Child Development Center Research Articles

A Clinical Experience of Autism in India

From the Ummeed Child Development Center, and Jaslok Hospital and Research Centre, Mumbai, India. Address correspondence to Vibha Krishnamurthy, M.D., Ummeed Child Development Center, N.M. Joshi Marg, Subhash Nagar, Lower Parel, Mumbai 400 011, India; e-mail: [email protected].

Pediatricians’ Communication Styles as Correlates of Global Trust Among Jewish and Bedouin Parents of Disabled Children

There is a paucity of empirical studies of trust among parents of children with developmental disabilities. Trust is an important element in the patient-physician relationship, especially in medical rehabilitation, where continuous cooperation is essential for positive therapeutic outcomes. Trust is dependent on a variety of psychosocial factors, one of which is the physician's communication style. The current study had three goals: (1) to compare two groups of Israeli parents, Jews and Bedouins, in terms of the levels of global trust in the pediatricians in a regional child development center; (2) to compare their perceptions of the pediatricians' communication styles; and (3) to assess the association between three communication styles (caring, interest, and collaboration) and the parents' trust in the pediatricians. The sample included 193 parents of disabled children ranging from 6 months to 6 years of age. Global trust and parents' perceptions concerning their communication with the center's pediatricians were measured by scales developed for this research. Despite the large cultural differences that exist between the Jewish and Bedouin groups, the only significant difference between them was that Jewish parents' reported a significantly higher level of collaboration compared with the Bedouins. Global trust in the pediatrician was significantly predicted by the interest and collaboration communication styles, but ethnicity was not a significant predictor. These findings underscore the importance of physicians' interpersonal competence and skills in the therapeutic relationship and support the increasing trend of including doctor-patient communication training in undergraduate and continuing medical education.

Predictive Factors of Early Mortality in Children With Developmental Disabilities: A Case-Comparison Analysis

The aim of this study was to identify the risk factors for early mortality in children with neurodevelopmental disabilities. Of 1000 children who were sequentially referred to the same child developmental center over the period 1975-1985, 81 children died between the ages of 6 months and 22 years (mean, 8.04 years; 6.1 SD). A group of 81 age-matched children and another group of 81 developmentally and age-matched children also referred to the center served as comparison groups. Following multivariate analysis, low developmental quotient, restricted mobility, assisted feeding, and genetic etiology were risk factors for early mortality when compared to the age-matched group (P < .01). In comparison to the developmentally matched group, restricted mobility, genetic etiology, and hearing deficit were identified as significant risk factors (P < .01). Comprehensive treatment at the child development center was demonstrated to be a significant protective factor (P = .004). Socioeconomic variables were not significant in predicting an increased mortality risk in disabled individuals. In conclusion, in addition to mobility and feeding skills, a genetic etiology and hearing deficit are risk factors for early mortality, whereas socioeconomic variables are not. A comprehensive treatment program was found to be a protective factor.

Differential exposure to early childhood education services and mother–toddler interaction

This study examined the associations of exposure to early childhood education (ECE) services upon 2.5-year-old children's task persistence and enthusiasm and their mothers’ authoritative and authoritarian behavior and support stimulation. Families participated in the Infant Health and Development Program, an eight-site randomized comprehensive ECE to enhance the development of low birth weight, premature infants. Exposure was measured for 269 families who received at least one home visit and 1 day at the Child Development Center (CDC): 131 with lower exposure (64 ± 11.6 home visits and 206 ± 53 CDC days) and 138 with higher exposure (67 ± 9.2 home visits and 301 ± 21 CDC days). These two groups were compared to the follow-up group (540 with no exposure). Compared to no exposure, high exposure was associated with greater child enthusiasm and persistence and maternal support stimulation. Infant and mother test scores and temperament/depression scores, child's sex, and ethnicity were examined as moderators. Compared to no exposure, high exposure was related to maternal authoritative behavior toward girls, less authoritarian behavior for mothers with lower PPVT scores, and greater task enthusiasm from Black children.

The Inclusive City: Design Solutions for Buildings, Neighborhoods and Urban Spaces

Children, Youth and Environments Vol. 18 No. 2 (2008) ISSN: 1546-2250 The Inclusive City: Design Solutions for Buildings, Neighborhoods and Urban Spaces Goltsman, Susan and Iacofano, Daniel (2007). Berkeley, CA: MIG Communications; 493 pages. ISBN 9780944661314. The Inclusive City is a guide to creating public buildings, green spaces, streets and neighborhoods with positive social impacts, edited by two founding principals in the firm of MIG, which has a long history of designing and facilitating projects of this kind. With text, drawings and many color photographs, it shows how cities can be inclusive for all ages, all abilities, all income levels, and how the people who use and inhabit places can participate in their design and creation. An opening chapter by the editors on “The Challenge of Our Cities” gives a brief history of the idea of “cities for people” and presents a vision of how cities can function as healthy and inclusive habitats for all community members. It is followed by 14 case studies which demonstrate how this vision can be realized, with detailed information on the design and planning process as well as outcomes in the form of new buildings, transformed parks and streets, and revitalized neighborhoods. It closes with an 80-page section on “Inclusive Design Guidelines,” which distills lessons from the case studies and other projects. This section by itself is worth the purchase of the book, but the book as a whole is a useful and attractive celebration of buildings and places that enhance the lives of all people who use them. Because the book’s topic is inclusive cities, every chapter is relevant for the creation of multigenerational community settings. In addition, a number of chapters focus on settings for children. Susan Goltsman describes the design of three institutions that serve children: Edelman Children’s Court in Los Angeles in the chapter “Helping Children Heal,” Tule Elk Park Child Development Center in “Bringing Nature into the 290 Urban School,” and St. Coletta of Greater Washington, D.C., a school for children with mental retardation, autism and multiple physical disabilities, in “Expanding the Learning Environment.” In “Combining Community Facilities,” she writes with Susan McKay about the design and program of the Edison School in Glendale, California, an elementary school that functions as a community focal point, open 15 hours a day and seven days a week. In “Growing Caring Children,” Robin Moore describes Explore! A Child’s Nature—the renovated and reinvented children’s zoo at the Brookfield Zoo in metropolitan Chicago, which has become a model for promoting connection with the natural world among young children and their families. All of these chapters demonstrate how institutions’ philosophies, policies, programs and places function can together to treat children as full-fledged community members whose comfort, engagement and inclusion matters. Reviewer Information Chawla, Louise Louise Chawla is a professor in the College of Architecture and Planning at the University of Colorado. ...

Attention-Deficit/Hyperactivity Disorder

&lt;h4&gt;EXCERPT&lt;/h4&gt; &lt;p&gt;Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobiological disorder that many clinicians address in their practices. ADHD has a prevalence rate in American youths that ranges from 4% to 12%, depending on the sampling design and restrictiveness of the definition of ADHD used. The impact of ADHD can include academic failure, delinquency, and low occupational performance. There is evidence to support at least the short-term efficacy of medication and behavioral therapy for children with ADHD. However, there is less evidence for long-term benefits.&lt;/p&gt; &lt;h4&gt;ABOUT THE GUEST EDITOR&lt;/h4&gt; &lt;p&gt;Mark L. Wolraich, MD, is the CMRI/Shaun Walters Professor of Pediatrics and the Director of the Section of Developmental-Behavioral Pediatrics at Oklahoma University Health Sciences Center and the Child Study Center. He received his MD from SUNY Syracuse Health Sciences Center. His residency training in pediatrics was split between the SUNY Syracuse Health Sciences Center and the University of Oklahoma, followed by a fellowship in the care of handicapped children at the University of Oregon. Dr. Wolraich was a pediatric faculty member at the University of Iowa for 14 years and at Vanderbilt University for 11 years, where he was Director of the Division of Child Development and the Director of the Child Development Center.&lt;/p&gt; &lt;p&gt;His research has been funded by the National Institutes of Health and Mental Health, Maternal and Child Health Research Program, National Institute on Disabilities and Rehabilitation Research, the Center for Disease Control and Prevention, and the Office of Special Education and Rehabilitation.&lt;/p&gt; &lt;p&gt;Dr. Wolraich has been active nationally in the American Academy of Pediatrics (AAP), where he participated on the Committee on Quality Improvement-Subcommittee on Attention-deficit/hyperactivity Disorder (ADHD). He currently serves on the AAP’s ADHD Advisory Committee, served on the Executive Committees of the Sections on Developmental-Behavioral Pediatrics and the Children with Disabilities, and chaired the Task Force on Coding Mental Health in Children, the Committee on Psychosocial Aspects of Child and Family Health and the Child, and the Child and Adolescent Health Action Group. Currently, he chairs the AAP’s Committee Forum Management Committee. Dr. Wolraich is a member and past president of the Society for Developmental and Behavioral Pediatrics. He contributed to obtaining board certification for Developmental-Behavioral Pediatrics and served on the Subboard of Developmental-Behavioral Pediatrics of the Board of Pediatrics. He currently serves on the Program for Maintenance of Certification in Pediatric Specialties-Advisory Committee of the Board.&lt;/p&gt; &lt;p&gt;Dr. Wolraich was the co-editor of &lt;cite&gt;Advances in Developmental and Behavioral Pediatrics&lt;/cite&gt; (1982-1992). He has authored numerous journal articles and book chapters, including articles in the &lt;cite&gt;New England Journal of Medicine&lt;/cite&gt;, &lt;cite&gt;Pediatrics&lt;/cite&gt;, and the &lt;cite&gt;Journal of the American Medical Association&lt;/cite&gt;. He has edited a number of books including a textbook: &lt;cite&gt;Disorders in Development and Learning&lt;/cite&gt; for its third edition, the &lt;cite&gt;DSM-PC Child and Adolescent Version&lt;/cite&gt;, and co-edited &lt;cite&gt;Behavioral Pediatrics&lt;/cite&gt;. Most recently, he is the senior editor for a textbook titled &lt;cite&gt;Developmental-Behavioral Pediatrics: Evidence and Practice&lt;/cite&gt;.&lt;/p&gt;

Attention-deficit/hyperactivity Disorders

&lt;P&gt;Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobiological disorder that primary care pediatricians address in their practices. ADHD has a prevalence rate in American youths that ranges from 4% to 12%, depending on the sampling design and restrictiveness of the definition of ADHD used. The impact of ADHD can include academic failure, delinquency, and low occupational performance. There is evidence to support at least the short-term efficacy of medication and behavioral therapy for children with ADHD. However, there is less evidence for long-term benefits.&lt;/P&gt;&lt;H4&gt;ABOUT THE GUEST EDITOR&lt;/H4&gt;&lt;P&gt;Mark L. Wolraich, MD, is the CMRI/Shaun Walters Professor of Pediatrics and the Director of the Section of Developmental-Behavioral Pediatrics at Oklahoma University Health Sciences Center and the Child Study Center. He received his MD from SUNY Syracuse Health Sciences Center. His residency training in pediatrics was split between the SUNY Syracuse Health Sciences Center and the University of Oklahoma, followed by a fellowship in the care of handicapped children at the University of Oregon. Dr. Wolraich was a pediatric faculty member at the University of Iowa for 14 years and at Vanderbilt University for 11 years, where he was Director of the Division of Child Development and the Director of the Child Development Center.&lt;/P&gt;&lt;P&gt;His research has been funded by the National Institutes of Health and Mental Health, Maternal and Child Health Research Program, National Institute on Disabilities and Rehabilitation Research, the Center for Disease Control and Prevention, and the Office of Special Education and Rehabilitation.&lt;/P&gt;&lt;P&gt;Dr. Wolraich has been active nationally in the American Academy of Pediatrics (AAP), where he participated on the Committee on Quality Improvement-Subcommittee on Attention-deficit/hyperactivity Disorder (ADHD). He currently serves on the AAP’s ADHD Advisory Committee, served on the Executive Committees of the Sections on Developmental-Behavioral Pediatrics and the Children with Disabilities, and chaired the Task Force on Coding Mental Health in Children, the Committee on Psychosocial Aspects of Child and Family Health and the Child, and the Child and Adolescent Health Action Group. Currently, he chairs the AAP’s Committee Forum Management Committee. Dr. Wolraich is a member and past president of the Society for Developmental and Behavioral Pediatrics. He contibuted to obtaining board certification for Developmental-Behavioral Pediatrics and served on the Subboard of Developmental-Behavioral Pediatrics of the Board of Pediatrics. He currently serves on the Program for Maintenance of Certification in Pediatric Specialties-Advisory Committee of the Board.&lt;/P&gt;&lt;P&gt;Dr. Wolraich was the co-editor of &lt;cite&gt;Advances in Developmental and Behavioral Pediatrics&lt;/cite&gt; (1982-1992). He has authored numerous journal articles and book chapters, including articles in the &lt;cite&gt;New England Journal of Medicine&lt;/cite&gt;, &lt;cite&gt;Pediatrics&lt;/cite&gt;, and the &lt;cite&gt;Journal of the American Medical Association&lt;/cite&gt;. He has edited a number of books including a textbook: &lt;cite&gt;Disorders in Development and Learning&lt;/cite&gt; for its third edition, the &lt;cite&gt;DSM-PC Child and Adolescent Version&lt;/cite&gt;, and co-edited &lt;cite&gt;Behavioral Pediatrics&lt;/cite&gt;. Most recently, he is the senior editor for a textbook titled &lt;cite&gt;Developmental-Behavioral Pediatrics: Evidence and Practice&lt;/cite&gt;.&lt;/P&gt;

Long-term Safety of Stimulant Medications Used to Treat Children with ADHD

&lt;P&gt;Attention deficit hyperactivity disorder (ADHD) is a common mental health condition that impacts children, adolescents, and adults. The practice parameters of both the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) acknowledge the chronic nature of this disorder and recommend treatments that address the need to manage it over time. Patient and parent education, individualized treatment plans, coordination of multiple health services, and working with the school system are some of the tools recommended as part of ADHD management. For decades, stimulant therapy has been the primary option for ADHD management.&lt;/P&gt; &lt;H4&gt;ABOUT THE AUTHORS&lt;/H4&gt; &lt;P&gt;Marc Lerner, MD, is Clinical Professor of Pediatrics, University of California, Irvine, CA. Tim Wigal, PhD, is Associate Clinical Professor of Pediatrics, UCI Child Development Center, Irvine, CA.&lt;/P&gt; &lt;P&gt;Address correspondence to: Marc Lerner, MD, UCI Medical Center, Department of Pediatrics, 101 The City Drive ZC 4482, Orange, CA 92868; &lt;a href="mailto:malerner@uci.edu"&gt;malerner@uci.edu&lt;/a&gt;.&lt;/P&gt; &lt;P&gt;Dr. Lerner has disclosed the following relevant financial relationships: McNeil Pediatrics, Novartis, and Shire: Consultant; Cephalon, Eli Lilly, McNeil Pediatrics, Novartis, and Shire: Research Support; and Eli Lilly, McNeil Pediatrics, Novartis/UCB, and Shire: Member of Speakers’ Bureaus. Dr. Wigal has disclosed the following relevant financial relationships: Celltech Pharmaceuticals Inc./UCB, Cephalon Inc, Eli Lilly and Company, McNeil Pharmaceutical, Novartis Pharmaceuticals Corporation, and Shire Development: Consultant; and McNeil and Shire: Member of Speakers’ Bureaus.&lt;/P&gt; &lt;H4&gt;EDUCATIONAL OBJECTIVES&lt;/H4&gt; &lt;OL&gt; &lt;LI&gt;Review the impact of new treatment options on the choice of long-term stimulant treatment regimens.&lt;/LI&gt; &lt;LI&gt;In light of new Food and Drug Administration warnings, review the current evidence on cardiovascular effects of long-term attention-deficit/hyperactivity disorder (ADHD) treatments.&lt;/LI&gt; &lt;LI&gt;Compare the safety of ADHD stimulant treatment in preschool children to the safety profiles found in school-aged children.&lt;/LI&gt; &lt;/OL&gt;

Long-term Safety of Stimulant Medications Used to Treat Children with ADHD

&lt;h4&gt;EXCERPT&lt;/h4&gt; &lt;p&gt;Attention deficit hyperactivity disorder (ADHD) is a common mental health condition that impacts children, adolescents, and adults. The practice parameters of both the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) acknowledge the chronic nature of this disorder and recommend treatments that address the need to manage it over time. Patient and parent education, individualized treatment plans, coordination of multiple health services, and working with the school system are some of the tools recommended as part of ADHD management. For decades, stimulant therapy has been the primary option for ADHD management.&lt;/p&gt; &lt;h4&gt;ABOUT THE AUTHORS&lt;/h4&gt; &lt;p&gt;Marc Lerner, MD, is Clinical Professor of Pediatrics, University of California, Irvine, CA. Tim Wigal, PhD, is Associate Clinical Professor of Pediatrics, UCI Child Development Center, Irvine, CA.&lt;/p&gt; &lt;p&gt;Address correspondence to: Marc Lerner, MD, UCI Medical Center, Department of Pediatrics, 101 The City Drive ZC 4482, Orange, CA 92868; &lt;a href="mailto:malerner@uci.edu"&gt;malerner@uci.edu&lt;/a&gt;.&lt;/p&gt; &lt;p&gt;Dr. Lerner has disclosed the following relevant financial relationships: McNeil Pediatrics, Novartis, and Shire: Consultant; Cephalon, Eli Lilly, McNeil Pediatrics, Novartis, and Shire: Research Support; and Eli Lilly, McNeil Pediatrics, Novartis/UCB, and Shire: Member of Speakers’ Bureaus. Dr. Wigal has disclosed the following relevant financial relationships: Celltech Pharmaceuticals Inc./UCB, Cephalon Inc, Eli Lilly and Company, McNeil Pharmaceutical, Novartis Pharmaceuticals Corporation, and Shire Development: Consultant; and McNeil and Shire: Member of Speakers’ Bureaus.&lt;/p&gt; &lt;H4&gt;EDUCATIONAL OBJECTIVES&lt;/H4&gt;&lt;OL&gt; &lt;LI&gt;Review the impact of new treatment options on the choice of long-term stimulant treatment regimens.&lt;/LI&gt;&lt;LI&gt;In light of new Food and Drug Administration warnings, review the current evidence on cardiovascular effects of long-term attention-deficit/hyperactivity disorder (ADHD) treatments.&lt;/LI&gt;&lt;LI&gt;Compare the safety of ADHD stimulant treatment in preschool children to the safety profiles found in school-aged children.&lt;/LI&gt;&lt;/OL&gt;

Childcare in Afghanistan: More than a warm crib

David Votroubek, a soldier serving in Afghanistan, gives an insight into child development centres in Kabul.

P1-133 The role of background music on auditory memory in children with language difficulties, treated by speech therapists in a Child Development Center as an impact of music of the development of language

P1-133 The role of background music on auditory memory in children with language difficulties, treated by speech therapists in a Child Development Center as an impact of music of the development of language

Clinical profile and predisposing factors of cerebral palsy

This was an analysis of one hundred ten children with cerebral palsy (CP) attending at the Child Development & Neurology Care Center of Dhaka Medical College Hospital during January 2002 to December 2003. These children were observed to study their clinical profile, etiological factors and associated problems. The mean age of these children was 2.9 +/- 2.9 years, mostly being males (n=79, 71.8%). Most of the families of these children belonged to poorer socioeconomic strata. Spastic diplegia constituted the predominant group (34.5 per cent), followed by spastic quadriplegia (25.5 per cent). Dyskinetic CP was present in 15.5 percent of the cases. Hypotonic CP constituted a significant proportion of cases. Delayed Motor Function was observed in all 110 cases, delayed speech was complained in 67.3% cases and impaired hearing was identified in 26.8% CP children. Mothers of 43.6% CP cases reported that they had prolonged labour during delivery and almost one third (29.1%) had suffered from pre-eclampsia or eclampsia. Majority (53.6%) of the CP cases were reported to have had perinatal asphyxia. Comprehensive assessment and early management of these problems are emphasized, which can minimize the extent of disabilities. By proper perinatal care, CP can be prevented.

Additional therapy for young children with spastic cerebral palsy: a randomised controlled trial

To investigate whether, in the short and medium term, additional support by (a) a physiotherapy assistant improved physical function in young children with spastic cerebral palsy and (b) a family support worker improved family functioning. This was a multi-centre randomised controlled trial (RCT) with blinded assessments and a cost-effectiveness analysis. The children studied had spastic cerebral palsy that was the consequence of perinatal adversity. All were less than 4 years old on entry to the study. In the child development centre and in the home. Seventy-six families completed the intervention period. Forty-three families were reassessed 6 months after the end of the intervention and 34 of these after a further 6-month period. Randomisation was to: (a) a group who received extra physiotherapy from a physiotherapy assistant; (b) a group who received standard physiotherapy; and (c) a group where the child received standard physiotherapy and the family was also visited by a family support worker. Children in all groups continued to receive standard physiotherapy in addition to the study interventions. The child outcome measures were motor functioning, developmental status and adaptive functioning. The family outcome measures were self-reported maternal stress, level of family needs and parental satisfaction. There was no evidence that additional physical therapy for 1 hour per week for 6 months by a physiotherapy assistant improved any child outcome measure in the short or medium term. Intervention by a family support worker did not have a clinically significant effect on parental stress or family needs. Over the 6-month period the total cost of services for each child ranged from 250 pounds to 6750 pounds, with higher costs associated with children with more severe impairments. No significant relationship was found between measures of intensity of services received by the children and families and the main outcome measures. Low-functioning children, in terms of both motor and cognitive function, were more likely to receive more services in terms of range and frequency. Parents generally reported high satisfaction ratings after all interventions and some stated that the interventions had benefited the child and/or the family. There was therefore a discrepancy between the perceptions of these parents and the objective, quantitative measurements. The family support workers identified a small number of families who were experiencing considerable family problems, but who had not been referred for appropriate support by any other agency. The findings of this study provide support for the current literature that there was no evidence that additional intervention (in this case by a physiotherapy assistant or family support worker) helped the motor or general development of young children with spastic cerebral palsy. Nor was there any quantitative evidence that providing extra family support helped levels of parental stress and family needs. The implication was that the provision of extra physical therapy does not necessarily improve the motor function of a young child with cerebral palsy and additional family support should not automatically be assumed to be beneficial. In addition, no significant association was found between the intensity of the local services provided and any outcome measure, other than a slight association with lowered family needs. The provision of local services was related to the severity of the child's impairments and not to family difficulties. A small group of families with complex family problems needed more service input. There was a wide range in the costs of services. Research is needed to examine what 'sufficient' levels of provision or therapy might be for which children and which families. A time series of different levels of input and outcomes would provide valuable information for practitioners. It is also recommended that future assessments of therapies of this type adopt a similar multifaceted approach, which is likely to be more suitable than a simple RCT for the evaluation of clinical interventions where the effects are complex. The most appropriate measures of outcome should be used, including assessment of provision of information and emotional support for families.

Interactive music therapy in child and family psychiatry: clinical practice, research and teachingInteractive music therapy in child and family psychiatry: clinical practice, research and teaching Amelia Oldfield Jessica Kingsley First 224 £17.99 184310444X 184310444X

Amelia Oldfield is a highly-respected music therapy practitioner, writer, researcher and teacher. In 1991 she co-authored (with John Bean) Pied Piper. This was a very practical little book of musical activities, many of which I was grateful to use as warm-up exercises for my own improvisational music workshops. This new book is one of a pair of more heavyweight titles. Its companion volume, also published in 2006 with a confusingly similar title, is Interactive Music Therapy – A Positive Approach. Both new books concern Oldfield’s work in a child development centre but the book being reviewed here, as its subtitle suggests, discusses not only clinical practice but research and teaching aspects of music therapy.

Motor and cognitive development at one-year follow-up in infants with torticollis

Background Clinical experience suggests infants with torticollis are at risk for developmental delay. Aims To examine gross motor (GM) skills at presentation in infants with torticollis; report first-year GM and cognitive outcomes; examine relationship between types of torticollis and above outcomes. Study design Prospective follow-up study. Subjects Infants referred to 2 regional child development centers from April 2001–December 2002 with torticollis/head tilt and no perinatal complications syndromes were studied. Outcome measures GM function was measured using the Alberta Infant Motor Scale and classified as normal (> 10%), suspect (5–10% inclusive), or abnormal (< 5%). Cognitive function was measured at follow-up using CAT-CLAMS-r Developmental Assessment. Follow-up data obtained between 8 and 15 months of age. Results One hundred and one infants with torticollis were seen for initial assessment at mean age 2.9 (SD 1.5) months. Eighteen had sternomastoid tumor, 47 muscular torticollis and 36 postural torticollis. At presentation, 35 (35%) of the 101 infants had suspect or abnormal GM function. 19/66 children with normal GM and 17/35 with suspect or abnormal GM function had postural torticollis ( p = 0.054). All children received physical theraphy. Follow-up assessment of 83 participants, mean age 12.8 (SD 3.6) months, showed 75 had normal GM function and 8 had suspect or abnormal GM function; 11/83 still had torticollis. Cognitive assessment on 66 infants, mean age 14.4 (SD 4.8) months, revealed 57 (87%) had normal cognitive function and 9 (13%) were either delayed or significantly delayed. Conclusions Infants with torticollis are at increased risk for early GM delay but most normalize by one year. Torticollis is not associated with delays in early cognitive function.

A Long-term, Epidemiological Survey of Outcome and Adjustment of Children with Developmental Disabilities

The medical, educational, and psychosocial outcomes of 3224 subjects (age range, 7-33 years; mean age, 20.06 years; SD, 5.74) diagnosed and treated in the Institute for Child Development in Tel Aviv between the years 1975 and 1994 were assessed by a telephone interview. Results indicate that only 9% of the subjects are seriously disabled, and 8% are mentally retarded. Over the years, subjects were referred to the Child Development Center at an increasingly younger age, probably reflecting greater professional and parental awareness of the importance of early intervention. The nature of interventions changed, so that physiotherapy, occupational therapy, and psychological guidance were more often provided. While more children were referred to special education at kindergarten, the percentage of those graduating from regular schools has increased. Most completed 12 years of schooling and successfully acquired full or partial matriculation certificates. As adults, most function independently; fulfill civic obligations, such as their army service; are fully employed; and express satisfaction with their life. These results suggest that children with developmental disabilities who receive early intervention are likely to be functionally independent and to be satisfied with their lives, although they continue to need medical services and require some government support. Further studies are essential to examine the correlation of specific risk factors and early interventions with outcome.

Seeking help for attention deficit hyperactivity disorder in developing countries: A study of parental explanatory models in Goa, India

This qualitative study analyzes the explanatory models employed by parents whose children have been diagnosed with attention deficit hyperactivity disorder (ADHD) and the ways in which these explanatory models change as they seek help for their child's problem. In-depth interviews were conducted with 24 parents recruited from a list of children who had been diagnosed with ADHD at a community-based child development center (CDC) in Goa, India. The most frequent reasons for consulting the CDC were educational difficulties. Despite having received an ADHD diagnosis and reporting significant adverse impact of the child's behavior, most parents were reluctant to accept the biomedical explanatory model or even consider their child's difficulties as an illness. Instead, parents most commonly attributed causality to psychological models, learning and memory difficulties, and to models which emphasized either the volitional or non-volitional nature of the problem, or to attribute blame of self or spouse. Interventions most commonly used were educational and religious; consultation with the CDC was the last resort for many parents. We conclude that cultural attitudes towards mental illness significantly affect parental perception and behavior in response to interventions by biomedical practitioners for child mental health problems in developing countries.

Twin Towers: The Ones Left Behind; Research Reviews: Chimeric DZ Twins, DZ Twin Mothers; Revisited: The New York Child Development Center Twin Study; New and Unusual Twins

AbstractTwin victims and survivors of the 2001 World Trade Tower attack are remembered. Central themes from the twin loss literature are also highlighted. Next, new research studies on dizygotic (DZ) twins and mothers of DZ twins are reviewed. Specifically, a rare monochorionic–diamniotic DZ twin pair with chimerism is described, and findings concerning genetic variants of GDF9 in mothers (that are associated with DZ twinning tendencies in families) are summarized. This is followed by another look at the controversial 1960s Child Development Center Twin Study that tracked the development of separated twins. Information on several new and unusual twins is also presented.

Twin Towers: The Ones Left Behind; Research Reviews: Chimeric DZ Twins, DZ Twin Mothers; Revisited: The New York Child Development Center Twin Study; New and Unusual Twins

Twin victims and survivors of the 2001 World Trade Tower attack are remembered. Central themes from the twin loss literature are also highlighted. Next, new research studies on dizygotic (DZ) twins and mothers of DZ twins are reviewed. Specifically, a rare monochorionic–diamniotic DZ twin pair with chimerism is described, and findings concerning genetic variants of GDF9 in mothers (that are associated with DZ twinning tendencies in families) are summarized. This is followed by another look at the controversial 1960s Child Development Center Twin Study that tracked the development of separated twins. Information on several new and unusual twins is also presented.

Multidisciplinary assessment at a child development centre: do we conform to recommended standards?

A proposed standard for the multidisciplinary assessment (MDA) of children with autism has been recently published by the National Autistic Society. This prompted a review of current practice at the child development centre in our local centre, to judge whether we were able to conform to the proposed national standard. The recommendation is that a child should complete a three-stage assessment process from referral to completion of assessment within 30 weeks, with set times for completion of each stage (6, 7 and 17 weeks respectively). We applied this assessment model to children with a range of neurodevelopment problems, as the process of MDA is the same, irrespective of diagnosis. A retrospective analysis of medical and therapy records of all MDAs was carried out between April 2001 and March 2002. In the 12-month period studied, 52 MDAs were performed. Delays occurred, as judged by the standard, at all three stages of the assessment process. A total of 42% of children were seen within 6 weeks of initial referral, 37% within a further 7 weeks for specialist assessment, and 37% within a further 17 weeks for completion of MDA. As delays occurred at all stages, the cumulative total showed that only 19% of children completed all three stages within the recommended 30-week standard. Barriers encountered included waiting times to see professionals, parental non-attendance and prolonged assessment of complex problems. Some of these factors are outside our control, and on removing these factors the data were re-analysed. This resulted in a slight improvement to 45%, 48% and 49% for completion of stages 1, 2 and 3 respectively. The major reason for delay remained the service capacity. In our experience the standards proposed by the National Autistic Society are not practical within present resources. We suggest that a reasonable expectation is to complete all assessments, from first concern to completed MDA, should be carried out within 52 weeks with present levels of resources. Any further improvement will require additional resources to reduce waiting times and increase the capacity.