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PubMed2001

Rumination.

Rumination is an unusual gastrointestinal symptom that is characterized by the repetitive regurgitation of gastric contents into the oropharynx. The regurgitation occurs very soon after a meal and tends to persist for 1 to 2 hours. Rumination is defined by the setting in which it occurs. It is seen in three distinct populations: infants; individuals with psychiatric and neurologic disorders, particularly developmental disabilities; and adults who do not have overt psychiatric or neurologic disorders. The hallmark of rumination, which separates it from other disorders of the upper gastrointestinal tract (such as gastroesophageal reflux disease or cyclic vomiting syndrome), is the fact that in patients with rumination, the gastric contents appear in the oropharynx without retching or nausea. Rather, the patient makes a conscious decision on how to handle the regurgitated material after it presents into the oropharynx. The regurgitated meal usually consists of undigested or partially digested food. The regurgitation is effortless or at most is preceded by a sensation of belching immediately prior to the regurgitation itself. The management of patients with rumination needs to be accomplished in a highly individualized manner. Children with infant rumination syndrome often have symptoms related to significant defects in bonding with their mother. Thus, problems of mother-child bonding in pediatric patients with rumination syndrome should be identified and appropriately addressed. The management of adult patients with developmental disabilities or neurologic impairments who ruminate focuses mainly on behavioral modalities, including adversive conditioning and contingency management. The healthy adult who ruminates and has no evidence of neurologic or developmental disability is best seen as someone with a habit. Management in these patients is directed towards adjunctive therapies (ie, the use of proton pump inhibitors or H(2 )receptor antagonists to decrease acid injury to the esophagus) as well as identifying situations and emotions that trigger the patient's symptoms. Randomized controlled trials of various treatment modalities need to be undertaken; likewise, the evaluation strategy needed to best diagnose rumination is yet to be well defined. At this time, the challenge for gastroenterologists is to understand the nature of rumination, to identify individuals at high risk, and to use the management strategies most associated with good outcomes in patients with rumination in various clinical settings.

Journal Article↗

PubMed2006

Comprehension: an overlooked component in augmented language development.

PURPOSE: Despite the importance of children's receptive skills as a foundation for later productive word use, the role of receptive language traditionally has received very limited attention since the focus in linguistic development has centered on language production. For children with significant developmental disabilities and communication impairments, augmented language systems have been devised as a tool both for language input and output. The role of both speech and symbol comprehension skills is emphasized in this paper. METHOD: Data collected from two longitudinal studies of children and youth with severe disabilities and limited speech serve as illustrations in this paper. The acquisition and use of the System for Augmenting Language (SAL) was studied in home and school settings. Communication behaviors of the children and youth and their communication partners were observed and language assessment measures were collected. RESULTS: Two patterns of symbol learning and achievement--beginning and advanced--were observed. Extant speech comprehension skills brought to the augmented language learning task impacted the participants' patterns of symbol learning and use. CONCLUSIONS: Though often overlooked, the importance of speech and symbol comprehension skills were underscored in the studies described. Future areas for research are identified.

Child↗

PubMed2005

Effects of prelinguistic communication levels on initiation and repair of communication in children with disabilities.

PURPOSE: This study examined the effects of expressive and receptive language levels on initiated and repaired communication acts by prelinguistic children with developmental disabilities. METHOD: In this descriptive study, participants were 45 children between the ages of 3 and 6 years who had severe delays in expressive communication. Some children communicated with 12 or fewer spoken words; others communicated exclusively with gestures and vocalizations. Participants also had delays in receptive language, and 41 of the 45 had below average IQ scores. The children participated in a scripted interaction with examiners that was designed to provide opportunities to initiate requests and comments, and to repair communication breakdowns. Videotapes of these interactions were later coded for analysis. RESULTS: Regression models indicated that differences in children's expressive communication levels and receptive language scores significantly predicted children's commenting communication acts during the scripted interaction, even after the authors accounted for child IQ. Expressive communication level was also a significant predictor of initiated requests when the authors controlled for IQ. Expressive communication level contributed to the variance in children's repairs following communication breakdowns; however, this contribution was not significant. CONCLUSION: Differences in levels of prelinguistic communication development predict commenting abilities in children with developmental disabilities but do not appear to predict likelihood to repair communication breakdowns.

Autistic Disorder↗

PubMed2005

Associations of social support and hardiness with mental health among mothers of adult children with intellectual disability.

BACKGROUND: The study was conducted with mothers of adult children with developmental disabilities and had two aims: (1) to examine the mental health, resources and stress among mothers who keep their adult child at home vs. those who choose placement in a community arrangement; and (2) to assess the associations of mothers' resources and stress with mental health. METHOD: A sample of 100 mothers (mean age 60.67 years) of adult children with intellectual disability, 50% of whom had been placed in a community arrangement were asked to complete questionnaires measuring mental health, stress, hardiness and social support. RESULTS: The comparisons between mothers who had placed their adult child in a community arrangement and those who had kept their child at home showed no significant differences for most indicators. Mental health, stress, hardiness and social support were highly intercorrelated, as expected, and hierarchical regression analyses indicated independent effects of stress, hardiness and out-of-home placement on mental health. CONCLUSIONS: The findings suggest that strengthening personal and social resources of mothers of adult children with developmental disabilities may be beneficial for their mental health.

Adult↗

PubMed1999

Adaptation during early childhood among mothers of children with disabilities.

This study documents the extent to which child-related and parenting stress vary during the early childhood period among mothers of children with developmental disabilities. The degree to which specific aspects of the family environment predict stress levels measured at age 3 years and 5 years, after controlling for child characteristics and family income, is also investigated. The Parenting Stress Index was completed by 79 mothers of children with developmental disabilities at three time points: (1) within 1 month of the child's entry into an early intervention program (T1); (2) within 1 month of the child's third birthday (T3); and (3) within 1 month of the child's fifth birthday (T5). Data on child characteristics and family income as well as measures of the family environment (i.e., negative life events, cohesion, and family support) were gathered at both T1 and T3. Repeated measures analysis of variance was used to assess whether there was significant change in the child-related and parenting stress scores across the three time points. Two sets of hierarchical regression equations were also analyzed. The first examined which child, family, and family environment characteristics assessed at T1 predicted stress at T3. The second identified the predictors of T5 stress based on independent variables measured at T3. Child-related stress increased significantly across the three time points, whereas parenting stress remained fairly stable. By age 5 years, one-third of the mothers had child-related stress scores above the clinical cutoff point. Regression analyses revealed the importance of the family environment in predicting both stress outcomes. The only statistically significant predictor of child-related stress at T3 was family cohesion, whereas parenting stress at T3 was predicted by income, cohesion, and family support. The predictors of both child-related and parenting stress at T5 were the same. Greater family cohesion and fewer negative life events predicted lower stress scores at T5. The significant increase in child-related stress during the early childhood period warrants attention by pediatricians, educators, and other professionals who must evaluate the needs of families of children with disabilities for supportive services. Aspects of the family environment were shown to be critical and consistent determinants of both child-related and parenting stress throughout the early childhood period. This finding suggests that pediatricians, in particular, must assess more than simply the diagnosis or the cognitive impairment of the child with a disability to make informed decisions about the frequency with which they should see particular families and whether referral to other services is necessary.

Adaptation, Psychological↗

PubMedDate not supplied

Reducing overselective attention to compound visual cues with extended training in adolescents with severe mental retardation.

Because of the devastating impact a disturbance in responding to multiple cues can have on a child's development, this investigation determined whether computer touch-screen technology could be utilized to improve the attentional skills of students with severe developmental disabilities after attentional deficits were initially identified. In particular, we assessed whether establishing prior reinforcement histories for separate stimuli would control how adolescents with severe mental retardation attended to visual compounds when extended training was given. Initially, prior reinforcement contingencies of individual stimuli failed to control the attention of the adolescents (Huguenin, 1997). Longer single stimulus pretraining and additional exposure to compounds containing stimulus components with conflicting reinforcement histories, however, eventually proved effective in determining what aspects of complex visual cues they attended to. In most instances, the adolescents selectively responded to stimulus elements whose prior reinforcement histories were unchanged in the compound after additional training was administered. Stimulus elements with a reversed prior reinforcement contingency were usually ignored. The reliability of the effect of prior reinforcement histories of individual stimulus elements on attention to visual compounds following additional training was confirmed with multiple testing procedures, automatically administered by a computer. Even though presenting conflict compounds initially identified students with overselective attention, extended exposure to single stimulus training and conflict compounds alleviated stimulus overselectivity and improved their attentional skills. After individual stimulus-response relations were reestablished and sufficiently reinforced to reduce disrupting effects when compound training cues were presented, stimulus overselectivity was eliminated. Through longer single stimulus pretraining and additional exposure to training compounds, adolescents with severe mental retardation learned to selectively attend to each component of visual compounds when prior reinforcement histories associated with the individual stimulus elements were manipulated. The findings of this investigation indicated that overselective attention among students with developmental disabilities is not an unmodifiable perceptual characteristic. They also revealed that overselective attention may be due to the disrupting effects of compound training cues which can be minimized through longer single stimulus pretraining and repeated presentations of compound training cues. Utilizing computer technology to administer procedures similar to those described in this study may permit students with developmental disabilities to acquire essential attentional skills for learning educational tasks involving complex cues.

Adolescent↗

PubMed1995

Early childhood surveillance of developmental disorders by a birth defects surveillance system: methods, prevalence comparisons, and mortality patterns.

The prevalence of developmental disabilities in early childhood is not well documented. An established birth defects registry extended surveillance to identify cases of developmental disorders in early childhood by adding all known sources of diagnosis and service to case-finding methods. Residents of a northwest Arkansas region born during 1985 to 1987 and diagnosed with either a birth defect or a developmental disorder by the 4th birthday comprised the studied cohort. Case records were linked with death certificates to examine the influence of mortality on prevalence ratios. Prevalence ratios estimated were 64.5/1000 resident live births (60.9/1000 among survivors to age 4 years) for either birth defect or developmental disorder, 33.4/1000 for developmental disorder, 37.0/1000 for birth defect, and 9.5/1000 for both developmental disorder and birth defect. Prevalence ratios of specific developmental disorders and the role of mortality in decreasing population prevalence are reported. The most common diagnostic categories in this age group were developmental delay, seizures, and failure to thrive. Overlap of birth defect categories with a diagnosed developmental disability was examined; 68.8% of children diagnosed with neural tube defects and 45.5% of those with chromosomal abnormalities who survived to age 4 years had clinically diagnosed developmental disorders. An anticipated high degree of overlap (77%) for other central nervous system defects was found. For other birth defect categories, developmental disorder diagnosis was present in 20 to 30% of the study group. Death before age 4 years occurred most often when the diagnosis was newborn seizures (17.1%) or "conditions of the brain" (13.6%); the mortality rate was 6 to 8% for epilepsy or seizure disorders, mental retardation, and vision loss. The large number of developmental diagnoses among this cohort indicates that surveillance of these disorders in early childhood, even with tentative diagnoses, is feasible. Data obtained indicate that many birth defects are associated with developmental disorders; potentially, this association can contribute to earlier identification of developmental disorders in childhood.

Arkansas↗

PubMed1993

The high-risk infant.

A large number of infants are born each year with biologic or environmental risk factors that put them at increased risk for developmental disability, although most do not go on to have major disabilities. Some risk factors, for example, intraparenchymal hemorrhage, periventricular cysts, encephalomalacia, and abnormal neurodevelopmental examination, carry a much higher risk of developmental disability than others. There is much overlap among risk factors, and infants with multiple risk factors generally have a greater risk of disability than infants with just a single risk factor. All high-risk infants should receive careful pediatric follow-up that includes developmental screening, but efficient use of so far quite limited resources argues for selection of the highest risk infants for comprehensive developmental follow-up or early intervention programs. A system of tracking and monitoring high-risk infants during infancy and childhood would allow for early identification of developmental delay and appropriate referral for community resources.

Child, Preschool↗

PubMed2000

Aetiology of childhood vision impairment, metropolitan Atlanta, 1991-93.

Data from the population-based Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) were used to describe the underlying causes of vision impairment (VI; corrected visual acuity in the better eye of 20/70 or worse) in young children (n = 228) in metropolitan Atlanta in 1991-93. Children with VI were identified through record review at multiple educational and medical sources. Children were categorised as having isolated VI or multiple disabilities (i.e. VI plus one or more of four additional developmental disabilities) and as having low vision (visual acuity 20/70-20/400) or blindness (visual acuity worse than 20/400). Medical conditions abstracted from MADDSP sources were reviewed to determine the probable aetiology of a child's VI. Aetiologies were assigned to one of three developmental time periods: prenatal, perinatal, or postnatal. Prenatal aetiologies were identified in 43% of the children; 38% of the prenatal aetiologies were genetic. Perinatal aetiologies were found in 27% of the children. Postnatal aetiologies were rare. Prenatal aetiologies were more common in children with isolated VI; perinatal and postnatal aetiologies were more common in children with multiple disabilities. Children with prenatal aetiologies tended to have less severe vision loss than did children with perinatal or postnatal aetiologies. The distribution varied by birthweight, but did not differ significantly by sex or race.

Abnormalities, Multiple↗

PubMed1998

Psychological services utilization: relationship to severity of behaviour problems in intellectual disability services.

Using the Developmental Disabilities Profile, a population service registry, the present study gives an analysis of the relationship between the rated frequency of contact with psychology specialists and a composite rating of 13 behaviour problems in intellectual disability services. An analysis of information on 45,810 adults with intellectual disability indicated that, when the population was divided into quintile groups based on behaviour severity, distinctively different distributions of rated contacts with psychologists were discernible. The people rated in the highest quintile for severity of maladaptive behaviour constituted especially high utilizers of psychology services. About 37% of participants had had no contact with psychologists during the past year, whereas 26% had such contact weekly or more frequently. The findings are introduced and discussed in the context of psychological practice in intellectual disability services and trends toward managed health and behavioural health care in the USA.

Adolescent↗

PubMed1996

Influence of child diagnosis on family and parental functioning: Down syndrome versus other disabilities.

Although children with Down syndrome are popularly conceived of as having easy temperaments and agreeable personalities, conflicting reports exist as to whether they are easier to rear than are children with other developmental disabilities. To compensate for possibly biased samples in earlier studies, we employed three methodological strategies, including case-by-case matching of families raising children with Down syndrome and families raising children with other types of developmental disabilities. Results showed no differences between matched groups on various measures of functioning, a finding replicated with multiple regression techniques. However, in unmatched samples families of children with Down syndrome showed better functioning. Thus, previous research demonstrating better adjustment for families rearing children with Down syndrome should be re-examined for sampling biases.

Child↗

PubMed1994

Prospective, controlled study of developmental outcome in survivors of extracorporeal membrane oxygenation: the first 24 months.

OBJECTIVE: Survivors of venoarterial extracorporeal membrane oxygenation (ECMO) are considered to be at risk for developmental disabilities, but there are few controlled outcome studies. A prospective, controlled study of outcome was performed to quantify the degree and frequency of developmental disabilities in ECMO survivors compared with a matched control group. METHODS: From May 1987 through November 1990, 40 of 47 neonates treated with ECMO survived at the University of Texas Medical Branch in Galveston. Longitudinal developmental data were collected, using the Bayley Scales of Infant Development, on 22 ECMO infants and 29 healthy term control infants at 6, 12, and 24 months. Language was assessed at 24 months using the Sequenced Inventory of Communication Development. An additional 13 ECMO infants had developmental data for at least one time point. RESULTS: Healthy term infants performed significantly better than ECMO infants on the Bayley Scales of Infant Development at 6 and 24 months and on the Sequenced Inventory of Communication Development at 24 months. Mean scores of ECMO infants were well within the average range and 77% of the ECMO infants were developmentally normal. CONCLUSIONS: These data suggest that early developmental morbidity in ECMO survivors is low, considering the severity of their neonatal illness.

Analysis of Variance↗

PubMed2002

[The role of nurses in early rehabilitation of children with developmental disorders].

The role of nurse in early rehabilitation of children with developmental disorders in our country is still not clear and little investigated. The main purpose of the study was to analyze the needs of nursing at the department of Early Rehabilitation, describe appropriate activity spheres for the nurses, and prepare methodical recommendations for the nurse's work with developmentally disabled children. The study was carried out at the in-patient department of Early Rehabilitation, Child Development Center, Vilnius University Hospital. Eighty six mothers of developmentally disabled children were interviewed and filled the questionnaire developed by the authors. Aspects of mothers' views, opinions, suggestions and needs were investigated. The data revealed an interesting overview of the current situation in the field from the patient's perspective. The need for the adequate nurse and care was obvious. The role of the nurses is underestimated and functions could be broader expanded regarding the specific needs of the disabled children and their families. Organizational and practical recommendations are provided.

Child↗

PubMed1993

Influence of social partner on interactions of toddlers with disabilities: comparison of interactions with mothers and familiar playmates.

The social exchanges of young children with developmental disabilities over time with two different social partners and the nature of these exchanges were compared. Thirty-three toddlers with developmental disabilities were video-taped for 15 minutes with each partner at two different data points. Data were transcribed and coded using a modification of Vandell and Wilson's (1979) coding system. Results showed that more of the observation time was spent socially with mothers than with peers, and the number of turns per exchange was longer with mothers. In contrast, toddlers initiated more social exchanges with peers than with mothers. There were similarities in the content of the social exchanges with both partners. There were few changes over time, although exchanges consisted of more purely social behaviors at Time 2. Results were interpreted with respect to implications for early intervention.

Child, Preschool↗

PubMed1988

Natural history of Williams syndrome: physical characteristics.

The natural history of Williams syndrome, including medical complications, growth patterns, and problems in adulthood, was investigated. A growth pattern characterized by delay in the first 4 years of life, catch-up growth in childhood, and low ultimate adult height was found. Despite multiple medical problems in infancy, including feeding problems, failure to thrive, colic, and otitis media, mean age at diagnosis was 6.4 years. Developmental disabilities and cardiovascular disease were the major concerns in childhood. The older children developed progressive joint limitation and hypertonia. Adult patients were handicapped by their developmental disabilities. Hypertension, and gastrointestinal and genitourinary problems occurred frequently. Independent living and competitive employment were limited less by the individual's physical problems than by the psychologic and adaptive limitations. Williams syndrome is a progressive disorder with multisystem involvement.

Abnormalities, Multiple↗

PubMed2003

Parents' evaluation of developmental status: how well do parents' concerns identify children with behavioral and emotional problems?

This study was undertaken to determine which parental concerns are most associated with significant behavioral/emotional problems and the extent to which parents' concerns can be depended on in the detection of mental health problems. An additional goal is to view how well a recently published screening test relying on parents' concerns, Parents' Evaluation of Developmental Status (PEDS), detects behavioral and emotional problems. Subjects were a national sample of 472 parents and their children (21 months to 8 years old) who were participants in 1 of 2 test standardization and validation studies. Sites included various pediatric settings, public schools, and Head Start programs in 5 diverse geographic locations. Subjects were representative of U.S. demographics in terms of ethnicity, parental level of education, gender, and socioeconomic status. At each site, psychological examiners, educational diagnosticians, or school psychologists recruited families, and obtained informed consent. Examiners disseminated a demographics questionnaire (in English or Spanish) and a developmental screening test that relies on parents' concerns (PEDS). Examiners were blinded to PEDS' scoring and interpretation administered either by interview or in writing, the Eyberg Child Behavior Inventory (ECBI) or the Possible Problems Checklist (PPC), a subtest of the Child Development Inventory that includes items measuring emotional well-being and behavioral self-control. PEDS was used to sort children into risk for developmental disabilities according to various types of parental concern. Those identified as having high or moderate risk were nominated for diagnostic testing or screening followed by developmental and mental health services when indicated. Because their emotional and behavioral needs would have been identified and addressed, these groups were removed from the analysis (N = 177). Of the 295 children who would not have been nominated for further scrutiny on PEDS due to their low risk of developmental problems, 102 had parents with concerns not predictive of developmental disabilities (e.g., behavior, social skills, self-help skills) and 193 had no concerns at all. Of the 295 children, 12% had scores on either the ECBI or the PPC indicative of mental health problems. Two parental concerns were identified through logistic regression as predictive of mental health status: behavior (OR = 4.74, CI = 1.69-13.30); and social skills (OR = 5.76, CI = 2.46-13.50). If one or more of these concerns was present, children had 8.5 times the risk of mental health problems (CI = 3.69-19.71) In children 434 years of age and older, one or both concerns was 87% sensitive and 79% specific to mental health status, figures keeping with standards for screening test accuracy. In young children, the presence of one or both concerns was 68% sensitive and 66% specific to mental health status. The findings suggest that certain parental concerns, if carefully elicited, can be depended on to detect mental health problems when children are 41 years and older and at low risk of developmental problems. For younger children, clinicians should counsel parents in disciplinary techniques, follow up, and if suggestions were not effective, administer a behavioral-emotional screening test such as the Pediatric Symptoms Checklist or the ECBI before making a referral decision.

Affective Symptoms↗

PubMed2002

Early rehabilitation service utilization patterns in young children with developmental delays.

OBJECTIVE: There is a growing demand for interdisciplinary rehabilitation services for children with developmental disabilities, however, information is lacking on service utilization patterns. This study describes the type, frequency and location of initial rehabilitation services provided to young children recently diagnosed with a developmental delay. METHODS: A telephone survey was conducted on a consecutive cohort of children referred to subspecialists for the first investigation of their delay. RESULTS: Out of 129 respondents, only 30 (23%) did not receive any rehabilitation services within the first 6 months following medical evaluation, and 61 (47%) received two or more services. Services were provided most frequently in the hospital setting, especially for occupational or physical therapy (73-80%). Services were less often rendered in a rehabilitation centre (5-13%) or in the community (< 10%). Services were provided privately for a subset, particularly for speech language pathology and psychology (34% and 30% respectively). Interventions were typically given weekly or bi-weekly. Children receiving physical therapy were significantly younger whereas children referred to speech language pathology were older than the age of our cohort at intake. Overall, parents' educational level did not influence services received with the exception of private services, which were more likely to occur in children of fathers with university education. CONCLUSIONS: The findings would suggest that long waiting times and lack of resources may limit access to comprehensive services, particularly in community settings. Service utilization patterns were not consistent within types of developmental disability, suggesting that formal and co-ordinated interdisciplinary programmes are not in place for this population of interest.

Child, Preschool↗

PubMed1998

Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA); interpretation of "federal public benefit"--HHS. Notice with comment period.

This notice with comment period interprets the term "Federal public benefit" as used in Title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Pub. L. 104-193, and identifies the HHS programs that provide such benefits under this interpretation. According to section 401 if PRWORA, aliens who are not "qualified aliens" are not eligible for any "Federal public benefit," unless the "Federal public benefit" falls within a specified exception. A "Federal public benefit" includes "any grant, contract, loan, professional license, or commercial license" provided to an individual, and also "any retirement, welfare, health, disability, public or assisted housing, postsecondary education, food assistance, unemployment benefit, or any other similar benefit for which payments or assistance are provided to an individual, household, or family eligibility unit." Under section 432, providers of a non-exempt "Federal public benefit" must verify that a person applying for the benefit is a qualified alien and is eligible to receive the benefit. The HHS programs that provide "Federal public benefits" and are not otherwise excluded from the definition by the exceptions provided in section 401(b) are: Adoption Assistance Administration on Developmental Disabilities (ADD)-State Developmental Disabilities Councils (direct services only) ADD-Special Projects (direct services only) ADD-University Affiliated Programs (clinical disability assessment services only) Adult Programs/Payments to Territories Agency for Health Care Policy and Research Dissertation Grants Child Care and Development Fund Clinical Training Grant for Faculty Development in Alcohol & Drug Abuse Foster Care Health Profession Education and Training Assistance Independent Living Program Job Opportunities for Low Income Individuals (JOLI) Low Income Home Energy Assistance Program (LIHEAP) Medicare Medicaid (except assistance for an emergency medical condition) Mental Health Clinical Training Grants Native Hawaiian Loan Program Refugee Cash Assistance Refugee Medical Assistance Refugee Preventive Health Services Program Refugee Social Services Formula Program Refugee Social Services Discretionary Program Refugee Targeted Assistance Formula Program Refugee Targeted Assistance Discretionary Program Refugee Unaccompanied Minors Program Refugee Voluntary Agency Matching Grant Program Repatriation Program Residential Energy Assistance Challenge Option (REACH) Social Services Block Grant (SSBG) State Child Health Insurance Program (CHIP) Temporary Assistance for Needy Families (TANF) While all of these programs provide "Federal public benefits" this does not mean that all benefits or services provided under these programs are "Federal public benefits." As discussed in sections II and III below, some benefits or services under these programs may not be provided to an "individual, household, or family eligibility unit" and, therefore, do not constitute "Federal public benefits" as defined by PRWORA.

Eligibility Determination↗