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PubMed1985

The treatment of autistic children.

The goals of treatment need to be decided on the basis of knowledge on the nature of autism. As with any developmental disorder, the first goal must be to foster normal development; with autistic children this involves a focus on intellectual, language and social development. The further goals include: the reduction of rigidity/stereotypy; the elimination of non-specific maladaptive behaviours; and alleviation of family distress. Research findings are used to translate these goals into a practical overall therapeutic programme with three main elements: a full diagnostic appraisal, special educational provision and a home-based programme for the family. Finally, the research findings are drawn together to derive inferences on the lessons to be learned and the questions that remain to be answered.

Autistic Disorder↗
PubMed2003

Treatment of depression among impoverished primary care patients from ethnic minority groups.

OBJECTIVE: The aim of this study was to determine whether supplementing traditional cognitive-behavioral therapy for depression with clinical case management would reduce the rate of dropout from care and improve outcomes for ethnically diverse, impoverished medical outpatients. METHODS: The study was a randomized trial that compared cognitive-behavioral group psychotherapy alone (N=103) with the same therapy supplemented by clinical case management (N=96). RESULTS: The patients who received supplemental case management had lower dropout rates than those who received cognitive-behavioral group therapy alone. Supplemental case management was associated with greater improvement in symptoms and functioning than cognitive-behavioral therapy alone for patients whose first language was Spanish (N=77) but was less effective for those whose first language was English (N=122). CONCLUSIONS: Supplemental case management improves retention in traditional mental health outpatient care and can improve outcomes for Spanish-speaking patients.

Adult↗
PubMed1998

Does medical antireflux therapy improve asthma in asthmatics with gastroesophageal reflux?: a critical review of the literature.

OBJECTIVE: Identify and critically review the peer-reviewed, English-language studies of the effects of medical antireflux therapy in asthmatics with gastroesophageal reflux (GER). DESIGN: Using the 1966 to 1996 MEDLINE database, asthma was combined with GER to identify all studies of the effects of medical antireflux therapy on asthma control. The articles' bibliographies were also reviewed. Studies were graded according to Sackett's criteria and grouped by levels of evidence. RESULTS: A total of 242 citations were found; 171 were published in English. Twelve studies of the effects of medical antireflux therapy on asthma control, with a total of 326 treated patients, were identified. Eight studies were placebo-controlled, three were open studies, and one used an untreated control. Eight studies treated 20 or fewer patients. Reflux symptoms either did not improve or the effects of antireflux therapy on them were not reported in four studies. The combined data from the controlled medical antireflux studies showed that: (1) asthma symptoms improved in 69% of the subjects; (2) asthma medication use was reduced in 62% of the subjects; (3) evening peak expiratory flow (PEF), but not PEF at other times, improved in 26% of the subjects; and (4) spirometry did not improve in any of the placebo-controlled antireflux studies. CONCLUSIONS: Analysis of the combined data suggests that medical antireflux therapy improves asthma symptoms, may reduce asthma medication use, but has minimal or no effect on lung function.

Antacids↗
PubMed2006

[The efficacy of early intervention for infants and toddlers with hearing loss].

OBJECTIVE: To investigate the efficacy of early intervention on language, pronunciation and cognitive developments of infants and toddlers with hearing loss and to build up an early intervention model. METHODS: Fifty-six children with moderate to profound sensorineural hearing loss aged 10 months to 2 years were divided into two groups. 20 children, aged 10 months to 2 years, received early intervention services after wearing hearing aids for 6 - 18 months, and 36 children, aged 11 months to 2 years, didn't receive any intervention. The type and degree of hearing loss were measured by a series of auditory tests. Language and cognitive developments of the children with hearing loss and 28 age, and sex-matched children with normal hearing, aged 10 to 23 months, were evaluated by the Gesell developmental schedules. The results were expressed as developmental quotient (DQ). Pronunciation test in mandarin Chinese was adopted to evaluate the speech development of the 56 children with hearing loss. RESULTS: (1) The language DQ according the Gesell developmental schedules of the children with hearing loss who received early intervention was (92.25 +/- 17.32), significantly higher than those children with hearing loss who didn't receive intervention (70.44 +/- 29.99, P = 0.00), whish was significantly lower than that of the normal hearing children (P = 0.00). However, there was no significant difference in language DQ between the children who received early intervention and the normal hearing children. There was no significant correlation between the degree of hearing loss and language DQ in the children who received early intervention (P = 0.27). (2) The personal-social developmental quotient (DQ) of the children who received intervention was (101.40 +/- 7.66), significantly higher than that of the children who didn't receive intervention (83.94 +/- 22.09, P = 0.00), that were significantly lower than that of the children with normal hearing (P = 0.00). However, there were no significant difference in the personal-social DQ between the children who received early intervention and the children with normal hearing. No significant differences in the gross motor ability, fine motor ability and adaptive ability were observed between the two groups of children with hearing loss and normal hearing children. (3) The consonant pronunciation of the children with moderate to severe hearing loss who received early intervention was normal. Among those children only one case with profound hearing loss had/d/error. The consonant pronunciation of the children with moderate hearing loss who didn't receive early intervention of those was normal. One case with moderate-severe hearing loss and one case with severe hearing loss had/d/errors. Six cases with profound hearing loss had/d, m/errors. The tone of the children with moderate to severe hearing loss who received early intervention was normal. Three cases with profound hearing loss exhibited tone errors. Among the children who didn't receive early intervention, tone errors were found in two cases with moderate hearing loss, one case with moderate-severe hearing loss, one case with severe hearing loss, and twelve cases with profound hearing loss showed. CONCLUSION: The language, pronunciation and cognitive developments of the children who don't receive early intervention are significantly lower than those of the children with normal hearing. Early intervention can significantly improve the language, speech and cognitive abilities of children with hearing loss.

Child, Preschool↗
PubMed2004

Homosexuality, ethics and identity synthesis.

Implicit metaphysical assumptions concerning the nature of sexual orientation are reflected in the language used to frame ethical debates concerning "reorientation" therapies. An alternative metaphysical construal is presented concerning sexual orientation and sexual identity development and synthesis. This alternative construal allows for humility concerning what we know and do not know about sexual orientation, underscores the client's self-determination and autonomy, and demonstrates regard for personal and religious valuative frameworks. Rather than focusing on therapies aimed specifically at sexual reorientation, clinicians would do well to provide clients with informed consent and to facilitate identity development and synthesis in keeping with their clients' requests for professional services.

Behavior Therapy↗
PubMed1994

Cognitive therapy with children and adolescents: from theory to practice.

Cognitive therapies are now well established as a component for the treatment of a wide range of child behaviour problems. There is a great deal of evidence to suggest that deficits and distortions in cognitive processes play a role in disorders of affect and behaviour in children and adults alike. This has led to the development of many different cognitive therapy approaches which aim to influence cognitive products, structures and operations. Cognitive assessment methods continue to lag behind the developments in therapy, and there is a marked need for the development of reliable and valid measures. Empirical studies support the value of cognitive interventions, although it is recognised that most cognitive therapies include aspects of behavioural techniques, making it difficult to draw valid conclusions. Certainly, the results of recent meta-analytic studies have produced optimistic conclusions and justify the continued use of cognitive therapy methods in clinical practice, with a wide range of behavioural problems. Cognitive therapy techniques have something to offer with internalising and externalising disorders alike. Future research should now focus on the identification of methods to enhance the effects of cognitive therapies and to determine the characteristics of children who are most likely to benefit from these methods. There is some evidence to suggest that younger children may benefit less from cognitive therapies than do adolescents. This perhaps reflects differences in cognitive and language development. Further consideration needs to be given to adapting cognitive therapy methods to the developmental level of younger children. Cognitive therapy approaches are now well entrenched within many multi-component programmes for most emotional and behavioural disorders in children. The degree to which cognitive therapies add to the effectiveness of behavioural methods, however, remains to be demonstrated for many types of behaviour problem. It is also unclear whether the changes in affect and overt behaviour produced in these intervention programmes is actually related to improvements in the cognitive activities that were targeted in therapy. From a theoretical perspective, however, cognitive therapies have a high degree of face validity. If deficits or excesses in specific cognitive events or processes are found during assessment, which can be hypothesised to underlie disturbances of affect of behaviour, then there is a strong case for attempting to change these aspects of cognition.

Adaptation, Psychological↗
PubMed1993

New developments in anti-asthma drugs.

OBJECTIVE: To review the current approach to the management of bronchial asthma with particular reference to drug therapy. DATA SOURCES: All significant English language journals were searched for current studies, particularly controlled clinical trials, in the management of asthma. STUDY SELECTION: Sixty articles were reviewed. They were selected on the basis of the known reputation of the author or the unit from which the study emanated, the place that the study has assumed in academic respiratory circles, and whether the study contributed something new to our understanding of drug therapy in asthma. Review articles from eminent scientific bodies were also analysed. CONCLUSIONS: Asthma is an inflammatory disease and therapy must be directed towards this as well as to bronchoconstriction. Inhaled corticosteroids are the mainstay of treatment and inhaled beta-agonists are best used on an as needed basis. Regular objective assessments of patients' progress are essential, as are written, individualised action plans. The adjunctive use of other drugs is discussed and new therapies which may prove useful in the future are reviewed.

Administration, Inhalation↗
PubMed1991

Audit from preschool developmental surveillance of vision, hearing, and language referrals.

Referrals from preschool medical examinations were followed up for two years to assess attendance rate, waiting time for appointment, appropriateness of the referral, the diagnosis and management of the condition. Altogether 184 children were referrals for ophthalmology, 285 for audiology, and 195 for speech therapy. The median waiting time for an appointment was 46 days in ophthalmology, 175 days in audiology, and 83 days in speech therapy. The poorest attendance rate was identified in speech therapy (75%). Approximately 60% of examined children had a justified referral to ophthalmology and 20% had a clear defect. Over half the children in audiology (55%) had an altered impedance or hearing impairment. Of those with a hearing problem kept under review only half improved spontaneously. In speech therapy 80% of those assessed had a language problem. Many health problems were detected for which parents were unaware or did not use the service. Parental awareness alone will not uncover the sizable level of lingual and sensorial problems in inner city areas. This audit identified specific deficiencies in the provision of services and a number of organisational changes are suggested to improve their effectiveness.

Age Factors↗
PubMed1976

Method: melodic intonation therapy for aphasia.

Melodic intonation therapy (MIT), a method developed to assist the adult aphasic regain verbal communication, is presented with step-by-step procedures and suggestions. Also described is the type of patient for whom the technique appears most successful.

Aphasia↗
PubMedDate not supplied

Clinical diagnostic and intervention studies of children with semantic-pragmatic language disorder.

The diagnosis of semantic-pragmatic language disorder (SPLD) has been the subject of a number of research studies over the last two decades. Classification and diagnostic debates, while illuminating, have done little to develop tools to improve services to these children. In this paper, two children whose communication difficulties are suggestive of an SPLD diagnosis but who have differing profiles are studied. Using existing models of psycholinguistics and pragmatics to guide assessment and intervention, the diversity of language and social communicative behaviours that are covered by the label SPLD are exemplified. Consideration is given to whether the term SPLD is appropriate for both children or whether Bishop's revision of the diagnosis to 'pragmatic language impairment' might be more useful. Methods of intervention and evaluation for semantic and pragmatic deficits in these two cases are described. It is argued that existing tools can enable accurate explanation and modelling of the communication of children with SPLD and that there is a role for intervention studies in helping to refine those tools, to improve therapies and to understand the nature of the condition more fully.

Child↗
PubMed1997

The singing/acting child: a speech-language pathologist's perspective.

Performance-oriented children who encounter voice problems benefit from a team approach to intervention. Developmental and psychosocial issues in addition to the acquisition of information and vocal skills must be addressed. This article presents information from a speech-language pathologist's perspective and includes some examples of clinical approaches and strategies. The importance of building motivation to change vocal habits and the need for the child to develop insight and self-evaluation strategies is emphasized.

Child↗
PubMed2003

Intravelar veloplasty in cleft lip, alveolus and palate and outcome of speech and language acquisition: a prospective study.

BACKGROUND: Speech and language acquisition are major, important criteria in the treatment outcomes of cleft lip and palate patients. A generally accepted and definitive treatment protocol regarding surgical techniques and the time schedule does not yet exist. In the world literature, there are reports of velo-pharyngeal insufficiency rates between 7 and 30%. PURPOSE: In a prospective study, all children aged 312 months with cleft lip, alveolus and palate, or cleft palate only, underwent an intravelar veloplasty. Follow-up monitoring consisted of frequent clinical linguistic checks and supervision of language development without a planned intention of articulation therapy before the age of about 5 years. RESULTS: Three hundred and ninety-seven children with non-syndromic clefts were included in this study, the youngest being 8-year old. Sixty children (15%) showed deviations in language and speech acquisition. From these, 56 (14%) had received articulation therapy after the 5th birthday. From these 56 children, 45 had overcome their problems with speech therapy alone whereas 11 (3%) needed a velo-pharyngeoplasty. DISCUSSION: Although these results are much better than those reported in other cohorts, some children still have velo-pharyngeal incompetence for no apparent reason. One possible explanation might be surgical, since on occasions, the intravelar muscle bundle is divided into two parts and the palato-pharyngeal part runs isolated more laterally and can be missed during reconstruction and retropositioning.

Alveolar Process↗
PubMed2000

Endometrial cancer. Prevention, detection, management, and follow up.

OBJECTIVE: To review risk factors for uterine cancer; to discuss strategies for detecting uterine cancer; to outline prognostic factors and treatment; and to review the role of follow up for patients who have completed primary therapy. QUALITY OF EVIDENCE: MEDLINE was searched from January 1996 to June 1998 using the terms endometrial neoplasms, estrogen replacement therapy, hormone replacement therapy, tamoxifen, and screening. Only English language articles were reviewed. Study types included reviews. Bibliographies of articles found were searched for further relevant titles. Causation literature is available from well conducted cohort trials. Treatment recommendations are based in part on prognostic information and a few randomized controlled trials. MAIN MESSAGE: Risk factors, both intrinsic and extrinsic, are associated with uterine cancer. Family physicians have a role in preventing disease by ensuring that all women with uteri in situ using hormone replacement therapy (HRT) have progesterone therapy as part of the HRT regimen. Detection is crucial; abnormal uterine bleeding or undiagnosed postmenopausal bleeding warrants investigation with endometrial biopsy. The goal of surgery is to remove the uterus and ovaries and identify factors that make the disease at high risk of recurrence. Although adjuvant radiation therapy does not prolong survival, it does alter the pattern of disease recurrence. The goal of follow up after primary therapy is to identify recurrent disease while it is still curable. CONCLUSIONS: Family physicians play an important role in preventing uterine cancer, initiating early diagnosis of disease, and in the future, might be more actively involved in caring for patients following primary therapy.

Adult↗
PubMed1996

[Diagnosis and logopedic rehabilitation in mandibulofacial dysostosis: a case report].

TCS is hereditary condition transmitted as an autosomal dominant with a high penetrance rate and variable expressivity. Over half the cases derives from new mutations. A pathological gene has been located on the chromosome 5, between locus 31 and 34 of the long arm. The clinical picture is dominated by mandible-facial impairment and by numerous associated deficits, among which a hearing deficit. Therapy requires plurispecialistic intervention, personalized according to each patients condition. The Authors report the case of a three-year-old girl with transmissive deafness and serious language retardation. The child successfully underwent logopedical therapy for three years. The Authors conclude affirming that very young patients with S. Treacher Collins-Franceschetti have a very good chance of being inserted into society furthermore improved by the absence lack of mental deficiency and by spontaneous improvement in physical appearance.

Child, Preschool↗
PubMed2000

Dysphonia related to medical therapy.

It is essential for laryngologists, speech and language pathologists, and others caring for professional voice users to be familiar with the potential vocal effects of any substance ingested by a professional voice patient. This article reviews pharmacologic agents that may have laryngeal side effects. Essentially, any ingested substance is suspect as a cause for voice dysfunction. It is also necessary for laryngologists to educate voice professionals about the consequences of drugs on the voice and the potential problems associated with properly prescribed medication.

Humans↗
PubMed1996

Intervention strategies for students with ADHD: creating a holistic approach.

An overview of therapy approaches commonly used by speech-language pathologists with students having ADHD and their primary intervention responsibilities with these students is presented. Several strategies for establishing the kinds of learning contexts necessary for success are described, which emphasize the importance of empowering students in meaningful and relevant contexts. Five major intervention strategies for working with ADHD students are reviewed briefly--modifying learning environments, pharmacological therapy, behavioral management, cognitive-behavior modification, and classroom academic management--and detailed references for each are provided.

Attention Deficit Disorder with Hyperactivity↗