100, 122, 130 antithesis, 19 anxiety, 67, 70, 74, 85, 91, 100, 101, 105, 127, 162, 184 anxiety disorder, 70, 100 apples, 205 architecture, 59, 107, 130, 218 Aristotle, 7, 11, 31, 37, 38, 39, 40, 42, 54 arousal, 67, 73, 74, 76, 78 Asia, 139, 159 asian countries, 52 aspiration, 200 assault, 100 assertiveness, 67, 205 assessment, viii, 64, 81, 82, 83, 86, 87, 89, 90, 91, 94, 95, 96, 122, 123, 125, 126, 127, 128, 130, 166, 178, 179, 205 assessment tools, 122, 127 assets, 125 associationism, 39

230

Index

atmosphere, 137 atoms, 13, 19 Attention Deficit Hyperactivity Disorder (ADHD), viii, 64, 65, 66, 68, 70, 71, 72, 73, 74, 75, 76, 77, 78, 80, 81, 83, 84, 85, 86, 87, 88, 89, 90, 93, 94, 95, 96 attribution, 158 attribution theory, 158 auditory stimuli, 139 autism, 132 automatisms, 217, 218 autonomy, x, 197 aversion, 65, 77 avoidance, 70, 100, 204 awareness, x, 69, 183, 184, 207, 212, 216, 217

brain, 3, 6, 15, 25, 41, 43, 50, 66, 72, 89, 95, 183, 222 brain functions, 15 brainstem, 69 branching, 112, 128 brand image, 134 brand perception, 157 breathing, 165 Brno, 60 bronchitis, 222 browser, 107 bullying, 95, 100, 116, 118, 127, 132, 202 burn, 216 burnout, 203, 208 buyer, 154

B

C

background noise, 218 bad behavior, 122 banks, 138 barriers, 206 basal ganglia, 72 batteries, 81 behavior of children, 94 behavior therapy, 90 behavioral change, 126 behavioral disorders, 77, 177 behavioral dysregulation, 79, 82 behavioral genetics, 71 behavioral inhibition system, 78 behavioral problems, ix, 63, 66, 68, 69, 79, 99, 161, 162, 178 behaviorists, 203 behaviors, vii, viii, x, 63, 64, 65, 66, 67, 68, 69, 70, 71, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 86, 89, 93, 101, 108, 112, 121, 122, 127, 137, 138, 140, 153, 161, 165, 175, 176, 178, 179, 197, 198, 199, 201, 202, 204, 205, 207, 208, 226 belief systems, 7, 184 beneficial effect, 189 benefits, 84, 102, 105, 124, 125, 135, 150, 199, 223 bias, vii, 1, 25, 122, 127, 129, 131, 151, 207 bipolar disorder, 91 birth weight, 73 black hole, 200, 206 bleeding, 17, 200 blind spot, 192 boredom, 227

calibration, 112, 118, 121 cancer, 193 cancer care, 193 candidates, 23, 206 capitalism, 154 cardiac activity, 69 carefulness, 17, 50 caregivers, viii, 64, 65, 67, 69, 78, 79, 82, 83, 162, 164, 165, 169, 170, 176, 200 caregiving, 83, 95, 167 caricatures, 45 Carnap, 47, 48, 49 cartoon, 109, 141, 144 case study, 219 causality, 10, 11, 42 causation, 43 cell signaling, 225 central executive, 76, 94 cerebellum, 72 cerebrovascular disease, 222 checks and balances, 17 chemical, 223 Chicago, 56, 57, 60, 93 Child Behavior Checklist, 82 child development, 87, 131, 159 childhood, viii, 6, 7, 22, 25, 32, 33, 64, 66, 68, 77, 78, 85, 87, 89, 90, 91, 92, 93, 95, 97, 126, 127, 128, 129, 130, 131, 157, 185, 203 China, 57, 159 Christianity, 7 cigarette smoking, 221, 225 city, 128, 179

Index civilization, 33 class, 76, 166, 168 classes, 48, 78 classical mechanics, 13 classification, 54, 97, 202 classroom, 71, 82, 83, 101, 126 classroom settings, 71 cleaning, 138, 164 clients, 192 climate, 127 clinical assessment, 91 close relationships, 222 clusters, 33, 42, 46 cocaine, 223, 227 coercion, 79, 83 coffee, 23 cognition, 4, 7, 48, 102, 127, 185 cognitive abilities, 68 cognitive capacities, 213 cognitive development, 68 cognitive effort, 216 cognitive function, ix, 72, 77, 161, 163, 164, 167, 168 cognitive impairment, 176, 178, 179 cognitive load, 132 cognitive process, 48, 73, 212, 213, 214 cognitive therapy, 192 coherence, 93, 103 collateral, 30 collisions, 110 color, 108, 110, 111, 117, 135 commercials, 155, 157, 158, 159 communication, x, 101, 108, 111, 112, 120, 121, 134, 135, 136, 138, 139, 142, 197, 198, 200, 201, 202, 203, 205, 206, 207, 208, 217 communication skills, 120, 121 community, viii, 2, 44, 86, 104, 162, 182, 185, 205 comorbidity, 71, 88, 164, 167, 177 compassion, 183 competition, 134 complaints, 163, 175, 206, 207 complement, 198 complexity, 3, 51, 208 compliance, 80, 84, 90 complications, xi, 73, 221 composition, 28 comprehension, 26, 103, 130 computation, 21 computer science, 102, 104, 109 computer software, 103

231

computer systems, 217 conceptualization, 36, 94, 164 conditioning, 79 conflict, 113, 156, 197, 205, 207 confrontation, 197 conscious perception, 41 consciousness, 2, 4, 5, 6, 7, 11, 12, 14, 15, 17, 18, 19, 20, 22, 23, 28, 31, 32, 33, 34, 40, 41, 51, 55, 154, 185 consensus, 13, 182, 202 consent, 117, 186 construct validity, 121, 124, 176 construction, 2, 4, 6, 11, 17, 18, 28, 47, 48, 50, 91 constructivism, 47, 48 constructivist learning, 130 consumer choice, 155 consumers, viii, 107, 133, 134, 135, 136, 137, 138, 141, 150, 153, 159 consumption, viii, 133, 135, 136, 137, 138, 140, 141, 146, 148, 150, 153, 154, 223 consumption patterns, 138 content analysis, 157 continental, 58 contingency, 84 control group, 86, 124 controlled studies, 183 convention, 9, 38 conviction, 30 cooperative learning, 128 coordination, 67, 208, 213, 216 coping strategies, 105 coronary heart disease, 222 correlation, 30, 120, 163, 164, 166, 168, 199 correlation coefficient, 166 correlations, 120, 167, 168 cortex, 15, 72 cost, xi, 12, 85, 93, 107, 123, 135, 221, 222, 225 counseling, 208 craving, 224 creative process, 23 creativity, 26, 125 crew, 108, 113, 206 criticism, 22, 39, 47, 117, 175 crystallisation, 40 crystals, 184 cues, 74, 76, 104, 106, 108, 112, 121, 128, 186, 189 culture, 3, 5, 32, 37, 41, 44, 46, 51, 53, 136 curricula, 129 curriculum, 91, 105, 113, 128, 129 cycles, 193

232

Index

Czech Republic, 52

D daily living, 162, 163, 164, 167, 168, 169 dance, 79, 144 dances, 137 danger, 47 Darwin, Charles, 10 Darwinism, 43 data collection, 117, 167 deaths, 221 decay, 144 decision-making process, 216, 217 declarative knowledge, 214 deconstruction, 4, 20, 31 deduction, vii, 1, 49 defence, 10, 29 deficiencies, 94 deficit, 73, 74, 75, 87, 88, 89, 90, 91, 93, 94 degenerative joint disease, 162 delinquency, 92, 93, 100 delinquent behavior, 74, 126 delinquent friends, 126 Delta, 192 delusions, 56 demand characteristic, 190 dementia, vii, ix, 161, 162, 163, 164, 165, 175, 177, 178, 179 Denmark, 52, 157 Department of Health and Human Services, 226, 227 depressants, 171 depression, ix, 85, 92, 100, 101, 161, 162, 163, 165, 167, 168, 173, 175, 176, 177, 178, 184, 202, 203, 208 depressive symptoms, 165, 224 deprivation, 154 derivatives, 49 Descartes, René, 9 designers, 102 detection, 184, 193, 216 developmental disorder, 97 developmental process, 47, 65, 78 developmental psychology, 5 developmental psychopathology, 93, 100, 131 deviation, 72, 166 diagnosis, 64, 66, 68, 70, 71, 72, 86, 94, 162, 164, 213, 214 Diagnostic and Statistical Manual of Mental Disorders, 63

diagnostic criteria, 65, 68, 77 dichotomy, 39 diet, 223, 227 dietary habits, 158 diffusion, 44 direct observation, 81, 122 directors, 130, 163 disability, 164, 167, 168, 176 disappointment, 89, 191 discomfort, ix, 34, 81, 161, 162, 163, 164, 165, 167, 168, 173, 175, 176, 177, 178, 179 discrimination, 158 disorder, 70, 71, 72, 76, 87, 88, 89, 90, 91, 93, 94, 129, 131 disposition, 64 distilled water, 184 distress, 80, 85 disturbances, ix, 74, 161, 163, 166, 168, 170, 171, 172, 173, 175, 176 divergence, 146 divergent thinking, 102 diversity, 6, 205, 207 dominance, 17, 25, 136 dopamine, xi, 72, 221, 223, 225, 227 dopaminergic, 222 drawing, 19 DRS, 164, 166 drug abuse, 132 drugs, 131, 223 dualism, 5, 6, 11, 14, 19, 37 dynamism, 134 dysphoria, 85

E Easter, 107 economy, 9, 18, 21, 36, 49, 134, 136 education, ix, 25, 26, 32, 44, 50, 52, 53, 54, 78, 133, 139, 141, 144, 146, 147, 151, 153, 154, 164, 204 educators, 51, 53 egg, 46 elaboration, 25 elders, 179 electromagnetic, 183 electrons, 19 elementary school, 89, 100, 105, 107, 116 emergency, 199, 200 emission, 225 emotion, 75, 83, 85, 86, 90, 92, 95, 96, 107, 132, 225 emotion regulation, 75, 85, 86, 90, 96

233

Index emotional experience, 19, 193 emotional intelligence, 128, 201, 207 emotional reactions, 65, 75 emotional responses, 75, 183 emotional state, 74, 85, 112 emotionality, 69, 79, 90, 92 emphysema, 222 empirical studies, 73 employment, 208, 219 empowerment, 189 enculturation, 3, 21 endurance, 135 enemies, 28 energy, 13, 135, 183, 191, 193 engineering, 5, 31, 217, 218, 220 England, 141, 210 environmental characteristics, 69, 73 environmental conditions, 162, 176 environmental factors, 69, 73, 101 environmental stimuli, 65, 66, 67, 74 epidemic, 227 epidemiology, 95 epistemology, 2, 3, 4, 5, 7, 11, 22, 24, 26, 35, 47, 52 equipment, x, 211, 212 equity, 207 ergonomics, 217, 218 error detection, 216 ethnic groups, 121 ethnicity, 116, 203 etiology, 71, 73, 77, 86, 164, 176 evacuation, 213, 215 evil, 7 excitation, 41, 43 exclusion, 100, 128 executive function, 72, 73, 74, 75, 76, 77, 78, 87, 88, 97 exercise, 224 expenditures, 137 experiences, 4, 7, 10, 11, 12, 13, 14, 15, 18, 23, 24, 30, 32, 33, 43, 48, 65, 85, 126, 137, 158, 182, 184, 186, 187, 189, 190, 192, 193, 198, 202, 203, 222, 223, 224, 225, 226 experimental design, 124 expertise, 104, 107, 109, 116, 218 exploitation, 217 exploration, 120, 131, 159, 192 exposure, 67, 85, 106, 120, 121, 122, 123, 131 expressivity, 65 external influences, 203

externalizing behavior, 66, 79, 80, 85, 95, 118, 119, 120, 121 externalizing disorders, 70, 95 eye movement, 68

F face validity, 122 Facial Action Coding, 127 facial expression, 79, 110, 112, 165 fairness, 190 faith, 206 family functioning, 92 fast food, 142 fat, 223, 227 fear, 34, 74, 123, 198, 204 feedback, 10, 49, 69, 74, 78, 84, 104, 106, 112, 115, 116, 123, 125, 130, 206 feelings, ix, 102, 151, 162, 163, 181, 187, 195, 203, 222 Finland, 47, 52, 59 first degree relative, 72 fishing, 113, 120 fitness, 224 five-factor model, 92 flexibility, 82 flight, 69 focus groups, 107, 108, 205 foundations, 11, 21, 47, 56, 95 fragments, 3, 40, 184 framing, 53, 105 France, 39, 140, 141, 211, 219, 220 friendship, 126, 131 frontal lobe, 72, 92, 97 funding, 99 fungus, 10

G Galileo, 7, 8, 29 gastric ulcer, 222 gender differences, 137, 138, 187 general knowledge, 13 general surgery, 208 genes, 44, 88 genetics, 71, 72, 73 geology, 10, 26 geometry, 17, 24 Germany, 39, 52, 59, 130, 132

234

Index

gerontology, 178 Gestalt, 44, 45, 54, 57, 60 goal setting, 102, 108 God, 7, 10, 11, 19, 47 good behavior, 122 goods and services, ix, 133, 134, 136, 149 grades, viii, 52, 127, 133, 138, 139, 141, 144, 149, 153 gravity, 10 Greece, 57 GRIN, 104, 105, 107, 108, 113, 124, 127, 128, 130 group therapy, 113 group work, 53 guessing, 183 guidance, 34, 125 guidelines, 108, 206 guilt, 66

H habituation, 49 hair, 110, 117, 187 hallucinations, 190 happiness, ix, 181, 182 harassment, 197, 207 harmony, 26 health care, vii, x, 197, 198, 202, 203, 204, 208, 213, 214 health problems, 69, 96, 167 heart disease, 222 helplessness, 128 heme, 7 heritability, 72 higher-order thinking, 103 homeostasis, 64 homework, 124 homogeneity, 167 host, 23 house, 131 human actions, 12 human activity, 131 human brain, 50 human experience, 10, 13, 182 human performance, x, 212, 219 human sciences, 217 Hume, David, 9 hyperactivity, 68, 70, 71, 72, 73, 76, 82, 87, 88, 89, 90, 91, 92, 93, 94, 95, 120 hyperactivity-impulsivity, 70, 71 hypersensitivity, 68

hyperventilation, 165 hypothesis, vii, 1, 3, 4, 9, 10, 12, 17, 20, 25, 27, 45, 51, 79, 87, 191, 193, 213, 214, 217, 218

I ideal, 31 idealism, 6 identity, 12, 222 illumination, 23 illusion, 3, 5, 7, 8, 9, 37, 184 illusions, 2, 7, 8, 12, 38 image, 20, 28, 32, 33, 34, 38, 39, 49, 134, 144, 216 images, 15, 26, 28, 32, 37, 38, 39, 41, 42, 49, 134, 144, 154 imagination, 25, 38, 39 imitation, 137 impacts, 51, 124, 198 impairments, 71, 73, 178 impulses, 40, 76, 77 impulsive, 66, 70, 71, 74, 76, 77, 84, 101, 113, 114, 119, 120 impulsivity, 68, 70, 71, 72, 73, 76, 81, 82, 93, 95 inattention, 67, 68, 70, 71, 73, 76, 82, 95 increased competition, 134 independence, 162, 163, 164 India, 194 individual character, 176 individual characteristics, 176 individual differences, 65, 66, 72, 96, 193 individuality, 89 induction, vii, 1, 8 industrialization, 134 inequity, 206 infancy, 65, 66, 68, 78, 89, 92, 97, 139 infants, 64, 65, 68, 74, 80, 87, 88, 89, 94 inferences, 59 information processing, 155, 214, 215 information processing theory, 155 infrastructure, 107 inheritance, 15, 40, 42, 71 inhibition, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 87, 89, 91, 92, 96, 97, 131 initiation, 7, 10, 164, 223 inner ear, 24 insecurity, 151 insertion, 59 instinct, 135, 136, 137 institutionalized individuals, 177 instructional methods, viii, 100, 103, 123

235

Index integration, 68, 212 intellect, 184 intelligence, 55, 128, 185, 194, 201, 207 interface, 95, 109, 110, 123, 212, 215, 218, 219 interference, 75 internal consistency, 49, 82, 117, 187 internalization, 73, 74, 76, 92, 106 internalizing, 85, 90, 93, 120 Internet, 54, 107, 116 interrelations, 4, 5 intervention, xi, 16, 83, 84, 85, 86, 89, 90, 91, 92, 93, 94, 95, 101, 102, 105, 113, 122, 123, 124, 125, 126, 129, 131, 158, 177, 204, 207, 208, 221, 223, 224 intervention strategies, 90, 122, 123, 125 intimidation, 100 introspection, vii, 1, 4, 12, 14, 17, 21, 22, 36, 40 Iowa, 179 irritability, 67 isolation, 162, 203 Italy, 130, 132

learning environment, 102, 103, 104, 105, 106, 107, 112, 121, 122, 123, 125, 129, 130, 131 learning process, 43 learning styles, 103, 123 leisure, 135 lending, 190 lens, 25, 41 leukemia, 222 level of education, 141, 153, 164 life changes, 227 life experiences, 203 linearity, 167 linguistics, 30, 205 literacy, viii, 100, 122, 124, 128, 134 locomotor, 216 logicism, 49, 54 logistics, 48, 215 longevity, 81 longitudinal study, 95 lung disease, 222 lying, 19

J

M

James, William, viii, 2, 4, 6, 7, 11, 14, 15, 21, 29, 32, 37, 42, 45, 56, 57, 59, 60 Japan, 126 job performance, 199 jurisdiction, 35, 51

K Kant, Immanuel, 9 kill, 115

L language development, 68 languages, 20 Latinos, 52 lead, viii, 13, 34, 36, 37, 46, 49, 74, 75, 78, 129, 133, 134, 138, 146, 148, 153, 162, 163, 197, 223, 224 leadership, 198, 204, 205 learners, 102, 103, 123 learning, 13, 17, 25, 43, 44, 46, 48, 70, 99, 102, 103, 104, 105, 106, 107, 109, 110, 112, 116, 121, 122, 123, 124, 125, 126, 128, 129, 130, 131, 132, 137, 216

magazines, 134 magnetic resonance, 89, 97 magnetic resonance imaging (MRI), 72, 89, 95 magnetic resonance spectroscopy, 97 MAI, 165 majority, 3, 34, 46, 53, 68, 77, 100, 141, 142, 144, 146, 151, 190, 207, 222 maltreatment, 95 management, 32, 69, 70, 83, 84, 92, 107, 112, 125, 132, 163, 178, 204, 205, 206, 207, 208, 213, 214, 215, 219 manipulation, 12, 187 marijuana, 223, 225, 226 marketing, 134, 135, 154 Mars, 202, 209 Marx, 162, 165, 176, 178 mass communication, 134, 136, 138, 139 materialism, 5, 12, 13, 14, 156, 192 maternal smoking, 73, 93 mathematics, vii, 1, 2, 15, 16, 17, 18, 21, 24, 25, 26, 28, 32, 34, 35, 38, 45, 46, 47, 49, 50, 52 media, 8, 107, 134, 142 medical care, 208 medication, ix, 91, 161, 163, 164, 167, 168, 169, 176, 200 membership, 76

236

Index

memory, 15, 20, 22, 33, 34, 36, 39, 40, 42, 43, 44, 47, 59, 72, 73, 74, 76, 82, 94, 96, 103, 123, 164, 189, 214, 216, 225 memory processes, 73 mental disorder, 70, 87, 128, 129 mental health, 84, 86, 87, 89, 96, 97, 100, 104, 125, 192 mental health professionals, 86 mental image, 38 mental processes, 15 mental representation, 214, 216, 217, 218 messages, 154, 217 meta-analysis, 49, 73, 76, 90, 95, 129, 131, 157 metaknowledge, 217 metaphor, 5, 27, 32, 47, 48, 49, 53 metapsychology, 3 methodological implications, 16 methodology, 24, 28, 29, 31 military, x, 212 misunderstanding, 122 mobile phone, 143 modeling, 86, 91, 105 models, viii, 50, 73, 93, 100, 102, 103, 106, 118, 122, 154, 185 modification, 43 modules, 84 molecules, 19 morale, 198 motivation, xi, 73, 74, 76, 101, 102, 103, 106, 107, 128, 221, 222, 223, 225 motor behavior, 75 motor control, 72, 73 motor skills, 67 motor system, 40 multidimensional, 81, 83, 86, 226 multimedia, 130 multiple regression, 163, 164, 167, 172 multiple regression analyses, 163, 167, 172 multivariate analysis, 163 muscles, 32 music, 137, 141, 144

N naming, 15 natural laws, 45 natural sciences, 25 natural selection, 79, 81 negative attitudes, 101 negative consequences, 74, 77

negative effects, 148, 155 negative emotions, 185 negative feedback, 49 negative mood, 79 negative outcomes, 79, 100, 101, 129 negative reinforcement, 80 negativity, 87, 182, 190 neglect, 26, 29, 30 negotiating, 120 nerve, 69 nervous system, 40 Netherlands, 52, 132 neural systems, 223 neurobiology, 81 neuroimaging, 91 neuroleptics, 164, 167, 168, 172 neurons, 49 neuropsychological tests, 82 neuropsychology, 91 neuroscience, 85 neurotransmission, 73 neurotransmitter, 72 neutrinos, 12 New England, 210 Newtonian physics, 12, 29 nicotine, 222, 224, 226, 227 noise, 165, 177 non-Euclidean geometry, 23 nonverbal cues, 128 normal development, 78 North America, 91 novel stimuli, 69 nucleus, 222, 227 null, 191 null hypothesis, 191 nursery school, 88 nurses, 198, 199, 200, 202, 204 nursing, 162, 166, 167, 176, 177, 178, 193, 198, 199 nursing home, 162, 177, 178 nutrition, 131, 135, 158

O obesity, 227 objective criteria, 135, 153 observable behavior, 165 observed behavior, 165 offenders, x, 197, 207 omission, 17 one dimension, 46

Index opacity, 16 operant conditioning, 79 operations, 46, 214, 216 opiates, 164, 167, 168 opioids, 172 opportunities, 106, 124, 208, 222 Oppositional Defiant Disorder, 71 optimization, 18, 21, 108 organism, 8 organize, 70, 130, 205 organizing, 76, 205 osteoporosis, 162 overlap, 63, 86

P PAA, 162, 163, 165, 167, 168, 169, 170, 171, 172, 175, 176 Pacific, 159 pacing, 162, 165 packaging, 136 pain, ix, 19, 161, 162, 163, 165, 166, 167, 168, 173, 175, 176, 177, 178, 190, 192, 195, 216 parallel, 19, 105, 134 parallelism, 3, 14 parental consent, 117 parenting, 63, 65, 71, 78, 79, 80, 81, 82, 83, 84, 86, 87, 89, 116 parenting styles, 79, 81 partition, 45 pathways, 77, 95, 214, 218 patient care, x, 197, 198, 199, 200, 208 Pearson correlations, 167 pedagogy, 53 pediatrician, 116 peer group, 100, 206 peer rejection, 126, 127 peer relationship, 84, 101, 132 perceptual sensitivity, 64, 66, 68, 82 performance, viii, 75, 82, 92, 99, 100, 104, 106, 115, 116, 117, 118, 119, 120, 121, 122, 124, 193, 202, 203, 216, 224 permission, 114, 117 permit, 124 perseverance, 164 personal relations, 128 personality, 90, 92, 94, 95, 131, 165, 185, 192, 202, 203, 224, 226 personality type, 202, 203 persuasion, 135, 158

237

pharmacology, 90 photographs, 183 photons, 12 physical abuse, 207 physical activity, 131 physical health, 69 physical sciences, 14 physicalism, 5, 47 physics, 2, 4, 5, 7, 8, 9, 11, 13, 19, 21, 24, 25, 26, 28, 29, 35, 42, 43, 45, 49, 51, 57, 102 physiology, 4, 15, 19, 35 pilot study, 177 PISA, 47, 50, 52, 58, 60 pitch, 48 planets, 8 plants, 40, 47, 183, 213, 218 platform, 106, 107 Plato, 7, 32 pleasure, xi, 81, 221 pluralism, 6 Poincaré, vii, 1, 20, 22, 23, 24, 25, 30, 32, 39, 47, 59 poor performance, 76, 122 positive behaviors, 84 positive correlation, 120, 163 positive feedback, 10 positive reinforcement, 105, 115, 116 positive relationship, 151, 162 positivism, 14, 30, 49 positron, 225 positron emission tomography, 225 potential benefits, 103 poverty, 100, 101 power plants, 213, 218 pragmatism, 15 prefrontal cortex, 72 pregnancy, 73, 93 prejudices, 8 preschool, 67, 68, 71, 80, 86, 87, 88, 90, 92, 93, 96, 97 preschool children, 88, 92, 93, 96, 97 preschoolers, 88, 89, 92, 93 prestige, 135 prevention, 101, 128, 129, 163 prima facie, 42 primacy, 46, 51 primary school, viii, 133, 138, 139 primary school age children, viii, 133, 138, 139 probability, 9, 44, 182 probands, 88 problem behavior, 71, 77, 117

238

Index

problem solving, viii, x, 78, 99, 100, 102, 103, 104, 105, 106, 107, 108, 109, 112, 113, 115, 116, 118, 119, 120, 121, 122, 124, 125, 130, 131, 212, 219 problem-solving, x, 211, 212, 213, 215 producers, 134, 136, 151, 153 productivity, 198, 208 programming, 107, 125, 158 progress reports, 106 project, 117, 125, 191 promoter, 53 prosocial behavior, 121 protective factors, 129 prototype, 104, 105, 113, 115, 116, 121, 123, 124, 125, 219 psychiatric disorders, 91, 92, 227 psychiatrist, 15 psycholinguistics, 132 psychological development, 16 psychological phenomena, 2 psychological processes, 37 psychologist, 8, 15, 22, 40, 47, 51 psychology, vii, viii, 1, 2, 3, 4, 5, 6, 8, 11, 12, 14, 15, 18, 19, 20, 21, 22, 24, 26, 27, 28, 31, 32, 33, 35, 36, 37, 38, 39, 40, 41, 42, 45, 47, 48, 50, 51, 52, 56, 87, 90, 94, 104, 131, 132, 184, 192 psychopathology, 79, 87, 89, 91, 93, 94, 100, 129, 131, 178 psychopharmacology, 90, 226 psychophysics, 5, 42 public health, 95 punishment, 74, 78

Q quantum mechanics, 11, 12 query, 198 questioning, 163, 182 questionnaire, 122, 186, 226

R race, 155 radar, 198 radical empiricism, 4, 6, 14, 51, 54 radio, 134 rating scale, 72, 81, 82, 89, 122 rational reconstruction, 48 rationality, 215 reaction time, 73, 75

reactions, 24, 64, 65, 66, 67, 69, 70, 75, 85, 92, 136, 202, 216 reactivity, 65, 66, 69, 70, 75, 79, 88 reading, 19, 30, 45, 103, 111, 114, 128, 139 real time, 122 realism, 45 reality, 3, 14, 30, 45, 50, 51, 132, 141, 217, 219 reasoning, 15, 16, 32, 106, 113, 118, 119, 121, 123, 124, 190, 213, 214, 219 recall, 103, 224 receptors, 226 reciprocal relationships, 76 recognition, 35, 45, 130 recommendations, 89, 207, 218 reconstruction, 5, 6, 9, 20, 21, 31, 36, 48, 73 reference frame, 8 reference system, 35, 37 reforms, 50, 52 regression, 163, 164, 167, 168, 172, 175 regression analysis, 167 regression equation, 168, 175 regression model, 167, 168 reinforcement, xi, 80, 85, 93, 105, 115, 116, 123, 221 reinforcers, 106 reintroduction, 44 rejection, 48, 80, 126, 127, 128, 129 relationship quality, 225, 227 relatives, 72, 88 relevance, 46, 74, 217 reliability, 82, 83, 164, 165, 166, 175, 212 religious beliefs, 202 remission, 85 replacement, 222, 224, 227 reporters, 82 reputation, 198, 200, 204 requirements, 46 researchers, ix, 39, 63, 84, 85, 161, 162, 163, 186, 190, 223, 225 residuals, 167 resilience, x, 130, 191, 192, 211, 212 resistance, 50, 77, 198 resolution, 132 resource management, 206 resources, 89, 209, 210, 225 response time, 200 responsiveness, 79, 80, 83, 158 responsivity, 69 restaurants, 142 retina, 7, 41

Index retirement, 53, 54 retribution, 123 revenue, 204 rewards, 74, 78 risk factors, 88, 95 risk management, 204 risks, 132, 204, 212, 214, 216 risk-taking, 217 Romania, 32, 59 romantic relationship, 222, 223 rules, 111, 112, 184, 214, 215

S sadness, 81 scheduling, 214, 215 schema, vii, 1, 48 schemata, 26, 214, 215 school adjustment, 73 school performance, 100 school success, 128 schooling, 203 science education, 3, 25, 50, 51, 52, 53, 54, 57, 105 scientific knowledge, 47 scientific observation, 43 selective attention, 88 selective mutism, 131 self esteem, 101, 203 self-assessment, 205 self-concept, 225 self-control, 79, 85, 86, 90, 118, 119 self-efficacy, 105 self-esteem, 100, 126 self-observation, 33 self-organization, 90 self-paced learning, 100 self-perceptions, 126 self-regulation, 64, 65, 66, 68, 69, 71, 74, 76, 77, 78, 80, 81, 85, 86, 90, 94, 95 sensation, 19, 24, 29, 36, 38, 39, 40, 41, 42, 45, 49, 77, 78, 216 sensation seeking, 77, 78 sensations, 24, 28, 29, 32, 33, 36, 37, 39, 40, 41, 42, 43, 49, 216 sense perception, 12, 184 senses, 6, 9, 103, 182, 185, 216 sensing, 187, 189 sensitivity, 64, 66, 67, 68, 74, 78, 80, 82, 175, 190, 205, 207, 223, 226 sensory experience, 190

239

SES, 73 sex, 128 sex differences, 128 sexual harassment, 197, 207 shape, 48, 111, 136, 137 shortage, 198 short-term memory, 214, 216 shyness, 67, 81, 128, 131 sibling, 101 siblings, 90 side effects, 154 signs, 28, 68, 71, 198 simulation, 103, 129 skill acquisition, 124 skills training, viii, 100, 101, 102, 105, 107, 116, 121, 122, 123, 124, 125, 126, 127, 128, 130 skin, 19, 41, 43, 110, 117 slaves, 146 sleep disturbance, ix, 161, 162, 163, 166, 167, 168, 173, 175, 176, 178, 179 sleep habits, 165 smoking, vii, xi, 73, 93, 221, 222, 223, 224, 225, 226, 227 smoking cessation, vii, xi, 221, 222, 224, 225, 226, 227 SMS, 112 social adjustment, 126 social anxiety, 101, 105 social behavior, viii, 71, 82, 94, 100, 101, 106, 108, 117, 121, 122, 124 social cognition, 127 social competence, 96, 123, 129 social context, 75 social desirability, 122, 123, 131 social development, 66, 92, 104, 118, 153 social environment, 53, 162 social interactions, 116 social learning, 99, 103, 104, 106, 107, 112, 116, 121, 122, 123, 124, 125 social learning theory, 106 social life, 132 social network, 223 social problems, 69, 99, 100, 102, 105 social relations, 99, 105 social responsibility, 154 social sciences, 25 social situations, 99, 100, 105, 108, 113, 116, 117, 122, 123, 124

240

Index

social skills, viii, 76, 85, 86, 99, 100, 101, 102, 104, 105, 106, 107, 108, 116, 117, 118, 120, 121, 122, 123, 124, 125, 127, 128, 131 social skills training, viii, 100, 101, 102, 104, 105, 107, 116, 121, 122, 123, 125, 127, 128 social status, 126 socialization, 90, 96, 132, 138, 141, 146, 148, 153, 157 socioeconomic status, 116 sociology, 192 software, viii, x, 99, 100, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 116, 117, 121, 122, 123, 124, 125, 164, 166, 212, 217, 219 solitude, 128 special education, 78, 129 specialists, 218 specialization, 25, 45, 46 spectroscopy, 97 speculation, 13, 29, 50 speech, 54, 73, 74, 76, 132, 162 spelling, 40 spirituality, 182, 184, 185, 189, 190, 191, 192, 194 spore, 10 SPSS software, 166 standard deviation, 166 standard error, 167 stars, 29, 115 states, 2, 22, 32, 45, 54, 73, 74, 112, 177, 182 statistics, 166, 167 stimulant, 83, 84 stimulus, 20, 34, 43, 67, 85, 136, 223 storage, 215 storytelling, 130 strategy use, 102 stressful life events, 99, 100 stressors, 73 striatum, 222, 225 stroke, 222 student achievement, 52 style, viii, 64, 65, 77, 78, 87, 88, 104, 108, 109, 110, 117, 132, 135, 202, 205 substance abuse, 100, 129, 203, 223 substitution, 223 substitution effect, 223 substitutions, 223 substrates, 73 success rate, 225 suicidal behavior, 126 suicide, 100 Sun, 222, 226

supervision, 213, 218 supervisor, 207 surging, 23 survey, 22, 138, 156, 189, 198, 199, 201, 205, 206, 207 susceptibility, 79, 81, 87, 222 Switzerland, 227 syllogisms, 22 symptoms, 63, 66, 67, 68, 70, 71, 72, 73, 74, 76, 77, 81, 82, 84, 85, 86, 88, 89, 96, 161, 165, 166, 178, 224 synergistic effect, 222 synthesis, 7, 9, 15, 16, 35, 40, 41, 42, 52, 53, 73, 103

T tactics, 155, 158 Taiwan, 130 target, viii, 101, 107, 108, 133, 136, 138, 141, 153, 198 task performance, 86 teacher training, 52 teachers, 51, 52, 54, 82, 85 technical support, x, 211, 212, 213 technician, 54 technologies, 128 technology, x, 94, 102, 103, 107, 109, 116, 121, 122, 123, 125, 134, 197, 217 teeth, 154 teleology, 6, 10, 35, 37, 38 television ads, viii, 133 television advertisements, viii, 133, 136, 137, 138, 141, 142, 144, 146, 147, 148, 151, 153, 155, 158 television viewing, 158 temperament, viii, 63, 64, 65, 66, 69, 70, 71, 74, 75, 77, 78, 79, 80, 81, 82, 86, 87, 88, 90, 95, 96, 97 tension, 130 test scores, 101, 127 testing, 28, 92, 99, 104, 111, 122, 124, 129, 213, 216 test-retest reliability, 83 theatre, 214 theoretical concepts, 17, 131 theoretical psychology, 56 therapeutic intervention, 85 therapy, 26, 88, 89, 90, 91, 92, 96, 113, 126, 127, 132, 192, 222, 227 thoughts, x, 2, 5, 9, 10, 11, 13, 17, 19, 21, 23, 29, 31, 33, 34, 35, 36, 37, 38, 39, 42, 45, 46, 47, 48, 49, 50, 53, 187, 192, 205, 212, 219 tides, 29

241

Index time-frame, 30 tobacco, 226, 227 tobacco smoking, 226 toddlers, 74, 83, 87, 96 tones, 117 toys, 137, 138, 142, 144, 146, 158 tracks, 99, 104, 110, 122 traditions, 3 traffic control, 213, 214, 216, 218, 219 training, viii, 2, 8, 26, 31, 45, 46, 50, 52, 57, 83, 84, 86, 90, 91, 92, 100, 102, 103, 104, 105, 110, 111, 116, 123, 124, 125, 126, 128, 130, 198, 203, 205, 207 training programs, 102, 104, 207 traits, 46, 202 trajectory, 86 transformation, 41, 167 transformations, 23, 41 translation, 3, 20, 33, 37, 61, 219 transmission, 21, 41, 44, 217 trauma, 185 trial, 93, 158 triggers, 215 troubleshooting, 219 Turkey, 133, 135, 136, 138, 139, 148, 153 turnover, 198, 204 tutoring, vii, 104, 121, 122, 123, 124, 125, 130 twins, 77 twist, 10

U unconscious influence, 30 unhappiness, 156 united, 63, 107, 198, 202, 221, 225 universe, 9, 138, 193 universities, 52 US Department of Health and Human Services, 227

victimization, 95, 105, 129, 131 victims, 131, 132 video, 124, 128, 224 video games, 128 violence, 48, 127 vision, 19 visual images, 26 visualization, 20 vocabulary, 15 vocalizations, 65, 177 voicing, 50 volunteers, 117 Vygotsky, 105, 132

W waking, 32 walking, 17, 23 Washington, 55, 87, 93, 95, 97, 129, 159 watches, 141 water, 5, 37, 184, 193 wealth, 202 web, 107, 108, 116, 124 web browser, 107 well-being, 100, 177, 184, 185, 186, 189, 190, 191, 193 wellness, 210 Wertheimer, Max, viii, 2 windows, x, 181 Wisconsin, 227 withdrawal, 70, 85, 131 workers, 202 working memory, 72, 73, 74, 76, 94, 96, 214, 216 workload, 216 workplace, 128, 198, 202 worldwide, 221 worry, 13, 198 wrongdoing, 192

V validation, 177, 178 variables, ix, 79, 81, 154, 161, 162, 163, 167, 168, 175, 176, 177 variations, 5, 77, 82, 104, 124 vector, 108 vein, 185 velocity, 29 Venus, 202, 209

X XML, 112, 217

Y Yale University, 55, 57, 58, 128, 129 yield, 23, 123