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Outcome of psychiatric treatment: what is relevant for our patients?

This study investigated relevant outcome domains in the patient's perspective following psychiatric outpatient treatment for non-psychotic, non-substance-related disorders. Questionnaires, including the Client Satisfaction Questionnaire (CSQ) and the Bern Inventory of Treatment Goals (BIT-C) applied as a broad typology of outcome domains, were mailed 1 year after treatment to outpatients who had undergone eight or more therapy sessions. Patients reported a wide range of relevant outcomes, including changes with respect to the interpersonal domain, their self-concept, and existential issues. Changes in depressive and anxiety symptoms were rated as particularly important; the reports of both symptomatic and more integral changes were related to treatment characteristics, patient's diagnostic category, and patient's employment status. Patient satisfaction was particularly related to reported changes in the interpersonal domain. This exploratory study provides evidence that traditional outcome measures that include mood, anxiety, and fear symptoms continue to assess the most important areas for change in patients' views. However, they might miss relevant therapeutic achievements in some of our patients, particularly in those suffering from adjustment and personality disorders. The use of measures that include dimensions such as personal growth, purpose of life, and positive relations with others may record important changes in these patients.

Adaptation, Psychological↗
PubMed2006

Growth following adversity: theoretical perspectives and implications for clinical practice.

A number of literatures and philosophies throughout human history have conveyed the idea that there is personal gain to be found in suffering, and it is an idea central to the existential-humanistic tradition of psychology. However, it is only relatively recently that the topic of growth following adversity has become the focus for empirical and theoretical work. In this paper, we review theoretical models of growth, and discuss the implications of growth for clinical practice. Three main theoretical perspectives are reviewed, the functional-descriptive model, the meta-theoretical person-centered perspective, and the biopsychosocial-evolutionary view. It is proposed that these three approaches to theory offer different but complementary levels of analysis, and that theoretical integration between them is possible. We then go on to explore the implications of this theoretical integration for clinical practice, and conclude with a consideration of the role of therapy in facilitating growth following adversity.

Humans↗
PubMed2004

Quality of life and personality disorders in heroin abusers.

OBJECTIVE: The aim of this study is to describe the personality disorders (PD) and personality profile of heroin-abusers and their quality of life (QoL), and to investigate the correlation between the two. METHOD: One hundred and eighty heroin-abusers during their residential treatment participated in the study. The Structured Clinical Interview-II (SCID-II) allowed the identification of two subgroups of heroin-abusers on the basis of presence/absence of a PD. All patients filled in the Temperament and Character Inventory (TCI), the McGill QoL Questionnaire (MQOL) and an anamnestic sheet. A control group of 63 non-clinical subjects was recruited. RESULTS: Abusers with a PD differ in their personality profile from abusers without PD and score lower on the total MQOL. As regards TCI scales, novelty seeking (NS), reward dependence (RD) and self-directedness (SD) predict the age of onset of the abuse, while cooperativeness (C) is a predictor of the number of community admissions. DISCUSSION: Low scores on self-directedness and cooperativeness in abusers support the hypothesis of an immature character and relational difficulties. Novelty seeking is the only dimension which is altered both in abusers with and without a PD and is not strictly dependent on Axis II comorbidity. QoL is lower in abusers than in controls, according to their physical, psychological and existential suffering. Last, an interesting link emerged between personality and perceived QoL.

Adult↗
PubMed2005

Addiction severity assessment tool: development of a self-report measure for clients in substance abuse treatment.

This article describes the development and reliability and validity testing of the Addiction Severity Assessment Tool (ASAT), a brief, 27-item multidimensional self-report measure of problem severity in daily functioning, relational functioning, dysphoric states, dependence severity, recovery skill/self-efficacy, and existential factors for adult substance abuse clients. Items generated for an Alpha version were conceptually and empirically evaluated. A Beta version underwent further empirical evaluation and item selection. Cross validation of the final version examined internal consistency, test-retest reliability, factor structure, and convergent/discriminant and known groups validity. Sensitivity to change was evaluated in a 3-month outcome study. Clients were recruited from inpatient, outpatient and residential substance abuse treatment centers, and a sample of 238 nonpatients were also recruited from community groups. The Beta version was tested with 201 clients, and cross validation involved 242 clients. Well-known standardized, self-report and interview-based comparison measures were used to test convergent/discriminant validity of the ASAT. Reliability coefficients for the six ASAT domains were acceptable. Reasonable convergent/discriminant and known groups, construct validity were demonstrated, along with sensitivity to change of the domain scale scores. The ASAT appears to comprise a useful new tool for assessing clinical outcomes of adult clients in substance abuse treatment.

Adult↗
PubMed2004

A new international framework for palliative care.

In spite of recent advances in anti-cancer treatments, most adult cancer patients still ultimately die from their disease. There should therefore be free access to palliative care around the clock and seven days a week, for all cancer patients, as a fundamental human right. At present, the implementation of palliative care and patients' access to it are inconsistent across Europe and many other parts of the world. The World Health Organisation (WHO) made an important advance in 1986 by first defining palliative care and, then updating this definition in 2002. However, this definition could benefit from further refinement in order to reflect the increasing multi-professional specialisation in this subject, and to recognise the different models for delivering this type of care. We recommend that palliative care should be defined as follows: Palliative care is the person-centred attention to symptoms, psychological, social and existential distress in patients with limited prognosis, in order to optimise the quality of life of patients and their families or close friends. Based on this definition, we propose two further types of palliative care which reflect the reality of how palliative care is actually delivered: Basic palliative care is the standard of palliative care which should be provided by all healthcare professionals, in primary or secondary care, within their normal duties to patients with life-limiting disease. Specialised palliative care is a higher standard of palliative care provided at the expert level, by a trained multi-professional team, who must continually update their skills and knowledge, in order to manage persisting and more complex problems and to provide specialised educational and practical resources to other non-specialised members of the primary or secondary care teams. If a patient has difficult symptoms which cannot be controlled by his/her current healthcare team, he/she has a right to be referred, and the current healthcare provider has an obligation to refer, to the local palliative care team. Important priorities to ensure the standardisation of, and uniform access to, palliative care for all cancer patients include: Integration of palliative care services with the primary care and oncology teams. Establishment of a specialised palliative care service in each major cancer centre. Establishment of educational programmes covering palliative care for undergraduates, oncologists, primary care team members and specialists training in palliative care. Support for research using appropriate methodologies to underpin the scientific basis of palliative care. Establishment of quality assurance programmes. Recognition of palliative medicine as a medical specialty. Establishment of academic centres of excellence with chairs of palliative medicine and palliative care nursing. Removal of unnecessary restrictions on all drugs which are proven to be of benefit in symptom control, especially improving access to strong opioids. Improved information for patients and family carers to allow them to make choices and exercise autonomy.

Humans↗
PubMed2005

The experience of agency nurses working in a London teaching hospital.

This Husserlian phenomenological study explored the lived experience of eight full-time agency nurses working in the environment of intensive care in London, United Kingdom. In-depth interviews were used to ascertain the participants' experiences of full-time agency nursing in intensive care. Colaizzi's [Colaizzi P. Psychological research as the phenomenologist views it. In: Vale R, King M, editors. Existential-phenomenological alternatives for psychology. London: Oxford University Press; 1978, p. 48-71] method of data analysis was utilised. Thematic analysis identified three cluster themes: the shared experience of lacking confidence; the shared experience of deskilling; and the shared experience of feelings of isolation. The theme of the shared experience of lacking confidence identified the importance of support and understanding of agency nurses' needs in the ICU. The theme of the shared experience of deskilling illuminated participants concern at not having the opportunity to care for patients of higher acuity. The theme of the shared experience of feelings of isolation highlighted that often participants did not feel they "belonged to a team". Study findings suggest the need to include: the implementation of protocols within the clinical setting; the provision of performance feedback to agency nurses; and the consideration of ongoing structured professional development and education for ICU agency nurses.

Attitude of Health Personnel↗
PubMed2006

Pedagogical encounters between nurses and patients in a medical ward--a field study.

BACKGROUND: Patient teaching is regarded as an important aspect of nursing care as well as an essential part of the nursing profession. In nursing practice, a distinction can be made between formal (planned) and informal (spontaneous) patient teaching. The major part of patient teaching research is within the area of formal teaching. In spite of the fact that spontaneous teaching occurs in everyday nursing practice, there is a lack of knowledge in this area. OBJECTIVES: The aim was to illuminate pedagogical dimensions in nursing situations and informal teaching. DESIGN: The study is a fieldwork study within the frames of a life-world phenomenological tradition. PARTICIPANTS AND SETTING: Fifteen registered nurses in a general medical ward of a university hospital in Sweden were followed in their daily work with patients. Twelve patients suffering from various chronic diseases were interviewed. METHODS: The observations comprised a total of 173 h on 34 separate occasions. Informal dialogues with nurses were carried through. Further, formal interviews were conducted with 12 of the observed patients. The data were analysed by means of a life-world phenomenological approach. RESULTS: Two different pedagogical encounters are presented: "Players in different field pedagogical encounters", in which there is a breakdown in the pedagogical dialogue, and "Players in same field pedagogical encounters", in which the pedagogical dialogue develops. Patients' experiences of seeking and acquiring knowledge within these two types of encounter are characterised as "worry" versus "preparedness". Patients' dignity is either threatened or supported, depending on the type of encounter. CONCLUSIONS: Health care organisations have to create a pedagogical climate where "Same field pedagogical encounters" can be created. The nurse has to view the patient as a learning person in order to help the patient to achieve "preparedness". "Preparedness" is described as a cognitive-emotive-existential state and emphasised as an important goal of patient teaching.

Adult↗
PubMed2004

An empirical analysis of the decision-making of limiting life-sustaining treatment for patients with advanced chronic obstructive pulmonary disease in Hong Kong, China.

OBJECTIVES: To understand the prognostic and quality-of-life considerations surrounding life-sustaining treatment decisions for patients with advanced chronic obstructive pulmonary disease (COPD) in Hong Kong China. METHODS: A documentary review of 49 COPD patients and 19 patient case studies from the medical departments of 2 hospitals were undertaken to examine the practices of DNI decision-making (do not perform mechanical ventilation and cardiopulmonary resuscitation). Statistical, event, and thematic analyses were conducted to delineate the prognostic and quality-of-life factors that shaped the not for intubation and mechanical ventilation (DNI) decisions. RESULTS: Three major treatment-limiting decision-making patterns existed in practice: 1) Patient-initiated and shared decision-making with physician (n = 14); 2) Physician-initiated and shared decision-making with the patient/family members (n = 24); and 3) Physician-initiated DNI decision-making with patient family, but without patient participation due to mental incapacity (n = 11). Prognostic considerations include physiological parameters, performance status, concomitant diseases, therapeutic regimens, and the utilization of medical services. Three major themes were delineated regarding the way in which the patients evaluated their life quality in the context of DNI status. They are prognostic awareness, illness burdens, and existential concerns. DISCUSSION: A decision-making framework used by patients/families/physicians to limit life-sustaining treatments in patients with advanced COPD is delineated. Observations regarding how treatment limiting decision-making for patients with advanced chronic illnesses can be improved in Hong Kong are discussed.

Aged↗
PubMed2004

Measuring the quality of structure and process in end-of-life care from the bereaved family perspective.

Measurement of the structure/process of care is the first step in improving end-of-life care. The primary aim of this study was to psychometrically validate an instrument for directly measuring the bereaved family's perception of the necessity for improvement in structural/procedural aspects of palliative care. Different sets of questionnaires were sent to 800 and 425 families who lost family members at one of 70 certified palliative care units in Japan in the development and validation phases, respectively, and 281 families of the latter group in the follow-up phase. The participants were requested to fill out a newly-developed Care Evaluation Scale (CES), along with outcome measures (the perceived experience and satisfaction levels) and potential covariates (the degree of expectation, the Center for Epidemiologic Studies Depression Scale, and the Social Desirability Scale). We obtained 485, 310, and 202 responses in the development, validation, and follow-up phases (response rates: 64%, 75%, and 72%, respectively). The 28-item CES had an overall Cronbach's coefficient alpha of 0.98; the intra-class correlation coefficient in the test-retest examination was 0.57. A confirmatory factor analysis revealed 10 subscales: physical care (by physicians, by nurses), psycho-existential care, help with decision-making (for patients, for family), environment, family burden, cost, availability, and coordination/consistency. The CES subscales were only moderately correlated with the perceived-experience and satisfaction levels of corresponding areas (r=0.36-0.52 and 0.39-0.60, respectively). The CES score was not significantly associated with the degree of expectation, the changes of depression, or the Social Desirability Scale. The CES is a useful tool to measure the bereaved family's perception of the necessity for improvement in structural/procedural aspects of palliative care. The advantages of the CES are: 1) it specifically evaluates the structure and process of care, 2) it directly identifies needed improvements, 3) it is not affected by the degree of expectation, depression, or social desirability, and 4) it has satisfactory psychometric properties.

Aged↗
PubMed2006

Menopausal women's positive experience of growing older.

OBJECTIVE: This paper aims to describe menopausal women's positive experience of growing older and becoming middle-aged. METHODS: Qualitative interviews with 24 menopausal women, selected on the basis of a questionnaire, covering a broad spectrum of Danish women in terms of experience of menopausal symptoms, treatment, contact with the health care system, and social background. RESULTS: The women expressed varied and many-facetted views on ageing and clearly connected the fact that they were menopausal to the ageing process. All, except one, mentioned positive aspects of growing older: 1. they had become more experienced and competent; 2. they had gained more freedom; 3. they perceived possibilities of personal development that made them able to hold on to their own opinions and better speak their minds. The described positive effects were the result of having lived a long life, of good and evil, not of the menopause itself. The women also mentioned negative aspects: 1. negative expectations; 2. negative experiences. Positive aspects, often of psychological or existential nature, seemed to outweigh the negative experiences which were mostly related to bodily changes or losses. CONCLUSION: This paper discusses the importance of avoiding unnecessary negative expectations of ageing and menopause and of focusing, instead, on the positive aspects of growing older. Health professionals should reconsider the necessity to talk about future risks with healthy women, and instead support the women's agenda when they try to cope with real-life problems.

Adaptation, Psychological↗
PubMed2006

A qualitative study of women's experiences of home birth in Sweden.

OBJECTIVE: to illuminate the experiences of women who have given birth at home. METHODS: a descriptive design with a qualitative approach based on interviews with 12 women. The text was analysed using a phenomenological-hermeneutic method. FINDINGS: giving birth at home meant preserved authority and autonomy whereby the women themselves ruled the situation. The women's experiences of giving birth at home can be divided into three themes, with internal variations viewed as sub-themes. The main themes were as follows: 'having faith in one's own competence'; 'choosing support on one's own terms'; and 'being at home'. The experience embraced an earthly dimension, represented by reliance on inherent natural forces, and an existential, spiritual dimension, represented by faith in life itself, expressed in terms of the sacredness of giving birth, a heavenly experience, and wisdom about life itself. CONCLUSION: the experience of giving birth at home seems to differ from findings of studies focusing on the experience of giving birth in hospital. A reasonable goal for maternity care in hospital could, however, be that all women should have the opportunity to give birth on their own terms in a supportive and calm environment, surrounded by people who can assist if needed.

Adult↗
PubMed2005

Nurses', midwives' and health visitors' perceptions of the impact of higher education on professional practice.

AIM: This study examines the perceptions of qualified nurses, midwives and health visitors of the impact of higher education on professional practice. METHODOLOGY: This is a qualitative study using a phenomenological approach. A non-probability convenience sample of 12 qualified nurses, midwives and health visitors who had enrolled upon a Master of Science programme in Professional Practice at a United Kingdom Higher Education Institution in the East Midlands were interviewed using semi-structured interviews, which were audio-taped and analysed using Colaizzi (1978) [Colaizzi, P., 1978. Psychological research as a phenomenologist views it. In: Valle, R., King, M., (Eds.), Existential Phenomenological Alternatives for Psychology. Oxford University Press, New York, pp. 48-71] approach. Approval to undertake this study was received from the University's Research Ethics Committee. RESULTS: Four themes emerged from the interview data. These were personal and professional motivation, workplace constraints, valuing "hands-on" nursing and client contact, and challenging and questioning practice. From the respondents' perspective, there was a strong view that higher education has a positive effect in practice, but a significant number of factors including time and support seemed to inhibit the possible benefits in practice. These are discussed in relation to the findings from similar studies. CONCLUSION: This study has highlighted the need for further research to explore the impact of higher education on client care and service delivery.

Adaptation, Psychological↗
PubMed2005

The psychiatric educational experiences of advance beginner RNs.

The nursing profession is in an extraordinary position to improve educational experiences of prospective nurses, particularly within psychiatric nursing. To acquire an enhanced understanding of the nurse's instructive learning process and skills regarding psychiatric nursing, this study described and explored the experiences of advance beginner nurses employed in mental health facilities. It also denoted the registered nurses' (RNs) educational preparedness to function in their new professional role. Reflection of the nurse's personal experiences was acquired by using a qualitative study with a phenomenological approach. Colaizzi's Frame work [Colaizzi, P., 1978. Psychological research as the phenomenologist views it. In: Valle, R., King, M. (Eds.), Existential Phenomenological Alternative for Psychology. Oxford University Press, NY, pp. 48-71] guided the mode of data analysis by enlisting 15 advance beginner nurses to participate in in-depth, audio-taped interviews. Results from this study indicated a need for educational improvements to accurately reflect trends of psychiatric patient care in order to emphasize interpersonal relationships as well as multi-diagnosis and co-morbidity. Additionally, increased contact with diverse patient populations and responsibilities congruent with other clinical placements in managing the patient's overall care were noted to be critical. This study suggests that some nursing educational programs can improve their curriculum, methods of teaching and approach used to introduce students to psychiatric mental health nursing.

Adaptation, Psychological↗
PubMed2004

Place of death: preferences among cancer patients and their carers.

The place of death of cancer patients has become an important theme in UK cancer and palliative care policy. This paper examines the place of death preferences of 41 terminally ill cancer patients and 18 of their informal carers, living in the Morecambe Bay area of north-west England. We interviewed cancer patients referred to the research team by 13 specialist palliative care professionals; patients had an estimated 3 months of life remaining. The study design involved an in-depth qualitative interview with each patient soon after referral to the study, followed by an interview some 4 weeks later and subsequent tracking interviews by telephone at 2-4 week intervals until death occurred. Interviews were also conducted with main coresident carers soon after patient referral to the study and again in the post-bereavement period. Thirteen factors were identified as shaping the place of death preference of patients and carers. These are organised into four thematic domains: the informal care resource, management of the body, experience of services, and existential perspectives. In documenting these factors, this paper adds significantly to current knowledge on the factors that shape place of death preference, a field of enquiry acknowledged to be underdeveloped (J. Palliative Med. 3 (2000) 287). More importantly, it uncovers some of the reasons that underpin these preferences. Our research revealed a much stronger preference for deaths in a hospice than had been anticipated, leading us to take a qualified stance on the current policy drive in favour of home deaths by those charged with delivering UK cancer and palliative care services.

Adult↗
PubMed2005

Making the invisible body visible. Bone scans, osteoporosis and women's bodily experiences.

The imaging technology of bone scans allows visualization of the bone structure, and determination of a numerical value. Both these are subjected to professional interpretation according to medical (epidemiological) evidence to estimate the individual's risk of fractures. But when bodily experience is challenged by a visual diagnosis, what effect does this have on an individual? The aim of this study was to explore women's bodily experiences after a bone scan and to analyse how the scan affects women's self-awareness, sense of bodily identity and integrity. We interviewed 16 Danish women (aged 61-63) who had had a bone scan for osteoporosis. The analysis was based on Merleau-Ponty's perspective of perception as an embodied experience in which bodily experience is understood to be the existential ground of culture and self. Women appeared to take the scan literally and planned their lives accordingly. They appeared to believe that the 'pictures' revealed some truth in themselves. The information supplied by the scan fostered a new body image. The women interpreted the scan result (a mark on a curve) to mean bodily fragility which they incorporated into their bodily perception. The embodiment of this new body image produced new symptom interpretations and preventive actions, including caution. The result of the bone scan and its cultural interpretation triggered a reconstruction of the body self as weak with reduced capacity. Women's interpretation of the bone scan reorganized their lived space and time, and their relations with others and themselves. Technological information about osteoporosis appeared to leave most affected women more uncertain and restricted rather than empowered. The findings raise some fundamental questions concerning the use of medical technology for the prevention of asymptomatic disorders.

Body Image↗
PubMed2006

Long-term survival from gynecologic cancer: psychosocial outcomes, supportive care needs and positive outcomes.

OBJECTIVES: To assess the long-term psychosocial outcomes and supportive care needs of gynecologic cancer survivors. METHODS: Women who had received care in a tertiary-based gynecologic cancer center 1-8 years earlier and who were disease-free were invited to complete a mailed self-report questionnaire to assess psychosocial outcomes and supportive care needs. RESULTS: In total, 199 survivors participated in the study. Survivors reported normal quality of life and relationship adjustment although functioning was at the lower end of the range; over two-thirds (68%) reported positive outcomes. However, nearly one-third (29%) reported clinical levels of anxiety and the most frequently endorsed need concerned fear of disease recurrence (24%). About one-fifth (19%) reported symptoms that indicated posttraumatic stress disorder (PTSD) and this rose to close to one-third (29%) for survivors of advanced stage disease. Nearly 90% of survivors reported supportive care needs and the diagnosis of anxiety or PTSD resulted in a four-fold increase in unmet needs. Needs most frequently concerned "existential survivorship" (e.g., spiritual beliefs, decision making, the meaning of life) and "comprehensive cancer care" (e.g., team care, communication, local health care services). Years since diagnosis was not related to distress or need levels. CONCLUSIONS: All members of the care team need to be aware that significant psychosocial morbidity may occur many years after the successful treatment of a gynecologic malignancy and may be associated with elevated supportive care needs. Comprehensive and extended supportive care services are required to address anxiety and trauma responses and investigate strategies to meet ongoing needs in order to improve long-term psychosocial outcomes.

Adult↗
PubMed1998

Types of spiritual well-being among persons with chronic illness: their relation to various forms of quality of life.

OBJECTIVES: Derive a spiritual well-being classification and thereby enhance understanding of the relation between spiritual well-being, quality of life (QOL), and health among persons with chronic illness or disability. DESIGN: Cluster analyses were performed to develop a spiritual well-being classification. Analysis of variance was used to compare cluster groups on various dimensions of QOL. SETTING: Part of a larger QOL study conducted at a midwestern medical center. PATIENTS: A convenience sample of 216 inpatients: amputation (n = 74), postpolio (n = 37), spinal cord injury (n = 34), breast cancer (n = 36), and prostate cancer (n = 35). Minors were excluded from the study. MAIN OUTCOME MEASURES: Spiritual Well-Being Scale (SWBS), Functional Assessment of Cancer Therapy (FACT), Functional Living Index-Cancer (FLIC), Sickness Impact Profile (SIP), Medical Outcome Survey-Short Form (SF-36), and the Satisfaction With Life Scale (SWLS). RESULTS: Three types of spiritual well-being were identified: religious (n = 146), existential (n = 37), and nonspiritual (n = 30). Significant cluster differences (p < .03 to p < .001) were observed across all QOL domains and life satisfaction. Compared with the other cluster groups, the nonspiritual group reported significantly lower levels of QOL and life satisfaction and the highest proportion of health status change with respect to both improvement and decline in health. CONCLUSIONS: Three types of spiritual well-being were empirically identified in this sample. Subtypes differed significantly with respect to various aspects of QOL. Further research is needed to validate this classification and to determine if type of spiritual well-being has a causal effect on treatment outcome or on the recovery process.

Attitude↗
PubMed2001

When children are more logical than adults: experimental investigations of scalar implicature.

A conversational implicature is an inference that consists of attributing to a speaker an implicit meaning that goes beyond the explicit linguistic meaning of an utterance. This paper experimentally investigates scalar implicature, a paradigmatic case of implicature in which a speaker's use of a term like Some indicates that the speaker had reasons not to use a more informative term from the same scale, e.g. All; thus, Some implicates Not all. Pragmatic theorists like Grice would predict that a pragmatic interpretation is determined only after its explicit, logical meaning is incorporated (e.g. where Some means at least one). The present work aims to developmentally examine this prediction by showing how younger, albeit competent, reasoners initially treat a relatively weak term logically before becoming aware of its pragmatic potential. Three experiments are presented. Experiment 1 presents a modal reasoning scenario offering an exhaustive set of conclusions; critical among these is participants' evaluation of a statement expressing Might be x when the context indicates that the stronger Must be x is true. The conversationally-infelicitous Might be x can be understood logically (e.g. as compatible with Must) or pragmatically (as exclusive to Must). Results from 5-, 7-, and 9-year-olds as well as adults revealed that (a) 7-year-olds are the youngest to demonstrate modal competence overall and that (b) 7- and 9-year-olds treat the infelicitous Might logically significantly more often than adults do. Experiment 2 showed how training with the modal task can suspend the implicatures for adults. Experiment 3 provides converging evidence of the developmental pragmatic effect with the French existential quantifier Certains (Some). While linguistically-sophisticated children (8- and 10-year-olds olds) typically treat Certains as compatible with Tous (All), adults are equivocal. These results, which are consistent with unanticipated findings in classic developmental papers, reveal a consistent ordering in which representations of weak scalar terms tend to be treated logically by young competent participants and more pragmatically by older ones. This work is also relevant to the treatment of scalar implicatures in the reasoning literature.

Adolescent↗