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Parent and teacher report of pragmatic aspects of communication: use of the children's communication checklist in a clinical setting.

The Children's Communication Checklist (CCC) was developed to provide an objective assessment of pragmatic aspects of children's communication difficulties. We aimed to (1) see whether the checklist provided valid and reliable information when completed by parents, and (2) consider its usefulness in a clinical context. Checklists were completed by parents and a professional who knew the child well for all 5 to 17-year-old referrals to a tertiary developmental paediatrics centre over a 31-month period. Children who were not yet speaking in sentences were excluded. From a sample of 151 children (81% male; mean age 8.7 years) with pervasive or specific developmental disorders, valid checklists were completed by 119 parents and 93 professionals. Reliability, as measured by internal consistency, was 0.7 or higher for most scales. Correlations between ratings for parents and professionals were in the range of 0.30 to 0.58 for individual pragmatic scales, with a correlation of 0.46 (n=82) for the pragmatic composite. For both parents and professionals, the pragmatic composite was lowest for children with a diagnosis of autism; intermediate for those with a diagnosis of Asperger syndrome, pervasive developmental disorder not otherwise specified or attention-deficit-hyperactivity disorder (ADHD); and highest for those with a diagnosis of specific learning disability. The strongest relation between the pragmatic composite and diagnosis was seen when ratings from parents and professionals were combined. Differences between diagnostic groups were not explicable in terms of age or verbal IQ.

Adolescent↗

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.

Adolescent↗

Cognitive-developmental systems theory in pervasive developmental disorders.

The concept of reality systems is introduced in context of cognitive-developmental systems theory. Examination of the parallels between the reality systems of normal infants and those of children with pervasive developmental disorders supports the view that the latter are stalled at an early stage of development. Evaluation of pervasively disordered children with closed-system and system-forming disorders indicates the aberrant manner in which such children orient toward and engage objects and events, a manner that precludes flexible adaptation to people or surroundings. Attention is given the role of interruption as it triggers a compensatory reaction to maintain systems and the contribution of such reactions in developing the intentional behavior so lacking in children with pervasive developmental disorders. Finally, the author discusses theory-driven strategies to correct deficits in the body schema, coping with surroundings, social development, and communication and representation.

Child↗

Conceptualizing "borderline syndrome of childhood" and "childhood schizophrenia" as a developmental disorder.

OBJECTIVE: This is the first attempt to define and validate criteria for an early onset, chronic syndrome of disturbances in affect modulation, social relatedness, and thinking. This study formulates and tests five hypotheses that follow from conceptualizing this syndrome as a developmental disorder. The advantages of viewing this syndrome as a developmental disorder are discussed and compared with alternative formulations such as childhood schizophrenia or borderline syndrome of childhood. METHOD: An inpatient cohort (26 boys, 4 girls) was ascertained using specific, defined criteria. Using standardized measures on retrospective chart reviews, these subjects were compared with two different inpatient samples: one diagnosed with dysthymic disorder, the other with conduct disorder. RESULTS: The criteria readily distinguished between developmentally disordered children and comparison groups. Findings also supported the hypotheses in the predicted directions; index subjects had earlier onset of symptoms, poorer social and overall adjustment, longer hospitalizations, and poorer outcomes. CONCLUSIONS: Findings support the validity of this developmental concept for a multiple complex developmental disorder and give preliminary, "first-cut" validity to these specified criteria.

Adolescent↗

Comorbidity of psychiatric and communication disorders in children.

The co-occurrence of psychiatric and communication disorders in children is considerable. Many children who are treated by mental health professionals are also in need of speech and language services. This article discusses comorbidity and outlines communication problems that accompany a variety of childhood psychiatric conditions. Empiric studies and clinical impressions of these co-occurring problems are described.

Attention Deficit Disorder with Hyperactivity↗

Clumsiness in autism and Asperger syndrome: a further report.

Clumsiness has been proposed as a diagnostic feature of Asperger syndrome (AS), a type of pervasive developmental disorder recently introduced in the ICD-10 and DSM-IV. However, the extent to which this symptom is specific to AS is not clear. To investigate this issue, we compared a sample of AS children with age- and sex-matched groups of children with autistic disorder and pervasive developmental disorder not otherwise specified (PDDNOS). Twelve subjects with AS (ICD-10/DSM-IV; 11 males; average age 11.4 years; mean full-scale IQ 104.9) were compared with 12 subjects with autistic disorder (DSM-III-R; II males; average age 10.3 years; mean full-scale IQ 78.4) and 12 subjects with PDDNOS (DSM-III-R; 10 males; average age 10.1 years; mean full-scale IQ 78.2). The BruininksOseretsky test, a standardized test of motor coordination, was administered blind by the same investigator to all the three groups. While coordination deficits were found in all three groups, children with AS were found to be less impaired than those with autistic disorder and PDDNOS. However, no significant relationship was found between coordination scores and diagnosis after adjusting for the level of intelligence. These findings suggest that some patients with AS may be less clumsy than those with autistic disorder and that this difference may be the result of their higher level of intelligence. Studies based on larger samples using multiple measures of coordination are needed to further clarify the role of clumsiness in the classification of pervasive developmental disorders.

Adolescent↗

Platelet serotonin levels in pervasive developmental disorders and mental retardation: diagnostic group differences, within-group distribution, and behavioral correlates.

OBJECTIVE: To investigate group differences, the within-group distributions, and the clinical correlates of platelet serotonin (5-HT) levels in pervasive developmental disorders (PDD). METHOD: Platelet 5-HT levels were measured in Dutch children and young adults, recruited from 2001 through 2003, with PDD (autism, Asperger's, and PDD-not otherwise specified [PDD-NOS]; n = 81) or with mental retardation (MR; n = 54) but without PDD, and in normal controls (n = 60). The distribution of platelet 5-HT levels was assessed using mixture-modeling analyses. Relationships between platelet 5-HT levels and a full range of demographic, clinical, and behavioral variables were examined. RESULTS: Group mean (+/- SD) platelet 5-HT levels (nmol/10 platelets) were significantly higher in the autistic (4.51 +/- 1.61, n = 33) and PDD-NOS (4.90 +/- 1.54, n = 43) groups compared to the MR (3.48 +/- 1.33, n = 54) or the normal control (3.58 +/- 1.08, n = 60) groups (F4,190 = 9.35, p <.001). Platelet 5-HT values in the combined PDD group showed a bimodal distribution, and an empirical cutpoint for hyperserotonemia was determined. None of the behavioral variables examined was significantly associated with platelet 5-HT levels. CONCLUSIONS: The platelet hyperserotonemia of autism was replicated in Dutch subjects. Platelet 5-HT levels were also increased in PDD-NOS, while no elevation was seen in MR. Platelet 5-HT levels appeared to be bimodally distributed in the PDD group, with an apparent hyperserotonemic subgroup.

Adolescent↗

[Detection of pervasive disorders in the child: a maternal perspective].

Invasive developmental disorders are characterized by the early occurrence of changes that come up in the areas of communication development, behavior and interpersonal relationship. This study aimed to discover how the disorder detection process took place from a maternal perspective. A quantitative and qualitative study was carried, based on a semi-structured survey with 20 mothers of children in this condition. Results were processed through content analysis and indicated that these disorders have been diagnosed after the established age and that early typical signs are noticed by the family, particularly by the mother. These findings that child health professionals do not seem to be aware of the importance of effective developmental follow-up, which would lead to the early detection of these disorders, thus minimizing its present and future negative effects.

Adult↗