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The aim of this study was to investigate pediatric occupational therapists' general experience and practice with weighted vests and their impressions about whether weighted vests are effective in changing specific behaviors of children with whom they have used weighted vests. A survey was mailed to a random sample of 514 pediatric occupational therapists who belonged to the School-Based Systems Special Interest Section or the Sensory Integration Special Interest Section of the American Occupational Therapy Association. The response rate was 68%. The survey included 43 items which covered therapist opinions, procedures, behavioral observations and knowledge about weighted vests, in addition to demographic information. Respondents who use weighted vests were more likely to have advanced degrees or certifications and more years of experience as pediatric therapists. They reported using weighted vests with preschool and young elementary school-aged children with the diagnoses of autism or attention deficit disorder. Staying on task, staying in seat and attention span were the most common behaviors that therapists reported improving when weighted vests were used.
A delayed matching-to-sample task with multiple sample stimuli was used to evaluate stimulus overselectivity in 70 individuals attending residential special-education schools. A Mental Age Equivalent score (MAE) was obtained for each student using the Peabody Picture Vocabulary Test. Twenty-one participants failed to complete matching-to-sample pretests (mean MAE = 3.70 years). Results on the multiple-sample test for the remaining 49 participants indicated no overselectivity for 14 students (mean MAE = 7.44 years) and were consistent with overselectivity for 35 students (mean MAE = 5.28 years). Performances of students with overselectivity were more variable than those with no overselectivity. The MAE scores were related to both matching-to-sample performance and stimulus overselectivity.
Autism is a neurodevelopmental disorder of unknown etiology. There is convincing data for the involvement of genetic factors in the development of autism, and the absence of any consistent evidence for an environmental, neuroanatomical, or biochemical cause has led to an increasing number of genetic studies to determine the basis of this complex disorder. The results of recent genetic linkage and candidate gene studies are reviewed in relation to the challenge of clinical and genetic heterogeneity, and prospects for the future of genetic research in autism are considered.
Autism is a lifelong condition usually described as affecting social, cognitive and imaginative abilities. For many years, parents and some professionals have observed that in concordance with the behavioural and psychological symptoms of the condition, there are a number of physiological and biochemical correlates which may also be of relevance to the syndrome. One area of interest that encompasses many of these observations is the opioid-excess theory of autism. The main premise of this theory is that autism is the result of a metabolic disorder. Peptides with opioid activity derived from dietary sources, in particular foods that contain gluten and casein, pass through an abnormally permeable intestinal membrane and enter the central nervous system (CNS) to exert an effect on neurotransmission, as well as producing other physiologically-based symptoms. Numerous parents and professionals worldwide have found that removal of these exogenously derived compounds through exclusion diets can produce some amelioration in autistic and related behaviours. There is a surprisingly long history of research accompanying these ideas. The aim of this paper is to review the accompanying evidence in support of this theory and present new directions of intervention as a result of it.
OBJECTIVE: To investigate the association between neonatal hyperbilirubinemia and autism spectrum disorders (ASD). METHODS: We conducted a large case-control study nested within the cohort of singleton term infants born between 1995 and 1998 at a northern California Kaiser Permanente hospital. Case subjects (n = 338) were children with an ASD diagnosis recorded in Kaiser Permanente outpatient databases; control subjects (n = 1817) were children without an ASD diagnosis, who were randomly sampled and frequency-matched to case subjects according to gender, birth year, and birth hospital. RESULTS: Approximately 28% of case and control subjects received > or =1 bilirubin test in the first 30 days of life. No case-control differences were observed for maximal bilirubin levels of > or =15 mg/dL (10.1% vs 12.1%), > or =20 mg/dL (2.1% vs 2.5%), or > or =25 mg/dL (0.3% vs 0.2%). Compared with children whose maximal neonatal bilirubin levels were <15 mg/dL or not measured, children with any degree of bilirubin level elevation were not at increased risk of ASD, after adjustment for gender, birth facility, maternal age, maternal race/ethnicity, maternal education, and gestational age (for bilirubin levels of 15-19.9 mg/dL: odds ratio: 0.7; 95% confidence interval: 0.5-1.2; for bilirubin levels of 20-24.9 mg/dL: odds ratio: 0.7; 95% confidence interval: 0.3-1.6; for bilirubin levels of > or =25 mg/dL: odds ratio: 1.1; 95% confidence interval: 0.1-11.2). CONCLUSION: These data suggest that neonatal hyperbilirubinemia is not a risk factor for ASD.
We evaluated the effects of two procedures for teaching four developmentally disabled children to respond yes/no appropriately. During baseline, tutoring was conducted in which five known items were individually presented with the question, "Is this a ----?", followed either by access to requested items or by remedial prompting contingent on responding. When tutoring did not improve performance, instruction was embedded in the regular classroom activities. In this condition, items requested by students were either presented or withheld on the basis of their response to the question, "Do you want ----?". Increases in correct responding were confirmed by a multiple-baseline design across all four students and were maintained with the introduction of new items. However, generalization to "Is this a ----?" questions did not occur in the tutoring setting until specifically programmed. Subsequently, students also demonstrated appropriate yes/no responding to questions involving actions, possession, and spatial relations.
We compared the effects of varied punishers (presentation of one of three available punishers) with the single presentation of one of the punishers on the occurrence of inappropriate behaviors with three developmentally delayed children. Two children were presented with varied-punisher conditions in which either overcorrection, time-out, or a verbal "no" was presented contingent upon inappropiate behavior. A loud noise was substituted for overcorrection for a third child. Results of the multielement with reversal design indicated that both punishment formats produced a decrease in the target behaviors with the varied-punisher format slightly more effective than the single presentations of the punishers. The results suggest the use of varied punishers as a means of enhancing the effects of less intrusive procedures to effectively reduce inappropriate behaviors.
A group of 22 children with diagnoses indicating one of the severe developmental disorders were tested for differential response patterns on the PPVT-R, in an extension of earlier research carried out by Shipe, Cromwell, and Dunn in 1966. Data supported the prediction of the children's greater difficulty with PPVT-R items featuring human content than with those featuring nonhuman content. In addition, children's relative success rates on human-content items correlated positively with a measure of differentiation of the children's drawings. The results suggest that the asociality of certain disturbed children may selectively lower intellectual efficiency and lead to underestimation of their intellectual potential.
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Brain development from late pregnancy to 3 years of age affects a child's learning, behaviour and health throughout life. Behavioural difficulties in children are usually symptoms of underlying problems. Observing a child's appearance and performance, and taking a detailed history (considering factors in the child, the home, the school and the wider environment) provide most of the information needed for diagnosing behavioural problems. It is important to know what is "normal" for all stages of a child's development, but equally important not to confuse behavioural difficulties with normal variations and behaviours associated with developmental stages. Assessment and early intervention for behavioural and learning difficulties in children require a multidisciplinary team approach. As well as the recommended "multimodal" approach for managing attention deficit hyperactivity disorder, shared care with a general practitioner is available in some states, but medication is likely to be the trigger for a positive outcome.
The developmental disorders of childhood autistic, developmental language, reading (dyslexia), and attention deficit-hyperactivity disorders-manifest with deficits in the traditional behavioral domains of cognition, language, visual-spatial function, attention, and socialization. However, none of these disorders has been associated with characteristic discrete focal lesions or recognized encephaloclastic processes. Developmental cognitive neuroscientists must therefore begin with the spectrum of sometimes divergent behaviors occurring within these disorders and work backward in an attempt to identify the responsible anomalous neural systems. Since the advent of "brain imaging" two decades ago, much effort has focused on identifying brain-behavior correlates in these disorders. The results of these neuropathologic, structural, and functional neuroimaging studies are presented and the reasons for the often divergent findings are discussed. As we approach the end of the Decade of the Brain, current neuroimaging techniques give us the technology for the first time to apply a fundamental cognitive approach to brain-behavior relationships in the developmental disorders, to eliminate the conglomeration of "apples and camels" phenomenon. Researchers are working together to create comparable protocols and to adhere to methods that can be replicated across sites. The future prospects for a greater understanding of the developmental disorders are now much brighter with neuroimaging technology.
This study investigated the reliability and stability of an autism diagnosis in children under 3 years of age who received independent diagnostic evaluations from two clinicians during two consecutive yearly evaluations. Strong evidence for the reliability and stability of the diagnosis was obtained. Diagnostic agreement between clinicians was higher for the broader discrimination of autism spectrum vs. no autism spectrum than for the more specific discrimination of autism vs. PDD-NOS. The diagnosis of autism at age 2 was more stable than the diagnosis of PDD-NOS at the same age. Social deficits and delays in spoken language were the most prominent DSM-IV characteristics evidenced by very young children with autism.
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The family physician is often the primary source of continuing guidance for the parents of autistic, schizophrenic, or brain-damaged children. It is essential to anticipate problems in such areas as use of medication, early education, reactions of siblings, and stresses within the lives of the parents. The family physician can help parents find the resources to cope with the multitude of problems confronting them and their children.
INTRODUCTION: We believe that it is of great interest, in neuropediatric clinic, to value the molar behavior disorders and to accomplish the corresponding molecular alterations in the central nervous system. PATIENTS AND METHODS: We studied 26 patients diagnosed of serious disorders of the development, that were presenting a typical clinic with manual stereotypes. We choose at random 5 children to practice them a study of metabolic neuroimaging through the Positron Emission Tomography with 18Fluoro-Deoxi-Glucose (PET-FDG). RESULTS AND CONCLUSIONS: The conclusion, more meaningful, is that the children with serious disorders of the development present a mature failure in the neuro-function circuits of the thalamus, as well as the cortical connection and association areas. This clinical situation is reinforced by the results of the PET-FDG, that presents a characteristic metabolic image of the autism children, with a bilateral decrease of the capitation of FDG, mainly in regions as thalamus, frontal and temporary lobes.
The article is a literature review of psychosis in children and adolescents. Earlier studies point to psychosis in children and adolescence being of the same types as the ones seen in adults. Schizophrenia has an early onset in boys, there are more premorbid dysfunctions, a gradual onset of disease, a number of unspecific symptoms and a poorer prognosis than for adults. For the children with bipolar affective disorder the prognosis is similar to that of adults, and it is better than for the schizophrenics. The relationships between developmental disorders and schizophrenia, and between hyperactivity syndromes and manic-depressive disorders need to be further clarified, as does the validity of the follow-up investigations.
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