Attachment in Developmental Psychology - 1796 Words

Introduction Attachment is the bond that links humans to vital people in their lives. This bond begins to develop early on in life. According to Berk (2012), infants can become attached to regular people in their lives before the second half of their first year of life. These early attachments are normally to the primary caregivers of the infant. An infant with an attachment disorder is an infant who is unable to connect with his or her caregiver. This can also be called insecure attachment, meaning that the infant is indifferent or opposed to the affections of his or her caregiver. Reactive attachment disorder, or RAD, is a common attachment disorder that causes an infant to show either no attachment to anyone or†¦show more content†¦This study indicates that infants with depressed caregivers have lower occurrences of secure attachment than those with non-depressed caregivers. This study has multiple limitations. First, the sample was almost completely Caucasian. Thus, the results may not be able to be generalized. External validity can also be called into question because most of the sample was Mormon. Another reason to be cautious when generalizing these findings is due to attrition, a common issue in longitudinal studies. The diagnoses of the mothers’ depression were obtained from their therapists and not verified by researchers, causing a lack of consistent diagnostic evidence. Finally, this study’s results are based solely on correlation, not causation. Parental Divorce Research has also been done to determine whether there is a connection between parental divorce and attachment disorders in children. A study conducted by Altenhofen, Sutherland, amp; Biringen (2010) examined the characteristics that contribute to postdivorce child attachment. The sample consisted of 24 mothers and their children. Attachment was determined using Waters’ Attachment Q-Set (AQS). Characteristics like age at the start of overnight stays, parental discord and emotional availability were assessed for their significance in attachment security. Although all of the study variables did not predict attachmentShow MoreRelatedDevelopmental Psychology: Attachment Essay1488 Words   |  6 Pages Attachment is the formation of a two-way emotional bond between a child and an adult caregiver. It is an important part of developmental psychology, which is concerned with reasons and causes for human behaviour, addressing both nurture and nature aspects of childrearing. John Bowlby (1907-1990) is a key psychologist involved in the studies and theories concerning attachment. 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Human Growth Perspectives on Personality

Question: Demonstrate your knowledge of early development normal behaviours and activities during early life stages (infancy to middle childhood). Explain developmental theories in your own words using your findings from naturalistic observation (research). Answer: Introduction The said paper leads to an intricate discussion about the human theory laid down by Erik Erikson who has divided a human beings stage of life into eight parts. The theorists clearly describes the nature and extent of development at each stage and how it helps in the furtherance of ones life cycle. The said paper also describes about my experience of a birthday party wherein I met kids of varying age groups and each with a differentiating character. All were reacting and behaving in a unique manner which clearly was matching with the theory spelt out by the eminent theorist Erik. The same could be very finely interrelated to. Thus the paper would demonstrate how well the theory can be read and understood with the practicality of life. Developmental Theory A human being undergoes various stages of development from infancy to maturity. Various theorists have examined these stages. One of the most eminent was a German psychotherapist named Erik Erikson. He was greatly influenced by Sigmond Freud but the two differed in their opinions with regards ego and id. Erikson believed in the theory of resolution of predicaments which leads to successful development of ego. It extends further in nurturing trust and creating ones own identity in the society and further serving the preparation of the upcoming generation for a brighter future. As per Erikson, a persons life can be divided into eight interlinked stages which comprises of four stages from infancy to middle childhood and the rest four belong to a stage from a young man to an old mature experienced person. He emphasized ,on the pubescent stage as according to Erik this stage is most sensitive of all. He studied basically on how the social life of a person aids in the positive development of the personality. Thus the theory proposed by Erik is rightly named as psychosocial theory. The model depicted by this eminent analyst is very straight-forward , elegant yet sophisticated in nature. He has divided the same into eight stages namely: Infancy Stage : The age covered in this stage is from birth to one and a half year i.e. from the time a baby is born till he or she starts to walk. The kid at this stage basically fights between the concept of trusting and mistrusting the people around him as he has no knowledge with regards how the public is around. The distinguishing power of a child is at its nascent stage of development. At this stage the child should not be loved overtly rather for trust to grow the child should be given the basic care and attention required. However distrust will grow if the child is ill-treated, scolded or treated in an unkind and negligent manner. However over protection given to a child during its initial stage will create a rosy picture in his mind and hence will not be able to react rationally in times of surprises, crisis or any normal as well as abnormal situations. Toddler Stage: The next stage is that of a toddler wherein the child learns the basics of how to live such as getting trained to do toilet in the washroom. This stage is the initial phases which helps a child to become independent and self reliant. This stage enables the infant to believe that he or she is growing up and has the ability to become independent. However this is the time period toughest from the parents point of view as here the toddlers generally tend to become very loud and naughty full of tantrums and they are expected to handle the same with utmost care. This is a very tricky task and the parents will have to deal with the emotional quotient of a child while controlling their own emotions and methodologies of handling such situations as they may at times find themselves standing in an embarrassing position (Heffner, 2014). Pre School Stage: This is the time when the child is exposed to the outer world. He or she becomes a part of a play school where they meet similar kids of their age. This is the first stage of interaction for them with people apart from their own parents and grandparents. During this period of a childs growth he or she tries to nurture its skills towards understanding the emotion of guilt as well as initiative. Once a child starts to understand the fact that a particular act conducted by him may lead to discontent from people around the feeling of guilt takes birth. Similarly a childs feeling to take initiative to do things by self will arise if he or she is encouraged optimistically to try to do something howsoever untidy or messy it be. This will also inculcate an attitude of looking towards thinks positively contrary to which the child may become introvert and highly scared to do anything or try anything unusual or new in life. His personality development will take a backseat if he or she receives only negation for all his acts. This is the stage wherein children learn the most while growing up with nature. They experiment and try new things in lieu of educating themselves. However there are some who become very notorious and this is where the parents should interfere and check upon the same tactfully. Thus in this stage indirect parental involvement is a must. Freedom coupled with supervision is the key to success at this stage of development of a child(McLeod, 2008) Early school Stage: This is the stage where the children understand the fact that they are individuals living in a society. This is the time frame when they develop the qualities of responsibility and rationality in thinking. They develop a distinct quality of distinguishing between what is acceptable and what is not acceptable. The sensitiveness of belongingness towards the society develops the most in this time period. The most important part of a childs life at this stage is the school and the other surroundings in the neighbourhood. The interacting components increase suddenly and the authority shifts from only parents to the school teachers and principal as well and in some cases to ones friends and peers too. For a child to cross this stage of life successfully has to be self motivated .Just like this stage enabled in nurturing ones confidence at the same time a child who fails academically or is not as good as expected by his parents struggles with his self confidence and if at that time is not dealt with care and love may develop a pessimistic feeling. Children with a low self esteem tend to fail in lifes race, hence it is the responsibility of the parents as well as the school to help dig deep inside a child to find out his or her interest and show him a path towards development of that interest (Cherry, 2016). Thus the said philanthropist has greatly described the various stages of a person from infancy to middle childhood very clearly bringing out all the possibilities of each stage. The theory adopted is very simple to understand and comprehend. Naturalistic Observation Exercise I had recently gone to a birthday party of my friends son who is 7 years old. The invitees were some of her friends and relatives and the childs school friends. The party was on a large scale where she had called a magician, a tattoo maker, art and craft and a bouncy for the kids to play. There was music also for the kids to dance if they wish too. Apart from all this she had organized some games for them like statue dance, memory game and passing the passers. She had arranged for return gifts basis the age of the kids as apart from the childs school friends there were kids of other age groups ranging from 1 year to 10 years. Each game had three prizes also so that kids dont feel bad (Stoneman et. al., 1984). I am a mother of a six month old boy so was sitting at one place with him watching the kids enjoy and observing their reactions towards various things. I also got an opportunity to gather the various kinds of behavioural patterns which kids adopt and how their mothers react. I would like to categorize my observation such as the style of playing games, the skills of children to react i.e. how does there sensory organs behave in various situations, the linguistic features, the kind of interaction they have with their parents and the maids who are employed to specifically take care of kids and the overall reaction of kids to a birthday party (Angrosino, 2007). She had kept numerous games but before that she got the magic show conducted thinking that kids may get tired after playing games and then may not enjoy the show. The magician was a very talented one who was communicating in a very polite manner in English as well as Hindi. The words that he used were very simple for them to comprehend. The magician was trying to involve each and every kid. There were around fifteen kids spread over an age bar of 1 to 10 years. Since there were less of girls the boys enjoyed a lot. There was one child A who was very introvert and shied away when he was called upon by the magician. His mother also supported the child and said that he is a bit of an introvert and safeguarded him from involving oneself. On the other hand there were some kids who were willing to participate not only once but twice and thrice. They were naughty but not unruly (Pepler Craig,1995). There was another child B who denied to the magicians request to come forwards for magic. Wh en forced by her mother she screamed her lungs out of resentment and then her mother also sided with her out of embarrassment. A while ago I even observed child B hitting her maid and the mother was sitting next to me like a silent watcher. This shows that it is not the fault of the child, it is the upbringing and the kind of support they receive. The child A who was also sided by her mother instead of being encouraged seems to be a quite kid as he was seen sitting all alone with his toys. This is also not a sign of healthy parenting as in this manner the child although proves to be a well-mannered kid yet is too aloof from the outside world which can be very detrimental for his future per se. Kids who were playing and enjoying the magic show though were loud and rowdy at times yet were very impulsive in nature which is what makes them confident (Smith Dickinson, 1994). The sensory organs of the chirpy kids are more developed than the ones who are a little subdued. They should be encouraged and their morale should be boosted else very soon they may turn up to become anti-social. Another very distinctive feature which I noticed was the language of these kids. The small kids between the age of 1 to 3 could hardly talk but there communication skills were yet very strong. Action is stronger than words is proven true by these kids (Berk, 2010). They know how to get their point clear to their parents and the maids. This is possible only if the people at home are attentive towards their child. Unfortunately this was missing in Child A who was quite at his age. Child C was seen talking to her friends in English and Hindi both depending upon to whom he was talking to. He was a relatively older kid of 8 years. Yet to have such an understanding is appreciable. This is possible only because of the kind of environment they get at home. I was having a conversatio n with her mother. She said that both the parents converse in English with each other in front of him and this is how he has developed this habit. Whereas child B simply communicates by shouting. She believes that all her wishes and demands should be fulfilled else she would end up behaving in a stubborn manner (Carver Scheir, 2000). Kids were playing games and were very receptive towards the rules of the game. Where they couldnt understand they asked twice to the instructor which was very appealing. This simply shows that kids enjoy to play. However I felt very sad on looking at the upbringing of child A who was quite and shelled inside his own world. He was least concerned about anything and seemed to be a part of the party customary. Thus the said birthday party made me aware of how I should nurture my child so as to be able to give him a balanced life (Otnes et.al. 1995) Discussion As per what I observed in the birthday party and what Erik suggests in his theory matches to a great extent. There were no infants ofcourse but for my son and he is too small to react. Yet he was seen enjoying the noises and was observing the lights and the bright decoration. I was continuously telling him knowing very well that he would hardly understand anything, yet this enables to develop a sense of trust which your child develops towards you. He is not a cranky kid and if he sees that I am comfortable talking to somebody then he easily goes in that persons arms (Charlesworth Lind, 2013). Most of the kids belong to the second and the third stages described. The child A who was very introvert belonged to the second stage and there still are chances for his parent to ensure that the kid takes part in all the activities. The kids sensory organs are still in its budding stage and a little bit of push may change his life for the better (Rosenblatt,. Howes, 1995). Child B belonged to the third stage and is not a well bought up kid. She is an over cared kid who has become snobbish by nature because of the family members who have fanned her tantrums always instilling her to become a spoilt brat. However child C who is in her fourth stage is a well mannered kid. She enjoyed the birthday party, played games and was also seen handling younger kids. This shows that she was cared and loved by her parents and family but at the same time was given the liberty to justify what is right and wrong (Booren et.al. 2012). Though there was some difficulty which I had to face as all children were different from each other yet I could segregate them into broad categories basis there behavioural patterns. Kids are very unpredictable as there were times when a child was chirpy but at the same time he was very well behaved. Yet the theory of Erikson helped me with this segregation (Searle, 1999). Conclusion On a conclusive note I would like to establish the fact that the human growth can be studied in detail only by breaking the same into smaller units of life. Erik Erikson has very rightly divided a persons life into various stages of which the most important are the first four stages which is the moulding stage for any human being. It is the base which should be strong enough to help build a healthier and a wiser person. Every person has a different unique characteristic and no two person are totally similar in nature. Thus human psychology is a very in depth subject which needs to be studied taking at least a small group of three to four persons. This pattern cannot be studied in isolation. References Angrosino, M. (2007). Naturalistic Observation. Left Coast Press: USA Berk, L. (2010). Development through the Lifespan. Boston : MA Pearson Education Inc. Booren, L.M., Downer, J.T. Vitiello, V.E. (2012). Observations of Childrens Interaction with Teachers , Peers and Tasks across Preschool Classroom Activity Settings. Early Educ. Dev Carver, C.S. Scheir, M.F. (2000). Perspectives on Personality . Needham Heights, MA: Allyn Bacon Charlesworth, R. Lind, K. (2013). Math and Science for Young Children , 7th Eds. Wadsworth Cengage Learning : USA Cherry, K. (2016). Erik Eriksons Stages of Psychosocial Development. Retrieved from https://www.verywell.com/erik-eriksons-stages-of-psychosocial-development-2795740 Heffner, C.L. (2014). Chapter 3:Section 3: Eriksons Stages of Psychosocial Development. Psychology 101. Retrieved from https://allpsych.com/psychology101/social_development/ McLeod, S. (2008). Erik Erikson. Retrieved from https://www.simplypsychology.org/Erik-Erikson.html Otnes, C., Nelson, M. McGrath, M.A. (1995). The childrens birthday party : A study of mothers as socialization agents. Advances in Consumer Research . vol. 22 Pepler, D.J., Craig, W. (1995) A peek behind the fence: naturalistic observation of aggressive children with remote audiovisual recording. Developmental Psychology. Vol. 31. Pp. 548-553 Rosenblatt, S.M. Howes, C. (1995). Alternative influences on childrens development of friendships : A social developmental perspective. American Journal of Community Psychology. 23(3). 429-434 Searle, A. (1999). Introducing research and data in psychology. Routledge: London Smith, M.W. Dickinson, D.K. (1994). Describing oral language oppurtunities and environments in Head Start and other preschool classrooms. Early Childhood Research Quarterly. Vol. 9, pp. 345-366 Stoneman, Z., Brody, G.H. MacKinnon, C. (1984). Naturalistic Observation of Childrens Activities and Roles While Playing with Their Siblings and Friends. Child Development. Vol.55, pp. 617-627

North Carolina Regulators Essays - Rebellions In The United States

North Carolina Regulators North Carolina Regulators The North Carolina Regulators were a group of people who rebelled against corrupt government officials. The people experienced strong feelings of discontent with the way in which the provincial government's officials were conducting the affairs. The government officials were running the colony both unfairly and unjustly. Many small groups of people formed. After the spring of 1768 when the small groups allied , they called themselves the Regulators. The Wealthy colonists considered these Regulators to be ?a mob.? North Carolina had a lack of supervision from the British monarchy. The colony was isolated from the rest of the country by numerous swamps, bad road conditions and unnavigable rivers. Therefore the government officials of North Carolina became independent, in a very unfair and unjust way to the people of North Carolina, such as excessive taxes, dishonest sheriffs, and illegal fees. The injustice of the government officials urged the Regulators for justice. The once peaceful negotiators became violent, and lawless from the slowness of legal remedies taking place. The Regulators refused to pay fees, and terrorized those who administered the law. They also disrupted court proceedings. The Regulators first tried negotiations; it was the injustice of the government officials that made them resort to violence. The Regulators intentions were not to terrorize the government officials, but only to find justice. The regulators fight for justice was a problem for royal Governor William Tryon, who wanted the Regulators revolt to stop. The governor's council was determined to crush the Regulators. General Hugh Waddell was ordered to approach Hillsborough by way of Salisbury and Governor Tryon and his army proceeded more directly towards Hillsborough. General Waddell had a small force of 284 men. The Regulators saw this and attacked General Waddell's troops. The Regulators almost 2,000 men strong sent General Waddell and his troops in a quick retreat. Tryon heard of this and brought his forces to go to Waddell's rescue. A battle began. Tryon's, the much better trained, equipped, and organized army, crushed the Regulators. The only thing the Regulators wanted was justice. That's what they were fighting for. They were abused by the government officials in such away that it caused them to revolt. The Regulators were killed in battle, wounded, captured, and executed. Some were pardoned in exchange for pledging an oath of allegiance to the royal government. The War of Regulations was a foreplay to the American Revolution. The Regulators opposed Royal authority with confidence. It was a lesson of armed resistance, a lesson that would be used in the War for Independence.

15 Words That Will Make You Sound Smarter

15 Words That Will Make You Sound Smarter Do you remember how exciting it was when you learned to say supercalifragilisticexpialidocious? Didn’t you feel smart? Just because youre older, doesnt mean acronyms and emojis should be your main form of communication. After all, if you want to be successful in life, you have to make an unforgettable first impression. Why Word Choice Is Important Having a strong vocabulary allows you to communicate in a thoughtful and intelligent way. Whether youre trying to land a job, impress your 3rd-period teacher, or nail a scholarship interview, your ability to choose your words carefully will help you stand out. But here’s something to consider: overusing complex language can turn people off, so it’s best to test out a few new words at a time and see what kind of reaction you get. Chances are, you’ve seen (or maybe even used) a few of these words. And while there are hundreds of words that can make you sound smarter, some are definitely more fun (and easier) than others to use. So, the next time youre toe-to-toe with your AP English teacher, ditch the toady act and impress her with a few of these scintillating words instead. Words to Add to Your Vocabulary Accolade: a mark of acknowledgement; an honor.Even though he received numerous accolades at the senior awards night, Ben is still one of the most humble people I know.Acquiesce: to go along with something without protest, even if you dont really want to.My grandma loves the ballet and bought tickets for us to go. I really wanted to watch the basketball game, but her sweet smile eventually caused me to acquiesce.Bamboozle: conceal one’s true motives; to cheat or deceive another person.I got bamboozled by my buddy to buy him a pair of new shoes even though his mom picked up a pair yesterday.Camaraderie: trust existing between friends who spend time together; a spirit of familiarity.There was a sense of camaraderie among the soccer team after they spent two weeks together at a wilderness camp.Conundrum: a difficult problem.Looks like you have  a bit of conundrum, but thats what happens when you cheat on a test and the teacher finds out.Idyllic: peaceful, happy, pleasing.The out door classroom at our school is in an idyllic location because you can see the mountain range and several acres of forest from every open window. Impeccable: faultless or without defect; incapable of wrongdoing.Have you ever had that one teacher who won’t accept any work unless it’s impeccable? There’s no way my essays are ever going to be that perfect.Perfunctory: something done without much care or attention.You did a perfunctory job including descriptive words in this essay. Next time, I expect you to show more interest in what you are writing.Ruminate: to think about something thoroughly and in great detail.People who struggle with anxiety tend to ruminate and fixate on their thoughts. Tempestuous: identified by explosive conditions.My older brother’s tempestuous relationship with our mom has led to very little communication between the two of them.Tenuous: very weak or slight and likely to change.We’re not sure if our boating store is going to survive this harsh winter season. Your employment will remain a bit tenuous until we know the total number of sales from this month.Vacillate: to go back and forth between two points, waver between different opinions, or to be indecisive.When I ask my sister where she’s going to college, she vacillates between her two favorite schools; but I know she will eventually make the best decision for her. Vitriolic: harsh or corrosive in tone.The student body election turned into an argument reaching vitriolic levels. The two candidates ended their speeches by shouting harmful words at each other.Wheelhouse: a metaphor for an individuals area of comfort or expertise.I need you to cover this story about the construction at our school, even though it’s not in your wheelhouse. Zealous: displaying or feeling energetic support for a person, cause, etc.My neighbor has been a zealous supporter of animal rights for as long as I’ve known her. Source Merriam-Webster Dictionary

The Article Summaries and Reaction Paper Management of Computers Essay

The Article Summaries and Reaction Paper Management of Computers - Essay Example Proper management of computers in the classroom and lab are so significant in the learning process of the students and so to the security and life of the computer system itself. The Net Support School or NSS, offers a comprehensive and proper management in the use of computers in classroom and computer lab. Their main objective is how to manage the use of computer, printers, and the devices more effectively. Teachers should act as administrator to control the user privileges of the students, they can also log-in and log-off remotely to student's computers through his unit. They can also monitor the screen of every student simultaneously as to observe what the students are doing. During the discussions, monitors or screens of the student's computers should be blank, keyboard and mouse must be locked to gain their focus and attentions. Considering that computer printing is important, teachers should also control the page limit of every student. Computers are subjective to malwares, spywares and other form of viruses, thus teacher or laboratory in-charge should not allow copying of files from USB devices and CDROMS to the hard drives or hard disk. The capabili ty to transfer files or handouts to selected computers and even to all units is also an advantage with regard to time management. In summarizing the proper management of computers, teachers can control various computer privileges such as; application and internet metering and control, teacher security, internet safe search, printer control and device control (Intel.com). Like the Net Support School, Intel Education Initiative also explained how to manage the computer use effectively, because they know that allocating more time for students in using the computer is so important. They are also taking into consideration about the subject matter, like, having a focus on discrete activities, where work activities are well-defined by the teachers to let the students do a desirable project immediately. They believed that computers must not be used in internet research during work activities for it is just a waste of time, since it could be assigned as homework to students. Creating a checklist for a task and a timeline respectively will help students to be more productive and efficient toward their work. It is also important that proper and appropriate use of computer must be implemented, and whatever inappropriate action will result in losing and deactivation of students' computer access and privilege as a form of their punishment. The computer classroom m ust be made available before school time, during break time, and after school time especially for students who don't have computers at home (Netsupportschool.com). In relation to my own professional thinking, both of the two articles were implementing better practice in proper management of computers in classroom and computer lab. I agree that the teachers should also be the administrator at the same time in terms of giving user access and privilege. Aside from the teaching procedures and guidelines, being a good administrator will also result to harmonious and smooth sailing learning for students. I also agree that during the discussions and defining of task, the monitor, mouse and keyboard should be disabled to let the students listen attentively. In addition to their principles of management, I would like to encourage that the classroom and com

Public Admiration Research Paper Example | Topics and Well Written Essays - 1250 words

Public Admiration - Research Paper Example Public admiration is a social and political science which is indispensable in governance and in the delivery of services for public welfare and interests. It involved intricate planning, strategizing, collaborating, networking, resource allocation but and utmost diligence in the exercise of authorities, functions and roles in accordance to policies and laws of the country. As integral part of organizational management, administrators use systems and models in the performance of their roles especially in this modern period when administration is integrated with information technology to hasten the delivery of services. Public administration can be done in classical ways or in a positivist construct, provided it helped systematized the performance of an government, corporation or an institution. Public administration is applied not only in government administration but also in managing non-government and private sectors whose extensive operation are implemented in a broader number of p opulace as their beneficiaries or clienteles (Stefan, 2009). Theoretically, the system of administration correlated the relation of administration, human resource management, access and use of resources, hence, require the skills managing organization inclusive of values in dealing with human relations (Stefan, 2009). Many of the managers attached to the nature of this profession are those who are intellectually gifted to pursue issues and concerns of public affairs. Experts opined that those experts or those who can offer quality public service can move freely within the thin domain between public, private and non-profit opportunities (Stefan, 2009). It is construed that those engaged in public administration have breadth of knowledge and perspectives of the science of public administration. They are expected to perform their responsibilities with combined skills of transformational and transactional leadership (Stefan, 2009). In matters of resource generation and utilization, publ ic administrators are reliant on existing policies but spending more what is expedient and essential for public concerns and for the organization (Stefan, 2009). Such must also be consistent to the vision, mission, goals and programs of the institution. Being focused on governance and organizational capacity enhancement, administrators are concern on transparency, devolution of functions, and analytical discourses in the disposition of cases and issues involving administrators and the public it served (Stefan, 2009). Science of Decision-Making and E-management In such context, public administration is therefore a science of decision-making based on existing regulations, done by public officials, done often in writing, and is always in congruent to the national policies and laws of public administration (Stefan, 2009). When officials are called to resolve on issues as a quasi-legal body, the administrators decides to appoint, discharge, suspend, dismiss or transfer public official ba sed on policies which is maybe inclusive of imposing disciplinary penalties as the law bestowed and in according to legal provisions required under administrative proceedings (Stefan, 2009). Recently, there is a national effort of

Use of Acupuncture for Treatment of Lateral Epicondylitis Essay Example for Free

Use of Acupuncture for Treatment of Lateral Epicondylitis Essay Lateral epiconylitis is a commonly encountered condition resulting from minor injury to the extensor muscles of the forearm, which originate from lateral epicondyle of humerus. This condition is characterized by pain and tenderness over the lateral epicondyle of humerus. Pain is typically present upon the resisted dorsiflexion of the wrist, middle finger or both (Buchbinder, Green Struijs, 2007). Lateral epiconylitis is known by many analogous terms like tennis elbow (TE), rowing elbow, tendonitis of the common extensor origin, peritendonitis of the elbow etc. In the United Kingdom, the incidence of tennis elbow in general practice has been estimated to be about four to seven per 1,000 persons a year (Buchbinder et al). Though TE is a self-resolving condition its symptoms can persist for as long as 18-24 months. Pain of tennis elbow can interfere with normal day to day functioning like carrying objects, lifting and gripping things etc. Though pain of TE can be initially cured with various conservative treatment modalities and rest, it can frequently recur after resumption of activity. Thus TE can cause significant amount of chronic pain and disability, which can lead to considerable morbidity and financial cost (Buchinder et al, 2007). Thus there is a need for an efficient treatment modality for TE. Till date, physicians and physiotherapists are uncertain about the exact etiology and best management option for patients with TE. There are several conventional therapies which are being used for treatment of TE. These therapies are believed to relieve pain, promote tissue healing and improve joint mechanics. These conventional therapies include anti-inflammatory medicines [NSAIDS (non-steroidal anti-inflammatory drugs) and corticosteroids], physiotherapy interventions (such as stretching and strengthening exercises), cast immobilization, ultrasound therapy, using ice packs, neural stretches, deep friction massages, surgery etc (Trinh, Philips, Ho Damsma, 2004). Various non conventional therapeutic modalities like acupuncture, pulsed electromagnetic field therapy, transcutaneous electric nerve stimulation etc have also been used for treatment of TE. In 1992, Labelle et al attempted to perform a quantitative meta-analysis in order to evaluate the therapeutic effectiveness of above mentioned treatment modalities (both conventional and non-conventional) for patients suffering from TE. They considered the results of 18 clinical trials conducted in the period from 1966 to 1990. From their analysis they concluded that the various randomized and controlled trials, which they had analyzed, were of poor quality and did not provide sufficient scientific evidence to support or oppose the therapeutic benefit of any of these conventional or non-conventional treatment modalities. Labelle et al (1992) did find some weak evidence supporting the beneficial effect of ultrasound therapy in comparison to that of placebo therapy in treatment of patients with TE. More recently, a systematic review of the literature, comprising of randomized controlled trials evaluating the effectiveness of various treatment options for TE was carried out by Assendelft, Green, Buchbinder, Struijs, Smidt, (2003). They have suggested significant beneficial effect of NSAIDS (both topical and oral) in comparison to placebo in the providing short term relief from pain in patients with TE. However they found little evidence regarding the beneficial effect of NSAIDS (both topical and oral) in providing long term pain relief. While the use of topical NSAIDS was not found to be associated with significant side effects, use of oral NSAIDS, typically aspirin was associated with significant side effects like gastro-intestinal bleeding etc. This review found limited evidence regarding the beneficial effects of steroid injections in comparison to placebo, local anaesthetic agents, elbow strapping or physiotherapy. Assendelft et al also found insufficient evidence to support long term or short term beneficial effect of treatment modalities like acupuncture, physiotherapy exercises, orthoses (elbow strapping), extra corporeal shock wave therapy and surgery. They have recommended long term use of oral and topical NSAIDS and physical therapies (elbow strapping, physiotherapy, etc and avoidance of provoking activities as the first line of treatment, especially in the early stages of the disease.   They have also suggested the use of corticosteroid injections as second line therapy for providing relief from pain. However the pain relief provided by corticosteroids is usually temporary in nature with the pain recurring again after a few months. Thus they have suggested that the patients receiving such therapy should be counselled about not subjecting the extensor muscles to increased activity during the pain-free period resulting from use of corticosteroid injections. On the other hand, Bisset, Paungmali, Vicenzino, Beller,   Herbert, (2005) from their systematic review of literature, comprising of studies evaluating   the effectiveness of   various physical interventions (non pharmaceutical or   non-surgical therapeutic modalities) for treatment of TE have shown short term benefit   with the use of physical interventions like ultrasound therapy, ionisation, and acupuncture. However no evidence of long term benefit due to these therapeutic modalities was observed in this review; benefit due to these interventions was usually seen to last between two to eight weeks. Bisset et al observed insufficient evidence regarding the beneficial effect of manual therapy (involving manipulation of elbow or cervical spine), use of elbow strapping and physiotherapy exercises in the management of TE. They also observed the presence of sufficient evidence that disapproved the beneficial effect of extracorporeal shockwave therapy and laser therapy in the treatment of TE (both in short term and long term). However they have indicated the requirement of larger studies in future in order to confirm this finding. Since no clinical study till date has been able to demonstrate definite clinical efficacy of any conventional therapeutic modality in treatment of TE, there has been increasing trend towards the use of non-pharmacological treatment modalities, especially acupuncture, since last two decades, for alleviation of chronic pain due to TE. One major advantage of using acupuncture for treating   pain of TE over the conventional anti-inflammatory drugs like NSAIDS (oral or topical), corticosteroids etc is that it is free from the numerous deleterious   side effects commonly associated with the use of these drugs. Also the evidence supporting the use of these conventional pharmacological interventions is no better than that supporting acupuncture [National Institute of Health (NIH), 1998]. Despite the growing popularity of acupuncture in treatment of pain related to lateral epicondylitis, presently, there is little evidence which confirms the efficacy of acupuncture in treatment of tennis elbow. The studies conducted until now have produced conflicting results. Bisset et al (2005), in their systematic review of literature considered four studies evaluating the therapeutic effect of acupuncture in treatment of TE. Three studies out of these four compared acupuncture with placebo whereas one study compared acupuncture with ultrasound. The overall evidence considered in this review supports short term beneficial therapeutic effect of acupuncture over placebo in patients with TE. Two studies, (Fink, Wolkenstein, Karst, Gehrke, 2002; Molsberger Hille, 1994) which compared acupuncture with placebo are described below in details. Fink et al (2002) conducted a study to evaluate the clinical efficacy of acupuncture in   treatment of TE. They also tried to compare the therapeutic effects produced by stimulating selected acupuncture points (as defined by traditional Chinese acupuncture) in contrast to those achieved through stimulation at non-specific points (these puncture points were at least 5 cm away from the traditional Chinese acupuncture points). The results of this study indicated that use of acupuncture with correct location and stimulation, in accordance to the recommendations of tradition Chinese acupuncture helped in significantly alleviating the pain, reducing disability of arms, shoulders and hands (measured through DASH questionnaire) and improving the strength of the extensor muscles in the patients suffering from TE. However these therapeutic effects (pain relief and muscle strength) of acupuncture were less evident in long term. In this study, at the time of follow-up after two months, though the overall functioning of the arm was observed to be better in the treatment group as compared to the control group, the differences in pain intensity and muscle strength were no longer found to be significant. The main aim of the study by Molsberger Hille (1994) was to find out whether acupuncture showed an intrinsic analgesic effect even after only one treatment session in comparison to that of placebo treatment for TE pain. In one single session of acupuncture treatment, patients in the treatment group were treated at a non-segmental distal point on the fibulo-tibial joint of the homolateral leg. The painful area of the elbow itself was not needled. The depth of insertion was 2 cm and during the procedure of needling, the patient was asked to move the painful arm. Patients were treated for a total of 5 min. Overall reduction in the pain score was 55.8% in the treatment group and 15% in the placebo group. After one treatment session, 79.2% (19 patients out of 24) patients in the treatment group reported pain relief of at least 50%, whereas in the placebo group only 25% patients (6 patients out of 24) reported pain relief. The average duration of analgesia after one treatment was 20.2 h in the treatment group whereas that after placebo was 1.4 h. All these results show that acupuncture has a statistically significant intrinsic analgesic effect in the clinical treatment of TE pain, which exceeds that of placebo treatment.   Since this study dealt with short term analgesic effects of acupuncture, further studies need to be carried out in future in order to evaluate the long-term therapeutic value of acupuncture for treatment chronic tennis elbow. Davidson et al (2001, cited in Bisset et al, 2005) conducted a study to compare the   therapeutic effect of acupuncture with that of ultrasound treatment in patients suffering from TE. Though significant improvement in two outcome measures i.e. pain reduction and disability prevention were observed in both the groups, no statistically significant differences in terms of these outcome measures were observed between the two groups. Thus this study indicates that there is no difference in therapeutic benefit between ultrasound and acupuncture in patients with TE. However it is difficult to reach to any definite conclusion from the results of a single study. More studies are required in future in order to arrive at a definite conclusion. In a publication by the NIH in 1998, it was determined that the results of various studies conducted till date has been promising enough to support the use of acupuncture as an adjunct treatment or an alternative to classical conventional therapeutic modalities for patients with TE. Trinh, et al (2004) conducted a systematic review of literature regarding use of acupuncture in treatment of TE, using the best evidence synthesis approach (BESA), which aimed at qualitative analysis of clinically homogeneous studies. The results of this review strongly suggested that acupuncture was an effective therapeutic modality for attaining short-term pain relief in patients with TE. Though there was a great deal of clinical heterogeneity between various studies considered in this review, five studies out of six studies considered in this review indicated that acupuncture treatment was more effective compared to placebo treatment. The studies conducted till date have failed to provide us with definite results. This can   be attributed to a variety of factors like: flaws in study design, heterogeneous treatment protocols, small sample size, inherent difficulty in the use of appropriate controls etc (NIH publication, 1998). Selection of method for performing the procedure in control group for these studies poses to be a difficult problem. Method of performing the   procedure in control group is important because the insertion of placebo needles itself results in inherent analgesic effect due to release of local ?-endorphins (opioid like substances), which can influence the outcome of the study too (NIH publication, 1998). Future research is recommended to resolve the issues discussed above. Thus there is a need for large scale, well-designed, multicentric, randomized control trials in future that will use standardized treatment protocol and appropriate methods for performing the procedure in controls. It is evident from the above discussion that various studies which aimed at assessing the   efficacy of acupuncture in treatment of TE had employed different processes for performing acupuncture, in terms of location of puncture points, depth of insertion of needles, the number of needles used, duration of treatment etc. In order to arrive at a definite conclusion regarding the efficacy of acupuncture in treatment of patients with TE and in order to maximize the chances for a successful treatment with acupuncture, there is a need for a uniform, accurate and complete description of the most effective method to be used for performing acupuncture in patients with TE. With this in mind, Webster-Harrison, White Rae (2002) conducted a study in order to develop a standardized treatment protocol for acupuncture therapy in patients with TE. They adopted a modified Delphi’s consensus technique to combine the opinions of fourteen British acupuncture experts into a standardized treatment protocol. This protocol contained eight items pertaining to the treatment of TE using acupuncture and has been described in table 1. The various items considered in this protocol were: selection of acupuncture points; length and diameter of needles used; depth of insertion; duration of treatment; interval between successive treatments; whether the needle should be stimulated or not; the type of response to be achieved upon stimulation and number of treatment cycles needed. Use of this protocol in randomized multicentric trials conducted in future is likely to give accurate results (Webster-Harrison et al). Conclusion From the discussion in this paper it becomes apparent that till date no study in published   literature has been able to demonstrate long term beneficial effects of any pharmacological, surgical or physical therapy in comparison to that of a placebo therapy for treatment of patients with TE. Among various non-pharmacological therapeutic options, acupuncture presents an effective and safe adjunct treatment or an alternative to classical conventional therapeutic modalities, especially in cases where these conventional therapeutic modalities had previously failed (NIH, 1998). Presently, the optimal treatment option for patients with tennis elbow in clinical care largely remains unclear. Acupuncture appears to be a lucrative treatment option for both clinicians and patients. However, the therapeutic benefits provided by use of acupuncture are not supported by sufficient evidence, at present. There is a need for well designed, high quality research studies, especially randomized control trials in future, in order to help in establishing the appropriate place for acupuncture in treatment of patients with TE in modern medical practice. References Assendelft, W., Green, S., Buchbinder, R., Struijs, P., Smidt, N. (2003). Extracts from concise   clinical evidence: Tennis elbow. British Medical Journal, 327, 329-340. Bisset, L., Paungmali, A., Vicenzino, B., Belle, E., Herbert, R.D. (2005). A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine, 39(7), 411 422. Buchinder, R., Green, S., Struijs, P. (2007). Tennis elbow. American Family Physician, 75 (5),   701-702. Retrieved on 30 June 2007 from http://www.aafp.org/afp/20070301/bmj.html Fink, M., Wolkenstein, E., Karst, M., Gehrke, A. (2002). Acupuncture in chronic   epicondylitis: A randomized controlled trial. Rheumatology, 41(2), 205 209. Labelle, H., Guibert, R, Joncas, J., Newman, N., Fallaha, M., Rivard, C. (1992). Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow: An attempted meta-analysis. Journal of Bone and Joint Surgery, 74, 646–51. Molsberger, A., Hille, E. (1994). The analgesic effect of acupuncture in chronic tennis elbow   pain.   British Journal of Rheumatology, 33(12), 1162-1165 National Institute of Health (1998). NIH consensus conference: Acupuncture. Journal of   American Medical Association, 280, 1518–24. Trinh, K.V., Philips, S.D., Ho, E., Damsma, K. (2004). Acupuncture for alleviation of lateral   epicondyle pain: A systematic review.   Rheumatology, 43, 1085–1090. Webster-Harrison, P., White, A., Rae, J. (2002).Acupuncture for tennis elbow: An e-mail   consensus study to define a standardised treatment in a GP’s surgery. Acupuncture in Medicine, 20(4), 181-5.