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PubMed2004

Looking for childhood schizophrenia: case series of false positives.

Extensive experience with the diagnosis of childhood-onset schizophrenia indicates a high rate of false positives. Most mislabeled patients have chronic disabling, affective, or behavioral disorders. The authors report the cases of three children who passed stringent initial childhood-onset schizophrenia "screens" but had no chronic psychotic disorder. For two, the European literature yielded more fitting diagnoses: psychosis not otherwise specified (e.g., reactive or psychogenic psychosis, paranoid schizophrenia), single episode in full remission (e.g., anxiety psychosis), and factitious disorder (DSM-IV 300.16). These cases illustrate that transient psychotic illnesses can be misdiagnosed as childhood-onset schizophrenia. Proper identification can prevent years of inappropriate therapies.

Adolescent↗
PubMedDate not supplied

Neurocognitive function and joint attention ability in young children with autism spectrum disorder versus developmental delay.

Studies have shown that young children with autism are not impaired on prefrontal tasks relative to what would be expected for their mental age, raising questions about the executive dysfunction hypothesis of autism. These studies did not include ventromedial prefrontal tasks, however. The present study examined whether young children with autism spectrum disorder (ASD) are impaired on ventromedial prefrontal tasks, and whether performance on such tasks is correlated with a core autism symptom, joint attention ability. Seventy-two 3- to 4-year-old children with ASD, 34 3- to 4-year-old developmentally delayed children, and 39 12- to 46-month-old typically developing children, matched on mental age, were administered ventromedial and dorsolateral prefrontal tasks and joint attention tasks. Children with ASD performed similarly to comparison groups on all executive function tasks, indicating that at this early age, there is no autism-specific pattern of executive dysfunction. Ventromedial, but not dorsolateral, prefrontal task performance was strongly correlated with joint attention ability, however. The ventromedial prefrontal cortex is hypothesized to play a role in the development of joint attention and possibly some aspects of the autistic syndrome.

Attention↗
PubMed2002

Theory of mind in children with 'lesser variants' of autism: a longitudinal study.

BACKGROUND: The study investigated the development of theory-of-mind (ToM) knowledge in children with lesser variants' of autism (PDD-NOS) over a period thought to be critical for ToM development (i.e., 3 to 5 years of age). METHOD: The sample included 11 children with PDD-NOS; 23 normally developing children were included for cross-sectional comparison and 13 normally developing children for longitudinal comparison. The groups were comparable in verbal and non-verbal mental age. Two storybooks were used for repeated assessment of various aspects of the children's theory of mind: emotion recognition, the distinction between physical and mental entities, prediction of behaviour and emotions on the basis of desires and prediction of behaviour and emotions on the basis of beliefs. RESULTS: The results showed that the children with PDD-NOS had specific difficulties in understanding and predicting other people's emotions on the basis of situational cues, desires and beliefs. However, their ability to predict actions from beliefs and desires were relatively intact. Compared to the normally developing children, these children achieved lower levels of theory-of-mind knowledge, both at time of initial assessment and approximately 6 months later. CONCLUSIONS: The data suggest that the theory-of-mind development of children with PDD-NOS is both delayed and deviant. The growth pattem of theory-of-mind skills in children with PDD-NOS seemed to be qualitatively different from the growth pattern found in the group of normally developing children.

Child Development Disorders, Pervasive↗
PubMed2004

Comparison of high-functioning atypical autism and childhood autism by Childhood Autism Rating Scale-Tokyo version.

To assess autistic symptom differences between high-functioning atypical autism (atypical symptomatology) (HAA; IQ >/= 70) and childhood autism (HCA), 53 HAA children (mean: 6.0 +/- 0.5 years) were compared with 21 HCA children (mean: 8.2 +/- 1.1 years) on the Childhood Autism Rating Scale-Tokyo version (CARS-TV). Because IQ on the Japanese version of the Stanford-Binet and CARS-TV total scores differed significantly between HAA and HCA, analysis of covariance was conducted with IQ and CARS-TV total scores controlled for. In two items of CARS-TV (relationship with people and general impressions) the HAA children were significantly less abnormal than the HCA children. Affect tended to be significantly milder in HAA than HCA. Anxiety reaction was significantly more abnormal in HAA than HCA. These findings may be useful to distinguish between HAA and HCA.

Adolescent↗
PubMed1997

How specific are "specific developmental disorders"? The relevance of the concept of specific developmental disorders for the classification of childhood developmental disorders.

The concept of "specific developmental disorder" (SDD) refers to delays in developmental domains such as language and speech development, motor coordination or the development of scholastic skills, in the absence of sensory deficits, subnormal intelligence or poor educational conditions. The key element in this concept is the notion of a discrepancy between observed and expected level of development. In DSM-III-R and ICD-10, SDD serves as a conceptual umbrella, suggesting that the subsumed disorders are of the same type. In DSM-IV, the SDD umbrella is not used explicitly, but the notion of a discrepancy is present in the categories of Learning Disorders, Motor Skill Disorder and Communication Disorders, suggesting a close relationship between these disorders. One of the advantages of the use of SDD as a unifying concept is that it contributes to the standardisation of the description of the various disorders. However, based on reviews of research regarding the reliability and validity of the SDD categories, we argue that the application of a unifying SDD concept has been premature. For each of the categories for disorders in scholastic skills, language, speech and motor coordination, the notion of a discrepancy between observed and expected level of development should be elaborated and tested more thoroughly, before SDD can be used as a unifying concept in classification.

Adolescent↗
PubMed1986

A therapeutic feeding programme. I: Theory and practice of feeding.

Feeding problems are often commented on in the literature, but very little has been reported on the systematic examination of these problems. In the present study feeding disturbances were treated as part of a full diagnostic and treatment programme for disturbed children in a small residential psychiatric unit. The feeding programme was based on the early work of Clancy and colleagues in Australia, and consisted of offering the child food in a set situation by the same 'feeder'. A one-way screen was used for observation and video-recording. Three children are described in detail, and a striking effect was the immediacy of change in their feeding disturbances. It is stressed that early feeding difficulties of disturbed children can give rise or contribute to ever-widening faulty development.

Autistic Disorder↗
PubMed1993

Children with deficits in attention, motor control and perception (DAMP) almost grown up: general health at 16 years.

One hundred and one children (56 with and 45 without deficits in attention, motor control and perception (DAMP)), originally diagnosed at six or seven years of age and belonging to a representative cohort of children from the general population were followed up at 16 and 17 years of age. There was a significant excess of substance abuse, fractures and other accidents in the DAMP group than among controls, in addition to more motor co-ordination problems, clumsiness, and height and weight problems. Mean complex visual reaction time was significantly longer in the DAMP group, accounted for by the number of boys in the group. It appears that 10-year outcome for children who had attention problems and clumsiness during the preschool period is considerably poorer than for those who did not have such problems.

Adolescent↗
PubMed1992

Psychosocial growth failure: a positive response to growth hormone and placebo.

Seven children were diagnosed as having an emotional cause for growth failure. Pretreatment growth hormone secretion profiles during sleep were analysed using PULSAR. Mean (+/- SD) growth hormone concentration was 10.9 (4.4) mU/l, mean peak 19.6 (6.7) mU/l and the peak-to-peak interval 147 (108) min. Mean (SEM) IGF-I was 1.08 (0.31). The seven children received a six-month course of recombinant growth hormone in a double-blind, crossover study using a dose of 1.2 U/kg/week (28 U/m2/week). Daily placebo injections were given for the other six-month epoch, with a one month washout period. The mean (SEM) growth velocity SD score after growth hormone administration was +4.66 (1.88) and after placebo -0.60 (0.69), each value being greater than the pretreatment value of -2.32 (0.122) (p less than 0.0001 on analysis of variance). The change in IGF-I during growth hormone treatment was not significant. No significant changes in food energy or protein intake occurred.

Age Determination by Skeleton↗
PubMedDate not supplied

My brother's keeper: simultaneous hospitalization of siblings.

Milieu therapists are confronted with a dilemma when more than one child in the same family requires hospitalization. Conventional wisdom discourages simultaneous hospitalization of siblings on the same unit. The sibling bond, however, is an important aspect of development and can be used therapeutically. This paper examines issues and opportunities presented to milieu therapists by the simultaneous hospitalization of siblings, and makes recommendations for maximizing therapeutic use of the sibling bond.

Adolescent↗
PubMed1988

DSM-III and DSM-III-R diagnoses of autism.

The authors examined the reliability, sensitivity, and specificity of DSM-III and DSM-III-R criteria for autism in relation to each other and to clinical diagnoses in 114 children and adults (52 diagnosed by clinicians' best judgment as autistic and 62 as nonautistic but developmentally disordered). They used a standard, structured coding scheme to evaluate each patient. The reliability of specific criteria was generally high. Although DSM-III criteria were highly specific, they were less sensitive; the reverse was true for DSM-III-R. The authors conclude that the diagnostic concept of autism in DSM-III-R appears to have been substantially broadened.

Adolescent↗
PubMed1985

Self-inflicted injuries in childhood. A review and diagnostic approach.

Eleven clinical and behavioral syndromes that can result in self-inflicted injury in childhood and adolescence are reviewed and classified. The causes and remedies of such injuries vary both among and within these 11 classes. Pediatricians should be alert to the possible presence and meaning of self-injury.

Adolescent↗
PubMed2003

Observational assessment of toy preferences among young children with disabilities in inclusive settings. Efficiency analysis and comparison with staff opinion.

Numerous investigations have demonstrated means of assessing preferences among students and adults with disabilities. In contrast, there has been little attention on preference identification among young children. We evaluated a preference assessment with 7 toddlers and preschoolers with disabilities in inclusive programs. First, identification of toy-play preferences was compared across three assessments that varied in amount of toy-play behavior sampled and time required for implementation (5-, 10-, and 15-session assessments). Second, results of the assessments were compared to staff opinion. Results indicated the most efficient assessment identified preferences that generally were consistent with preferences identified with the less time-efficient assessments. Results also indicated staff reports did not consistently indicate which toys were played with most frequently. Overall, results demonstrate an efficient means of determining preferences among young children with disabilities in inclusive settings. Results also suggest that staff opinion should not be relied on exclusively to determine preferences.

Child Development Disorders, Pervasive↗
PubMed1992

Severe problem behaviors related to social interaction. 1: Attention seeking and social avoidance.

Studies concerning the functional analysis of severe problem behaviors have suggested that it is important to identify the different categories of stimuli that control problem behavior because each has unique treatment implications. The present study explored the differential effects of adult attention on the severe problem behaviors of two groups of children with developmental disabilities. A third group of nonproblem children was examined for comparison purposes. Children participated in three experimental conditions in which the level of adult attention was manipulated: noncontingent high attention, noncontingent low attention, and contingent attention. Results validated the existence of two groups of children who differed as to their social orientation: (a) One group of children commonly initiated social interactions and was most likely to exhibit problem behaviors under conditions of low adult attention, and (b) the other group of children rarely initiated social interactions and exhibited frequent problem behaviors under conditions of high adult attention. Implications of these data for escape and attention theories of child problem behavior are discussed, as are the applied implications for reinforcer assessment and teaching strategies.

Attention↗
PubMed1999

Functional brain imaging in neuropsychiatric disorders of childhood.

This review article presents a summary of the current state-of-the-art of functional brain imaging, with a primary focus on childhood neuropsychiatric disorders. Coverage is emphasized for developments that appear to be of current or potential future importance for the child neurologist and related pediatric specialist, and also from the perspective of the developmental neuroscientist. Emphasis is placed on the modalities of single photon emission computed tomography (SPECT), positron emission tomography (PET), and both "conventional" and "functional" magnetic resonance imaging, (MRI) including reference to the major new radiopharmaceutical and magnetic resonance-based imaging agents and techniques. The fundamental physicochemical processes underlying such studies are outlined, with citation of sources of more detailed information for the interested reader. A variety of imaging studies are reviewed for selected groups of childhood neuropsychiatric disorders, designed to illustrate the achievements and future promise of these imaging modalities. Areas of concentration are suggested for future imaging research in the field of childhood behavioral disorders, where these methods seem critical to improved understanding of pathogenetic mechanisms, as well as development of more effective treatment strategies.

Adolescent↗
PubMedDate not supplied

Building pharmacoepidemiological capacity to monitor psychotropic drug use among children enrolled in Medicaid.

This study's objective was to develop a methodology to apply pharmacoepidemiological research toward understanding and improving psychotropic drug use among children enrolled in Medicaid. Using Kansas Medicaid data for 1995-1996, we summarized drug claims, diagnoses, and demographics for children under 20 who received at least one psychotropic drug prescription over either year. The sequence of steps needed to assure a quality improvement role is discussed. Use of key personnel in less regulatory and more clinical data applications is critical. Illustrating this approach, we found disproportionate numbers of children receiving psychotropic drugs who were young boys and larger numbers of white children receiving psychotropic prescriptions relative to their Medicaid enrollment than either African-American or Hispanic children. Medicaid agencies can expand epidemiological capacity to understand service use among segments of the population they insure as part of an overall commitment to improving quality.

Adolescent↗