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Animal-assisted therapy for children with pervasive developmental disorders.

The present study quantitatively evaluated the effects of interaction with dogs on children with pervasive developmental disorders (PDD), disorders characterized by lack of social communications and abilities. While interacting with a therapist, children were exposed to three different conditions: (a) a nonsocial toy (ball), (b) a stuffed dog, and (c) a live dog. Prosocial and nonsocial interactions were evaluated in terms of both behavioral and verbal dimensions. Results show that children exhibited a more playful mood, were more focused, and were more aware of their social environments when in the presence of a therapy dog. These findings indicate that interaction with dogs may have specific benefits for this population and suggest that animal-assisted therapy (AAT) may be an appropriate forrm of therapy

Adolescent↗

Is Rett syndrome a subtype of pervasive developmental disorders?

The author reviews the issue on whether Rett syndrome (RS) is a subtype of pervasive developmental disorders (PDDs). More than 200 articles of RS have been published in the last 10 years. Internal and external validities of RS have been established by several independent studies. There remains the question whether RS presents clinical features that meet the total criteria for PDDs. The available data seem to support the idea of classifying RS as a subtype of PDDs in the DSM-IV.

Child↗

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↗

Spatial attention in individuals with pervasive developmental disorders using the gap overlap task.

The present study examined spatial attention in individuals with pervasive developmental disorders (PDD) using the gap overlap task and analyzed the express saccade, which is defined by its extremely short reaction time, as a measure of the state of attention. Participants were required to move their eyes to the target stimulus appearing on the left or right side of a fixation point. In this task, participants had to disengage their attention from the central fixation point and shift it to the peripheral target stimulus. In the gap condition, the fixation point disappeared 200 ms before the target stimulus was presented, and in the overlap condition, the fixation point remained while the target stimulus was presented. Saccade latencies were not different between the groups. However, the express saccade was more frequent in the PDD group than in the normal group in the overlap condition. We conclude that individuals with PDD have deficiencies in attentional engagement. Moreover, our study suggests that analysis of the express saccade will be useful in further examinations of attentional processes in PDD.

Adult↗

Low-frequency hearing assessment by middle latency responses in children with pervasive developmental disorder.

OBJECTIVE: In this study, we assessed middle latency responses (MLR) in children diagnosed with pervasive developmental disorder (PDD) in order to detect low-frequency auditory thresholds. METHODS: 35 children, 25 males and 10 females, aged below 5, diagnosed with PDD were referred to rule out any possible hearing deficit. Audiologic evaluation included free-field testing, tympanometry, and both MLR and auditory brainstem responses. A control group of 15 normal children matched for sex and age were used. RESULTS: In 9 out of 35 children (25%), low-frequency sensory hearing loss was revealed. The hearing loss was unilateral in seven children and bilateral in two, and varied from slight to severe. In four out of the nine cases (44%), parents had not suspected hearing loss, since these children always responded to sound. CONCLUSIONS: Among children diagnosed with PDD a significant proportion (25%) was affected by low-frequency sensory hearing loss, detected by MLR. In these children, when low-frequency hearing loss was found bilateral or severe unilateral, aural rehabilitation was initiated in order to improve their responses to auditory stimuli and their impaired communication with the environment. PDD children, even if their reaction to sound is normal, must be referred to thorough audiometric evaluation while low-frequency hearing level should always be tested.

Acoustic Impedance Tests↗

Psychiatric comorbidity in patients with developmental disorders and epilepsy: a practical approach to its diagnosis and treatment.

Psychiatric comorbidity in patients with developmental disorders and epilepsy (PDDEs) is relatively frequent. The majority of its pharmacological treatment has consisted of the use of neuroleptic drugs in an attempt to control behavioral disturbances, despite the fact that these symptoms may often mask underlying psychiatric disorders such as anxiety and depression, which require other types of psychotropic drugs. In this article, we review the pathogenic mechanisms that mediate the clinical manifestations of psychiatric disorders in PDDEs, highlight diagnostic strategies that may help in elucidating the correct psychiatric diagnosis, and review the psychopharmacological treatments available.

Journal Article↗

A review of the diagnostic methods reported in the Journal of Autism and Developmental Disorders.

This review summarizes subject selection and diagnostic procedures documented in the Journal of Autism and Developmental Disorders. One hundred forty-two empirical articles published between February 1993 and April 1997 were examined. Reviewers independently evaluated articles using a coding instrument developed by the authors. Results indicated that a majority of researchers reported the use of one or more standard diagnostic criteria in classifying their subjects. However, numerous studies did not report the methods by which the diagnostic criteria were quantified or applied. Additionally, there was a lack of clear specification of inclusion and exclusion criteria for comorbid disorders. Improving the documentation of diagnostic practices in research on autism will benefit researchers and practitioners.

Autistic Disorder↗

Communication profiles of individuals with Down's syndrome, Angelman syndrome and pervasive developmental disorder.

The communication profiles of individuals with Down's syndrome (DS), Angelman syndrome (AS) and pervasive developmental disorder (PDD) were investigated and contrasted. Seventy-seven individuals participated in the study. A within-group analysis revealed that those with DS performed better on tacting or labelling and echoing than on manding or requesting. No other effects were found, apart from an absence of echoing in those with AS, a result that is hardly surprising. A between-groups analysis revealed no differences between the aetiological groups in terms of their use of mands or requests and tacts. Individuals with DS and PDD did not differ in their scores on echoic functioning. The implications of these findings for the study of behavioural phenotypes and for communication intervention are discussed.

Adolescent↗

Functional neuroimaging of social cognition in pervasive developmental disorders: a brief review.

An emerging literature on the neuroanatomical correlates of social cognition in pervasive developmental disorders is reviewed. Studies conducted with high-functioning adults with autism or Asperger's syndrome highlight patterns of decreased activation in ventromedial prefrontal cortex, temporo-parietal junction, amygdala, and periamygdaloid cortex, along with aberrantly increased activation in primary sensory cortices. Future studies should extend these important initial results to younger and more severely affected subjects.

Adult↗

Targeting symptom domains: a strategy for pharmacotherapy in childhood pervasive developmental disorders.

This article summarizes clinical guidelines and reviews psychopharmacologic studies involving children and adolescents with Pervasive Developmental Disorders (PDDs). Strategies are drawn from basic principles of pediatric psychopharmacology, nonpharmacological approaches to the treatment of PDDs, and practical clinical experience in an attempt to provide the practitioner with an evidence-based approach to utilizing pharmacotherapy in children and adolescents with PDDs. Although early identification followed by intensive educational and behavioral interventions remains the essential treatment of PDDs, there is evidence to support the identification of target behaviors or symptom domains, for medication. Evidence-based medicine (EBM) is then used to guide pharmacotherapy with the overall goal of optimizing the benefits of multidisciplinary treatment interventions.

Adolescent↗

Reproductive wastage and developmental disorders in relation to consanguinity in south India.

The effect of consanguinity on fertility, reproductive loss and developmental disorders were studied in 156 consanguineous marriages in comparison with 221 non-consanguineous marriages. Although fertility was greater (P less than 0.05) in consanguineous than in non-consanguineous marriages, the number of living children were approximately equal in both groups, on account of increased child mortality in the former (P less than 0.05). The frequencies of abortion and stillbirth were (also) approximately equal in both groups. Developmental anomalies were significantly more frequent (P less than 0.001) among the offspring of consanguineous parents. These results indicate the continued presence of deleterious genes in this population, in spite of the practice of consanguinity over many generations.

Abortion, Spontaneous↗

Musical behavior in a neurogenetic developmental disorder: evidence from Williams Syndrome.

This paper reviews a series of studies performed to assess the musical abilities and behaviors of individuals with Williams syndrome, a neurogenetic developmental disorder, in the hope of eventually being able to link genes, neurodevelopment, and cognition. Two questionnaire studies addressing the role of music in everyday life, and unusual reactions to sound, are described. Additionally, the findings from two empirical behavioral studies and a neuroimaging study are reviewed. The findings show that individuals with Williams syndrome tend to be more engaged in musical activities than others, and I report a possible neuroanatomical correlate of this engagement, with increased activation in the right amygdala to music and to noise. Williams syndrome represents a compelling model of the relationship between genes, brains, and such complex cognitive behaviors as music.

Adolescent↗

Kazal type trypsin inhibitor in amniotic fluid in fetal developmental disorders.

The amniotic fluid concentrations of the Kazal type trypsin inhibitor were studied in pregnancies with fetal developmental disorders. The samples were obtained by amniocentesis between 14 and 19 weeks of gestation. In cases with fetal malformations, the level was below the normal 10th centile in 15 out of 28 cases (54 per cent, p less than 0.05) and above the normal 90th centile in 2 cases (7.1 per cent). Low values were common in cases with intrauterine fetal death or congenital nephrosis. The levels were normal in fetal chromosomal aberrations.

Amniocentesis↗

Life events and depression in children with pervasive developmental disorders.

To determine the role of life events in the occurrence of depression in children with pervasive developmental disorders (PDD), we compared 11 patients (DSM-III-R; 9 male; 2 female; M age: 11.0 years; M full-scale IQ: 75.3) with PDD and depression, with an age- and sex-matched control group of patients with PDD without depression (DSM-III-R; 9 male; 2 female; M age: 9.8 years; M full-scale IQ: 60.6). Information was collected about the occurrence of unpleasant life events in the 12 months prior to the onset of depression. Depressed children experienced significantly more life events in the 12 months prior to the onset of depression. Exit events such as bereavement were more common in the depressed group. Findings suggest that, as in the general population, significant life events, particularly those with a negative impact, may contribute to the occurrence of depression in children with PDD. Future studies should explore the role of both biologic factors and environmental stressors in the onset of depression in this population.

Autistic Disorder↗

ERPs and eye movements reflect atypical visual perception in pervasive developmental disorder.

Many studies of eye tracking or event-related brain potentials (ERPs) in subjects with Pervasive Developmental Disorder (PDD) have yielded inconsistent results on attentional processing. However, recent studies have indicated that there are specific abnormalities in early processing that are probably related to perception. ERP amplitudes in response to visual stimuli, measured above the occipital (modality-specific) cortex, are reported to be abnormally small in patients with PDD, and the abnormal visual processing is possibly associated with the spatial visual frequency content of stimuli. It is suggested that subjects with PDD show abnormal activation of visual pathways dedicated to the processing of high and low spatial frequencies.

Attention↗

Donepezil in the treatment of ADHD-like symptoms in youths with pervasive developmental disorder: a case series.

BACKGROUND: Recent studies reported ADHD-like symptoms and cognitive deficits in pervasive developmental disorder (PDD). Because work in dementia documents improvement in executive function deficits with the acetylcholinesterase inhibitor donepezil, the authors reason that similar benefits could be obtained in PDD. METHOD: The authors describe eight cases of PDD youth ages 10 to 17 treated with donepezil targeting ADHD-like symptoms associated with PDD. RESULTS: Most participants improve ADHD-like symptomatology. In addition, improvement in communication and socialization is noted. CONCLUSION: Donepezil may have a role in treating ADHD-like symptoms in children with PDD.

Adolescent↗

Regression in pervasive developmental disorders: seizures and epileptiform electroencephalogram correlates.

BACKGROUND: Approximately one third of the parents of children with pervasive developmental disorders or autistic spectrum disorders reports an early regression of unknown cause in their children's language, sociability, and play. Seizures or an epileptiform electroencephalogram (EEG) are associated with language regression in acquired epileptic aphasia (Landau-Kleffner syndrome) and some other pediatric epileptic syndromes. The importance of epilepsy or epileptic EEGs as contributors to autistic regression is not known. METHOD: Subjects were 482 boys and 103 girls on the autistic spectrum seen consecutively in consultation by one child neurologist. Data on autistic regression, seizures, sleep EEGs, and cognitive function were entered prospectively into a data base. RESULTS: Of the 585 children, 176 (30%) had a history of regression, and 66 children (11%) had a history of epilepsy, defined as two or more unprovoked seizures. Among 392 children with available sleep EEGs, the EEG was epileptiform in 59% of the 66 epileptic children and 8% of the 335 nonepileptic children. Regression had occurred equally among children without seizures and in those with epilepsy. Regression was associated with an epileptiform EEG in 14% of 155 nonepileptic children who had undergone a regression, as opposed to 6% of 364 children with neither regression nor epilepsy. Mean age at regression was 21 months. There was no difference in the proportion of children with epilepsy or epileptiform EEGs who had regressed before or after 2 years of age. Approximately half of the epileptiform discharges were centrotemporal, whether or not the child was epileptic or had regressed. Children with lower cognitive function were more likely to have undergone regression than those with better cognitive skills (34% vs 20%). CONCLUSION: Epilepsy or epileptiform EEGs occur in a significant minority of autistic children with a history of regression and in a smaller minority without regression. Prompt recognition of regression and recording of prolonged sleep EEGs is recommended, even though information on the potential efficacy of antiepileptic treatment to improve language and behavior in autistic children with epilepsy or an epileptiform EEG is still lacking.

Adolescent↗

Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. American Academy of Child and Adolescent Psychiatry Working Group on Quality Issues.

Autism and the related pervasive developmental disorders are characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills, which arise in the first years of life. Although frequently associated with mental retardation, these conditions are distinctive in terms of their course and treatment. These conditions have a wide range of syndrome expression, and their management presents particular challenges for clinicians. Individuals with these conditions can present for clinical care at any point in development. The multiple developmental and behavioral problems associated with these conditions often require the care of multiple providers; coordination of services and advocacy for individuals and their families is important. Early, sustained intervention is indicated, as is the use of various treatment modalities (e.g., pharmacotherapy, special education, speech/communication therapy, and behavior modification).

Adolescent↗