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PubMed2002

Symptom domains in autism and related conditions: evidence for familiality.

Heterogeneity in autism impairs efforts to localize and identify the genes underlying this disorder. As autism comprises severe but variable deficits and traits in three symptom domains (social interaction, communication, and repetitive behaviors) and shows variability in the presence and emergence of useful phrase speech, different genetic factors may be associated with each. The affected cases (n=457) in multiply affected siblingships (n=212), including a proband with autism and one or more siblings with either autism or marked deficits in autism symptom domains, were assessed using the Autism Diagnostic Interview, Revised. Symptom domain scores and language features were examined to determine their similarity within siblingships. The variance within siblingships was reduced for the repetitive behavior domain and for delays in and the presence of useful phrase speech. These features and the nonverbal communication subdomain provided evidence of familiality when we considered only the diagnosis of autism to define multiply affected siblingships (cases: n=289; siblingships: n=136). In addition, the same familial features identified also appeared familial for those with autism-related conditions. Finally, the level of severity of almost all of the familial features varied within multiplex siblingships independently. The features identified as familial replicate the combined set suggested in earlier, smaller studies. Furthermore, the familiality of these features extend to related conditions of milder severity than autism and appear to be independent. Making distinctions among families by the severity of these features may be useful for identifying more genetically homogeneous subgroups in studies targeted at genes for specific autism-related symptom domains.

Autistic Disorder↗
PubMed1993

The critical times: meeting parental communication needs throughout the NICU experience.

The parental stresses caused by a premature birth and the NICU experience may create problems in the parent-child relationship. These problems may lead to subsequent difficulty in bonding or parenting, and may even be related to child neglect and abuse. The NICU staff is in a unique position to help minimize parental stress by providing information, support, and understanding to facilitate coping with fear and uncertainty. Parents need help in adjusting their expectations to reality, especially during the early days in the NICU. While the mother is still hospitalized, the father is in an especially vulnerable position, as he may be unprepared to be a primary caregiver, threatened by the female staff, and expected to assume a focal role while he may need comfort himself. Information that is most helpful to parents is that which helps return some control to them. Involving parents in the child's caregiving and in decision making also helps increase parental feelings of control and decrease feelings of stress. Attention should be paid to the questions and nonverbal communication of the parents to ascertain when communication is especially important. Key times during which communication is typically crucial are identified.

Adaptation, Psychological↗
PubMedDate not supplied

Impact of an electronic meeting system on the group decision-making process.

Traditional face-to-face meetings are effective for many meeting formats; however, there are occasions when communication needs to be conducted in a more open, anonymous style. When the discussion centers on controversial and/or emotional issues, such as curriculum planning, the need for a nontraditional style may even be greater. Our nursing program decided to utilize a new campus resource called the Group Decision Center to facilitate undergraduate curriculum planning. The Group Decision Center is an electronic meeting system in which the discussion takes place in a face-to-face electronic format. The advantages of an electronic meeting system format include participant anonymity, equal and increased participation by group members, increased productivity and efficiency, automated record keeping, group synergy, and a more structured meeting. The disadvantages include the potential for inappropriate or hostile conversations, loss of acknowledgment for individual idea generation, breakdown of linear conversation, and lack of the nonverbal communication that often influences the meaning within a traditional conversation. The process of developing, planning, and participating in the electronic meeting and the automated record are discussed.

Curriculum↗
PubMed2002

Learning disability nurses' experiences of being with clients who may be in pain.

AIMS: This study aims to describe the experiences of Learning Disability Nurses (RNLDs) when they are with clients who may be in pain but who cannot communicate their feelings verbally. BACKGROUND: Research indicates that general nurses often find it difficult to perceive their patients' pain accurately, but no studies refer to the experiences of RNLDs. For people with severe learning disabilities this could lead not only to unnecessary suffering, but also to long-term tissue damage and may even prove fatal. METHOD: A phenomenological approach was adopted, as unrecognized pain is a subject about which little is known and the lived experiences of nurses and the meanings that they attach to them were being explored. Data were collected by unstructured interviews with a snowball sample of eight RNLDs. The participants were asked to describe a situation in which they thought a client was in pain. Analysis was based on Hycner's guidelines for the phenomenological analysis of interviews. FINDINGS: Five central themes emerged: the importance of a caring relationship with the client, recognizing changes in verbal and nonverbal behaviour, searching for a meaning in the client's behaviour, negotiating with other health professionals and sharing in the client's feelings. CONCLUSIONS: Nurses valued highly their relationship with a client, which can, in itself, be therapeutic. Clients apparently used a wide range of both conventional and nonconventional forms of nonverbal communication, including aggressive and self-harming behaviours, as the primary way of expressing pain. Functional speech cannot be taken as an indicator that the clients can self-care with regard to pain. RNLDs play an important role in negotiating between their clients and other health professionals, but must be careful not to make assumptions about the causes of pain and pass these assumptions on to the General Practitioner as a professional opinion. The use of diagnostic tests should be supported. RNLDs appeared to be sympathetic, rather than empathetic, towards their client's painful experiences.

Communication↗
PubMed2006

Risperidone in children with autism: randomized, placebo-controlled, double-blind study.

Some open-label studies suggest that risperidone can be useful in the treatment of certain target symptoms in children with autism. We aimed to study whether the use of risperidone in comparison with placebo improved functioning in children with autism with regard to behavior (aggressiveness, hyperactivity, irritability), social and emotional responsiveness, and communication skills. We conducted a randomized, double-blind, placebo-controlled trial with 40 consecutive children with autism, whose ages ranged from 2 to 9 years, who were receiving either risperidone or placebo given orally at a dose of 1 mg/day for 6 months. Autism symptoms were monitored periodically. The outcome variables were total scores on the Childhood Autism Rating Scale (CARS) and the Children's Global Assessment Scale (CGAS) after 6 months. Of the 40 children enrolled, 39 completed the trial over a period of 18 months; 19 received risperidone, and 20 received placebo. In the risperidone group, 12 of 19 children showed improvement in the total Childhood Autism Rating Scale score and 17 of 19 children in the Children's Global Assessment Scale score compared with 0 of 20 children for the Childhood Autism Rating Scale score and 2 of 20 children for the Children's Global Assessment Scale score in the placebo group (P < .001 and P = .035, respectively). Risperidone also improved social responsiveness and nonverbal communication and reduced the symptoms of hyperactivity and aggression. Risperidone was associated with increased appetite and a mild weight gain, mild sedation in 20%, and transient dyskinesias in three children. Risperidone improved global functioning and social responsiveness while reducing hyperactivity and aggression in children with autism and was well tolerated.

Autistic Disorder↗
PubMed1995

Signs of defensive control locate conflicted topics in discourse.

BACKGROUND: Psychodynamic clinicians cite defensive actions observed in evaluation and treatment as a source of important information. Empirical support for such assertions has seldom been based on objective study of recorded psychotherapy. A quantitative study of the association of signs of defensive control with disclosure of conflicted beliefs was undertaken. METHODS: Brief dynamic psychotherapies of two patients with pathological grief reactions were recorded and reviewed by independent judges. Periods of heightened defensive control of verbal and nonverbal communication were quantified using operational definitions. Reliably scored defensive episodes were algorithmically selected by computer programs. The people and topics discussed by patients were independently scored. RESULTS: Highly defensive periods contained disproportionately more frequent instances of patient discourse about people involved in conflict and unresolved topics. CONCLUSIONS: The findings support the psychodynamic hypothesis that observation of defensive behaviors may locate times of communication about conflicted themes.

Adult↗
PubMed1976

The audiovisual interview. A new tool in medical education.

The audiovisual interview with a patient in the office of the student physician or physician is an essential undergraduate, graduate, and postgraduate educational management tool. Immediate feedback and insight are obtained as to how the patient and educator perceive the performance and service of the student or professional. Therapeutic failures may be recognized, and misconceptions and misreading of verbal and nonverbal communications can be corrected immediately. There is access to integrating psychosocial and biologic variables, with a better chance to extract more valid information for creative problem-solving and less of a chance for therapeutic failures. The student recognizes and appreciates the therapy and healing in the dialogue.

Audiovisual Aids↗
PubMed1997

Flight style of the black-billed magpie: variation in wing kinematics, neuromuscular control, and muscle composition.

Black-billed magpies (Pica pica; Corvidae) exhibit an unusual flight style with pronounced, cyclic variation in wingbeat frequency and amplitude during level, cruising flight. In an effort to better understand the underlying internal mechanisms associated with this flight style, we studied muscle activity patterns, fiber composition of the pectoralis muscle, and wingbeat kinematics using both laboratory and field techniques. Over a wide range of speeds in a windtunnel (0-13.4 m s-1), wingbeat frequency, wingtip elevation, and relative intensity of electromyographic (EMG) signals s-1 from the flight muscles were least at intermediate speeds, and increased at both slower and faster speeds, in approximate agreement with theoretical models that predict a U-shaped curve of power output with flight speed. Considerable variation was evident in kinematic and electromyographic variables, but variation was continuous, and, thus, was not adequately described by the simple two-gait system which is currently accepted as describing gait selection during vertebrate flight. Indirect evidence suggests that magpies vary their flight style consistent with reducing average power costs in comparison to costs associated with continuous flapping at a fixed level of power per wingbeat. The range of variation for the kinematic variables was similar in the field and lab; however, in the field, proportionally fewer flights showed significant correlations between wingbeat frequency and the other variables. Average flight speed in the field was 8.0 m s-1. Average wingbeat frequency was less in the field than in the windtunnel, but mean values for wingtip elevation and wingspan at midupstroke were not significantly different. Histological study revealed that the pectoralis muscle of magpies contained only fast-twitch (acid-stable) muscle fibers, which were classified as red (R) and intermediate (I) based on oxidative and glycolytic capacities along with fiber diameter. This fiber composition may be related to variation in wingbeat kinematics, but such composition is found in the pectoralis of other bird species. This suggests that the muscle fibers commonly found in the pectoralis of small to medium sized birds are capable of a wider range of efficient contractile velocities than predicted by existing theory. Future studies should explore alternative explanations for variation in wingbeat kinematics, including the potential role of nonverbal communication among cospecifics.

Animals↗
PubMedDate not supplied

Behavioral phenotype of fragile X syndrome: DSM-III-R autistic behavior in male children.

Comparison of 34 fragile X [(fra(X)] male children (age 3-18 years) with 32 IQ- and age-matched, non-fra(X) male control children was conducted using specific DSM-III-R criteria for autism. Statistical analyses supported predictions that fra(X) males show increased dysfunction in peer social play, nonverbal communication (e.g., gaze aversion, gesturing), verbal communication (e.g., rate, volume, word/phrase perseveration), and repetitive motor behaviors (e.g., handflapping, rocking). There was a trend for fra(X) children to show abnormal responsivity to sensory stimuli as well such as oversensitivity to sound and increased mouthing or smelling of objects. The investigation supports the contention that fra(X) males manifest a specific subset of behaviors from the autistic spectrum. Implications for treatment are discussed.

Adolescent↗
PubMed1996

Disorders of affective and linguistic prosody in children after early unilateral brain damage.

Prosody is that quality of speech that imparts meaning by changes in intonation, pitch, and stress. The right hemisphere (RH) appears to be dominant for affective prosody in adults, while the left hemisphere (LH) mediates the more linguistic aspects of nonverbal communication. Few similar studies have been reported of individuals who suffered early unilateral brain damage, when brain reorganization or plasticity might be expected to play a role in ameliorating the adverse effects of focal brain damage. In this study, comprehension and expression of affective and linguistic prosody were tested in subjects with documented unilateral brain damage of pre- or perinatal onset and in matched controls. Both RH- and LH-lesion groups demonstrated difficulty on tasks involving expression of affective prosody, and on tests of linguistic prosody, compared with controls. Only the RH-lesion group was impaired on an affective comprehension task. The results indicate that even after very early unilateral brain damage, prosodic deficits may be present. However, only for affective comprehension does the side of the lesion appear to determine such deficits. The findings suggest that during brain development there is not clear brain lateralization for prosody and there may be bilateral representation for these skills during early development. There may be limitations to the ability of the developing brain to reorganize after early injury.

Adolescent↗
PubMed2003

Muscles of facial expression in Otolemur, with a comparison to lemuroidea.

Gross and histologic aspects of facial expression muscles are presented here for Otolemur spp. (suborder Prosimii, family Lorisidae) and are compared with those of lemuroids. Muscles of facial expression are involved in social signaling among primates, and are a primary means by which close-proximity nonverbal communication is achieved. These muscles have been well described in catarrhines and many of the lemuroids; however, their arrangement is not well known in the lorisids. In the present study we examined muscles of facial expression in Otolemur by dissecting preserved faces. The arrangement and appearance of the muscles were noted, and samples were gathered from each muscle for histologic processing. The results showed 17 muscles of facial expression in Otolemur, as compared to seven reported in previous studies. Histologically, muscles of the ear region were arranged in tight, dense fascicles, while muscles of the orbital region were arranged more loosely. Grossly, the facial expression muscles in Otolemur were very similar in morphology and attachments to those in the lemuroids, with some differences in the ear region. Otolemur garnettii had several muscles that appeared to be more robust than in the larger O. crassicaudatus. This may be due to dietary and/or social differences between the species. In previous studies it was concluded that, relative to lemuroids, Otolemur has a primitive arrangement of facial expression muscles. The current results do not support that conclusion, and in fact support a far greater similarity between Otolemur and lemuroids in general. These results underscore the need for a reexamination of facial musculature in prosimians in general, and may have taxonomic value as regards the position of Otolemur with lemuroids and other galagos.

Animals↗
PubMed1999

Infantile spasms: facial expression of affect before and after epilepsy surgery.

This is a longitudinal study of facial expression of affect in 28 children with intractable infantile spasms who underwent epilepsy surgery. After a mean follow-up period of 1.8 years, there was a significant increase in positive affect, a significant decrease in neutral affect, and no change in negative affect during a nonverbal communication paradigm. These findings were unrelated to surgical (i. e., side of surgery, type of surgery) or seizure-related variables (i.e., seizure control, age at onset of illness, duration of illness, change in antiepileptic drugs). Comparison of affect in a subgroup of 16 patients with those of 32 normal subjects suggest a normal age-related increase in the use of positive affect. Both before and after surgery, the patients used the most positive affect while not communicating. They also used significantly more positive affect during while requesting objects or assistance rather than during social referencing. Intractable infantile spasms might be associated with reduction in the facial expression of positive affect and with impaired use during social communication.

Affect↗
PubMed1993

Parapraxes in song recall: a neglected variable.

In addition to expressing themselves with verbal and nonverbal communications, and by the countertransference reactions perceived by analysts, patients also reveal their inner world of images and feelings specifically with music evocations. This paper presents an initial attempt to identify and classify some of the parapraxes produced in the evocation of lyrics and music by polyglot members of treatment dyads in two empirical studies and in private practice. There may be many others, particularly related to the music per se. This paper has focused mainly on the lyrics, the equivalent of the manifest content of dreams, which nonmusician therapists can learn to handle well. Instead, in the case of the musical latent content, some knowledge of music is necessary. Supervisors' songs were considered beyond the scope of this paper and will be addressed separately. Parapraxes in song recall signal unconscious transference-countertransference states in process at the moment of evocation.

Countertransference↗
PubMed1975

Factors in the diagnosis and treatment of chronic pain.

Symptoms are the verbal and nonverbal communicative expressions of experience. At any one time, the symptom is dependent on structural changes, genetic variations, metabolic abnormalities, immunopathic and other disorders, and the totality of social, economic, and situational experience. Complaints of pain may vary with time depending on the interaction of these features in a manner not directly related to the intensity of a noxious stimulus.

Antidepressive Agents↗
PubMed1994

Subtypes of autism by cluster analysis.

Multidisciplinary data from 166 children with autistic spectrum disorders were subjected to cluster analysis. Cross-validation between random halves of the sample showed acceptable consistency of the clustering method. Four clinically meaningful subtypes emerged from the analysis. They did not differ in demographic characteristics but did show, on average, distinct differences in behavioral and cognitive areas. Over half of the sample fell into a subtype described as typically autistic with abnormal verbal and nonverbal communication, aloofness, impaired social skills, and sensory disturbances. Another 19% were similarly autistic but with moderate to severe mental handicap. The remaining children formed two subtypes: a high-functioning Asperger-like group who were overactive and aggressive, and a small group who were impaired in social and language skills, had restricted interests, and a family history of learning problems. This study highlights important differences among children with autism and emphasizes relationships between cognitive functioning and subtypes of the disorder.

Attention Deficit Disorder with Hyperactivity↗
PubMed1989

Infantile autism: a syndrome of multiple primary deficits?

Attempts to explain infantile autism in terms of just one underlying neurological or psychological deficit may be misguided. As in the case of many neurological syndromes, autism may involve multiple functional deficits due to multiple coexistent neurological deficits. Comparison with Asperger's syndrome and the developmental dysphasias suggests that the autistic syndrome results from the coexistence of at least two distinct constellations of functional impairments: deficits in mechanical language skills, as in the developmental dysphasias; and deficits in social relatedness, play, and nonverbal communication, as in Asperger's syndrome. Possible neurological underpinnings are considered, including the relative contribution of the two cerebral hemispheres. Implications for etiology and research are discussed.

Aphasia↗
PubMed2006

Cognitive and symptom profiles in high-functioning pervasive developmental disorder not otherwise specified and attention-deficit/hyperactivity disorder.

Age- and IQ-balanced 27 children with high-functioning (IQ>or=70) pervasive developmental disorder not otherwise specified (HPDDNOS) and 27 children with attention-deficit/hyperactivity disorder (ADHD) were compared on the Japanese version of Wechsler Intelligence Scale for Children Third Edition (WISC-III) and the Childhood Autism Rating Scale-Tokyo Version (CARS-TV). Compared with the ADHD children, the HPDDNOS children scored significantly lower on verbal comprehension, vocabulary, and comprehension, but significantly higher on block design. After controlling for the total CARS-TV score, the HPDDNOS children were significantly more abnormal on "relationships with people," "nonverbal communication," and "general impressions," but less abnormal on "near receptor responsiveness" and "activity level." These differences in cognitive and autistic symptom profiles may help professionals to distinguish clinically between both conditions.

Adolescent↗
PubMed2004

Early Diagnosis of Autism Spectrum Disorders.

Autistic spectrum disorders (ASD) are an often-disabling continuum of disorders affecting two to four in 1000 children. These disorders have a core set of defining features including impaired verbal and nonverbal communication, impaired social interaction, and restricted or repetitive patterns of behavior. The cause of autism is unclear. The disorder can be defined only by related behaviors. Although there has been considerable improvement in standardized screening techniques for ASD in the past 10 years, screening and diagnostic practices in medicine and education lag far behind clinical research. Various studies have found the average age of diagnosis to be between 3 and 6 years, with significant differences as a function of ethnicity and socio-economic status. Preliminary research suggests that in some populations, missed diagnosis and misdiagnosis of ASD are common. This may be caused partly by inadequate screening practices. It also may reflect that presentation of symptoms varies from patient to patient. Lack of resources for appropriate referral, diagnosis, and treatment may play an important role. This article discusses recent progress in ASD screening, what is known of current screening and diagnostic practices, and future directions for research and practice improvement. The best practice model for the screening and early diagnosis of autism spectrum disorders and other developmental disabilities should include routine developmental surveillance as part of well-child pediatric care. General developmental screening should be followed by autism-specific screening for those children who fail the initial developmental screen, or whose parents report suspect behaviors.

Journal Article↗