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The autonomic nervous system in functional bowel disorders.

Communications along the brain-gut axis involve neural pathways as well as immune and endocrine mechanisms. The two branches of the autonomic nervous system are integrated anatomically and functionally with visceral sensory pathways, and are responsible for the homeostatic regulation of gut function. The autonomic nervous system is also a major mediator of the visceral response to central influences such as psychological stress. As defined, functional disorders comprise a constellation of symptoms, some of which suggest the presence of altered perception, while other symptoms point to disordered gastrointestinal function as the cause of the symptoms. A growing number of reports have demonstrated disordered autonomic function in subgroups of functional bowel patients. While a number of different methods were used to assess autonomic function, the reports point to a generally decreased vagal (parasympathetic) outflow or increased sympathetic activity in conditions usually associated with slow or decreased gastrointestinal motility, while other studies found either an increased cholinergic activity or a decreased sympathetic activity in patients with symptoms compatible with an increased motor activity. Under certain conditions, altered autonomic balance (including low vagal tone and increased sympathetic activity) may alter visceral perception. Autonomic dysfunction may also represent the physiological pathway accounting for many of the extraintestinal symptoms seen in irritable bowel syndrome patients and some of the frequent gastrointestinal complaints reported by patients with disorders such as chronic fatigue and fibromyalgia.

Autonomic Nervous System↗

Children's Communication Checklist (CCC) scores in 11-year-old children with communication impairments.

BACKGROUND: The pragmatic skills of children with communication disorders and their assessment are currently an issue for speech and language therapy and educational placement. AIMS: To explore whether different subgroups of children with communication disorders score differently on the Children's Communication Checklist (CCC) and to study how they compare with published normative data. METHODS & PROCEDURES: A sample of 161 eleven-year-old children with a history of communication disorders was assessed using the CCC. The main use of this questionnaire was to establish whether pragmatic impairments were part of a child's communication difficulty. Although the checklist was originally designed for research purposes, normative data for this scale have been recently published as well as group data from a number of different clinical groups. Whilst the present CCC data have been previously reported descriptively for a wider sample, they have not been examined in terms of subgroups or compared directly with normative information and similarly diagnosed individuals from other studies. OUTCOMES & RESULTS: Of the children assessed, 52 (33%) scored in the normal range (within 1 SD) on the pragmatic scale, 40 (26%) fell between 1 and 2 SD below the normative mean, and 64 (41%) scored below 2 SD of the mean of typically developing children (aged 6-16 years). Thus, the majority (67%) scored out of the normal range for pragmatic skill at 11 years of age. The cohort was separated into four diagnostic subcategories: those with a definite diagnosis of autistic spectrum disorder (n=15); those with typical specific language impairment (n=82); generally impaired (n=37); and those with a clinical history of primary pragmatic language impairment (independent of CCC score, n=27). CONCLUSIONS: Findings show that those generally impaired and with specific language impairment were less impaired than the other groups on the CCC pragmatic scale. There was a significant trend for those with autistic spectrum disorders to score lowest through pragmatic language impairment, generally impairment to specific language impairment. It is argued that a cut-off of 140 may prove more useful at this age than the 132 level previously published for 8 year olds. Results suggest that the CCC can be used as a clinical tool, but in conjunction with other reliable measures.

Autistic Disorder↗

The relationship between psychopathology and speech and language disorders in neurologic patients.

Depression, anxiety, and conversion reaction are common in neurologic patients. These disorders can produce neurologic-like symptoms that either mask or intensify those produced by the neurologic disease. This paper reviews clinical and research findings relating psychopathology to the formation and remediation of speech and language disorders in neurologic patients. The need to consider the psychosocial and psychopathological aspects of neurologic communicative disorders, and the link between emotional and communicative processes, are emphasized. Diagnostic criteria for the identification of psychogenic communicative disorders are outlined.

Communication Disorders↗

Communication and its disorders.

This article defines communication and describes its various disorders. Some of these disorders are associated with other DSM-IV conditions, such as mental retardation or pervasive developmental disorder. Others are specific to the language-learning process. The interactions between communication and psychiatric disorders are discussed. Suggestions for integrating treating approaches among communication disorders and mental health professionals are presented.

Child↗

The prevalence of disabilities and maltreatment among runaway children.

OBJECTIVE: This research was conducted to determine the prevalence of disabilities among abused and nonabused runaways within a hospital population (Study 1) and community school population (Study 2) and to identify any associations between disability, maltreatment, family stress factors, academic achievement, school attendance, domestic violence and runaway status. METHOD: Descriptive information was collected for maltreated and nonmaltreated runaways from hospital (N = 39,352; 255 runaways) and school (N = 40,211; 562 runaways) populations including: disability status, type of maltreatment, family stress factors, record of domestic violence in the family, academic achievement and attendance. RESULTS: The prevalence rate of disabilities among the maltreated runaways was 83.1% and 47% among the nonmaltreated runaways in the hospital sample and 34% and 17%, respectively, in the school sample. Children and youth with disabilities were at increased risk to become runaways in both populations. The presence of maltreatment significantly increased the association between running away and disability status. Children with behavior disorders, mental retardation, and some type of communication disorder were significantly more likely to run away than children with other disabilities. Among the maltreated runaways with and without disabilities, physical abuse and sexual abuse were significantly associated with running away. Records of domestic violence were more prevalent in the families of runaways with behavior disorders and no diagnosed disability. Lower academic achievement, poor school attendance, and more family stress factors were associated with maltreatment, disability and runaway status. CONCLUSIONS: Children and youth with disabilities are unidentified and unrecognized among runaways. Professionals working with runaways and their families need to be cognizant of the special needs of the population, particularly with respect to behavior disorders, communication disabilities, and mental retardation and reconsider current policy to routinely reunite runaways with their families when running away was precipitated by traumatagenic factors within the family.

Achievement↗

Communication intervention and therapeutic issues in pediatric human immunodeficiency virus.

This article provides an overview of treatment strategies that target communicative disorders exhibited by children exposed to human immunodeficiency virus (HIV). The myriad of communicative disorders presented by these children is discussed in relationship to the complex needs of culturally diverse families. Rehabilitation considerations, the impact of health status on treatment outcomes, and the need to work collaboratively with other health care professionals in meeting children's needs from a family-focused perspective are further discussed.

Child↗

Selective mutism: how a successful speech and language assessment really is possible.

A speech and language assessment of children with selective mutism is often difficult because these children are silent in most situations. In Australia, a study was designed to assess the children in their homes, the place where they usually speak. Five children who met the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 1994) criteria for selective mutism participated in the study. Assessment included audio-taping extracts of the children's conversations with members of their family and the administration of a number of standardised speech and language tests. The study found that four of the five children had a communication disorder. This paper outlines these communication disorders and describes how a successful speech and language assessment of children with selective mutism is possible.

Child↗

Working with older people with communication difficulties: an evaluation of care worker training.

Studies suggest that a high proportion of older people in residential and nursing care have communication difficulties and there is some awareness of the need for staff training to allow effective communication to be achieved. This paper describes part of the evaluation of a one-day training package aimed at enabling care staff to communicate with older people who have a variety of communication difficulties. Care staff from four partner agencies completed questionnaires pre- and post-training, addressing contact with people with communication disorders, previous training on communication, knowledge about communication, attitudes towards communication problems and strategies to help communication with people who have communication difficulties. Positive gains were found in attitudes and self-perceptions of knowledge and competence, as well as in appropriate citations of strategies to enhance communication. The findings are discussed with reference to the need for enhanced communication skills in care workers engendered by current developments in care policy.

Adult↗

Speech, language and hearing disorders in a adult penal institution.

It has been speculated that the prevalence of communicative disorders among prison inmates is considerably higher than that found in the general population, but research regarding inmate speech and hearing disorders is limited. This study investigated the nature and extent of communicative disorders in an inmate population of a medium-security penal institution in southeastern Virginia. The results of the screening indicated a slightly lower prevalence of stuttering, higher prevalences of articulation, voice, and hearing disorders, and more deficient receptive vocabulary skills than found in the general population. Some dialectal variations among black inmates are noted and the possible influence of linguistic-cultural interference on the results is discussed.

Adolescent↗