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PubMed2000

A prevalence methodology for mental illness and developmental disorders in rural and frontier settings.

A prevalence study methodology developed for use in rural and frontier settings is described. The general method was developed over a 15 year period and has been successfully adapted and used in studies of 14 different childhood onset developmental disorders. Subjects were the 168,000 school aged children from North Dakota who were first surveyed for cases of autism--pervasive developmental disorders in 1985 and 1986. The results of the prevalence study were compared with the results of a 12-year ongoing surveillance of the cohort. The 12-year ongoing surveillance identified one case missed by the original prevalence study. Thus the original prevalence study methodology identified 98% of the cases of autism-pervasive developmental disorder in the population. This methodology may also be useful for studies of other developmental disorders in rural and frontier settings.

Adolescent↗
PubMed1995

Adverse health effects of lead at low exposure levels: trends in the management of childhood lead poisoning.

An extensive database has provided a direct link between low-level lead exposure during early development and deficits in neurobehavioral-cognitive performance evident late in childhood through adolescence. These consistent studies have demonstrated the presence of a constellation of neurotoxic and other adverse effects of lead at blood lead (BPb) levels at least as low as 10 micrograms/dl). Federal agencies and advisory groups have redefined childhood lead poisoning as a BPb level of 10 micrograms/dl. Before discussing some of these studies in greater detail, the pervasiveness of this entirely preventable disease today in millions of American children must be recognized.

Child↗
PubMed1999

Domains of social communication handicap in autism spectrum disorder.

OBJECTIVE: To investigate whether specific "social communication" handicaps could be identified in autism spectrum disorder using the Autism Diagnostic Observation Schedule and to compare the results with those found in a previous factor-analysis study using the Autism Diagnostic Interview-Revised. METHOD: All subjects were evaluated with both instruments. J.R. and P.E.T. independently diagnosed autism, Asperger's disorder, or pervasive developmental disorder--not otherwise specified in 51 children. Items from the Autism Diagnostic Observation Schedule that represented social communication behaviors were factor-analyzed. RESULTS: Three factors were identified: joint attention, affective reciprocity, and theory of mind. These are the same social communication domains that were identified in the previous study. CONCLUSIONS: These 3 social communication domains have been discussed in the literature regarding normal development and in previous research on autism spectrum disorders. If these domains are replicated in larger sample sizes, they could be used to monitor the results of pharmacological and psychotherapeutic interventions in autism spectrum disorders.

Adolescent↗
PubMed1994

Autism: fifty years on from Kanner.

It is now 50 years since Leo Kanner first described autism as a distinctive pattern of symptoms in some children with severe developmental problems. Since then the assessment and diagnosis of children with pervasive disorders of development has been refined and much is known about the phenomenology and epidemiology. Autism is a biological disorder of the central nervous system (CNS) of unknown cause. It is associated with a number of organic disorders such as epilepsy and has comorbidity with other psychiatric disorders such as tic disorder. Cognitive abnormalities in social interactions, affect and language are present but there is still debate regarding which of these, if any, is the primary cognitive deficit. Special education and behavioral management has led to modest but important developmental improvement in many children with autism. Autism remains a life-long condition but patterns of symptoms change and skills develop from childhood into adult life.

Autistic Disorder↗
PubMed1987

Development, disintegration and dementia.

It has been argued that there is an important group of conditions, seen for the first time in late infancy and early childhood, which are both remarkably persistent and pervasive in their influence on cognitive and social development. They combine features of childhood autism, mental retardation and cognitive deterioration and the term 'disintegrative' most precisely characterizes their impact on development. The term 'psychosis' is only usually appropriate in describing the severity of the psychiatric symptoms. In order to avoid confusion with the psychoses or dementia of adult life, the term 'disintegrative disorder of development' may be preferred. While specific pathology is being identified in an increasing number of cases, the combined use of psychiatric and physical diagnostic categories perhaps best serves to draw attention to this important group of disorders. It is likely that, with increasing knowledge, the need for such an interim diagnostic category may become unnecessary.

Autistic Disorder↗
PubMed2006

Attention-deficit/hyperactivity disorder (ADHD) in the course of life.

ADHD is a pervasive disorder that extensively impairs the quality of life and that can lead to serious secondary problems. Contrary to the prior assumption long-term studies have demonstrated that the disorder is not limited to childhood and adolescence. Unfortunately appropriate criteria for adults with ADHD are not given in the ICD-10. The clinical experience indicates substantial difficulties of adults, whose ADHS is not diagnosed and treated. They often cause extensive costs for the welfare system. The evidence-based psychiatric treatment is highly effective and inexpensive.

Adolescent↗
PubMed1992

Working with refugee survivors of torture.

Numerous factors must be taken into account to best provide for the health and well-being of refugee patients in developed countries. One issue that is rarely considered is the awful and not uncommon occurrence of political torture. Large numbers of refugees and other displaced persons are survivors of political torture, and health care professionals must be prepared for this possibility when treating refugee patients. The effects of torture are pervasive, and we provide some practical considerations for health professionals who care for survivors of torture. Specific challenges include problems relating to exile and resettlement, somatic symptoms and pain, and the "medicalization" of torture sequelae.

Child, Preschool↗
PubMed1989

Autism diagnostic interview: a standardized investigator-based instrument.

The development of a new standardized investigator-based interview for use in the differential diagnosis of pervasive developmental disorders is described, together with a diagnostic algorithm (using ICD-10 criteria) based on its use. Good interrater reliability for algorithm items was shown between four raters, two in Canada and two in the UK, who rated 32 videotaped interviews. The items also significantly discriminated between 16 autistic and 16 nonautistic mentally handicapped subjects. The algorithm based on ICD-10 identified all 16 autistic individuals and none of the 16 nonautistic subjects.

Adolescent↗
PubMed1995

Autistic regression and disintegrative disorder: how important the role of epilepsy?

At least a third of autistic toddlers regress in language, sociability, play, and often cognition. Many fewer children undergo a similar, unexplained regression after language is fully developed (disintegrative disorder [DD]). Epilepsy or a paroxysmal electroencephalogram (EEG) with/without clinical seizures, including electrical status epilepticus in slow wave sleep (ESES), may be associated, in occasional children, with either selective loss of language (Landau-Kleffner syndrome [LKS]) or with pervasive autistic regression. Fluctuation in language and behavior deficits should raise the suspicion of epilepsy. Review of the literature and of the author's experience suggests that epilepsy probably plays a relatively minor, although non-negligible, pathogenetic role in autistic regression. Multidisciplinary, possibly multi-institutional, longitudinal studies that encompass the regression are needed to sharpen diagnostic criteria to devise more effective therapies.

Autistic Disorder↗
PubMedDate not supplied

Autism in young children: an update.

Autism is a pervasive developmental disorder with onset in infancy or childhood. Research has identified infant/toddler characteristics that should suggest autism to pediatric primary care providers. Many autistic children can be referred for diagnosis as young toddlers if social, perceptual, and language delays are considered significant. Early diagnosis of children with autism allows intervention, which helps the child modulate disturbing sensory stimuli and seeks to meet his/her unique social and communication needs. This article describes the disorder and its management and offers guidelines for recognizing young children who would benefit from further comprehensive neurobiologic evaluations by developmental specialists.

Autistic Disorder↗
PubMed2003

Asperger syndrome: to be or not to be?

PURPOSE OF REVIEW: Asperger syndrome is a pervasive developmental disorder characterized by impairments in social interactions, such as nonverbal behaviors, failure to develop peer relationships, and lack of social reciprocity with restricted, repetitive and stereotyped patterns of interest or behavior. The diagnosis of Asperger syndrome is increasingly common, and it is timely to review its phenomenology and treatment. RECENT FINDINGS: As there is a growing public awareness and acceptance of Asperger syndrome, clinical research has produced mixed results that do not clearly discriminate Asperger syndrome from high-functioning autism. However, research does indicate that children with pervasive developmental disorder achieve better outcomes when diagnosis is made early and appropriate community supports can be marshaled. SUMMARY: The history and phenomenology of Asperger syndrome is briefly reviewed, and recent literature relating to assessment and treatment is highlighted.

Asperger Syndrome↗
PubMed2000

Long-term risperidone for pervasive developmental disorder: efficacy, tolerability, and discontinuation.

To investigate the safety (e.g., weight gain, liver function, extrapyramidal side effects, and seizures) and efficacy of the long-term use of risperidone in children and adolescents and to ascertain the effects of drug withdrawal in a semi-naturalistic prospective, subjects with autism or pervasive developmental disorders not otherwise specified (PDDNOS) were treated with risperidone for 6 months after which parents were given the option of continuing for a further 6 months (final assessment at 12 months). Behavioral rating included Childhood Autism Rating Scale (CARS), Child Psychiatric Rating Scale (CPRS), Clinical Global Impression (CGI), and Child-Global Assessment Scale (C-GAS). Risperidone significantly ameliorated behavioral symptoms of PDD in 10 out of 11 subjects, with the effects on core symptoms being of smaller amplitude and of slower onset. No loss of effectiveness was observed in patients who continued risperidone for 12 months, while a relapse of associated behavioral symptoms occurred in the others. Weight gain was common, although the rate of increase lessened over a period of time; after drug withdrawal, considerable weight loss was observed in the patient who had previously shown the most significant increase. After 6 months of therapy, two patients developed facial dystonia: this disappeared after reducing dosage in one case, after drug discontinuation in the other. Amenorrhea was also observed, but no changes in liver function, blood tests or EEG were reported. The data indicate that risperidone is an effective and relatively safe drug for long term treatment of behavioral disruption in autistic children and adolescents.

Adolescent↗
PubMed2005

Autism -- experiences in a tertiary care hospital.

UNLABELLED: Pervasive developmental disorders (PDD) or Autistic Spectrum Disorders (ASD) include Autistic Disorder (commonest), Asperger's syndrome, Childhood Disintegrative Disorders, Rett's syndrome and PDD-NOS (not otherwise specified). OBJECTIVE: Autism is an important cause of social disability and reported more often from the developed world than from the developing countries. The present study was aimed to establish the diagnosis of autism amongst children with derangements of language, communication and behavior; ascertain and treat the co-morbidities; identify underlying cause and create a sensitivity and awareness among various health care professionals. METHODS: Sixty-two of the seventy-five referred patients fulfilled the DSM-IV (Diagnostic and Statistical Manual of Mental Disorder) criteria for autism. Evaluation included a detailed history, clinical examination, IQ assessment, Connor's scoring for hyperactivity and Fragile-X screening. Management of co-morbidities was done. A follow up of these patients was done. Parents' assessment of the child was also done. A registry for autistic children was established at the Department of Pediatrics with other major institutions of Delhi. RESULTS: The male:female ratio was 8:1 and missed diagnosis was common. Professional awareness is merited. Behavioral modification by early intervention and stimulation improved the core symptoms of autism. Important co-morbidities included mental retardation (95%), hyperactivity (53%) and seizures (10%) cases. Control of co-morbidities in these children facilitated child's periodic assessment and implementation of intervention programmes. In the registry initiated 62 patients were enrolled at AIIMS and 6 were identified from other hospitals. CONCLUSION: Autism does occur in Indian children too. Diagnosis is often missed. Capacity building among health professionals by a more structured teaching of developmental disabilities in the medical curriculum is required. The need to attend to co-morbidities and associated symptoms was clear. The initiation of the registry and beginning of networking was important.

Attention Deficit Disorder with Hyperactivity↗
PubMed2006

A coding scheme for the evaluation of the relationship in music therapy sessions.

This study presents a coding system for observation and monitoring of changes in the interactive behaviour between patient and therapist during music therapy sessions. The coding scheme was developed from a psychodynamic framework and mainly consists of four behavioural classes: Verbal Communication, Nonverbal Communication, Countenance, and Sonorous Musical Communication. The 15 minutes in the middle of each videotape concerning the first active music therapy session--based on the sonorous musical improvisation--were coded. Subjects were children (4 boys; 3 girls) ages 3 to 10 years (M age = 6.3), diagnosed with Pervasive Developmental Disorder, and seven therapists. The method for data collection was continuous recording, applied through The Observer Video-Pro 5.0. For the reliability indexes there was a substantial agreement between assessments by video raters.

Autistic Disorder↗
PubMed1991

[Current concept of autism].

Childhood autism, the most characteristic subgroup of the broader PDD (pervasive developmental disorders) category, is the consequence of genetic or typically prenatal, organic factors causing cerebral damage. The resulting mental handicap lasts for a lifetime. It is characterized by a behavioural syndrome, that becomes recognizable between the 2.-3. year. The core of the syndrome is a deviant and/or retarded development of cognitive capacities and skills necessary for social relations, communication, fantasy and symbolic thinking. Almost all autistic people (95%) would not reach independence as adults, and most of them (75%) is mentally retarded as well. According to our calculations about 16,000 people are affected in Hungary, in a more or less serious degree, 2000 children among them. Their condition would require intensive, early and long lasting intervention: conditioning, training, education, and special social services. Today we do not possess the necessary organisational background, nor the professional training, and knowledge. For the early diagnosis, proper care and services the competence of child- and general psychiatrists, also of family doctors is indispensable. The author summarizes the most important available informations on the field first of all for those, who work in the general medical services.

Autistic Disorder↗
PubMed1998

[Symptomatological patterns of infancy diseases. Presentation of a new Symptom Checklist].

BACKGROUND: Recently it is often very frequent a request of specialist consultation for children with psychic discomfort expressed through somatic complaints and/or behavior disorders. The real meaning of these symptoms in terms of prognosis, is not clear; indeed they can be the first signs of a poor prognosis of developmental disorders or a transient developmental crisis. The objective of this study is the evaluation of a Symptom Checklist as an instrument which allows to point out the somatic complaints and the behavior disorders of Italian children aged less than 48 months and to identify symptoms patterns which label the main neurological and psychiatric diseases in that age. METHODS: The Symptom Checklist has been used transversely in a clinical sample of 30 subjects (24 males and 6 females) aged less than 48 months with developmental linguistic disorder, born prematurely or with a developmental pervasive disorder and in a control sample of 37 children (21 males and 16 females). RESULTS AND CONCLUSIONS: The results obtained, matching every single group to each other and every single group to the control group, identify symptoms pattern (somatic or behavioral) specific for each clinical condition examined; therefore, the clinical utility of Symptom Checklist in pointing out in infancy psychiatric risk cases for a poor prognosis is confirmed.

Age Factors↗
PubMed2001

Speech and prosody characteristics of adolescents and adults with high-functioning autism and Asperger syndrome.

Speech and prosody-voice profiles for 15 male speakers with High-Functioning Autism (HFA) and 15 male speakers with Asperger syndrome (AS) were compared to one another and to profiles for 53 typically developing male speakers in the same 10- to 50-years age range. Compared to the typically developing speakers, significantly more participants in both the HFA and AS groups had residual articulation distortion errors, uncodable utterances due to discourse constraints, and utterances coded as inappropriate in the domains of phrasing, stress, and resonance. Speakers with AS were significantly more voluble than speakers with HFA, but otherwise there were few statistically significant differences between the two groups of speakers with pervasive developmental disorders. Discussion focuses on perceptual-motor and social sources of differences in the prosody-voice findings for individuals with Pervasive Developmental Disorders as compared with findings for typical speakers, including comment on the grammatical, pragmatic, and affective aspects of prosody.

Adolescent↗
PubMed1994

Becoming strangers: the changing family caregiving relationship in Alzheimer's disease.

Alzheimer-type dementia (AD) is an insidious pervasive debilitating disorder that destroys the affected person's capacity for self-care. In this grounded theory study, we explored the reciprocal process of becoming strangers in which eastern Canadian family caregivers and care recipients with AD interact on a continuum from intimacy to alienation through dimensions of dawning, holding on and letting go. The findings illuminate the experiences of family members who struggle on a daily basis with their commitment to the person they knew and their increasing detachment from the stranger that person has become. With the increasing emphasis on home care, these findings offer insights for individual care and health policy development.

Aged↗