Laura Jenkins

The diagnostic distinction between epilepsy and psychogenic nonepileptic seizures (PNES) can be challenging. Previous studies have demonstrated that experts in conversation analysis can identify linguistic and interactional features in transcripts and recordings of interviews with patients that reliably distinguish between epilepsy and PNES. In this study, ten senior neurology trainees took part in a one-day intervention workshop about linguistic and interactional differences in the conversation behavior of patients with epilepsy and those with PNES. Participants were familiarized with a 12-item questionnaire designed to capture their conversational observations immediately after talking to a patient with seizures. After the intervention, 55 initial outpatient visits of patients referred to seizure clinics were video and audio recorded. All medical diagnoses were confirmed two years after initial presentation on the basis of a chart review (including MRI and EEG findings) by a fully trained epilepsy expert. Postvisit questionnaires relating to patients confirmed to have epilepsy (n = 20) or PNES (n = 13) were analyzed. Doctors' mean responses to 6 of the 12 questions about linguistic and interactional observations differed significantly between the groups with epilepsy and PNES. Receiver operating curve analysis showed that a summation scale based on items demonstrating significant between-group differences correctly classified 81.8% of patients as having epilepsy or PNES. This study shows that a brief Conversation Analytic teaching intervention can enable neurologists to identify linguistic and interactional features supporting the differentiation of epilepsy and PNES as they take their patients' history in routine seizure clinic consultations, potentially improving diagnostic accuracy.

Clinicians making medical diagnoses explaining presentations with transient loss of consciousness are faced with the complex task of having to distinguish between epileptic and (dissociative) non-epileptic seizures and rely heavily on patients' verbal accounts in this process. In this paper we summarise a series of four studies using different techniques to analyse talk between 21 patients with seizures and a neurologist, with the aim of describing conversational profiles typically associated with a medical diagnosis of epilepsy or nonepileptic seizures. The methods employed included conversation analysis, metaphor analysis and content analysis. This summary focuses on the way in which these qualitative methods had to be adapted in order to contribute to the diagnostic process and how quantitative methods were used to explore the differential diagnostic potential of the qualitative findings. In our discussion we consider some of the challenges of combining qualitative and quantitative approaches to talk-in-interaction, whilst recognizing the remarkable benefits the combination of these approaches has for clinical practice.

Traditional theories of socialisation, in which the child was viewed as a passive subject of external influences, are increasingly being rejected in favour of a new sociology of childhood which frames the child as a social actor. This paper demonstrates the way in which conversation analysis can reveal children’s agency in the micro-detail of naturally-occurring episodes in which children express bodily sensations and pain in everyday life. Based on 71 video-recordings of mealtimes with five families, each with two children under ten years old, the analysis focuses on the components of children’s expressions of bodily sensation (including pain), the character of parents’ responses, and the nature of the subsequent trajectory. The findings provide further evidence that children are social actors, active in constructing, accepting and resisting the nature of their physical experience and pain. A conversation analysis of ordinary family talk facilitates a description of how a child’s agency is built, maintained or resisted through the interactional practices participants employ to display knowledge.

Recent conversation analytic work has revealed that there are systematic differences between the ways in which patients with epilepsy and patients with “psychogenic” nonepileptic seizures describe their seizure experiences. But these differences may not become apparent if patients are exposed to traditional fact-oriented questioning. This article describes a one-day intervention workshop, informed by conversation analysis, which was designed to help doctors change their questioning style and solicit diagnostically useful narrative features. A comparison of video recordings of 38 routine consultations before the intervention, and 20 consultations after it, showed that the intervention had the desired effect. Doctors’ problem-presentation solicitation changed, and the patient responses were better suited to revealing diagnostically relevant features of their talk. Data are in British English.

Background: Observational approaches are a means by which children’s pain can be described and analysed, however, they tend to involve coding talk in a way that obscures the mechanisms which connect one utterance to the next (Vervoort et al., 2011; Von Baeyer and Spagrud, 2007). Conversation analysis involves examining the interactional nature of talk by considering what individual utterances accomplish, how utterances are linked in a sequence and how participants display understanding of each other’s talk (Maynard and Heritage, 2005).

Aim(s): This study aims to describe the interactional properties of children’s expressions of pain, and to demonstrate the utility of conversation analysis as a means by which to understand the way in which pain is produced and managed within families.

Methods: Three families in the UK each with two children under nine years old consented to video-record between 15-17 family mealtimes. From the 47 mealtimes (21 hours of data), episodes in which children expressed pain were identified and subjected to conversation analysis.

Findings: Four distinct components of children’s expressions of pain and physical experience were identified; (a) lexical formulations; (b) prosodic features of crying and upset; (c) pain cries; and (d) embodied actions.  The analysis demonstrates the way in which these elements have different interactional properties; conveying informational or emotional content with different propositional (or non-propositional) qualities.

Discussion: The paper will discuss future directions for the application of Conversation analysis to understanding children’s expressions of pain and to Health Psychology more widely.

References
Maynard, D.W., & Heritage, J. (2005) Conversation analysis, doctor-patient interaction and medical communication. Medical Education, 39(4), 428-35

Vervoort, T., Caes, L., Trost, Z., Sullivan, M., Vangronsveld, K., & Goubert, L. (2011) Social modulation of facial pain display in high-catastrophizing children: An observational study in schoolchildren and their parents. Pain, 152, 1591–1599

von Baeyer, C.L., & Spagrud, L.J. (2007) Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain, 127, 140–150

In this paper expression and formulation of bodily sensations are examined as elements of interactional practice, produced through talk and gesture (cf. Heath, 1989). Analysis draws upon a corpus of 21 video-recorded mealtimes with three British families who have children with a chronic illness. The focus will be on how children’s expressions of pain are responded to by their parents.

I will first set out how children’s displays of bodily sensations are delivered with lexical formulations, pain cries, prosodic features of upset and embodied actions. These components have elements which function to display emotion, whilst also conveying informational content.

Analysis reveals several forms of response that are more or less affiliative. Parents may 1) produce a diagnostic explanation for the pain, 2) propose remedies to alleviate the discomfort, 3) continue to promote the ongoing activity potentially resisted by the expressed pain or 4) explicitly express doubt as to the existence of the suffering.

I examine how these response forms orient to the informational element of the expressed suffering, and refrain from attending to the emotional aspect of the reported experience. I will consider the interactional consequences of the way these responses treat and re-embed the painful situation as a problem rather than an emotional ‘trouble’, and what this says about the way in which children’s displays of emotion are dealt with in mealtime interaction.

Heath, C. (1989). Pain talk: The expression of suffering in the medical consultation. Social Psychology Quarterly, 52; 113-125

I examine children’s displays of bodily sensations in talk and embodied action, showing how children’s verbal formulations and gestures collaboratively produce an expression of physical experience.

Feeling ill and other childhood bodily experiences have often been approached as mental concepts that develop cognitively, such as knowledge about physical functions. Rather than approaching being unwell in terms of individual experience and cognition, I adopt the framework of Discursive Psychology in which putatively private, cognitive and experiential states are handled and managed in talk and social interaction. Thus the expression and formulation of bodily sensations are examined as elements of interactional practice, produced through talk and gesture (cf. Heath, 1989).

The research conducts conversation analysis on a corpus of 21 mealtimes, which were recorded by three families across the UK who have children with a chronic illness. This study focuses on the organisation of bodily interaction, specifically on how gestures are deployed in sequences where children initiate expressions of physical experience.

Analysis reveals that embodied displays of pain or other negative sensations such as holding or rubbing the painful area, moving the body in a way that demonstrates discomfort, and facial expressions such as grimacing, can function to display disengagement with the ‘normative’ tasks associated with mealtimes. Deploying such displays without a lexical formulation provides the opportunity for the co-participant to initiate a ‘noticing’. Embodied displays of pain can also be deployed in co-ordination with lexical formulations in a way that provide for the teller to initiate the topic by announcing the physical sensation.

I examine how embodied displays and reports of physical experience are oriented to and managed in the subsequent interaction, and consider the competencies that underlie the construction of illness in interaction and what these carefully organised actions accomplish practically in everyday life.

Heath, C. (1989)  Pain talk: The expression of suffering in the medical consultation. Social Psychology Quarterly, 52; 113-125

Objectives:
Despite frequent use with adolescents across topics, focus groups are rarely used with younger children. This study explores the challenges of using focus groups to investigate healthy eating and evaluates the extent to which it reflects ‘real life’.

Method:
Four activity-based focus groups included hands-on tasks related to healthy eating, including creating menus, evaluating current media messages, and designing campaigns. Nineteen children aged 7–11 years from a primary school in the Midlands took part in the sessions which were transcribed and analysed using Interpretative Phenomenological Analysis (IPA).

Results:
Using activities successfully provided a stimulating non-intensive research environment which participants enjoyed. Analysis revealed that children reflected positively on national and local school level changes aiming to improve healthy eating. However, these intellectual responses to the research questions sometimes conflicted with experiences children recounted, which revolved around play and social connectedness. School changes to menus and lunchtimes had sometimes negatively impacted their social context.

Conclusions:
This study demonstrates the advantages of undertaking focus groups with younger children. Improving the research environment and encouraging greater participant interaction indicates a significant potential for this approach in future research. It also highlights the challenges of tracing individual accounts within group data, and issues relating to transcribing overlapping and interactive speech. The findings emphasise the potential disconnection between experiences children share and educational responses given in a focus group setting. This reinforces the notion that findings are bound to the research environment, and should be considered to be examples of interaction between children and an adult researcher.