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Advances in drug treatments for children and adolescents with autism and other pervasive developmental disorders.

Autism is a disorder characterised by abnormalities in language and social development, and repetitive behaviours. Antipsychotics, including haloperidol and risperidone, are the most widely studied drugs for reducing symptoms in children and adolescents with autism. When administered at relatively low dosages, antipsychotics have been shown to reduce repetitive behaviours (stereotypies) and social withdrawal, as well as a number of related symptoms, such as hyperactivity, aggression, self-abusive behaviour, temper tantrums, lability of mood and irritability. Adverse effects of antipsychotics include sedation, dizziness, increased appetite, weight gain, changes in the electrocardiogram parameters, drooling, hyperprolactinemia and a risk of drug-related dyskinesias. Other agents have been less well studied for the treatment of autism, but there are suggestive data regarding their safety and efficacy. Of these agents, a number have been investigated, based on theories about the aetiology of autism, including SSRIs and naltrexone, although the efficacy of these agents has been limited. Stimulant drugs have been shown to reduce hyperactivity and improve focus, but they may cause behavioural worsening, weight loss and stereotypies de novo. Secretin is a treatment that has received much media attention after reports of efficacy from small open studies, but all controlled studies have failed to show any benefit. In autism, alternative treatments have also been used, but none have shown benefit in well-designed studies.

Adolescent↗

Predicting boys' social acceptance and aggression: the role of mother-child interactions and boys' beliefs about peers.

Seven- to 9-year-old boys (N = 177) and their mothers participated in this study in which the associations between boys' experiences with their mothers, their beliefs about familiar and unfamiliar peers, and their peer adjustment were examined across a 2-year period. Boys' negative behavior with mothers was associated with their having more negative beliefs about familiar and unfamiliar peers and with their being more aggressive and less well-liked. Beliefs about familiar peers predicted changes in boys' social acceptance, whereas negative beliefs about unfamiliar peers predicted changes in aggression. In addition, boys' beliefs about peers changed in response to their social experience. The implications of these findings for children's social development are discussed.

Adult↗

Three-year follow-up of 100 vagrant adolescent drug abusers in Oslo.

One hundred homeless adolescents were interviewed in 1971 when they still were active drug abusers. The same group was followed-up 3 years later in 1974 with personal interviews. All were traced, with the exception of three individuals residing in foreign countries and four who had died. At follow-up one third were abstinent and were well adapted socially, one third showed an uncertain social adaptation, and one third were still addicted and had a poor social adaptation. The various factors responsible for their psycho-social development and relation to drug abuse are discussed.

Adolescent↗

The question of autism in an atypical infant.

The evaluation and brief treatment of a less-than-a-year-old girl whose parents were concerned she was autistic is described. We review what is known about the initial symptoms of autism and consider how early it is feasible to make a diagnosis. We outline the domains of cognitive, language, and social development that ought to be monitored given concern about autism and explain how we evaluated these domains in our home-based intervention. Finally, we consider possible explanations for this infant's recovery from a serious early disturbance in social relatedness.

Autistic Disorder↗

Joint attention training for children with autism using behavior modification procedures.

BACKGROUND: Deficits in joint attention are considered by many researchers to be an early predictor of childhood autism (e.g., Osterling & Dawson, 1994) and are considered to be pivotal to deficits in language, play, and social development in this population (Mundy, 1995). Although many researchers have noted the importance of joint attention deficits in the development of children with autism (e.g., Mundy, Sigman, & Kasari, 1994) and have called for intervention strategies (e.g., Mundy & Crowson, 1997), few studies have attempted to target joint attention. In this study, joint attention behaviors were taught to children with autism using a behavior modification procedure. METHODS: A multiple-baseline design was implemented to evaluate intervention effects. The following target behaviors were included in the intervention: 1) Responding to showing, pointing, and gaze shifting of adult; 2) Coordinated gaze shifting (i.e., coordinated joint attention); and 3) Pointing (with the purpose of sharing, not requesting). Generalization to setting and parent, follow-up sessions, and social validation measures were also analyzed. RESULTS: Joint attention behaviors were effectively trained and targeted behaviors generalized to other settings. In addition, positive changes were noted by naive observers using social validation measures. CONCLUSIONS: Integrating joint attention training into existing interventions may be important for children with autism. In addition, training parents in these techniques may help to maintain joint attention skills outside of the treatment setting.

Attention↗

Friendship group identification, multidimensional self-concept, and experience of developmental tasks in adolescence.

This study applied a social identity perspective to the study of adolescent self-concept and social development. British adolescents aged 14-15 years (N=114) completed a questionnaire which asked them to: (i) rate their degree of identification with a school-based friendship group; (ii) complete a measure of multi-dimensional self-concept; and (iii) report their experiences of a variety of personal, relational and socio-institutional (e.g., achieving economic independence) developmental tasks. Compared to low identifiers, participants who were highly identified with a friendship group reported highest levels of self-esteem; and these differences were most marked in non-academic domains of self. High identifiers also displayed higher levels of general self-esteem and reported more positive experiences of personal and relational developmental tasks. The discussion focuses on the potential benefits to understanding of social developmental processes that can be derived from a consideration of adolescents' subjective appraisals of their peer relations.

Adolescent↗

Monitoring ethical, legal, and social issues in developing population genetic databases.

PURPOSE: To characterize ethical, legal, and social issues unique to population genetic database research and to determine the relevance of international recommendations and guidelines for addressing these issues in the development of "genebank" projects globally. METHODS: Building on our previous description of eight international genebanks, we conducted a comprehensive electronic search and literature review of relevant publications and consulted national and international documents applicable to genebank research. RESULTS: We identified and characterized five categories of ethical, legal, and social issues unique to genebank development: sponsorship and benefit-sharing, neutrality and regulatory power of ethics committees, public engagement, consent, and data protection. We illustrate these issues with examples from specific genebanks. Not all of the issues are addressed in current international guidelines, many of which are nonspecific and unenforceable. CONCLUSION: The trend of genebank development promises to provide new discoveries to the field of medical science and to greatly improve public health. However, there is a growing need for more explicit, enforceable, and coordinated international guidelines relevant to the development and implementation of genebanks. By comparing ethical, legal and social issues as they arise in genebanks, researchers can better evaluate how to best use these projects to improve public health while protecting participating populations.

Access to Information↗

Using social stories and comic strip conversations to promote socially valid outcomes for children with autism.

Very little is documented regarding the efficacy of social stories and comic strip conversations for promoting an understanding of social situations and the appropriate social behaviors of individuals with autism spectrum disorder (ASD). In addition, few studies on the efficacy of social stories have examined whether outcomes are socially valid. The purpose of this article is to respond to some of the gaps in the literature on the efficacy of a frequently used intervention for children with ASD and to describe a family-centered collaborative approach to developing social stories and comic strip conversations. The results of intervention employing an A-B design are reported for two case vignettes. Clinical implications, limitations of the available data, and potential factors contributing to outcome variability are discussed.

Autistic Disorder↗

The Young Children's Empathy Measure: reliability, validity and effects of companion animal bonding.

The Young Children's Empathy Measure is a brief measure of young children's cognitive and affective perspective taking developed to assess preschool children's empathy. The Cronbach alpha coefficient of internal reliability for the empathy score was acceptable and interrater reliability across four rates was very high. The children's empathy scores were correlated with their ages and social development, but not with their IQs. Empathy toward children was correlated with empathy for pets, and children with a strong pet bond had higher scores on empathy for children than young children without pets.

Child↗

Serving the world's poor, profitably.

By stimulating commerce and development at the bottom of the economic pyramid, multi-nationals could radically improve the lives of billions of people and help create a more stable, less dangerous world. Achieving this goal does not require MNCs to spearhead global social-development initiatives for charitable purposes. They need only act in their own self-interest. How? The authors lay out the business case for entering the world's poorest markets. Fully 65% of the world's population earns less than $2,000 per year--that's 4 billion people. But despite the vastness of this market, it remains largely untapped. The reluctance to invest is easy to understand, but it is, by and large, based on outdated assumptions of the developing world. While individual incomes may be low, the aggregate buying power of poor communities is actually quite large, representing a substantial market in many countries for what some might consider luxury goods like satellite television and phone services. Prices, and margins, are often much higher in poor neighborhoods than in their middle-class counterparts. And new technologies are already steadily reducing the effects of corruption, illiteracy, inadequate infrastructure, and other such barriers. Because these markets are in the earliest stages of economic development, revenue growth for multi-nationals entering them can be extremely rapid. MNCs can also lower costs, not only through low-cost labor but by transferring operating efficiencies and innovations developed to serve their existing operations. Certainly, succeeding in such markets requires MNCs to think creatively. The biggest change, though, has to come from executives: Unless business leaders confront their own preconceptions--particularly about the value of high-volume, low-margin businesses--companies are unlikely to master the challenges or reap the rewards of these developing markets.

Developing Countries↗

The effects of an anti-bullying intervention programme on peers' attitudes and behaviour.

This study aimed to evaluate the effect of an anti-bullying intervention programme on peers' attitudes towards bullying and their attempts to solve bully/victim conflicts. An experimental pre-test/post-test design with a control group was used. For secondary school students, positive outcomes were observed at post-test 1 on attitudes and on actual rates of intervention. However, the effects had disappeared at post-test 2. For primary school students, significant differences were found at post-test 2, showing a smaller decline in seeking teacher's help and in heightening students' support for victims. Students' competence to solve bully/victim problems in relation to their general pro-social development is discussed.

Adolescent↗

What goes around comes around: re-emerging themes in sport and exercise psychology.

Sport and exercise psychology research appearing in Research Quarterly for Exercise and Sport (RQES) over the past 75 years can be characterized by re-emerging themes-hot topics in the 1930s remain hot topics now. Re-emerging themes include sportsmanship/moral development, social development/significant others, self-perceptions, attitudes/motivation, modeling/observational learning, emotion/arousal/anxiety, competition/achievement orientations, and gender roles. Although research paradigms and methodologies have changed, these topics have endured. We also identified dominant emergent themes appearing in RQES over the last 25 years: measurement development and validation; physical activity adoption and adherence; and multidisciplinary approaches to psychological issues. Given the many specialty journals and trends toward integrating models and methods from multiple disciplines, we suggest that RQES adopt a multidisciplinary focus for research in the field of kinesiology.

Exercise↗

Socio-economic position and height in early adulthood.

OBJECTIVES: To examine the relationship between socio-economic position and height in early adulthood. METHOD: A representative probability sample of Australian households (part of the 1995 National Health Survey). Data were collected by face-to-face interviews. Socio-economic position was measured using occupation and family income. Participants comprised 9,577 Australian-born males and females aged 20-24 (n = 3,186), 25-29 (n = 3,184), and 30-34 (n = 3,207). Height was self-reported and operationalised in terms of mean height and 'short' stature (defined as 1 SD below mean height for each sex-age subgroup). RESULTS: Graded, positive associations were found between occupation, family income, and height for males and females in each age cohort. Among males, mean height differences between blue-collar employees and professionals were 1.1 cm to 1.5 cm (depending on age-cohort), and for females, 1.6 cm to 2.1 cm. The corresponding height differences for males and females living in the least and most affluent families were 1.6 cm to 2.3 cm, and 1.0 cm to 2.5 cm, respectively. Persons in blue-collar jobs and those in low-income families were more likely to be classified as 'short'. CONCLUSIONS AND IMPLICATIONS: Estimates of mortality risk associated with short stature suggest that these height differences translate to about a 2-5% increased risk of death for the most disadvantaged groups. Given that socioeconomic height differences in adulthood have their genesis in the formative stages of biological and social development, public health intervention efforts need to focus on early life exposures and environments. The greatest reduction in height inequalities, and by extension health inequalities, is likely to flow from macro-level public policies to alleviate poverty and minimise the social and economic divide.

Adult↗

National Health Accounts development: lessons from Thailand.

National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National Economic and Social Development Board (NESDB) of Thailand produces aggregate health expenditure data but its estimation methods have several limitations. This has led to the research and development of an NHA prototype in 1994, through an agreed definition of health expenditure and methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies; and secondly, the use of funds by financing agencies. Five ultimate sources and 12 financing agencies (seven public and five private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. Using 1994 figures, we estimated a total health expenditure of 128,305.11 million Baht; 84.07% consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% was spent on purchasing care from public providers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were responsible for 48.79% and private 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumption expenditure estimate in 1994 was 180,516 million Baht or 5.01% of GDP, of which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP. There is also a large difference in the public and private proportion of consumption expenses, at 46:54 in NHA and 18:82 in NESDB. Future NHA sustainable development is proposed. Firstly, we need more accurate aggregate and disaggregated data, especially from households, who take the lion's share of total expenditure, based on amended questionnaires in the National Statistical Office Household Socio-Economic Survey. Secondly, partnership building with NESDB and other financing agencies is needed in the further development of the financial information system to suit the biennial NHA report. Thirdly, expenditures need breaking down into ambulatory and inpatient care for monitoring and the proper introduction of policy instruments. We also suggest that in a pluralistic health care system, the breakdown of spending on public and private providers is important. Finally, a sustainable NHA development and utilization of NHA for planning and policy development is the prime objective. International comparisons through collaborative efforts in standardizing definition and methodology will be a useful by-product when developing countries are able to sustain their NHA reports.

Data Collection↗

Epidemiology of schizophrenia.

OBJECTIVE: To characterize the epidemiology of schizophrenia. METHOD: Narrative literature review. RESULTS: Each year 1 in 10,000 adults (12 to 60 years of age) develops schizophrenia. Based on a restrictive and precise definition of the diagnosis and using standardized assessment methods and large, representative populations, the incidence rates appear stable across countries and cultures and over time, at least for the last 50 years. Schizophrenic patients are not born into ecological and social disadvantage. The uneven distribution of prevalence rates is a result of social selection: an early onset leads to social stagnation, a late onset to descent from a higher social status. The main age range of risk for schizophrenia is 20 to 35 years. It is still unclear whether schizophrenia-like late-onset psychoses (for example, late paraphrenia) after age 60 should be classified as schizophrenia either psychopathologically or etiologically. In 75% of cases, first admission is preceded by a prodromal phase with a mean length of 5 years and a psychotic prephase of one year's duration. On average, women fall ill 3 to 4 years later than men and show a second peak of onset around menopause. Consequently, late-onset schizophrenias are more frequent and more severe in women than in men. The sex difference in age of onset is smaller in cases with a high genetic load and greater in cases with a low genetic load. Type of onset and core symptoms do not differ between the sexes. The most pronounced sex difference is the socially negative illness behaviour of young men. CONCLUSIONS: Among the factors determining social course and outcome are level of social development at onset, the disorder itself (for example, genetic liability, severity of symptoms, and functional deficits), general biological factors (for example, estrogen), and sex- and age-specific illness behaviour.

Adolescent↗

[Vocational preparation and education of adolescent patients with epilepsy].

Often young epileptics cannot begin a regular apprenticeship immediately after leaving school. Many cases show some somatic and psychointellectual retardation and delayed social development and maturation. Impairment of learning and concentration due to drug-side effects aggravates gaps in basic knowledge which result from frequent school absences due to epileptic illness. Attendance of a vocational training scheme for one year ensures that educational and social deficiencies can be reduced and the practice of daily work can be obtained. The epileptologist should pay particular attention to good compliance. The large variety of psycho-social and behavioural problems can be improved by event-orientated group psychotherapy. A vocational testing period can follow. Time and type of seizures have to be respected in vocational counselling. The vocational training centre for handicapped adolescents offers a comprehensive education by vocational instructors, epileptologists and psychologists.

Adolescent↗

Post-communism: postmodernity or modernity revisited?

Coinciding with the popularity of postmodern theory, the fall of communism appeared to offer further evidence of the exhaustion of modernity. Such analysis is grounded in a view that the Soviet system was the epitome of modernity. An alternative approach regards post-communism as opening new terrains of struggle for modernity. Thus Habermas and others suggest that post-communist societies are rejoining the trajectory of western modernity whose problems they now recapitulate. This alternative view implies that Soviet systems were something other than 'modern', although their nature is not always clearly defined. However, even if post-communist societies do encounter problems of modernity, they do so in new circumstances where modernist notions of social development have become problematic. This article argues that, contrary to those who regard modernization or postmodernization as irresistible trends, core post-communist societies are likely to develop along an alternative path to that of western modernity. This is tentatively described as 'neo-mercantilist'.

Communism↗