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PubMed1996

Clinical features of developmental disability associated with cerebellar hypoplasia.

Sporadic nonsyndromic cerebellar hypoplasia is a radiological diagnosis with clinical features and a relation with developmental disability that are presently not known. Through a retrospective review of a comprehensive standardized computerized database containing more than 2,500 patients examined consecutively by a pediatric neurologist, 11 with nonfamilial, nonsyndromic cerebellar hypoplasia on neuroimaging (CT and/or MRI) were identified. With the exception of two patients, all had been originally referred during infancy or the preschool years for assessment of a developmental disability. All 11 had "cerebellar" findings on initial examination and five were microcephalic; three others were below the 10th percentile. All exhibited developmental disability, commonly of mild to moderate degree. Motor involvement predominated, often involving fine motor skills more than gross motor functions. Imaging consistently disclosed vermis hypoplasia with additional supratentorial cerebral dysgenesis in one child and cerebellar hemispheric hypoplasia in another. Cerebellar hypoplasia is a developmental anomaly that appears to be either etiologically related to, or a marker for, developmental disability, thus confirming the intact cerebellum's integral role in normal psychomotor development. This series suggests that cerebellar hypoplasia should be considered in the young child presenting with developmental delay with prominent motor involvement, together with cerebellar signs and/or microcephaly.

Cerebellar Diseases↗
PubMed1994

Developmental disabilities prevention and the distribution of risk among American Indians.

Selected risk factors for developmental disabilities demonstrate an apparent differential pattern of risk for American Indians as compared to the U.S. general population. Indian children appear to experience comparable or even lower rates of certain congenital anomalies which are associated with developmental disabilities and are difficult to prevent. Conversely, Indians are reported to experience higher rates of conditions which can be effectively targeted for prevention, including those related to prenatal exposure to alcohol, cigarette smoking, and maternal diabetes, as well as disabling sequelae of accidents and otitis media. Primary prevention is critical because of the long-term chronic nature of developmental disabilities and strategies focused on risk factors of particular relevance to Indian communities can achieve the greatest potential benefit.

Child↗
PubMed1990

Toward social system theory: implications for older people with developmental disabilities and service delivery.

The literature refers to older people with developmental disabilities as the "new service population." How and why this population emerged as a special category is discussed conceptually with reference to social systems theory. A brief review of social systems theory and some basic systemic tenets are presented. Systemic tenets are employed in examining the historical development of social gerontology and present trends in the service-delivery system. I show that the systemic variable of the economic model of human development has significantly impacted on the making of older people with developmental disabilities a dependent population. In the conclusion the systems perspective is explored in relation to recognizing the liminal, in-between parts between components. It is argued that such a perception minimizes the dichotomy between older people with developmental disabilities and the non-disabled population, paving the way for a genuine encounter.

Aged↗
PubMed1994

Caregivers' expectations of future learning of dependents with a developmental disability.

Attitudes and expectations of caregivers affect the development of children, including those with a developmental disability. The purpose of this study was to examine caregivers' expectations of their dependent with a developmental disability and caregiver attributions in relation to these expectations. Primary caregivers (N = 35) were interviewed about their expectations and attributions related to the dependents' achievements. Expectations were measured by the Predictive Adaptive Ability Questionnaire (PAAQ). Expectations were significantly predicted by the degree of developmental delay and number of handicaps. Caregivers expected less of dependents who had a lower developmental age/chronological age ratio than for dependents whose developmental level more closely approximated the chronological age. Results suggest that nurses should assess caregivers' expectations for the future development of their dependent with a developmental disability and the basis for those expectations.

Adolescent↗
PubMed1981

Spectrum of developmental disabilities: continuum of motor dysfunction.

The spectrum of developmental disabilities encompasses a diverse group of interrelated disorders with multiple manifestations resulting from brain dysfunction. Motor disability has been highlighted, as it is the most frequent presenting sign of developmental disability. Such disability may vary from severe to minimal. Severe disability, or cerebral palsy, is well appreciated, as are the additional associated disabilities that affect habilitation. Mild to minimal motor disability (mild to minimal cerebral palsy), because it is usually nonhandicapping, is less frequently appreciated as a marker of brain dysfunction. Further delineation of the child's nonmotor abilities is necessary in order to define the scope of the disability. Cognitive limitation is not an important cause for the gross motor delay seen in children with mental retardation. It is our postulation that the motor deficit is on the basis of mild to minimal cerebral palsy. This diagnosis is frequently obscured by the mental retardation.

Humans↗
PubMedDate not supplied

General anesthesia for developmentally disabled dental care patients: a comparison of reinforced laryngeal mask airway and endotracheal intubation anesthesia.

Providing dental care for developmentally disabled patients who require general anesthesia is challenging for both and dentists and anesthesiologists. This study aimed to compare the efficacy of two anesthetic methods for dental care. The researchers retrospectively analyzed morbidity data following anesthesia using either a reinforced laryngeal mask airway (LMA) or endotracheal intubation anesthesia for a two-year time period. The subjects were developmentally disabled patients receiving dental care. Statistical analyses were by unpaired student t-tests and chi-square tests. Patients were who anesthetized with a reinforced laryngeal mask airway had a significantly shorter recovery period and lower postanesthetic complication rates when compared to patients undergoing endotracheal intubation anesthesia. Although hypoxemia (SPO2 < 90%) during dental care occurred more frequently when using the reinforced laryngeal mask airway, the difference was not significant. Nausea and vomiting were the major complications in the postanesthetic care unit and after discharge. When complication rates were compared in the two patient groups, nausea and vomiting were significantly higher during postanesthetic care and after discharge in the intubated group. In conclusion, reinforced laryngeal mask airway provides general anesthesia with less risk of side effects for developmentally disabled patients undergoing dental care.

Adolescent↗
PubMed2004

Public health monitoring of developmental disabilities with a focus on the autism spectrum disorders.

Developmental disabilities (DDs) are conditions characterized by physical, cognitive, psychological, sensory, adaptive, and/or communication impairments manifested during development. Approximately 17% of individuals in the United States 18 years and younger have a DD, and for most children the cause of their condition is unknown. Of particular interest are the autism spectrum disorders (ASDs), characterized by unusual social, communication, and behavioral development. Previously autism was thought to be a rare condition, but the number of children receiving services for an ASD has increased dramatically in the last decade. Concerns about increases in DDs, particularly ASDs, their causes, and the high costs of intervention have highlighted the need for systematic public health monitoring. Service provider data, such as annual reporting of special education services or of state DD programs, do not provide a complete estimate of the rates for DDs, including ASDs. Unlike genetic metabolic disorders or congenital hearing loss (HL) for which newborn screening programs can provide accurate prevalence rates, there are currently no genetic or biologic markers for the ASDs to enable consistent and early identification of affected children. Centers for Disease Control and Prevention's (CDC) Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) is a model for population monitoring of ASDs/DDs that has been implemented in other states. This article discusses the role of ASD/DD tracking in public health, as well as the challenges of ASD/DD tracking, including case definition and identification, associated conditions, linkages, and data access.

Autistic Disorder↗
PubMed1992

Dental fellowships in developmental disabilities help broaden care of disabled.

Continuation of the national trend toward deinstitutionalization and community placement for persons with developmental disabilities, physical handicaps and other medical problems will mean increased demand for dentists trained to care for this segment of the population. The New York State Office of Mental Retardation and Developmental Disabilities now offers dental fellowships in developmental disabilities to help fill the learning gap.

Academic Medical Centers↗
PubMed1999

Special considerations for medication use in children with developmental disabilities.

Regardless of the underlying cause of a child's developmental disability, a similar constellation of associated medical conditions may occur. Successful management approaches in children with developmental disabilities are generally interdisciplinary, frequently involving a variety of medical and surgical disciplines, allied health professionals, and the child's family. Pharmacologic intervention is an integral aspect of the management plan, but consideration must be given both to the possible effects of the medications on a child's growth and development, and to the avoidance of adverse drug interactions and reactions.

Adolescent↗
PubMed2005

Guidelines for the use of clozapine in individuals with developmental disabilities.

Clozapine is the most effective antipsychotic medication currently in use, but there has been a paucity of well-controlled research on its efficacy with people with developmental disabilities. We present a set of guidelines to ensure proper utilization of clozapine in individuals with developmental disabilities, because it can offer them therapeutic advantages similar to those observed in people with schizophrenia. We provide recommendations regarding the use of clozapine that are based on three main sources: literature and published professional practice guidelines regarding the use of clozapine in individuals who do not have developmental disabilities, the limited literature on the use of clozapine in individuals who have developmental disabilities, and our own clinical experience. The first part of the guidelines contains an overview of necessary practical knowledge regarding side effects, dose and blood level considerations, and interactions with other medications, diet and tobacco smoking. In the second part, we offer procedures for selecting individuals for clozapine therapy based on proper indications and contraindications for treatment. We also include requirements regarding informed consent, dosage and special laboratory and clinical monitoring.

Adult↗
PubMedDate not supplied

Developmentally disabled children can be adopted.

People have often thought that developmentally disabled children were hard to place and poor risks in adoption. However, this research shows that a large number of children of all ages and disabilities were placed for adoption with few disruptions. In light of these findings, agencies may well put more effort into identifying developmentally disabled children as suitable candidates for adoption services.

Adolescent↗
PubMedDate not supplied

Otitis media and developmental disability. Epidemiologic considerations.

Review of the literature indicates that: a) otitis media is a common disorder with risk being highest in the pre- and early school years, b) no marked differences in sex distribution of incidence exist, c) frequent recurrences are the hallmark of this disease, and d) mild hearing deficit lasting for months is not uncommon. A retrospective study in a defined population is suggested as an initial effort to investigate the proposed associations between developmental disability and hearing loss, developmental disability and history of otitis media, and finally, hearing loss and history of otitis media. Such an approach, however, a) could not determine the absolute risk of developmental disability in children with otitis media, and b) would underestimate the frequency of otitis media, since occult otitis media would not be thus identified. The determination of an accurate incidence of otitis media and of the absolute risk of developmental disability in children with otitis media calls for a prospective study. Such an investigation is likely to be justified only as a part of a collaborative study designed to measure multiple outcomes from a limited number of antecedents.

Adolescent↗
PubMed2005

A methodology for assessing the functions of emerging speech in children with developmental disabilities.

An approach based on Skinner's (1957) theory of verbal behavior has been developed to understand and teach elementary communication skills to children with autism and developmental disabilities (Sundberg & Partington, 1998). However, few studies have directly examined the characteristics of emerging language in children with developmental disabilities. The purpose of this study was to develop and evaluate an assessment for identifying the elementary functions of vocal speech in children. Participants were 4 children with developmental disabilities, aged 6 years to 12 years, who exhibited at least one distinguishable vocal response (word or phrase) frequently in the natural environment. The assessment focused on three verbal operants delineated by Skinner (mand, tact, and intraverbal). One or more functions were identified for at least one vocal response of each child. Results suggested that this assessment would be useful for (a) evaluating Skinner's theory, (b) guiding decisions about language training for individual children, and (c) studying the nature of expressive language development in children with developmental disabilities.

Child↗
PubMed2001

Aging adult children with developmental disabilities and their families: challenges for occupational therapists and physical therapists.

The purpose of this article was to review the literature about families of adult children with developmental disabilities, the impact of culture on access to health care services, and community-based health care services for adults with developmental disabilities to answer the following questions: (1) How do parents of adult children with mental retardation and other developmental disabilities describe their caregiving experiences?, (2) What are frequently identified unmet service needs by the parents/families?, (3) Does the family's culture or ethnic background influence how they view their caregiving experiences?, and (4) What are the unique challenges facing families when attempting to access health care services? Currently little information exists about the needs of parents and other family members who live with adults with developmental disabilities. Longitudinal studies and studies to assess the influence of culture on care giving are especially needed. Therapists need to use approaches that will empower children and their families so they can better meet their current challenges and provide a foundation for the skills they will need to meet future challenges as adults.

Adolescent↗
PubMedDate not supplied

Health care service provision for country people with developmental disability: an Australian perspective.

Priorities in the delivery of health care to Australian country people with developmental disability were explored through focus groups and interviews of key stakeholder groups from four rural/regional towns. Data were analysed for themes, which converged on lack of access to primary health care providers who lacked knowledge about and had poor attitudes towards developmental disability, discriminatory practices, the burden on support people, and communication difficulties between GPs and people with developmental disability. Potential strategies to address the apparent dissatisfaction with primary health care and GP concerns about working with this group were also evident in the data. In particular, open communication between stakeholders as a mechanism for collaborative problem solving and a strategy to avoid burn out for both support people and GPs is recommended. Facilitation of such communication can best occur through undergraduate training and participation of disability workers in activities of organisations that support GPs.

Adult↗
PubMed1989

Psychological predictors of adjustment by siblings of developmentally disabled children.

Psychological predictors of self-concept, behavior problems, and social competence of siblings of developmentally disabled children were identified and compared with those in matched siblings of nondisabled children. Subjects were 110 children (ages 8 to 15 years), 55 with a developmentally disabled younger sibling and 55 with a nondisabled sibling of the same age range as the disabled child (under 7 years). The subjects completed the child psychological measures that were analyzed in the context of family measures completed by the parents. Results show that distinct psychological predictors exist for children with developmentally disabled siblings, with parental stress and some dimensions of the family social environment being most significant.

Adolescent↗
PubMed1993

Behavior management in the child with developmental disabilities.

Pediatricians who serve children with developmental disabilities would be well advised to study and practice applied behavior analysis. Within a behavior analytic framework, the pediatrician views the child's aberrant performance as being a constellation of behavioral excesses and skill deficits that serve a functional purpose, rather than as being a symptom of some underlying illness or intrapsychic mechanism. The pediatrician can counsel the child, parents, and teachers to rearrange their environment, with an emphasis on how they can behave differently toward one another in specific situations, so as to alter the target behavior. When the child's problem behaviors are relatively severe or intractable, the pediatrician can refer the patient and family to a behavior specialist while continuing to support efforts to improve the child's overall health and adjustment.

Behavior Therapy↗
PubMedDate not supplied

A review of the nature and treatment of sleep disorders in individuals with developmental disabilities.

This paper describes research on the prevalence, correlates, and treatment of sleep disorders in individuals with developmental disabilities. A significant number of individuals with developmental disabilities have disordered sleep, although prevalence estimates vary from 13% to 86%. Constitutional variables, including age, presence of physical and sensory impairments, and certain genetic syndromes and medical conditions appear to be related to sleep disturbance, but the evidence is mainly correlational and therefore cannot be said to show a causal relation. While a number of behavioral interventions have proven effective in the treatment of sleep disturbance, and drug therapy involving melatonin appears promising, epidemiologic work on the correlates of sleep disorders appear to have had little impact on treatment. Consideration of the nature of sleep disorders may enhance treatments for individuals with developmental disabilities.

Behavior Therapy↗