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PubMed2004

Diagnosis and management of depression and psychosis in children and adolescents with epilepsy.

The neurologic dysfunction underlying epilepsy can predispose patients to psychiatric disorders, and the incidence of both depression and psychosis is increased in people with epilepsy. Depressive disorders are the most frequently recognized psychiatric comorbidities in people with epilepsy, but depression in children can be particularly difficult to recognize. Clinicians need to inquire about not only classic symptoms of depression such as anhedonia but also less obvious symptoms such as unprovoked irritability, unsubstantiated complaints of lack of love from family members, somatic complaints, and problems with concentration and poor school performance. The diagnosis of depressive disorders in children with epilepsy and mental retardation is even more difficult. Physicians need to be alert for the presence of iatrogenic depression, which may result from antiepileptic drugs or epilepsy surgery. People with epilepsy are also at increased risk for psychosis, which can be interictal, postictal, or (rarely) an expression of ictal activity. This psychosis can be related to seizure remission (ie, alternative psychosis) or iatrogenic (eg, related to antiepileptic drugs or following temporal lobectomy). Although both antidepressants and antipsychotic drugs have the potential to lower the seizure threshold and increase seizures, careful drug selection, dosing, and slow titration can minimize this risk, allowing treatment to proceed.

Adolescent↗
PubMed2005

Are the non-classical auditory pathways involved in autism and PDD?

OBJECTIVE: To test the hypothesis that some of the abnormal sensory perceptions that characterize autism may be explained by an abnormal activation of non-classical (extra-lemniscal) sensory pathways. METHODS: Twenty-one individuals, 18--45 years of age who were diagnosed with autism participated in the study. Sounds (clicks presented at a rate of 40 per second and 65 dB above the normal threshold) were applied through earphones. Electrical stimulation (100 microS rectangular impulses at a rate of 4 per second) was applied through electrodes placed on the skin over the median nerve at the wrist. The participants were asked to match the loudness of the sound with and without the electrical stimulation applied to the median nerve. RESULTS: Electrical stimulation of the median nerve at the wrist in individuals with autism could change the perception of loudness of sounds presented to one ear through an earphone showing a statistically significant abnormal sensory cross-modal interaction. DISCUSSION: We interpreted our results to support the hypothesis that some individuals with autism have an abnormal cross-modal interaction between the auditory and the somatosensory systems. Cross-modal interaction between senses such as hearing and the somatosensory system does not occur normally in adults. As only the non-classical (extralemniscal) ascending auditory pathways receive somatosensory input, the presence of cross-modal interaction in autistic individuals is a sign that autism is associated with abnormal involvement of the non-classical auditory pathways, implying that sensory information is processed by different populations of neurons than in non-autistic individuals.

Acoustic Stimulation↗
PubMed2003

Is fever suppression involved in the etiology of autism and neurodevelopmental disorders?

BACKGROUND: There appears to be a significant increase in the prevalence rate of autism. Reasons for the increase are unknown, however, there is a substantial body of evidence that suggests the etiology involves infections of the pregnant mother or of a young child. Most infections result in fever that is routinely controlled with antipyretics such as acetaminophen. The blocking of fever inhibits processes that evolved over millions of years to protect against microbial attack. Immune mechanisms in the central nervous system are part of this protective process. HYPOTHESIS: The blockage of fever with antipyretics interferes with normal immunological development in the brain leading to neurodevelopmental disorders such as autism in certain genetically and immunologically disposed individuals. TESTING THE HYPOTHESIS: Epidemiological studies to determine associations between the use of antipyretics and neurodevelopmental disorders should be undertaken. Biochemical tests will involve the examination of fluids/serum by mass spectrometry and the determination of cytokine/chemokine levels in serum and cell culture fluids after stimulation with fever-inducing molecules from bacteria, viruses and yeast. Postmortem brain can be examined by immunohistochemistry or other methods such as fluorescent in situ hybridization (FISH) to determine altered expression levels of chemokines/cytokines and other molecules. IMPLICATIONS OF THE HYPOTHESIS: 1) The use of antipyretics during pregnancy or in young children may be reserved for more severe fevers. 2) The perplexing genetic findings in autism may be better understood by categorizing genes along functional pathways. 3) New treatments based on immune, cell, pharmacological or even heat therapies may be developed.

Analgesics, Non-Narcotic↗
PubMed1992

Severe deprivation in childhood: a case report from Thailand.

A 3 1/2-year-old girl was incarcerated in a bamboo cage after it was feared she had contracted rabies. Six years later, when she was released, she had lost almost all motor control, displayed a number of stereotypies, was incontinent of both faeces and urine, and was diagnosed as having grand mal epilepsy. After four years of treatment (aged 13) she had shown considerable improvement and her mental age was seven years.

Child↗
PubMed2003

Erna and Melanie Klein.

Erna was one of the child patients treated by Melanie Klein in Berlin, employing her recently discovered play technique. Since Erna died in Chile, the authors considered the IPA Congress in Santiago an opportunity to present a paper as a homage both to Erna and, especially, to Klein. She learned much from that very disturbed child, which she later used to sustain the ongoing development of her theories. The paper explores biographic data relevant to understanding both the case and the theories. It analyses the case material to follow Klein in the discovery and the handling of the child's transference and the harsh expressions of hate, jealousy and envy, which are brought in, with sad consequences, by strong persecutory feelings. Klein's comparison of this case with that of Freud's Wolf-man is also considered, mostly to show that the similarities were less than originally claimed, and that Klein, perhaps, was introducing a theoretic shift which led her technique to gradually change from 'Nachträglichkeit' to the 'signification-resignification' pair, akin to Strachey's concept of the mutative interpretation. Lastly, the comprehension of Erna's strong psychotic traits and the links with later developments of the theory on psychosis are studied.

Child↗
PubMed2000

Counseling parents regarding prognosis in autistic spectrum disorder.

A triaxial model for autistic spectrum disorder (ASD) is presented, incorporating age, degree of intelligence, and severity of autistic features. As the name implies, ASD can vary in degree of expression from minimal to profound. Furthermore, the symptoms of ASD change in predictable ways with the passage of time. For example, echolalia during early childhood may be replaced by verbal literalism and difficulty with verbal humor during later childhood or adolescence. The prognosis for children with ASD is governed by the joint impact of the degree of expression of ASD and the degree of developmental delay, if any. All combinations of ASD and intellect are possible (ie, severe ASD plus severe mental retardation, severe ASD plus normal general intelligence, and so forth). The relationship among these 3 parameters-severity of ASD, level of general intelligence, and change in symptom expression over time, is represented schematically as a 3-dimensional graph. The utility of this graph as a counseling tool, and as the basis for future research on the prognosis of ASD are discussed.

Age Factors↗
PubMed2004

Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data.

OBJECTIVE: The issue of thimerosal-containing vaccines as a possible cause of autistic spectrum disorders (ASD) and neurodevelopmental disorders (NDDs) has been a controversial topic since 1999. Although most practitioners are familiar with the controversy, many are not familiar with the type or quality of evidence in published articles that have addressed this issue. To assess the quality of evidence assessing a potential association between thimerosal-containing vaccines and autism and evaluate whether that evidence suggests accepting or rejecting the hypothesis, we systematically reviewed published articles that report original data pertinent to the potential association between thimerosal-containing vaccines and ASD/NDDs. METHODS: Articles for analysis were identified in the National Library of Medicine's Medline database using a PubMed search of the English-language literature for articles published between 1966 and 2004, using keywords thimerosal, thiomersal, mercury, methylmercury, or ethylmercury alone and combined with keywords autistic disorder, autistic spectrum disorder, and neurodevelopment. In addition, we used the "related links" option in PubMed and reviewed the reference sections in the identified articles. All original articles that evaluated an association between thimerosal-containing vaccines and ASD/NDDs or pharmacokinetics of ethylmercury in vaccines were included. RESULTS: Twelve publications that met the selection criteria were identified by the literature search: 10 epidemiologic studies and 2 pharmacokinetic studies of ethylmercury. The design and quality of the studies showed significant variation. The preponderance of epidemiologic evidence does not support an association between thimerosal-containing vaccines and ASD. Epidemiologic studies that support an association are of poor quality and cannot be interpreted. Pharmacokinetic studies suggest that the half-life of ethylmercury is significantly shorter when compared with methylmercury. CONCLUSIONS: Studies do not demonstrate a link between thimerosal-containing vaccines and ASD, and the pharmacokinetics of ethylmercury make such an association less likely. Epidemiologic studies that support a link demonstrated significant design flaws that invalidate their conclusions. Evidence does not support a change in the standard of practice with regard to administration of thimerosal-containing vaccines in areas of the world where they are used.

Autistic Disorder↗
PubMed1987

Social influences on "self-stimulatory" behavior: analysis and treatment application.

We tested the hypothesis that the "self-stimulatory" behaviors exhibited by some individuals may be socially mediated. Four developmentally disabled children who exhibited hand flapping and body rocking participated in a series of three experiments conducted to assess the influence of social variables on stereotyped behavior and to develop a treatment based on the assessment. Experiment 1 used an assessment procedure to determine the relative influences of social attention and task demands on stereotyped behavior. For all four children, hand flapping and body rocking increased when difficult academic tasks were introduced. Experiment 2 involved the use of a procedural time-out and demonstrated that removing task demands contingent on stereotyped behavior resulted in increased rates of hand flapping and body rocking. In Experiment 3, these results were used to develop a communication treatment that consisted of teaching the children to request assistance on the difficult tasks. This treatment resulted in significant reductions in self-stimulatory behavior. These results are consistent with the hypothesis that some forms of repetitive stereotyped behavior may come to serve social functions (e.g., escape from aversive situations). Teaching a functionally equivalent communicative alternative to escape-motivated stereotyped behavior can be an effective form of intervention for this problem.

Autistic Disorder↗
PubMed1999

Reduction of stimulus overselectivity with nonverbal differential observing responses.

Three individuals with mental retardation exhibited stimulus overselectivity in a delayed matching-to-sample task in which two sample stimuli were displayed on each trial. Intermediate accuracy scores indicated that participants could match one of the samples but not both of them. Accuracy in a baseline condition was compared to accuracy with a differential observing response procedure. This procedure prompted participants to make simultaneous identity-matching responses that required observation and discrimination of both sample stimuli. These observing responses were never followed by differential consequences. When observing responses were prompted, participants' accuracy scores improved. In a return to the baseline condition, when differential observing responses were no longer prompted, accuracy returned to intermediate levels. The results show that stimulus overselectivity can be greatly reduced by a behavioral intervention that controls observing behavior and verifies discrimination, but that exposure to such procedures alone may be insufficient for lasting benefits.

Adolescent↗
PubMed2001

Effects of a fixed-time schedule on aberrant and adaptive behavior.

Fixed-time (FT) schedules of reinforcement have been used to decrease destructive behavior. However, the effects of FT schedules on acquisition and maintenance of appropriate behavior remain unclear. In this study, we present a case in which an FT schedule produced an increase in adaptive behavior and resulted in a significant decrease in destructive behavior.

Adaptation, Psychological↗
PubMed2004

[Use of psychoactive and antiepileptic drugs: guidelines for pediatricians].

OBJECTIVE: To review the guidelines for the use of psychoactive and antiepileptic drugs in childhood and adolescence. SOURCES OF DATA: Literature review. SUMMARY OF THE FINDINGS: The clinical indications, dosage and side effects of psychoactive and antiepileptic drugs are presented. The use of psychoactive drugs is increasing due to the release of new drugs and to the better understanding of emotional disorders in children and adolescents. CONCLUSIONS: The use of antiepileptic and psychoactive drugs in childhood requires extensive knowledge concerning pharmacokinetics and deleterious side effects. An adequate choice of drugs is essential to ensure a successful treatment.

Adolescent↗
PubMed1989

Autism, Asperger's syndrome and semantic-pragmatic disorder: where are the boundaries?

The diagnostic criteria for autism have been refined and made more objective since Kanner first described the syndrome, so there is now reasonable consistency in how this diagnosis is applied. However, many children do not meet these criteria, yet show some of the features of autism. Where language development is impaired, such children tend to be classed as cases of developmental dysphasia (or specific language impairment) whereas those who learn to talk at the normal age may be diagnosed as having Asperger's syndrome. It is argued that rather than thinking in terms of rigid diagnostic categories, we should recognise that the core syndrome of autism shades into other milder forms of disorder in which language or non-verbal behaviour may be disproportionately impaired.

Autistic Disorder↗