Pervasive Developmental Disabilities Research Articles

Global developmental delay – globally helpful?

Identification of children with delay in acquisition of developmental milestones is a frequent reason for seeking a paediatric opinion. Around 17% of children referred to a community paediatric clinic, will be because of a developmental concern1 and is acknowledged as affecting 1–3% of children. 2 The role of the paediatrician is to seek to establish the aetiology and to help the child and family. Global developmental delay (GDD) is a term not used in the main index of either the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10)3 or the National Institute of Health CRISP thesaurus (now replaced by the RePORT Expenditures and Results query tool).4 In the former there is reference to specific developmental disorders, mixed or pervasive, and in the latter the term developmental disabilities is used. The term GDD, however, frequently appears in case notes, discharge letters, and journals. It is widely accepted that this term means significant delay in two or more areas of developmental performance: defined as gross/fine motor, speech/language, cognition, social/personal, and activities of daily living. Significant delay is defined as occurring when performance is two standard deviations below the mean on age appropriate, standardized norm reference tests. On developmental examination, however, we tend to separate gross motor and fine motor developmental domains since delay in one of these does not necessarily mean difficulties in the other (e.g. some neuromuscular disease). In addition, using this definition, children with autism would fulfil the criteria for GDD – but we don’t use this term when we see the triad of impairments associated with autism. I believe, therefore, that in practice we use the term GDD when the child has a motor delay and delays in at least two other areas of developmental performance. The majority of children with late acquisition of several developmental milestones will experience learning disability. As Newton and Wraith5 said, children with learning disability present in various ways and times, some in the newborn period, others in infancy and a few after school entry. It is, important however, that we convey our concerns to the parents in a realistic fashion at time of recognition, neither being too optimistic or pessimistic, but clarifying that delay in acquisition of developmental milestones usually means that the individual will have continuing difficulties with learning later in life.5,6 Do parents who are told their child had GDD appreciate what this means, or do they assume that development is slow but will get to its destination eventually? GDD is a term that parents may find unclear; it certainly is not a diagnosis and should not be used as a diagnostic term. A recent handbook of neurological investigations in children7 classifies the presenting neurological problem as the key to the investigative pathway and late attainment of all milestones is termed learning disability. What, therefore, would I recommend? Firstly, clinicians must continue to take a thorough history, examine the child, use standardized developmental assessments, seek therapists and teachers’ opinions, and describe the problem (e.g. late walking, late talking, etc.). Second, the cause of the delay must be investigated, bearing in mind that even mild delay may have a diagnostic cause.1 The vast majority of children with late development will go onto have learning disabilities of varying degree. There is a paucity of long-term data looking at outcomes of children with slow development under 5 years, but what is available suggests that early recognition of developmental delay appears to predict long-term learning problems. Better outcomes are found in children with more positive family support but further studies are needed.6 Clearly there is no consensus. It may be more helpful to use the ICD terms specific, mixed, or pervasive developmental disabilities, describing the developmental domains which are affected (e.g. walking, communication, etc.). Precision is preferable.

Barriers to inclusive education in Ireland: the case for pupils with a diagnosis of intellectual and/or pervasive developmental disabilities

Accessible summary • Today all children in Ireland, including children with disabilities, have the right to go to their local school, if they want to and to get extra help if they need it. • Parents and teachers get very little training to help them understand the best way to teach pupils with intellectual disabilities. • Most mainstream teachers do not have access to psychologists or therapists and cannot get advice to help them provide the best learning programmes. • Some teachers do not believe that they will be able to teach pupils with intellectual disabilities properly. Therefore they may not allow these children to come to their school. • All teachers should have the information and training to teach all pupils, including pupils with disabilities. Then more students with special education needs would be able to get their education in mainstream schools. Summary Equality of access to mainstream education environments for all, and more specifically for children with disabilities, is the documented policy of the United Nations, European Union and the Irish Nation State. Transition from historical segregation practices requires States’ commitment to the provision of relevant resources. This paper argues that although access to mainstream environments has improved, lack of capacity at multiple levels within the system to provide resources to enhance the habitus of teaching personnel and parents and to meet the special education needs of pupils with intellectual and/or pervasive developmental disabilities impedes access to enrolments in mainstream primary education environments. Pierre Bourdieu’s Theory of Practice and Symbolic Power, which highlights how the accruals of various resources, termed capital, affect one’s habitus and power relationships in the social arena, is utilised to examine the enrolment practices that are resource sensitive. The paper offers recommendations to enhance a positive habitus and universal enrolment practices.

発達障害支援プログラムにおける粗大運動活動の意義

This study was designed to examine the effect of gross motor activity on the social skill acquisition in the children diagnosed as autism, the pervasive developmental disabilities, and the Asperger syndrome. It is especially difficult for children in this study to observe the rules, and to feel surrounding circumstances, and play with others jointly. In gross motor activity, a lot of interpersonal behaviors could be seen, and they came to recognize the rules and cooperate with others. Moreover, to the parent, it was a good chance for recognizing their child's behavior problem objectively. From these results, the gross motor activity is effective for the development of social skills.

広汎性発達障害児における既学習課題の挿入が標的課題の獲得に与える効果 : 標的課題と既学習課題における反応型についての検討

広汎性発達障害児における既学習課題の挿入が標的課題の獲得に与える効果 : 標的課題と既学習課題における反応型についての検討

The Effects of Fixed Ratio Values on Concurrent Mand and Play Responses

Three children diagnosed with pervasive developmental disabilities emitted a high rate of mands and a low-to-zero rate of appropriate play responses when the two responses were reinforced on concurrent Fixed Ratio 1 (FR1) schedules. When mands were reinforced on an FR10 schedule and play responses were concurrently reinforced on an FR1 schedule, play responses increased. Two participants' mands decreased from baseline levels but were maintained, and the third participant's mands increased. Implications of the use of choice procedures for clinical settings are discussed.

Literacy Learning: An Intervention for Children With Autism

Literacy Learning: An Intervention for Children With Autism

Validity of the Autism Diagnostic Interview-Revised

The factor structure, internal consistency, and convergent validity of the Autism Diagnostic Interview-Revised (ADI-R) algorithm items were examined in a sample of 226 youngsters with pervasive developmental disabilities. Exploratory factor analyses indicated a three-factor solution closely resembling the original algorithm and explaining 38% of the variance, with one significant discrepancy: Unlike the algorithm, all nonverbal communication items were associated with the Social factor. Internal consistencies of domain scores ranged from .54 to .84. Correlations between ADI-R domain and total scores and instruments assessing adaptive behavior, psychopathology, and autism were examined. They indicated some similarities between constructs, but also that the ADI-R measures autism in a unique fashion.

Psychotropic Medication Use among Kansas Medicaid Youths with Disabilities

Knowledge of current patterns of psychotropic medication use by disabled youths is an important starting point for targeting future efforts to improve prescribing practices. This study provides a retrospective, descriptive analysis of the prevalence and patterns of psychotropic medication among 1022 Kansas Medicaid youths in 2001 who were enrolled with either Supplemental Security Income (SSI) or Medically Needy benefits and who were having clearly defined mental and neurological disabilities. Rates of psychotropic medication use were generally higher for the Medically Needy than for the SSI youths: Central nervous system (CNS) stimulants (24.6% versus 20.0%), antidepressants (30.9% versus 13.7%), anticonvulsants (22.0% versus 13.9%), and antipsychotics (23.3% versus 11.5%). Use of the four major drug classes varied among children with attention-deficit/hyperactivity disorder (ADHD) and disruptive disorders, pervasive developmental disabilities, mental retardation (MR) and learning disabilities, mood and anxiety disorders, and adjustment disorders. Future work should explore the appropriateness and effectiveness of these medications within specifically targeted subgroups.

Secretin is an ineffective treatment for pervasive developmental disabilities: a review of 15 double-blind randomized controlled trials

In 1998, Horvath et al. [Horvath, K., Stefanatos, G., Sokolski, K. N., Wachtel, R., Nabors, L., & Tildon, J. T. (1998). Improved social and language skills after secretin administration in patients with autism spectrum disorders. Journal of the Association of the Academy of Minority Physicians, 9, 9–15] reported an uncontrolled trial of secretin with three participants with autism, which apparently resulted in significant behavioral improvement. Subsequently, secretin was widely used. Sandler et al. [Sandler, A. D., Sutton, K. A., SeWeese, J., Girardi, M. A., Sheppard, V., & Bodfish, J. W. (1999). Lack of benefit of a single dose of synthetic human secretin in the treatment of autism and pervasive and developmental disorder. The New England Journal of Medicine, 341, 1801–1806] reported the first double-blind trial of secretin with negative results. This article is a review of 15 double-blind trials of secretin. Almost none of the studies reported any significant effects and none concluded that secretin was effective. Transient effects of secretin, including both minor benefits and behavioral deterioration were reported, probably due to multiple statistical tests. Four papers reported data on differential responding in sub-groups of participants, including those with gastrointestinal symptoms. These effects were not replicable. At this time there is no robust evidence that secretin is an effective treatment for pervasive developmental disorders.

Toilet training for a young boy with pervasive developmental disorder

AbstractWe employed a variation of the Azrin–Foxx (1971) procedure with a 3.5‐year‐old boy diagnosed with Pervasive Developmental Disability (PDD). Unique features of our design included tailoring to the in‐home environment, training without systematically increasing fluid intake, introduction under circumstances that facilitated generalization and transfer without special procedures, the elimination of some specialized equipment, and use of social and activity reinforcers. Training was successful and was reported to have generalized to the inclusive school environment. Copyright © 2004 John Wiley & Sons, Ltd.

Relationships between psychiatric conditions and behavior problems among adults with mental retardation.

Adults with predominantly severe and profound mental retardation (N = 180) who lived in a developmental center were assessed with the Behavior Problems Inventory and the Diagnostic Assessment for the Severely Handicapped-II. Individuals with self-injurious, stereotyped, or aggressive/destructive behavior had generally higher psychopathology scores than individuals without, and the presence of behavior problems increased the likelihood of almost all psychiatric conditions up to three-fold. Factor analysis revealed that behavior problems tended to be associated with psychiatric conditions conventionally linked with behavior problems. A Self-Injury and Aggression/Destruction factor was related to impulse control and conduct problems, and a Stereotyped Behavior factor was linked to pervasive developmental disabilities and somewhat less so to schizophrenia. Stereotyped Behavior factor was independent of the Self-Injury/Aggression/Destruction factor.

Examining the Services Received by Young Children with Autism and Their Families

This study was designed to examine the services received by 3- to 9-year-old children with autism and pervasive developmental disabilities. Four questions were addressed: (1) What services are received? (2) How are families involved in their services? (3) How do providers ensure that their services have continuity or are organized around a common set of child needs? and (4) What problems do families report? These questions were addressed by conducting a telephone interview with 25 families in western Pennsylvania. Results indicated that families interacted with a host of different agencies and professionals. Several problems also became apparent, as many families reported difficulty accessing needed services and minimal involvement in planning or implementing these interventions.

Legal Issues concerning Children with Autism and Pervasive Developmental Disabilities

Children and youth with autism often present special challenges to the educational system. Issues related to these challenges are reflected in court cases involving these students and those charged with providing services. Much of the litigation of the past few years has been related to appropriate educational placement, extended school year services, the use of aversive contingencies to central aberrant behavior, and the use of specific forms of augmentative communication (i.e., facilitated communication). This article examines recent ruling in these areas and their implications for the education of children with autism.

Is fragile X syndrome a pervasive developmental disability? Cognitive ability and adaptive behavior in males with the full mutation

In addition to mental retardation (MR), fragile X [fra(X)] syndrome has been associated with various psychopathologies, although it appears that the link is secondary to MR. It has been proposed that individuals with the full mutation be classified as a subcategory of pervasive developmental disorders (PDD). If fra(X) males are to be categorized as PDD, how do they compare with other types of developmental disabilities? We examined 27 fra(X) males aged 3-14 years, from 4 sites in North America. Measures of cognitive abilities were obtained from the Stanford-Binet Fourth Edition (SBFE), while levels of adaptive behavior were evaluated using the Vineland Adaptive Behavior Scales (VABS). Control subjects were sex-, age-, and IQ matched children and adolescents ascertained from the Developmental Evaluation Clinic (DEC) at Kings County Hospital. At the DEC, control subjects were diagnosed as either MR (n = 43) or autistic disorder (AD; n = 22). To compare subjects' adaptive behavior (SQ) with their cognitive abilities (IQ), a ratio of [(SQ/IQ) x 100] was computed. Results graphed as cumulative distribution functions (cdf) revealed that the cdf for AD males, who by definition are socially impaired, was positioned to the left of the cdf for MR controls, as expected. Mean ratio for AD males (70) was lower than for MR males (84). On the other hand, the cdf for fra(X) males was positioned far to the right of either AD or MR controls (mean ratio = 125). Statistical tests showed that SQ of fra(X) males was significantly higher than controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic illness: psychosocial effects on siblings--I. Chronically ill boys.

Focusing on the adjustment of the siblings of three groups of male children: with pervasive developmental disability, diabetes and no known chronic illness, the present study failed to support the view that siblings of ill children are uniformly at greater risk for psychosocial impairment. However, several domains were identified in which siblings as well as parents of sick children were more susceptible to adjustment problems, though 'risk' seemed to relate more closely to illness-specific variables than the presence or absence of illness. Several sex differences were found suggesting that same-sexed siblings may be more vulnerable to maladjustment than opposite-sexed pairs. The results are discussed in terms of their implications for investigation and intervention for families with an ill member.