Medical risk report: the dental patient with developmental disabilities.
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Adult↗
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Results for “Developmental Disabilities”
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Nutritional assessment of common problems found among the developmentally disabled.
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Body Weight↗
Chemicals in the environment and developmental toxicity to children: a public health and policy perspective.
There are numerous pesticides and toxic chemicals in the environment that have yet to be evaluated for potential to cause developmental neurotoxicity. Recent legislation and testing initiatives provide an impetus to generating more information about potential hazards to children. In the United States, the 1996 Food Quality Protection Act (FQPA) required the U.S. Environmental Protection Agency (U.S. EPA) to make a finding that a pesticide food use is safe for children. In addition, the law requires U.S. EPA to incorporate an additional 10-fold factor in risk assessments for pesticide residue tolerances to take into account the special sensitivities of infants and children as well as incomplete data with respect to toxicity and exposures. The potential of chemicals in food and drinking water to cause endocrine disruption will also be examined via the Endocrine Disruptor Screening and Testing Program required by the FQPA and the 1996 Safe Drinking Water Act. In addition, a new voluntary chemical information program will provide screening-level information for the some 2,800 high-volume chemicals in commerce in the United States. These initiatives will need to be accompanied by research focused on developmental toxicity for children, including developmental disabilities. Developmental disabilities exact a large toll on children's health in the United States. Three major developmental disabilities--autism, cerebral palsy, and severe mental retardation--each affect substantial numbers of children. We know very little about the etiology of these conditions. A number of priority areas for research are suggested, including a large environmental prospective study of developmental neurotoxicity.
Child↗
Pediatric assessment of the child with developmental delay.
With the recent mandate for early intervention services, the pediatrician is more involved than ever in the identification and evaluation of children with developmental disabilities. Developmental surveillance at routine visits and listening to parental concerns are crucial in the early diagnosis of developmental delay so that therapeutic interventions can be provided at a time when there is a good chance of decreasing disability and family stress. Medical evaluations and consultations must be prudent and based on a thorough history and physical. The pediatrician must have the knowledge and skills to coordinate medical care and to counsel and provide support to the child and family as they receive habilitative services and come to terms with the developmental diagnoses.
Child↗
Down syndrome children often have brain with maturation delay, retardation of growth, and cortical dysgenesis.
All Down syndrome (DS) children have different degrees of developmental disabilities, developmental delay, and developmental brain abnormalities associated with CNS maturation delay and cortical dysgenesis. We have examined 780 occipitofrontal circumferences (OFC), mean and +/- SD, of DS children from birth to age 5 years. Also, gross and microscopic neuropathological studies in the same age group were performed, with special attention to brain weight (BW), shape, myelin formation, cortical organization of 101 DS and 80 non-DS individuals; ultrastructural studies were also performed on selective cases (five DS and five non-DS). The OFC was plotted on Nellhause curves and showed microcranium after mid-infancy in most cases. Twenty percent of DS children had an OFC in the lower normal range. The brain shape in DS newborn infants was the same as in non-DS infants, but after 3-5 months of age in DS infants the antero-posterior diameter was found to be shorter than in non-DS infants. Narrowness of the superior temporal gyrus was noted in 34 of 101 (33%) of DS brains. Microscopic examination showed myelination delay in 22.5% DS and only in 6.8% non-DS children. Morphometric studies in DS cases from birth showed fewer neurons (20-50% less), lower neuronal densities, and neuronal distribution, especially of cortical layers II and IV. Ultrastructurally in DS, the synaptic density, synaptic length, and contact zones were found to be abnormal. The retardation of brain growth, maturation delay, and cortical dysgenesis present in DS children most likely are regulated by the extra chromosome 21, but the gene responsible for the abnormalities remains to be determined.
Brain↗
Impaired processing of complex auditory stimuli in rats with induced cerebrocortical microgyria: An animal model of developmental language disabilities.
Individuals with developmental language disabilities, including developmental dyslexia and specific language impairment (SLI), exhibit impairments in processing rapidly presented auditory stimuli. It has been hypothesized that these deficits are associated with concurrent deficits in speech perception and, in turn, impaired language development. Additionally, postmortem analyses of human dyslexic brains have revealed the presence of focal neocortical malformations such as cerebrocortical microgyria. In an initial study bridging these research domains, we found that male rats with induced microgyria were impaired in discriminating rapidly presented auditory stimuli. In order to further assess this anatomical- behavioral association, we designed two experiments using auditory-reflex modification. These studies were intended to assess whether auditory processing deficits in microgyric male rats would be seen in threshold detection of a silent gap in white noise, and in oddball detection of a two-tone stimulus of variable duration. Results showed no differences between sham and microgyric subjects on gap detection, but did show that microgyric subjects were impaired in the discrimination of two-tone stimuli presented in an oddball paradigm. This impairment was evident for stimuli with total duration of 64 msec or less, while both groups were able to discriminate stimuli with duration of 89 msec or greater. The current results further support the relationship between malformations of the cerebral cortex and deficits in rapid auditory processing. They also suggest that the parameters characterizing rapid auditory processing deficits for a specific task may be influenced by stimulus features and/or cognitive demand of that particular task.
Acoustic Stimulation↗
Medicaid program; mental retardation--definition of "persons with related conditions"--Health Care Financing Administration. Proposed rule.
We propose to amend the 1978 Medicaid regulations on intermediate care facility services for the mentally retarded and persons with related conditions to correct the definition of "persons with related conditions". This definition, because of an inadvertent error in 1978, is currently tied to the definition of developmental disability in the Developmental Disabilities Assistance and Bill of Rights Act (DDABRA) as amended in 1978. The DDABRA, as amended, covers the mentally ill. The 1978 regulations intended to make "no substantive change" to prior Medicaid regulations which did not cover the mentally ill. The cross-reference to the DDABRA produced the unintended result of incorporating into Medicaid regulations the revision to the definition of the developmentally disabled created by the 1978 amendments to the DDABRA and may tend to cause confusion about the kind of care that is covered by the Medicaid program. Therefore, a correction of this drafting error is necessary. To avoid results of this kind in the future this proposal would establish a Medicaid definition of conditions related to mental retardation that would meet specific needs of the Medicaid program and would be independent of the definition of developmental disability in the DDABRA.
Centers for Medicare and Medicaid Services, U.S.↗
Pertussis: should we immunise neurologically disabled and developmentally delayed children?
A total of 400 children with neurological disorders were studied to ascertain whether they had been immunised against pertussis, the reasons for non-immunisation, and the "validity" of these reasons, as judged by interpretation of the recommendations of the Department of Health and Social Security. The results for this group were compared with those for a group of 400 aged matched controls. The study group had a significantly lower rate of immunisation than controls (p less than 0.01); rates for both groups fell sharply after 1975. A total of 192 study patients and 186 controls were not immunised. Those children with cerebral palsy had the lowest rate of immunisation (19%) and the highest number of valid reasons for non-immunisation (63%). Paediatricians apparently advised against immunisation in 61 (32%) of the index group but in only four (2%) of the controls. The risk of serious neurological handicap after pertussis immunisation is small and there is little evidence to support the view that underlying neurological disease predisposes a child to increased risk. The advice currently given by paediatricians may need to be reconsidered.
Attitude to Health↗
Spatial cognition in children. II. Visuospatial and constructional skills in developmental reading disability.
Cognitive models for developmental dyslexia are nowadays centered on the hypothesis of a specific deficit within the phonologic module of the language system. To ascertain whether defects of spatial cognition are associated with developmental reading disability, we investigated a sample of 43 school children (aged 8-9 years) found to be reading impaired during a wide screening survey for developmental dyslexia in the province of Naples, Italy. After one year all children were tested again and only 9/43 still presented reading impairment, while the remaining had achieved a variable range of spontaneous recovery. A detailed analysis was performed on all children to characterize their cognitive performances using on one hand classical conventional tests for constructional praxis, visuospatial cognition, and visuospatial memory and on the other a specific neuropsychological battery for constructional disorders. The results of our study demonstrated that children with long-lasting reading impairment exhibited normal performances on spatial cognition tasks. Moreover, one single child was found with relevant visuospatial deficits pointing to the possible existence of a visuospatial subtype for developmental dyslexia.
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Media reports on disability: a binational comparison of types and causes of disability as reported in major newspapers.
PURPOSE: The study aimed to examine the way in which newspapers in two countries relate to problems of disability and people with disabilities. In particular, we looked at the way the extent, type and focus of newspaper articles in both countries varied with the type and cause of the disability under discussion. METHOD: A content analysis of over 400 newspaper articles collected over a 3 month period in Canada and Israel was carried out. RESULTS: The findings show that physical disabilities received the most media attention and positive treatment in both countries, followed by psychiatric disabilities and then developmental disabilities. Likewise, disabilities stemming from congenital problems were treated more positively. The Canadian press was somewhat more progressive than the Israeli press at naming individuals with disability, using appropriate labelling and focusing on somewhat more progressive issues. On the other hand, people with developmental disabilities received more favourable treatment in the Israeli press. CONCLUSIONS: The press has an important role in reflecting and shaping public attitudes. In many ways media coverage reinforces negative attitudes towards people with disabilities, particularly those with psychiatric and developmental disabilities. While there were some differences between the two countries, overall the results suggest that these tendencies, which have been observed in other countries as well, are not limited by national boundaries.
Attitude to Health↗
Atypical brain development: a conceptual framework for understanding developmental learning disabilities.
This article presents ideas that are, in part, a response to the ambiguity in the neurological research on learning disorders, the growing awareness that developmental disabilities are typically nonspecific and heterogeneous, and the growing scientific literature showing that comorbidity of symptoms and syndromes is the rule rather than the exception. This article proposes the term atypical brain development (ABD) as a unifying concept to assist researchers and educators trying to come to terms with these dilemmas. ABD is meant to serve as an integrative concept of etiology, the expression of which is variable within and across individuals. ABD does not itself represent a specific disorder or disease. It is a term that can be used to address the full range of developmental disorders that are found to be overlapping much of the time in any sample of children. Although similar in spirit to the older term of minimal brain dysfunction (MBD), in that it closely links neurology with behavioral difficulties, ABD as proposed here differs in several ways. In support of the ABD conceptual framework, first, we consider the ABD concept in terms of its superiority to the older notion of MBD. Second, we provide a brief review of the burgeoning literature on the overlap of the various developmental disabilities. Third, we review some of the scientific literature that supports the ABD concept. Our sole purpose in proposing this concept is to initiate dialogue and debate on several critical issues across a wide variety disciplines. Hence, this article is not intended to be a definitive statement of a rigid perspective. It reflects neither a nonmalleable philosophical position, nor any type of condemnation of other perspectives. It does, however, reflect a data-based and philosophical trend visible in the field of learning disabilities, as well as the broader area of childhood developmental disorders.
Attention Deficit Disorder with Hyperactivity↗
Focal cerebral dysfunction in developmental learning disabilities.
In 24 children with developmental learning disabilities and 15 age-matched controls regional cerebral activity was studied with xenon-133 single photon emission tomography. In the 9 children with pure attention deficit and hyperactivity disorder (ADHD), the distribution of regional cerebral activity was abnormal--low in striatal and posterior periventricular regions and high in occipital regions. Low activity in striatal and posterior periventricular areas was also seen in the 8 children with ADHD in combination with phonologic-syntactic dysphasia. 7 children with dysphasia, but without hyperactive behaviour, had low cerebral activity in left temporofrontal regions.
Adolescent↗
Quantification of postural sway patterns in tardive dyskinesia.
An assessment was made of the orientation and variability in postural center of pressure patterns in individuals with tardive dyskinesia (TD) and/or developmental disability during quiet standing. Postural patterns were compared and contrasted between four groups of individuals: those with (a) TD and developmentally disabled (severely and profoundly retarded); (b) developmental disability only; (c) TD but of normal intelligence; and (d) a healthy control group. The center of pressure displacements were derived from the lateral, vertical, and anterior-posterior force and moment components of force platform measurements. Analyses demonstrated that individuals with TD in combination with developmental disability had a different center of pressure orientation and variability compared to healthy individuals and individuals suffering only from developmental disability or TD. The center of pressure pattern in the developmentally disabled TD group was characterized by a more prominent lateral orientation, whereas in the other three groups, it had a more predominant anterior-posterior orientation. In addition, the variability in these orientation components was much smaller in the developmentally disabled TD group, indicating a more regular pattern of sway in the center of pressure during quiet standing in these individuals. These findings show that assessments of postural center of pressure profile orientation and variability may be useful indicators for investigating TD, especially in distinguishing between developmental disability and TD.
Adult↗
Aging in individuals with lifelong disabilities.
The major research data and findings related to aging among persons with developmental disabilities are discussed. Differences between the aging processes noted in the general population and individuals who have developmental disabilities are highlighted. Topics addressed include prevalence of developmental disabilities and mortality rates for individuals with developmental disabilities. The effects of aging on the senses, the neuromusculoskeletal system, and the cardiopulmonary system are presented along with the clinical implications of these changes in individuals with developmental disabilities who are aging.
Adolescent↗
Effect of reinforced laryngeal mask airway or endotracheal intubation anesthesia on adverse events: quality of life issues for dental patients requiring general sedation.
This study tested whether the use of a reinforced laryngeal mask airway (LMA) compared to endotracheal intubation (El) anesthesia diminished adverse events and improved the post-operative quality of life for 146 dental patients who required general anesthesia due to developmental disabilities. In this randomized, crossover trial, patients received either reinforced LMA or El anesthesia during an initial dental treatment visit; the other anesthetic method was used during a second visit scheduled after six months or more. Data were assessed with Student's t-test, chi-square test and McNemar's test to evaluate the affect on quality of life by analyzing disturbances in daily activity, such as eating patterns and sleeping behaviors after the procedure. Although the reinforced LMA anesthesia was associated with a significantly lowered incidence of adverse events (p = .04), neither method significantly disturbed quality of life activities.
Activities of Daily Living↗
Predoctoral education in special care dentistry: paving the way to better access?
The number of people with mental retardation and developmental disabilities (MR/DD) living in small community-based group residences is increasing throughout the United States. Dental services to this population, once provided in large institutional settings, must increasingly be sought at the community level. The purpose of this study was to determine whether U.S. and Canadian dental schools are adequately training their students to provide quality dental care to this group with complex psychosocial and medical issues. With a response rate of 78 percent to a mail survey, it was found that 53 percent of the schools provide less than five hours of didactic training in special care dentistry. Clinical training in this area comprised only 0-5 percent of predoctoral students' time in 73 percent of the responding schools.
Canada↗
Community-based dental services for patients with special needs.
Deinstitutionalization of individuals with mental retardation and developmental disabilities has increased the demand for dental services for these patients by community practitioners. There are numerous difficulties associated with the delivery of care to this population with special needs. Nevertheless, a county-by-county review for New York State indicates that in most instances, if all dentists are willing to help, there would be a relatively small number of these patients per dental practitioner.
Child↗
Medicaid program--mental retardation; definition of "persons with related conditions"--HCFA. Final rule.
This rule amends a definition in Medicaid regulations concerning intermediate care facilities for the mentally retarded (ICF/MR) and persons with related conditions. The definition of "persons with related conditions" contained in our regulations was tied to the definition of developmental disability included in the Developmental Disabilities Assistance and Bill of Rights Act (DDABRA) as amended in 1978. The DDABRA, as amended, however, also included the mentally ill within the definition of developmental disability. The prior cross-reference in our regulations to the DDABRA definition resulted in confusion about the kind of care covered by the ICF/MR benefit. To avoid misunderstandings in the future, this rule establishes an independent Medicaid definition of persons with conditions related to mental retardation.
Centers for Medicare and Medicaid Services, U.S.↗