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Skin communication: early skin disorders and their effect on transference and countertransference.

Eczema in the first year of life results in a basic disturbance of the earliest mother-infant relationship, a disturbance that is renewed with every transitional phase of the life-cycle. The pervasive fear of disintegration or loss of the self, and the need to be contained and held, affects subsequent character formation. Infants who experience extended periods of bodily soothing learn to translate psychic pain into visible bodily suffering and so arouse concern and care. This is illustrated by direct observation of women patients suffering from skin diseases and their interaction with women doctors in hospital. In the analysis of patients who have had such an infantile experience, whether they know it or not, a disturbance in concepts of the self linked with narcissistic difficulties and acute sensitivity to object relationships may be anticipated. The mother's human disappointment in her baby's appearance gives rise to an unsatisfying and unsatisfactory self image which remains unaltered in the true self. Transference and countertransference problems derived from the analysis of a female patient are described in order to illustrate these themes.

Adult↗

Measuring early language development in preschool children with autism spectrum disorder using the MacArthur Communicative Development Inventory (Infant Form).

Parent report data on early language development measured using the MacArthur Communicative Development Inventory (CDI-Infant Form) was collected on 134 preschool children with autism spectrum disorder. The pattern of development of understanding of phrases, word comprehension and expression, and production of gestures, was compared to the typical pattern. In common with typical development there was considerable variability in language acquisition, although for the group as a whole this was significantly delayed compared to the normal course. In addition, atypical patterns were identified in the emergence of language skills in the sample. Comprehension of words was delayed in comparison to word production, and production of early gestures (involving sharing reference) was delayed relative to production of later gestures (involving use of objects). However, other aspects of language development were similar to that found in typically developing infants, including word comprehension being in advance of word production in absolute terms, gesture production acting as a 'bridge' between word comprehension and word production and the broad pattern of acquisition across word categories and word forms. The implications for assessment and intervention with preschool children with autism spectrum disorder are discussed.

Age Factors↗

Multiplex developmental disorders. The role of communication in the construction of a self.

This article discusses the integration of various aspects of the child's development, particularly the development of language and communication and the way in which these developments interact to enable the child to construct a coherent sense of self. Multiplex developmental disorder is presented as an example of a disorder that affects several of these crucial strands of development. Recent research and controversies regarding the diagnostic descriptions of multiplex and other pervasive developmental disorders are presented. This discussion is used to illustrate the ways in which such disorders affect not only the individual aspects of development, but the child's ability to form a cohesive sense of self. The implications of these difficulties in self-definition for treating children with disorders that affect a variety of aspects of development are also discussed.

Child↗

Social communication deficits in conduct disorder: a clinical and community survey.

BACKGROUND: Increasing numbers of children are referred to Child and Adolescent Mental Health Services because of disruptive behaviour. Recent reviews on the origins of conduct problems indicate that the most severe and persistent forms are found predominantly among males with a range of neurodevelopmental vulnerabilities, which are likely to have biological substrates. In this study, we tested the hypothesis that many children who are identified with conduct disorder actually have a primary deficit in pragmatic language skills, of a quality and degree that is similar to children on the autistic spectrum. We hypothesised that pragmatic difficulties may underlie the antisocial behaviour in a proportion of children who are labelled as conduct disordered. METHODS: Using the Children's Communication Checklist (Bishop, 1998), we surveyed 142 children who had been referred for clinical investigation, with a predominant diagnosis of either an autistic spectrum condition (n = 87) or conduct disorder (n = 55), and 60 typically developing comparison children. Among children with conduct disorders, males predominated 9:1. RESULTS: On the basis of parent and teacher ratings, two-thirds of those with conduct disorders had pragmatic language impairments and other behavioural features similar in nature and degree to those of children with autism, independent of IQ. In a further study, we surveyed 54 children who had been excluded from elementary schools in a socio-economically disadvantaged inner-London borough and found over two-thirds to have comparable deficits. CONCLUSIONS: These findings have both theoretical and practical implications. First, they indicate the presence of communicative problems in a sub-group of children in whom conduct rather than language had been the major concern. Second, they indicate that severe deficits in pragmatic abilities and autistic-like behaviours can coexist with psychiatric conditions other than autism, especially in boys. Third, they imply that the management of many disruptive children could profitably be addressed to ameliorating their social and communicative skill deficits.

Autistic Disorder↗

Communicative abilities in autism: evidence for attentional deficits.

Although there are many theories about autism, something all of them agree upon is that autistics are impaired in the ability to communicate. The explanation is either their incapacity to attribute mental states to others or the interference of irrelevant stimuli with the access and processing of the communication (low). Our study on mute autistic children aims to investigate their communicative ability in order to bring some new evidence on the debate. We used an experimental technique that allows autistic children to access and process the communicative acts in a familiar context for as long as needed. The experimental results show that our sample of autistic children performs as well as the control group of normal children in dealing with directs, indirects, ironies, deceits, and recoveries of failure. Independent of their respective difficulty, the felicitous outcome of any of these acts requires the capacity to attribute an adequate communicative intention to the actor. Moreover, our results show that, contrary to the established findings in the literature, autistics' performance in the standard false belief task, a task that requires one to understand the mental states of other people, is equivalent to the performance of normal subjects. We argue that an attentional deficit affects the communicative performance of autistics in experiments where classic methodologies are used; with the proper methodology, we can access the unexplored world where mute autistic children also communicate. As far as we know, this is the first systematic experiment on pragmatic abilities in mute autistic children. Indeed, our work shows that tests and methodologies which help to focus on the communicative task improve the autistics' performance with respect to those used in the literature. We conclude that the autistic communicative deficit is at the performance level and that it has an attentional nature.

Adolescent↗

[Treatment of children with hyperkinetic disorders (ADHD) based on communications- and systems analysis].

Inquired for a therapeutic mode changing hyperactive behavior without application of drugs or diets we analyzed the patterns of cognition, communication and system behavior related to such disturbed children and their families. Following our observations we created a clinically useful therapy basing on a special view to system- and communication theory. We applied our therapeutic mode generally to as hyperactive identified primary school children and collected in N = 46 cases catamnestic data about five years later. In more than 80% out of the sample we found successful developments after application of in means 8 therapeutic sessions during 9 months. About 53% out of the successful treatment children show a splendid school success. Our results are demanding for an extended discussion of relations and family constellations including hyperactive behavior of one child. Searching for the possibilities of change in the view of system theory it seems to be more appropriate to consider relations but individual behavior.

Attention↗

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↗

Perceptions of parental communication orientation, perfectionism, and disordered eating behaviors of sons and daughters.

This study investigated the influence of perceived parental communication orientation and individual perfectionism on late adolescent offspring's maladaptive eating behaviors using a nonclinical sample ( N=424). College students' perceptions of their communication patterns with parents, self- and parentally prescribed perfectionism, and perceptions of personal control were measured to explore possible associations among these variables and whether they, in combination, predicted maladaptive eating. Results revealed that 23% of the sample participated in maladaptive eating behaviors; in addition, a father-child conformity communication pattern and paternally prescribed perfectionism predicted maladaptive eating within this sample when controlling for individual factors such as offspring's perfectionism and perceived loss of personal control. These findings suggest that father-child communicative interaction that emphasizes conformity to high paternal standards may increase offspring's risk of developing maladaptive eating behaviors.

Adolescent↗