Severe Behavioral Disorders Research Articles

Self-Regulated Strategy Development and Generalization Instruction: Effects on Story Writing and Personal Narratives among Students with Severe Emotional and Behavioral Disorders

The effects of Self-Regulated Strategy Development (SRSD) and generalization instruction with 3 second and third grade students with severe emotional/behavioral disorders, in one self-contained classroom were examined. The effects of the intervention on multiple measures of story writing were examined at baseline, postinstruction and maintenance. A generalization measure was administered at baseline and postinstruction to assess if the effects of the intervention would transfer to writing personal narratives. Student self-efficacy and social validity of SRSD were also investigated. At both postinstruction and maintenance, students wrote stories that were longer, contained more essential elements, and were qualitatively better than baseline stories. In addition, effects generalized to writing personal narratives, as these papers became longer, contained more essential elements, and were of overall better quality following SRSD instruction. Self-efficacy for writing improved for two of the three students. All three students reported that the strategies they learned were useful and valued their impact on their writing.

The interpretation of the amended RAF Act 56 of 1996 and the regulations thereto by the courts with regard to "serious injury" claims.

The RAF Amendment Act 19 of 2005 came into effect on 1 August 2008 and sections 17(1) and 17(1A) introduced the concept of “serious injury”. This entails that a third-party claimant who wishes to claim compensation for non-patrimonial loss suffered after a motor-vehicle accident has to prove that his or her injury is “serious”. If the claimant’s injury is not considered “serious” no compensation will be awarded for the non-patrimonial loss suffered and, furthermore, the claimant will also not be entitled to claim any compensation from the wrongdoer in terms of common law (s 21 of the RAF Act). In a sequence of unreported cases the courts have provided guidelines on the procedure to be followed in serious-injury claims. Firstly, a claimant must submit himself or herself to an assessment by a medical practitioner registered under the Health Professions Act. Secondly, the medical practitioner must assess if the injuries sustained by the claimant fall within the list of “non-serious injuries”, and if so, compensation for non-patrimonial loss will not be awarded. If the injury is not on the list of non-serious injuries, the medical practitioner may assess the injuries and if they result in 30 per cent or more of whole-person impairment (“WPI”) compensation for non-patrimonial loss may be awarded. If the evaluation is that the 30 per cent of WPI cannot be reached, non-patrimonial loss may still be claimed if the injuries fall within the “narrative test”, namely (a) resulting in a serious long-term impairment or loss of a body function; (b) constituting permanent serious disfigurement; (c) resulting in severe long-term mental or severe long-term behavioural disturbance or disorder; or (d) resulting in the loss of a foetus. A plaintiff may use either of the two tests to establish serious injury and in such a manner qualify for compensation for  non-patrimonial loss. A medical practitioner must complete and submit a serious-injury assessment report on the RAF 4. If the RAF is not satisfied that the injury has been correctly assessed they must (a) reject the serious-injury assessment report within 60 days and furnish reasons for the rejection; or (b) direct that the third party submit himself or herself, at the cost of the Fund, to a further assessment. Thereafter the RAF must either accept the further assessment or dispute the further assessment within 90 days. An Appeal Tribunal, consisting of three independent medical practitioners, has been created to hear these disputes.KEYWORDS: Road Accident Fund, serious injury, patrimonial loss, narrative test, assessment report

Reliability and validity of a treatment adherence measure for child psychiatric rehabilitation.

Treatment adherence, defined as the degree to which practitioners implemented prescribed program principles and activities and avoided proscribed activities, has been an area of growing interest in mental health services for children with severe emotional and behavioral disorders. This study evaluated the reliability and validity of a treatment adherence measure for child psychiatric rehabilitation (CPSR). Parents of children receiving CPSR (n = 79) or psychotherapy (n = 27) completed the Children's Psychosocial Rehabilitation Treatment Adherence Measure (CTAM) and a measure of 2-week session impact. Psychiatric rehabilitation (PSR) supervisors identified PSR practitioners with reputations for high or low adherence to the model. The CTAM's discriminant validity was assessed by using known-groups procedures and predictive validity by examining its relationship to 2-week session impact. The CTAM demonstrated excellent internal consistency (α = .92), discriminant validity (p = .002, d = .72; p = .021, d = .59), and predictive validity (B = 2.24, SE = .31, p < .001), accounting for 28% of the child-level variance in 2-week session impact. Findings suggest the CTAM is a reliable and valid measure of treatment adherence for CPSR programs with a skill-teaching focus. Providers and agencies should take steps to enhance treatment adherence because it may be an important predictor of children's short-term response to CPSR.

Should Maximum Conservative Management be the Standard Paradigm for Very Elderly Adults with Chronic Kidney Disease or is There a Role for Dialysis?

Should Maximum Conservative Management be the Standard Paradigm for Very Elderly Adults with Chronic Kidney Disease or is There a Role for Dialysis?

Early Prevention of Severe Neurodevelopmental Behavior Disorders: An Integration

There is a very substantial literature over the past 50 years on the advantages of early detection and intervention on the cognitive, communicative, and social-emotional development of infants and toddlers at risk for developmental delay due to premature birth or social disadvantage. Most of these studies excluded children with severe delays or other predisposing conditions, such as genetic or brain disorders. Many studies of children with biological or sociodevelopmental risk suggest that behavior disorders appear as early as 3 years and persist into adulthood if not effectively treated. By contrast, little is known about the infants and toddlers with established risk for severe delays who make up a significant proportion of the population with dual diagnoses later in life. In the past decade, there has been a growing interest in early detection and intervention with children age birth to 3 years, for example, the Birth-Three population (Individuals with Disabilities Education Act, 1997), who may have disabilities and severe behavior problems, for example, aggression, self-injury, and repetitive stereotyped behaviors. The available research is scattered in the behavior analytic literature and in the child development literature as well as in the child mental health and psychiatry literature, the developmental disability literature, the animal modeling literature, and the genetics literature. The goal of this introductory overview is to integrate these literatures, by cross-referencing members of these various groups who have worked in this field, in order to provide the reader with an integrated picture of what is known and of future directions that need more research.

Antipsychotic Medication Prescribing Trends in Children and Adolescents

The Food and Drug Administration has approved the use of antipsychotic medications in some children and adolescents with severe emotional and behavioral disorders. However, recent national data show a dramatic rise in off-label and Food and Drug Administration–approved uses of these medications. Of particular note is a twofold to fivefold increase in the use of antipsychotic medications in preschool children, despite little information on their long-term effects. This article describes the trend in pediatric antipsychotic medication use, possible explanations for the increase, implications for children’s health, and recommendations for pediatric providers who work with parents of children and adolescents who seek or receive antipsychotic medication treatments.

UV‐B Exposure Causes DNA Damage and Changes in Protein Expression in Northern Pike (Esox lucius) Posthatched Embryos

The ongoing anthropogenically caused ozone depletion and climate change has increased the amount of biologically harmful UV-B radiation, which is detrimental to fish in embryonal stages. The effects of UV-B radiation on the levels and locations of DNA damage manifested as cyclobutane pyrimidine dimers (CPDs), heat shock protein 70 (HSP70) and p53 protein in newly hatched embryos of pike were examined. Pike larvae were exposed in the laboratory to current and enhanced doses of UV-B radiation. UV-B exposure caused the formation of CPDs in a fluence rate-dependent manner, and the CPDs were found deeper in the tissues with increasing fluence rates. UV-B radiation induced HSP70 in epidermis, and caused plausible p53 activation in the brain and epidermis of some individuals. Also at a fluence rate occurring in nature, the DNA damage in the brain and eyes of pike and changes in protein expression were followed by severe behavioral disorders, suggesting that neural molecular changes were associated with functional consequences.

Functional Communication Training Without Extinction Using Concurrent Schedules of Differing Magnitudes of Reinforcement in Classrooms

This study investigated the effects of functional communication training (FCT) implemented with concurrent schedules of differing magnitudes of reinforcement in lieu of extinction to reduce inappropriate behaviors and increase alternative mands. Participants were four adolescent students diagnosed with severe emotional and behavior disorders (SEBD), and mild to severe intellectual disabilities. Functional analyses revealed inappropriate behaviors as escape maintained. During subsequent FCT, the reinforcement provided for inappropriate behaviors was escape from task for 30 s (SR−). The reinforcement for the alternative mand was a 30-s escape from task during which access to a preferred activity was provided (SR−/PA). Results for three of the participants who had mild to moderate intellectual disabilities were highly successful. Time on task and generalization data also were recorded for two of the participants All sessions were implemented in the participants’ natural classrooms by their classroom teachers, without the adverse side effects of extinction.

Multidisciplinary approach in managing adult with autism: A single case study

Autism is a Neurodevelopmental disorder believed to have neurological and genetic components. It was first identified in 1943. Since that time, research has shown that children with Autism spectrum disorders (ASD) have difficulties in three general areas :Social Interaction: qualitative difficulties responding to and interacting with other people in social situations, ranging from avoiding social interactions altogether at one extreme to being interactive but inappropriate at the other.Communication: qualitative difficulties in verbal and non-verbal communication, ranging from a lack of language and gestures in some cases to the use of complex language in odd or inappropriate ways in other cases.Behaviour: behaviours are often described as being repetitive and stereotypical, ranging from needing to perform daily activities in a very specific way to having a very restricted range of interests.Autism is a polygenetic developmental neurobiologie disorder with multiorgan system involvement, though it predominantly involves central nervous system dysfunction. The evidence supports autism as a disorder of the association cortex, both its neurons and their projections. In particular, it is a disorder of connectivity, which appears, from current evidence, to primarily involve intrahemispheric connectivity (Nancy & Diane, 2007).Investigators have suggested that, to achieve the best possible outcomes, children with autism should begin intensive behavioural treatment as early as possible, preferably before the age of 4 years (Green, 1996). Younger children with autism may have more behavioral and neural plasticity than older children do (Borman & Fletcher, 1999)andthey may not have fallen as far behind their peers. Many children with autism do not have an opportunity to start intensive behavioral treatment prior to age 4. Some do not even receive a diagnosis of autism until they are past this age (Howlin & Moore, 1997)Homer, Carr, Strain et al. (2002) discuss the importance of comprehensive intervention planning and state that comprehensive interventions involve multiple strategies applied across all or most of the individual's day.The process of comprehensive intervention planning begins with a thorough understanding of the individual's needs, especially those related to the underlying characteristics of ASD. Next, a comprehensive daily schedule for the child is critical. A schedule should embed the supports needed for success as well as develop individual skills and measure those skills with a vision of how this will affect the child now and in the future (National Research Council, 2001).The caseA 19 year old boy was brought with the complaints of age inappropriate communication skills, poor socialization and severe behavioural disorders including soiling self, frequent urination and loud screaming if his demands are not met immediately. He was diagnosed with Autistic disorder at the age of 4 years, since then he was taken to different treatment approaches including special education and even Ayurveda, but no significant improvement noticed as reported.During the first visit his parents were almost hopeless in taking into the new place for the treatment since they were rejected from many places due to the age factor of the boy and severity of the condition.AssessmentsInitial assessments were done using detailed clinical interview with the parents, behavioural observation and with the use of Sensory Integration (SI) Inventory and Childhood Autism Rating Scale (CARS). In behavioural observation, he was not co-operative, eye contact was not maintained, no name calling response noticed. Productive verbal communication was absent and he showed the sign of distress throughout the session through self stimulatory loud voices and behaviours. He was motivated by objects especially balls not by humans.Sensory Integration (SI) Inventory suggests that, he had tactile defensiveness, hyposensitivity in vestibular, proprioceptive, visual, auditory & olfactory senses. …

Family Relationship of Children with Behavior Disorders

Abstract The present study aims to determine the relationship of the families of children with childhood behavior disorders. In a sample of 263 students in the age group of 10-12 years studying in 4th, 5th and 6th standards in the elementary schools of Tafila city. The researcher analyzed the family relationship of the three groups of families based on two factors such as cohesion and conflict. Investigator also compared these factors in the families of children with no behavior disorders, with that of families of children with mild and severe behavior disorders. The results of the study reveals that, a high cohesion and less conflict is found among the families of children with no behavior problems and low cohesion and conflict in the families of children with severe behavior problems. Keywords: family, relationship, children, behavior disorders

PROGRAMAS DE REFORZAMIENTO INDEPENDIENTE DE LA RESPUESTA COMO TRATAMIENTO PARA DESÓRDENES CONDUCTUALES SEVEROS

This paper describes some recent work involving the application of time-based schedules as treatment br severe behavior disorders. ln time-based schedules, reinforcer delivery depends on neither the occurrence or nonoccurrence of behavior. For example, in a fixed-time (FT) schedule, reinforcer presentation is at set time intervals whether or not behavior occurs. Such schedules are a logical form of treatment because they disrupt preexisting response-reinforcer relations when problem behavior is maintained by socially mediated reinforcement. Numerous applied studies en time-based schedules have been published in the past five years; this paper is intended primarily te introduce the logic of using such schedules as treatment, but not te proVide an exhaustive literature review.

Mortality of Cohort of Very Young Injecting Drug Users in Prague, 1996-2010

To determine the mortality in a cohort of very young injecting drug users (IDUs), and the factors associated with it. A database linkage prospective (follow-up) cohort study. A convenience sample of clients of 2 low-threshold facilities, 1 drug treatment clinic, and one special facility for children with severe behavioural disorders, who were all younger than 19 and older than 15, was interviewed one or more times in 1996-8 and asked to agree with their being interviewed again after 10 or more years. 151 (65 male, 86 female) IDUs recruited in October 1996 - December 1998. Database linkage study compared unique identifiers (IDs) of the recruited subjects with the general register of deaths to determine the life status, and the causes of death of those deceased. Where necessary, we examined the death protocols directly. Altogether, 8 deaths were registered between recruitment and 31st December 2008 (1,660 person-years). All the deceased were male, and all their deaths were "unnatural"--that is, caused by drug overdose or accident. This translates into the crude mortality rates for the whole cohort being 4.8 deaths per 1,000 person-years (PY), and into a specific mortality ratio in the males SMR=14.4 with the peak at the age of 15-20 (SMR=60.1), declining to SMR=8.2 at the age of 25-30. Except gender, we found no "predictors of death" in this high-risk cohort. The overall mortality in the cohort was substantially higher than in the general population; in the male part of the cohort of young injecting drug users it was excessively high in the first three years after recruitment, and caused by external causes exclusively; the mortality in the female sub-cohort was zero, i.e. lower than in the general population of the same age range. Our findings suggest a need to develop targeted prevention of overdoses and other unnatural deaths in young male drug injectors.

Los Trastornos Graves de Conducta en el contexto educativo

This article provides a synthetic route on the approach to be held in the school setting with students with special educational needs with severe behavioral disorders. The analysis is done from the practical perspective of a team of specialized educational guidance in these disorders, which have a key role advising, and acting as provincial level and between levels, provides an overview of this complex problem in all its dimensions including aspects related to the detection, assessment, schooling, education response and coordination. It also highlights the importance of education and training of teaching professionals for the development of inclusive education projects of these students, as well as improving other important aspects such as the updating of the censuscategories of educational development specific forms of schooling where necessary, and the development of optimal protocols for coordination of the institutions involvedin caring for these students.

Cholinergic Treatment of Alzheimer’s Disease and Its Influence on Health and the Quality of Life of Carers

The efficacy and safety of four-month courses of rivastigmine and changes in measures of carer burden were studied in a non-randomized group of 25 patients with Alzheimer’s disease (AD). All patients received p.o. rivastigmine and 22 patients received antipsychotic therapy along with rivastigmine on admission. Treatment was continued for 16 weeks (12 weeks in hospital and four weeks in out-patient conditions). These studies showed that the use of rivastigmine in AD patients with behavioral and psychotic disorders at the stage of moderately severe dementia not only improved the patients’ cognitive functions, but also had positive effects in terms of decreasing psychotic and behavioral disorders. Inclusion of rivastigmine in the complex treatment of AD patients led to significant decreases in the need for psychotherapeutic agents, and in some patients to complete withdrawal of all antipsychotics. It is extremely important to emphasize that the use of rivastigmine in patients with moderately severe AD and behavioral disorders led to significant (up to 30%) decreases in the time spent on the care and supervision of the patients, along with decreases in the level of stress and improvements in the health of carers, indicating increases in the quality of life of both patients and their families.

After a Long-Term Placement: Investigating Educational Achievement, Behaviour, and Transition to Independent Living

This study describes the transition towards independent living of 123 former fostered young people reared for long periods in a private French organisation, SOS Children’s Villages. Three generations of care leavers were analysed through a postal survey and interviews. Their narratives show typical pathways after leaving care. Two-thirds became independent without major problems by the age of 24–25. Analyses have shown that the absence of severe emotional and behavioural disorders, and diplomas obtained, improved their odds of becoming independent. Results suggest a vital need to implement appropriate therapeutic care during placement and to develop care leaver support well beyond the age of 18, in order to help them personally and academically and to ensure their successful transition to adulthood.

Music Therapy Methods with Children, Adolescents, and Adults with Severe Neurobehavioral Disorders Due to Brain Injury

The purpose of this paper is to illustrate the application of music therapy intervention in neurobehavioral treatment programs with pediatric, adolescent and adult populations through the presentation of six case reports, with special reference to post-traumatic amnesia. Severe behavioral disorders stemming from brain injury are challenging for both the affected individual and their support network. Managing neurobehavioral disorders requires specialist skills and knowledge of various strategies to minimize behavioral incidents and decrease episodes of agitation. Music therapy interventions are effective in increasing orientation and decreasing agitation in people with post-traumatic amnesia following brain injury (Baker, 2001). However, there is little published guidance or research on music therapy interventions for use in interdisciplinary rehabilitation programs for patients with short-term or chronic neurobehavioral disorders following traumatic brain injury. Music therapy is well-placed as a part of interdisciplinary rehabilitation with this population, offering opportunities to enable emotional expression and improve pragmatic communication skills and social interaction. This case material provided illustrates how music therapists integrate family members into treatment programs, and work with others to enable multidisciplinary and interdisciplinary outcomes.

Empowering schools to serve as safety nets for children with behavior problems in Serbia

Children with special needs have been a focus of institutional reforms in Serbia for nearly two decades. Historically, as in other Eastern European countries, children with severe developmental, emotional, and/or behavior disorders in Serbia were often placed in institutions far from their families for much of their lives. Since the fall of communism, extensive government reforms in Serbia, guided by Western development agencies, have focused on deinstitutionalizing youth, but only with modest results. Underdeveloped special education programs within the Serbian public school system, have also contributed to children with special needs being at increased risk for leaving school and having legal problems. However, newly passed legislation is empowering Serbian schools and communities to serve as safety nets for vulnerable youth.

Outcome of severe unilateral cerebellar hypoplasia

Complete or subtotal absence of one cerebellar hemisphere is exceptional; only single cases have been described. We aimed to assess the long-term outcome in children with severe unilateral cerebellar hypoplasia (UCH). As part of a retrospective study we describe neuroimaging features, clinical findings, and cognitive outcomes of seven children with UCH (five males, two females; age at first magnetic resonance imaging [MRI]: median 1y 3mo, range 9d-8y 10mo; age at latest follow-up: median 6y 6mo, range 2y 3mo-14y 11mo). One child had abnormalities on prenatal MRI at 21 weeks' gestation. The left cerebellar hemisphere was affected in five children, and the right hemisphere in two children. The vermis was involved in five children. The volume of the posterior fossa was variable. At the latest follow-up, neurological findings included truncal ataxia and muscular hypotonia in five children, limb ataxia in three patients, and head nodding in two patients. Three children had learning disability*, five had speech and language disorders, and one had a severe behavioural disorder. Severe UCH is a residual change after a disruptive prenatal cerebellar insult, most likely haemorrhagic. The outcome is variable, ranging from almost normal development to marked developmental impairment. Ataxia is a frequent but not a leading sign. It seems that involvement of the cerebellar vermis is often, but not consistently, associated with a poorer cognitive outcome, whereas an intact vermis is associated with normal outcome and no truncal ataxia.

Surgical treatment of scoliosis in Smith-Magenis syndrome: a case report

IntroductionSmith-Magenis syndrome is a rare genetic condition associated with scoliosis in approximately 30% of cases. There is limited information in the literature on the treatment of scoliosis and the surgical outcome in patients with this condition. Characteristic features of the syndrome, such as the presence of congenital heart and renal disease, inherent immunodeficiency, as well as severe behavioural disorders may complicate the surgical treatment of patients.Case presentationWe present the case of an 11-year-old British Caucasian girl with Smith-Magenis syndrome who developed a severe, progressive thoracic and lumbar scoliosis measuring 85° and 80°, respectively. She had no cardiac or renal anomalies. Brace treatment was unsuccessful to prevent deterioration of the scoliosis. Both curves were rigid on supine maximum side-bending and traction radiographs. Our patient underwent a posterior spinal arthrodesis with pedicle screw/hook and rod instrumentation and autologous iliac crest graft, supplemented by allograft bone. She had an uneventful postoperative course other than the development of a small wound dehiscence which required resuturing with no signs of a wound infection. A good correction of both scoliotic curvatures to 45° and 40° and a balanced spine in both the coronal and sagittal planes was achieved. Follow-up to skeletal maturity (4 years post-surgery) showed no loss of deformity correction, no detected pseudarthrosis and a good clinical outcome.ConclusionPatients with Smith-Magenis syndrome can develop a severe scoliosis that may require surgical treatment. Congenital cardiac and renal disease, immunodeficiency and severe behavioural problems can affect the surgical outcome following spinal arthrodesis and need to be taken into consideration. Our case demonstrates that surgical correction of the deformity can be performed safely on this group of patients, with a good outcome and an uncomplicated postoperative course.

P02-200 - The beginning of dual pathology psychiatric inpatient care section (UPD)

IntroductionUPD is a regional referral hospital psychiatric care unit, endowed with multidisciplinary equipment. It provides care to people with light/moderate/severe intellectual incapacity coexisting with mental disease and/or severe behavioral disorders. It offers attention to patients who need a protected therapeutical environment for correcting behavior disorders. It was opened in September 2008.ObjectivesDescription of:therapeutic goals, inclusion/exclusion criteria, admission protocol and psychotherapeutic/pharmacological interventions.Analysis of inpatients's sociodemographic/clinical characteristics and preliminary assessment of therapy goals.MethodologyRetrospective study(13-month) of patients admitted to UPD of Leon Hospital from its inception to date. Data are collected from medical histories.Results47 referrals have been received,5 of them have been rejected not to fulfill criteria. We’ve 16 patients on waiting list.32 incomes have been realized and 22 discharges have occurred.19 of the incomes correspond to Mild,6 to Moderate,6 to Severe and 1 to Profound mental Retardation.Regarding co-morbidity:22 patients presented serious behavioral disorder. From this group, 2 met criteria for autistic disorder, 5 had schizophrenia or unspecific psychotic disorders, 5 presented Personality Disorder and one ADHD.10 patients did’nt present any important behavioral disturbance. From this group 2 were diagnosed with OCD,3 presented problems due to Alcohol and Substance-related Disorders,3 had Psychotic Disorders, one met criteria for Impulse Control Disorder and one presented Mood Disorder.Before admission, 12 patients resided in specific handicappeds center, 5 intermittently at selected centers and in family, and 15 lived with family.ConclusionsPsychotherapeutic intervention and treatment were useful in most cases. It was particularly helpful in treatment of behavioral disturbances. Now we must determine effectiveness in maintenance of improvement when they return to their community.