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Motor presetting was investigated in hyperactive children, learning disabled children and normal controls. The reaction time of the hyperactive group was more sensitive to increases in interstimulus interval (event rate) than was that of the learning disabled and the controls. This finding indicates that hyperactive children have difficulty with motor presetting.
OBJECTIVE: To discuss issues in the education of children with disabilities, particularly with respect to inclusion in mainstream classes. METHODOLOGY: Review of the literature on education for children with disabilities, focusing on the inclusion versus segregation debate. RESULTS: The literature provides no support for segregation and some support for the view that segregated children are disadvantaged. What seems to be important is the way the child is educated rather than where the education takes place. In addition, there are ethical, sociological, and legal arguments in favour of an inclusive educational system. CONCLUSIONS: There are good arguments to encourage inclusive education for children with disabilities. In advising parents, doctors should focus on how rather than where the child with a disability should be educated.
PURPOSE: The purpose of this study was to determine if independent raters would arrive at similar decisions about which codes from the Activities and Participation component of the International Classification of Functioning, Disability, and Health (ICF) to assign to children with disabilities based on the results of standard paediatric functional assessment measures. METHOD: Children (N = 60), 9 months to 17.75 years old, with a range of disabilities were assessed using either the Vineland Adaptive Behavior Scales (n = 20), the Pediatric Evaluation of Disability Inventory (PEDI) (n = 20), or the School Function Assessment (SFA) (n = 20). Two raters independently determined which of 40 codes from the Activities and Participation component of the ICF applied to each child based on items and standard scores from the assessment measure. The Cohen's kappa statistic was used as the measure of inter-rater reliability. RESULTS: The kappa statistic was >/= 0.70, the criterion for good agreement in this study, for 23/40 codes using the Vineland, 17/40 codes using the PEDI, and 17/40 codes using the SFA. The mean kappa statistic reached >/= 0.70 for the Self care domain, using all three tools. The mean kappa statistic also reached >/= 0.70 for Learning and Applying Knowledge and Mobility using the Vineland. CONCLUSIONS: Independent raters reached high rates of agreement when assessment test items were structured developmentally and corresponded to a single ICF code. For domains other than Self care, alternative assessment strategies may be necessary to improve assigning ICF codes to children with disabilities.
Technological advances, including the use of virtual reality, have contributed enormously to improving the treatment, training, and quality of life of children with disabilities. This paper describes the advantages of VR for children with disabilities, how VR can minimize the effects of a disability, the role of VR in training and skills enhancement, and how social participation and the child's quality of life may be improved through the use of VR. Examples from published literature and Internet sites are given of current and completed projects which focus on improving the lives of children with disabilities. The research describing the efficacy of knowledge and skills transfer from a virtual environment to the real world are examined in relation to children with disabilities. Finally, the current limitations and future directions of VR for children with disabilities are considered.
OBJECTIVES: To determine the prevalence of maltreated children with disabilities, the demographic characteristics, the frequency of the type of maltreatment, the perpetrator of the maltreatment, the family, social and environmental risk factors and to contribute information to knowledge of the etiopathogenesis of child maltreatment. PATIENTS AND METHODS: We performed a retrospective cross-sectional study over a 10-year period (1991-2001). The health and socio-familial reports of 1,115 maltreated children entering foster care in Saragossa (Spain) were reviewed and those presenting physical, psychological and/or sensorial disability were included. RESULTS: Sixty-two children with disabilities were admitted during the study period (a prevalence of 5.56 % below that expected). Mean age was 7.47 years (5.60 SDU) (range: 0-17 years). The most frequent age group was 0-5 years (43.5 %). The male-to-female ratio was 1.36:1. The most prevalent disability was psychological (35.5 %), followed by mixed (27.4 %), physical (25.8 %), and sensorial (11.2 %). The most frequent type of maltreatment was physical neglect (82.2 %). A total of 16.2 % of the children presented several types of maltreatment. In 83.8 % of the patients the perpetrator of the maltreatment was the mother. At least one family, social and/or environmental risk factor was present in 93.5 % of the children and more than one risk factor was present in 64.5 %. CONCLUSIONS: We believe that in most of the cases of maltreatment of disabled children from our environment, the etiopathogenesis was unrelated to the presence of an isolated individual risk factor (disability). Instead, maltreatment was related to the existence of familial, social and environmental risk factors. The greater the number of risk factors associated with a disabled child, the greater will be the possibility of maltreatment.
Listing of the numbers of children with disabilities provide little to no insight in the difficulties faced by children with disabilities and their families. A review is provided of the emotional and psychological hurdles that need to be considered as pediatric dentists continue to provide the necessary services.
Using measures of child and family functioning, this study evaluated levels of parenting stress in 880 families of children with disabilities. Results suggest that factors such as income, time available for interaction with the child, and social support predict parenting stress much better than do aspects of child functioning. Implications for intervention and for future research are discussed.
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PROBLEM STATEMENT: There is a dearth of research on how to respond to children with disabilities who have been maltreated. The literature that does exist recommends a collaborative team approach, with each team member possessing a broad understanding of the special considerations of working with children with disabilities. The literature does not define current understanding levels of response team members in comparison to essential knowledge levels. METHOD: The current study used a needs assessment instrument tailored to each of three key groups: parents, educators, and investigators. Respondents were asked about their knowledge level, experience with, and training interests on maltreatment of children with disabilities. RESULTS: While respondents seemed to have a cursory awareness in some of the topic areas, their knowledge levels were not extensive in most of the survey areas. A majority of respondents were willing to attend training, and all three groups ranked the recognition of maltreatment of children with disabilities as a top training priority. CONCLUSIONS: It was concluded that these integral players in the response to maltreatment of children with disabilities are receptive to becoming more effective partners, by attending training to bridge the knowledge gaps they possess. The current study helps document the nature of those knowledge gaps and, thereby informs the development of training programs for building a more coordinated and informed response to maltreatment of children with disabilities.
A specific model of care coordination for children with disabilities is described, comprising parental empowerment, a defined client population, individual tailoring of service based on assessment of need, inter-agency collaboration beyond existing team boundaries, continuity of named professional contact across transitions important to families, and a named care coordinator. The first stages of local implementation of the model are described for children with a disability making the transition into nursery school provision. Qualitative findings from interviews with families and care coordinators are presented, and the possibility of care coordinators providing a Named Person function is examined.
A selected population of children with disabilities in Melbourne, Australia, was studied with reference to their oral disease and treatment needs. A total of 300 children (aged 9-13 years), 150 attending special developmental schools (SDS) and 150 attending special schools (SS), received an oral examination and the parent/guardian completed a questionnaire. Six levels of function were defined, based on the child's independence for five self-care activities (brushing teeth, feeding self, dressing self, walking and performing toilet). The caries experience of children in the SS was lower than in SDS (d + D: 1.3 +/- 1.6 versus 1.5 +/- 2.4; dmft + DMFT: 2.0 +/- 2.3 versus 2.5 +/- 3.1); those attending SDS had higher unmet preventive and restorative needs. Significant associations were seen between the number of decayed teeth, the dmft + DMFT index, and the level of function (p < 0.005). Periodontal disease was prevalent; significant associations were seen between periodontal status, the need for periodontal therapy, and the level of function (p < 0.005). Assessment of the level of function by staff could assist in triaging individuals for urgent dental examination. Despite 41 per cent of children requiring simple treatment, the preventive and treatment needs of many remained unmet. Following examination, diagnosis and treatment planning by a dentist, much of the preventive, simple treatment and oral health promotion could be performed by trained dental auxiliaries. An epidemiological survey followed by the implementation and evaluation of a long-range public dental health care plan for children and adolescents with disabilities is needed urgently.
Normal-learning children (NL) and children with learning disabilities (LD) reported their perceptions of unisensory (auditory or visual), concordant audiovisual (e.g. visual /apa/ and auditory /apa/) and conflicting (e.g. visual /aka/ and auditory /apa/) speech stimuli in quiet and noise (0 dB and -12 dB signal-to-noise ratio, SNR). In normal populations, watching such conflicting combinations typically changes auditory percepts ('McGurk effect'). NL and LD children identified unisensory auditory and congruent audiovisual stimuli similarly in all conditions. Despite being less accurate identifying unisensory visual stimuli, LD children were more likely than NL children to report hearing only the visual component of incongruent audiovisual stimuli at -12 dB SNR. Furthermore, LD children with brainstem timing deficits demonstrated a distinctive pattern of audiovisual perception. The results suggest that the perception of simultaneous auditory and visual speech differs between NL and LD children, perhaps reflecting variations in neural processing underlying multisensory integration.
Pediatricians, family physicians, and surgical specialists are the main providers of medical care for children with disabilities. Physicians who treat these children often find themselves wallowing in a confusing mass of acronyms, laws; agencies, regulations, criteria, and bureaucracy. By defining and explaining some of the current laws and regulations related to services and financial assistance for children with disabilities, this article will help physicians serve these children more effectively.
UNLABELLED: The osteogenic potential of short durations of low-level mechanical stimuli was examined in children with disabling conditions. The mean change in tibia vTBMD was +6.3% in the intervention group compared with -11.9% in the control group. This pilot randomized controlled trial provides preliminary evidence that low-level mechanical stimuli represent a noninvasive, non-pharmacological treatment of low BMD in children with disabling conditions. INTRODUCTION: Recent animal studies have demonstrated the anabolic potential of low-magnitude, high-frequency mechanical stimuli to the trabecular bone of weight-bearing regions of the skeleton. The main aim of this prospective, double-blind, randomized placebo-controlled pilot trial (RCT) was to examine whether these signals could effectively increase tibial and spinal volumetric trabecular BMD (vTBMD; mg/ml) in children with disabling conditions. MATERIALS AND METHODS: Twenty pre-or postpubertal disabled, ambulant, children (14 males, 6 females; mean age, 9.1 +/- 4.3 years; range, 4-19 years) were randomized to standing on active (n = 10; 0.3g, 90 Hz) or placebo (n = 10) devices for 10 minutes/day, 5 days/week for 6 months. The primary outcomes of the trial were proximal tibial and spinal (L2) vTBMD (mg/ml), measured using 3-D QCT. Posthoc analyses were performed to determine whether the treatment had an effect on diaphyseal cortical bone and muscle parameters. RESULTS AND CONCLUSIONS: Compliance was 44% (4.4 minutes per day), as determined by mean time on treatment (567.9 minutes) compared with expected time on treatment over the 6 months (1300 minutes). After 6 months, the mean change in proximal tibial vTBMD in children who stood on active devices was 6.27 mg/ml (+6.3%); in children who stood on placebo devices, vTBMD decreased by -9.45 mg/ml (-11.9%). Thus, the net benefit of treatment was +15.72 mg/ml (17.7%; p = 0.0033). In the spine, the net benefit of treatment, compared with placebo, was +6.72 mg/ml, (p = 0.14). Diaphyseal bone and muscle parameters did not show a response to treatment. The results of this pilot RCT have shown for the first time that low-magnitude, high-frequency mechanical stimuli are anabolic to trabecular bone in children, possibly by providing a surrogate for suppressed muscular activity in the disabled. Over the course of a longer treatment period, harnessing bone's sensitivity to these stimuli may provide a non-pharmacological treatment for bone fragility in children.
This study compared performance on the Functional Independence Measure for Children (WeeFIM), the Battelle Developmental Inventory Screening Test (BDIST), and the Vineland Adaptive Behavior Scales (VABS) in children with developmental disabilities. The three instruments were administered to 205 children with identified disabilities. All 205 children were tested using the WeeFIM instrument. The BDIST was administered to 101 children and the VABS to the remaining 104 children. Administration was counterbalanced and randomized across all three instruments. A proportional sampling plan was used to select the 205 children, who ranged in age from 11 to 87 months. A variety of medical diagnoses and levels of severity of motor, cognitive, and communication impairments were systematically included in the sample. Correlations (r) among subscales for all three instruments ranged from 0.42 to 0.92. Correlations for total scores ranged from 0.72 to 0.94. Analyses of potential moderator variables found no significant relation between age and severity of disability (r=0.05) or between socioeconomic status (SES) and severity of disability (r=0.21). Correlations with age were strongest for those subscale scores involving gross and fine motor skills. Correlations with SES and subscale scores ranged from 0.03 to 0.18. The three instruments provide important information regarding childhood performance in motor, self-care, communicative, cognitive, and social skills. The WeeFIM instrument requires less administration time and provides information directly relevant to evaluating functional outcomes for children with disabilities and their families.
Because of the multifactorial nature of the nutrition problems associated with developmental disabilities, a well-organized, interdisciplinary effort is necessary to deal with such problems. A team composed of professional and support staff, the client, and the family needs to be involved in an integrated approach to service. The team members share their knowledge and expertise in developing an individual program plan to meet identified needs. This article describes the development and implementation of a prototype for interdisciplinary nutritional evaluation and intervention in an outpatient setting. In 1987, a Regional Nutrition and Feeding Diagnosis and Evaluation Clinic was established through a contractual agreement between the University of Georgia University Affiliated Program and St. Mary's Hospital in Athens, GA. The purposes of the clinic are twofold: to offer direct services to developmentally disabled infants and children who require outpatient services and to provide a unique community-based interdisciplinary training experience for graduate students in nutrition and other health disciplines. The interdisciplinary treatment protocol is based on current knowledge in the treatment of developmental disabilities.
The Perceived Efficacy and Goal Setting System (PEGS) is an instrument and a process that enables children with disabilities to reflect on their ability to perform everyday occupations and to identify goals for occupational therapy intervention. In this study, 117 children with disabilities in grades 1-3 completed the PEGS with occupational therapists who work in school settings. Children from 6-9 years of age with a variety of disabilities were able to self-report perceptions of their effectiveness performing 24 activities that would be expected of them each day. Parents and teachers, who completed a parallel questionnaire, rated their abilities lower than the children did. The School Function Assessment, a measure of the amount and type of support required for school participation, had low correlations with the Parent and Teacher PEGS questionnaires and did not correlate with the Child PEGS. No differences in perceived efficacy were found for children across grades or gender; however, differences were found across types of disabilities. Children were able to use the perceived efficacy information to identify and prioritize goals for intervention and these goals remained stable 2 weeks later. Occupational therapists can use the PEGS within a client-centered practice to help the child set goals for therapy and to incorporate explicitly the perspectives of parents and teachers.
OBJECTIVES: The purpose of this study was to obtain data about a national sample of children without disabilities on the 125-item revision of the Sensory Profile, a tool derived from sensory history items reported in the literature and designed to evaluate children's responses to commonly occurring sensory events. METHOD: Parents of 1,115 children completed the Sensory Profile. The children were 3 to 10 years of age and did not have disabilities. Parents used a 5-point Likert scale to report the percentage of time their children engaged in each behavior. Researchers then analyzed the data, using multivariate methods to identify trends in performance and age and gender differences. RESULTS: Ninety-one (73%) of the profile's 125 items were found to be uncommon behaviors for this national sample of children without disabilities. Although age and gender differences were significant (p < .001), effect sizes were so small (i.e., below .2) that differences were not meaningful for clinical application (i.e., mean differences less than .5 points). Only two items in the visual category approached a 1-point difference when comparing younger and older children. CONCLUSION: There were no meaningful gender differences on the revised Sensory Profile, and only 2 items approached a meaningful difference related to age. Nearly three fourths of the items on the profile were uncommon for children without disabilities. If children with various disabilities display these behaviors, the Sensory Profile can be useful in evaluation and program planning for children with disabilities.