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Affective communication of infants with autistic spectrum disorder and internal representation of their mothers.

We have been examining the developmental process of affective communication in infants with autistic spectrum disorders from the viewpoint of relationship disturbance through our developmental and psychopathological studies on autism. In particular, the role of internal representation of the mother in the process of development of affective communication is discussed through the presentation of two cases diagnosed as autistic spectrum disorder in early infancy. In these cases, we postulate approach-avoidance motivational conflict as the primary factor impeding development of affective communication, focusing therapeutic intervention on this perspective. As a result, attachment behavior was remarkably improved in the children, but affective communication with their mothers was not readily improved. Taking up the mothers' own internal representation in mother-infant psychotherapy, in particular, the mothers' problems in attachment behavior with their own mothers in infancy precipitated transition in the mothers' internal representation of their children, leading to active evolution in mother-child interaction and development in affective communication between mother and child. In this context, the basis and significance of internal representation of both parties being determinants in the quality of mother-child communication are discussed.

Affect↗

[Experience with the use of communicative movement therapy in children and adolescents].

Our experience shows that the use of communicative motion therapy for children and youths demands greater flexibility in the handling of the task and exercise conception and of the verbalization phases than when this form of treatment is used for adults. The behaviour of the therepeutist is particularly important. In contrast to his role when treating adults, he must be integrated more completely into the group and must act as an indirect leader. Although this makes the group more or less leader-centred, it loses none of its inherent dynamics if the therapeutist uses appropriate forms of communication.

Acting Out↗

Psychiatric aspects of sexual abuse involving persons with developmental disabilities.

OBJECTIVE: To consider psychiatric issues that relate to the prevention and management of sexual abuse involving persons with developmental disabilities as either abusers or victims. METHOD: Seven case descriptions illustrate the clinical challenges raised by allegations of sexual abuse. RESULTS: Mental disorders and communication problems often coexist with the cognitive impairment that is primary in developmental disabilities. Pedophilic behaviour prompts allegations of abuse, and posttraumatic stress disorder often follows abuse. Difficulties communicating with others may preclude the detection of abuse or normal legal proceedings once an allegation is made. CONCLUSIONS: Psychiatric expertise applied both directly and indirectly through others is relevant in the prevention of sexual abuse and the management of those with developmental disabilities who are abusers or abused.

Adult↗

Supporting augmentative and alternative communication use by beginning communicators with severe disabilities.

Augmentative and alternative modes of communication (AAC) have assumed an increasingly important role in meeting the communicative needs of individuals with severe disabilities. Despite the potential of AAC to enhance an individual's communicative effectiveness, practitioners may encounter challenges in implementing AAC interventions with individuals with severe disabilities. This article provides strategies addressing some of the challenges faced by practitioners as they teach beginning communicators with severe disabilities to use AAC. Specifically, this article discusses strategies for dealing with situations when learners (a) have AAC systems but are not using them, (b) have AAC systems but their communication partners are not actively participating, or (c) use alternative, but socially or contextually inappropriate, strategies for communication. This article culminates in a framework for increasing the effectiveness of AAC interventions and presents a discussion of needed research.

Communication↗

Enhancing socially adaptive communicative repairs of beginning communicators with disabilities.

Young children with significant disability often have limited communicative repertoires. The means they have available to communicate with others might include natural gesturing, vocalizing, and occasionally challenging behavior. These forms frequently are unconventional, ambiguous, and idiosyncratic and are therefore difficult for partners to understand. As a result of these compromised repertoires, communication breakdowns are the rule rather than the exception and the children's capacity to repair these breakdowns becomes critical. This article focuses on communication breakdowns and repairs by (a) identifying and defining their variations, (b) providing a rationale for their importance (especially for children with substantial language delays), and (c) developing a conceptual framework to facilitate their assessment and to assist in the design of interventions that are logically related to the assessment results. Guidelines for conducting the assessments and for implementing the interventions are provided.

Child↗

Discourse comprehension test performance of elders with dementia of the Alzheimer type.

Spoken language comprehension, including comprehension for inferential material in narrative discourse, is diminished in dementia of the Alzheimer type (DAT). There are, however, no empirical data concerning comprehension by adults with DAT of main ideas versus details in narratives. Evidence from other groups with and without brain damage has shown that comprehension for main ideas is relatively better than for details and that comprehension for stated material is relatively better than comprehension for inferential material. Participants in the present investigation were 24 older adults, 8 with early-stage DAT (EDAT), 8 with middle-stage DAT (MDAT), and 8 with no brain damage (NBD). Selected narratives and associated sets of yes-no questions from the Discourse Comprehension Test (DCT) (Brookshire and Nicholas, 1993) were presented on videotape. Participants with EDAT and MDAT had significantly poorer overall comprehension of DCT narratives than did those in the NBD group (p < .0001), but they did not differ significantly from each other. Responses to DCT narratives by participants in the NBD, EDAT, and MDAT groups followed the same pattern of relatively better comprehension for main ideas than for details and relatively better comprehension for stated than for implied information. Working memory and episodic memory were shown to be significantly associated with DCT overall scores. Together, these findings suggest that although overall narrative comprehension is diminished in those with DAT, individuals appear to retain a mental representation for narratives that facilitates better comprehension of main ideas than of details as well as better comprehension of stated information than of implied information. This interpretation is consistent with schema-based accounts of narrative comprehension.

Aged↗

Can severely mentally ill adults reliably report their needs?

Proponents of psychiatric rehabilitation believe that active patient participation in rehabilitation planning is essential. Participation assumes, however, that severely mentally ill patients can reliably report their needs. Unfortunately, reliably responding to a needs assessment may be diminished by cognitive deficits that are associated with psychosis and low intelligence. To address this issue, 35 severely mentally ill outpatients completed the Needs and Resources Assessment twice, with 1 week intervening. Their reliability on this task was compared with that of 16 control subjects. Results showed that subjects in both groups performed more reliably (measured as raw agreement) on the more highly structured, standardized items. Patients were less reliable than controls on individualized and standardized items. Further analyses suggested that the patients' raw agreement was found to be significantly associated with thought disturbance. Assessment methods must be sufficiently structured to help cognitively disordered patients provide reliable information for rehabilitation planning.

Adult↗

Treatment of the borderline patient, relationship management.

The author suggests that not the borderline syndrome itself but many of the worst behaviours of borderline patients are essentially iatrogenic. To do no harm should be the primary goal of any therapist encountering a patient exhibiting borderline features. Management of the patient-therapist relationship is paramount and may be in itself the most effective and safe treatment for both crisis situations and longer therapy. A conceptual model borrowing from and bridging self psychology and interpersonal theory is described. This model leads to a reframing or new interpretation of borderline symptoms and therapists' reactions. Realtionship management guidelines and specific interventions are suggested.

Borderline Personality Disorder↗

Early intervention critical to autism treatment.

It is still not universally accepted within the scientific community that the habilitation of autistic children is possible, or that their ability to function without supports in regular education by third, fourth, or fifth grade happens as a direct result of EIBI. However, using the outcome studies that have been reported, the rate of children reaching a best-outcome status appears to be between about 10% and 47%. There is a more global way to look at the effects of EIBI or behavioral intervention. Even if the child retains many characteristics of autism, the usual outcome of treatment is that the child learns useful skills. Behavioral intervention results in effective and efficient learning, which is precisely what it aims to accomplish and what behavioral techniques have been developed to do. Children and families have been able to achieve much more than many would ever have believed before EIBI became a realistic possibility.

Age Factors↗

[Comorbid disorders of the attention deficit with hyperactivity disorder].

OBJECTIVE: To show the comorbid pathology associated with the attention deficit/hyperactivity disorder (ADHD) during the pediatric and adult ages. PATIENTS AND METHODS: We use the disorders included by the international literature as the most frequents. There are included as main disorders: problems of affectivity, learning disabilities, dyslexia, vehicle driving problems, anxiety, bipolar disorder, motor coordination problems, tics and Tourette syndrome, oppositional defiant disorder, impulsive aggressive, antisocial behavior, and predisposition to delinquency, and to be alcohol and drugs abusers. CONCLUSION: The presence of comorbid disorders in the ADHD may show a higher severity of the disorder which makes that many of these subjects to be predisposed to be in contact with psychiatrics, policemen and justice during the entire life.

Attention Deficit Disorder with Hyperactivity↗