Biomedical subjects

Domenic Cicchetti

Publications and source records attributed to Domenic Cicchetti.

11 recordsLinked to original sources

PubMed2006

Risperidone and adaptive behavior in children with autism.

OBJECTIVE: To evaluate the impact of risperidone on adaptive behavior in children with autistic disorder who have serious behavior problems and to examine different methods of scoring the Vineland Adaptive Behavior Scales to measure change. METHOD: Forty-eight children (5 years to 16 years, 5 months) who showed behavioral improvement during acute treatment with risperidone were followed for 6 months and assessed with the Vineland Scales. RESULTS: Raw scores, age-equivalents, and special norm percentile scores all showed significant increases in adaptive behavior in the areas of communication, daily living skills, and socialization (p <.01). During a period of 6 to 8 months, children gained an average of 7.8 age-equivalent months in the area of socialization, a > 6% improvement beyond what would be expected based on baseline growth rates. CONCLUSIONS: Although limited by the absence of a control group, these results suggest that risperidone may improve adaptive skills in children with autistic disorder accompanied by serious behavioral problems. Vineland age-equivalent scores appear to be most useful in assessing change with treatment over time.

Activities of Daily Living↗

PubMed2006

Rating scales, scales of measurement, issues of reliability: resolving some critical issues for clinicians and researchers.

We focus upon several broad issues that are of concern to clinicians and clinical researchers in the areas of biobehavioral and biomedical research, including, but not limited to, the fields of psychiatry, psychology, neuropsychology, and neurology. These issues are the critical reassessment of S. S. Stevens' quadripartite conceptualization of scales of measurement; the application of criteria to determine the clinical significance of reliability estimates; the detection of subsets of reliable and unreliable raters, when the overall level is of little clinical import; and finally, the application of Kappa statistics when multiple raters evaluate a single case.

Behavioral Research↗

PubMed2006

The bed requirement inventory: a simple measure to estimate the need for a psychiatric bed.

OBJECTIVE: To develop an assessment of bed need that was as little affected by personal bias as possible. METHOD: The Bed Requirement Inventory (BRI) is an eight-point scale designed to identify the appropriate use of an acute psychiatric bed. This is completed by a member of the ward staff, usually a nurse, and takes 5 minutes to fill in. The reliability, validity and feasibility of using the scale in normal practice were tested in a one-year study, and variations in inappropriate bed use described. RESULTS: The inter-rater reliability of the scale was good (intra-class correlation coefficient = 0.63) and a comparison of the need for a psychiatric bed (comparing the BRI score with the judgement of an independent multidisciplinary group of professionals) also showed good agreement (k = 0.69), suggesting reasonable validity (although when the assessment was made by the named nurse agreement was less good). Results from a year-long survey in two West London hospitals showed that 17% of admissions were inappropriate and 32% had delayed discharge, black Caribbean patients had a significantly higher proportion (25%) of inappropriate admission than others (11%) and those referred from housing charities and hostels had a higher proportion (50%) of inappropriate bed use at some time than other groups (33%). CONCLUSIONS: The Bed Requirement Inventory is a quick and reliable method of determining the appropriate use of a psychiatric bed and could be of use in estimating local bed needs. Delayed discharge remains a serious reason for inappropriate bed use in London.

Adult↗

PubMed2005

Defining the "disruptive" in preschool behavior: what diagnostic observation can teach us.

This paper presents the clinical/developmental framework underlying a new diagnostic observational tool, the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). The special importance of observation for clinical assessment during the preschool period is delineated. The developmental rationale for a multi-dimensional assessment of disruptive behavior in young children, including problems in modulation of negative affect and low competence is discussed. The ways in which the DB-DOS will elucidate distinctions between normative and atypical behavior during this developmental period via (a) the integration of qualitative and quantitative dimensions of behavior within a clinically-sensitive coding system, (b) the observation of child behavior both within, and outside of, the parent-child context and (c) the use of specially designed tasks to "press" for clinically salient behaviors are addressed. The promise of this new method for yielding a more precise, developmentally based description of the phenotype of early onset disruptive behavior problems and for providing a standardized clinical tool for observational assessment of disruptive behavior in young children is presented. Large-scale validation of the measure is currently underway.

Attention Deficit and Disruptive Behavior Disorder↗

PubMed2005

Brief report: relations between prosodic performance and communication and socialization ratings in high functioning speakers with autism spectrum disorders.

Shriberg et al. [Shriberg, L. et al. (2001). Journal of Speech, Language and Hearing Research, 44, 1097-1115] described prosody-voice features of 30 high functioning speakers with autistic spectrum disorder (ASD) compared to age-matched control speakers. The present study reports additional information on the speakers with ASD, including associations among prosody-voice variables and ratings of communication social abilities. Results suggest that the inappropriate sentential stress and hypernasality previously identified in some of these speakers is related to communication/sociability ratings. These findings and associated trends are interpreted to indicate important links between prosodic performance and social and communicative competence. They suggest the need for careful assessment of inappropriate prosody and voice features in speakers with ASD, and for effective intervention programs aimed at reducing the stigmatization of individuals with these conditions.

Adolescent↗

PubMed2004

Adaptive behavior in autism and Pervasive Developmental Disorder-Not Otherwise Specified: microanalysis of scores on the Vineland Adaptive Behavior Scales.

The purpose of this study is to provide a microanalysis of differences in adaptive functioning seen between well-matched groups of school-aged children with autism and those diagnosed as having Pervasive Developmental Disorder-Not Otherwise Specified, all of whom functioned in the mild to moderate range of intellectual impairment. Findings indicate that the major area of difference between children with autism and those with Pervasive Developmental Disorder-Not Otherwise Specified, was expressive communication; specifically, the use of elaborations in syntax and morphology and in pragmatic use of language to convey and to seek information in discourse. Linear discriminant function analysis revealed that scores on just three of these expressive communication item sets correctly identified subjects in the two diagnostic categories with 80% overall accuracy. Implications of these findings for both diagnosis and intervention with children with Autism Spectrum Disorders will be discussed.

Activities of Daily Living↗

PubMed2004

The Dependent Personality Questionnaire (DPQ): a screening instrument for dependent personality.

BACKGROUND: There are no specific instruments for rating dependent personality, although this may be an important subject in clinical practice, where knowledge of dependent personality features may influence treatment. AIMS: To develop a simple self-rating questionnaire for dependent personality features and compare the findings in two groups, one with and one without established dependent personality disorder. METHOD: An 8-item Dependent Personality Questionnaire (DPQ) was developed and its acceptability and validity tested by administration to 30 psychiatric patients, half of whom had dependent personality disorder using clinical and research data, and the other 15 (pair-matched for age and sex) having other psychiatric diagnoses (including other personality disorders) but no dependent personality features. RESULTS: The mean score on the dependent personality questionnaire (DPQ) was 13.7 in those with dependent personality disorder and 7.5 in those without such a disorder (p < .005). The DPQ was also a good predictor of the diagnosis of dependent personality disorder, with sensitivity, specificity, predicted positive, and predicted negative accuracies of 87%. CONCLUSIONS: The results suggest that the DPQ may be a suitable screening instrument for dependent personality characteristics.

Adult↗

PubMed2003

Reduced thalamic volume in high-functioning individuals with autism.

BACKGROUND: In this study, specific consideration is given to a role for the thalamus in autism. METHODS: A volumetric analysis of the thalamus was conducted using magnetic resonance imaging, based on segmentation of continuous 1.2 mm(3) coronal images. The sample consisted of 12 high-functioning individuals with autism, mean age of 21.0 years (SD = 10.4) and mean IQ of 106.4 (SD = 18.3). Normal control subjects were selected to match this group; the mean age was 18.1 years (SD = 6.3); mean IQ was 108.8 (SD = 15.6). RESULTS: Unadjusted mean thalamic volume was not significantly different; however, there were significant differences in the relationship between thalamic volume and total brain volume (TBV). The correlation was strong and positive in the control group but statistically nonsignificant in the autism group. Group differences were found when adjustments were made for TBV, achieved by grouping subjects' measurements on this variable using a split median procedure. Mean thalamic volume was significantly reduced in the autism group relative to normal control subjects, specifically within the high TBV group. CONCLUSION: The increase in thalamic volume with increase in TBV was not seen in autism, suggesting underdeveloped connections between cortical and subcortical regions and indicating a need to examine this structure further.

Adolescent↗

PubMed2003

Concurrent validity and classification accuracy of the Leiter and Leiter-R in low-functioning children with autism.

The concurrent validity of the Leiter International Performance Scale (Leiter) and Leiter International Performance Scale-Revised (Leiter-R) was examined in a sample of children with autism who could not be assessed with more traditional measures of intelligence (e.g., the Wechsler scales). The sample consisted of 26 children ranging in age from 4 to 16 years. The correlation between the Leiter scales was high (r = .87), and there was a difference of 3.7 points between the two mean scores, nonsignificant at both statistical and clinical levels. However, significant intraindividual discrepancies were present in 10 cases, 2 of which were both large (24 and 36 points) and clinically meaningful. The mean profile of performance on Leiter-R subtests is also presented for this sample of children with autism, to allow for comparison with other groups. Based on the results of this initial evaluation, together with the current normative data, good psychometric properties, and availability of global and subtest scores with the Leiter-R, the instrument is generally recommended for use with children with autism. However, because of changes in the design of the Leiter-R, there may be greater clinical success with the original Leiter for those children who are very low functioning and severely affected, particularly younger children.

Adolescent↗

PubMed2003

Developmental trajectories of cocaine-and-other-drug-exposed and non-cocaine-exposed children.

Few data are available concerning the trajectories of mental and motor development across time for cocaine-exposed children compared with others. Findings are presented from individual group curve analyses of the mental and motor development measured by the Bayley Scales of Infant Development-II (BSID-II) on repeated visits from 3 through 36 months of a group of prenatally cocaine-and-other-drug-exposed children (n = 265) compared with those exposed to no drugs (n = 129) or no-cocaine-but-other-drugs (n = 66), including alcohol and/or tobacco. Across time, there was a general decline in motor performance but cocaine-exposed-infants showed a trend toward a greater decrease than children in the other two comparison groups. For mental performance, there was also a decline across age but only through 24 months and no differences in the trajectory of the cocaine-exposed group compared to the other two. And, across all assessment ages, cocaine-exposed-infants showed lower BSID-II mental performance compared to both non-drug and non-cocaine-exposed children. Results suggest that prenatally cocaine-exposed children show delayed developmental indices, particularly in their mental performance, but their trajectories across time are similar to those from impoverished, non-cocaine-exposed groups.

Child↗

PubMed2003

Use of the Global Assessment of Function scale in learning disability.

BACKGROUND: The Global Assessment of Function (GAF) scale is widely used in adult psychiatric practice and research but it has not often been used in learning disability, which is inherently more complex. AIMS: To evaluate the reliability of GAF in the assessment of learning disability. METHOD: GAF reliability was tested by simultaneous multiple rating of unselected case vignettes (n=19-25) from health professionals of different disciplines, under controlled conditions. Analysis of reliability was made with the intraclass correlation coefficient (R(1)) with separate assessments to determine rater bias and individual performance of raters. RESULTS: The results of three data-sets showed generally poor overall levels of agreement, with R(1) levels of 0.35 and 0.28 and somewhat better levels for current GAF scores (R(1)=0.49). However, a subset of raters was identified that achieved much higher levels (R(1)=0.54 to 0.74). CONCLUSIONS: The GAF, in its current format, is not reliable enough to be used in the routine assessment of learning disability. A subgroup of raters, however, have ratings that are, by current biostatistical criteria, sufficiently reliable.

Adult↗