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[The child as a substitute].

The feeling of temporarily not being oneself is a common phenomenon, with many manifestations in normality and psychopathology. I relate it here to the Freudian category of the uncanny (das Unheimliche) and to the literary device of the double (der Doppelgänger) and I consider the splitting in the ego and the distortion of the sense of identity to be their main psychological characteristics. An extreme instance of this phenomenon is represented by the replacement child, that is a child conceived with the conscious purpose on the part of its parents of substituting a dead sibling. Replacement children inevitably suffer from a sense of confusion in the area of self-identity and often display serious difficulties in the development of self-esteem and in the establishment of mature object-relationships. As illustrations of some of the problems encountered by replacement children, I briefly refer to the experiences of two great artists (Van Gogh and Dali) and I use clinical material from two of my psychoanalytic patients.

Bereavement↗

Cohesive discourse in pervasive developmental disorders.

Investigated the use of cohesive links to create a reciprocal conversation in individuals with autism, Asperger syndrome, and a control group of children and adolescents with nonspecific social problems. All subjects engaged in a 10-minute conversation with an examiner that touched on various topics. The conversation was audiotaped, transcribed, and coded blindly for several types of cohesive links. Compared to controls, the higher functioning autistic group referred less to a previous stretch of the conversation and more to an aspect of the physical environment. The Asperger group, on the other hand, was very similar to the controls except they made more unclear references that were difficult to interpret. Implications of these findings for understanding the communicative failure of subjects with pervasive developmental disorder are discussed.

Adolescent↗

Brief report: parental reporting of regression in children with pervasive developmental disorders.

Information on age and nature of the onset of autism and other developmental disorders was obtained through review of parent completed developmental history; in addition information on the child's early development, diagnostic information, and information on parent characteristics was also obtained. In this relatively large series of cases the parents of children with autism were more likely than parents of children with other developmental disorders to report possible loss of developmental skills. However, the question of actual skill loss was complicated since in some cases parents also had reported even earlier developmental delays or a pattern more of developmental stagnation than clear loss of abilities. Only a few children exhibited a clear and unequivocal loss of developmental skills.

Child↗

Use of atypical neuroleptics in child and adolescent psychiatry.

BACKGROUND: This article reviews the published clinical experience with atypical neuroleptics in children and adolescents. METHOD: A computerized literature search was conducted (MEDLINE, 1974-1998) to retrieve all reports on the use of atypical neuroleptics in children and adolescents. A hand search was performed as well. All relevant clinical data were collated by type of drug. RESULTS: We found 5 blind placebo-controlled clinical trials (105 patients), 24 open-label clinical trials (387 patients), and 33 case series (115 patients) describing the use of the atypical neuroleptics clozapine, risperidone, olanzapine, sulpiride, tiapride, amisulpride, remoxipride, and clothiapine in children and adolescents. Some of these agents, especially clozapine, risperidone, and olanzapine, were found to be efficacious in the treatment of schizophrenia, bipolar disorders, and pervasive developmental disorders. The role of atypical neuroleptics as augmenters of serotonin reuptake inhibitors in obsessive-compulsive disorder is unclear. Risperidone appears to possess anti-tic properties in patients with Tourette's disorder. CONCLUSION: The most convincing evidence of the efficacy of atypical neuroleptics in children and adolescents concerns clozapine in the treatment of schizophrenia. Data on other atypical neuroleptics in other disorders are still sparse, and further research is needed. Some of the atypical neuroleptics may become the first-line treatment for childhood schizophrenia and pervasive developmental disorders.

Adolescent↗

A prevalence estimate of pervasive developmental disorder among immigrants to Israel and Israeli natives- a file review study.

BACKGROUND: The prevalence rates of pervasive developmental disorder (PDD) have risen in the West over the last 10 years. There is argument over the etiology of this change in rates. Social and cultural processes including migration have been hypothesized. Israel, as a country of ongoing immigration with a national registry of children diagnosed with PDD, offers an opportunity to compare rates of PDD among immigrants from developing countries and native Israelis. METHOD: A Social Security national registry of 1004 children diagnosed with PDD was reviewed and rates were calculated using data extracted from the Israel National Bureau of Statistics. Of all Jewish children that were born in the years 1983-1997 and who are currently living in Israel, we defined four groups: (1). native Israelis of non-Ethiopian extraction (N = 1198, 300), (2). native Israelis of Ethiopian extraction (N = 15600), (3). immigrants of non-Ethiopian extraction (N = 110300) and (4). children born in Ethiopia (N = 11800). A further breakdown of groups 1 and 3 by well-characterized ethnic or geographical origins was not possible. RESULTS: The rate of PDD was significantly elevated in native Israelis as compared to all immigrant children. Among immigrants, the rate of PDD in Ethiopian-born children was lower than that of those born in other countries. The rate of PDD in immigrant Ethiopian children was much lower than in native Israeli children of Ethiopian extraction. CONCLUSIONS: Birth in Israel, an industrialized country, is a marker for an environmental risk factor for PDD. This may indicate that gestation, birth or infancy in industrialized countries exposes children to environmental insults that increase the risk for contracting PDD.

Adolescent↗

Familial pervasive development disorder, Tourette disorder and hyperlexia.

Four children and one adult have been found to have Pervasive Developmental Disorder, Tourette disorder and hyperlexia in North Dakota, a state with a population of 204,161 children ages 0-18. Assuming that these are independent disorders the probability of these three disorders occurring by chance in one child is 3.39 x 10(-12). Two of these individuals are from the same family. This suggests evidence for genetic linkage among these three disorders.

Adult↗

Pervasive developmental disorders and immunological tolerance.

A wide range of studies in man and other species suggest that early compromise of immunological tolerance (both maternal-fetal and self) may lead to severe and varied cognitive deficits. This article briefly reviews what is known of the genesis and maintenance of normal tolerance and current ideas on pathological deviances in tolerance. These ideas are discussed in relation to risk factor, family, twin, biochemical, anatomical, and immunological studies of pervasive developmental disorders (particularly infantile autism). A range of immunological injury hypotheses for the genesis of the pervasive developmental disorders are considered and technical problems in deciding among them are presented.

Autistic Disorder↗

Psychotherapy of children with pervasive developmental disorders.

In recent years, the role of psychotherapy in the treatment of children with pervasive developmental disorders, such as autism and Asperger's Syndrome, has been questioned. Advances in neuropsychiatry, neuropsychology, and genetics, as well as the refinement of behavioral and educational techniques, have relegated discussions about psychotherapy mostly to reviews about the history of treatment for autism. Even when psychotherapeutic work is suggested, it is typically only very structured supportive counseling for older and high functioning children and adolescents that is considered. This paper argues that there is a central role for psychotherapy for children with pervasive developmental disorders, and that psychotherapeutic interventions should begin at a younger, rather than older age.

Adolescent↗

Olanzapine in the treatment of pervasive developmental disorders: a case series analysis.

Controlling the symptoms that are characteristic of patients with pervasive developmental disorders is often challenging. We report on the safety and efficacy of olanzapine in the treatment of 7 patients with pervasive developmental disorders. The patients were all male and ranged in age from 8 to 52 years. They received olanzapine doses of 5-10 mg/d along with their various other drug regimens. Patients were monitored and evaluated for a mean duration of 17.7 (range 12-26) months while on olanzapine therapy. Very few side effects were observed during treatment. All patients showed clinically significant improvement on the Clinical Global Impressions scale, as well as an improved score as measured by the Global Assessment of Functioning scale. Our observations support the use of long-term olanzapine therapy for symptom control in patients with pervasive developmental disorders.

Adolescent↗

Clinic observations in the assessment of pervasiveness of childhood hyperactivity.

Sixty-one boys, 6-12 years old, met both the diagnostic criteria of ADHD of DSM-III-R and hyperkinetic syndrome of ICD-9. They could be subdivided into two groups: 43 showed hyperactive symptoms in the clinic situation and 18 did not. The former group were younger and showed significantly poorer performance in measures of general intelligence, attention, cognitive styles, motor clumsiness and minor neurological deficits. Controlling for age and intelligence attenuated the differences, but significant differences remained in activity level, attention, and minor neurological deficits. This result suggests that direct observation is important in the assessment of pervasiveness of childhood hyperactivity.

Attention↗

Aggressive behavior in patients with attention-deficit/hyperactivity disorder, conduct disorder, and pervasive developmental disorders.

Aggressive behaviors are frequently observed in patients with attention-deficit/hyperactivity disorder, conduct disorder, and pervasive developmental disorders. Several theories have been postulated to explain the etiology of aggression in these disorders, but no one theory can account for all the different types of aggressive behaviors observed. Numerous uncontrolled studies with small sample sizes have produced mixed results of pharmacologic agents now being used to treat aggression. This article discusses the phenomenology, etiology, assessment, and pharmacologic treatment of aggressive behavior in patients who have attention-deficit/hyperactivity disorder, conduct disorder, and pervasive developmental disorders.

Adolescent↗