Reading disability, or developmental dyslexia.
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Dyslexia↗
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Educational and social competencies at 8 years in children with threshold retinopathy of prematurity in the CRYO-ROP multicenter study.
OBJECTIVE: To describe the educational status and special education services at 8 years among children who had threshold retinopathy of prematurity (ROP). METHODS: A prospective study was conducted of a cohort of children who had birth weight of <1251 g and threshold ROP in the Cryotherapy for Retinopathy of Prematurity multicenter study. At age 5.5 years, visual status, functional skills, and social information were obtained. At 8 years, special education classes, developmental disabilities, rehabilitation therapies, and academic and social competencies were determined by questionnaire. Visual status was considered favorable/unfavorable on the basis of the better eye. RESULTS: Of 255 survivors, 216 (85%) were evaluated at both 5.5 and 8 years. Major impairments were significantly more prevalent in children with unfavorable versus favorable visual status: cerebral palsy (39% vs 16%), developmental disability (57% vs 22%), autism (9% vs 1%), and epilepsy (23% vs 3%). Special education services (63% vs 27%), below-grade-level academic performance (84% vs 48%), and school-based rehabilitation services were significantly less common in children with favorable visual status. Favorable visual status, favorable functional ratings at 5.5 years, markers of higher socioeconomic status, and nonblack race were associated with significantly lower rates of both special education placement and below-grade-level academic performance at age 8. On multivariate logistic regression, only favorable visual status and functional status remained significant predictors for decreasing special education placement. CONCLUSION: Threshold ROP is associated with high rates of developmental, educational, and social challenges in middle childhood; preserved vision was associated with a clear advantage, with more than half of the children with favorable visual status performing at grade level.
Analysis of Variance↗
Diabetic ketoacidosis. Neurologic collapse during treatment followed by severe developmental morbidity.
Diabetic Ketoacidosis (DKA) remains the leading cause of death in children with type 1 diabetes mellitus. Complications occurring during DKA treatment include cerebral edema and neurologic collapse. Developmental outcomes following neurologic deterioration during DKA have varied from no sequelae to severe developmental disabilities. A total of three children developed neurologic deterioration during treatment of DKA at Buffalo Children's Hospital between 1984 and 1987. The authors treated aggressively for cerebral edema. Characteristic findings on the computed tomography (CT) scans and magnetic resonance imaging (MRI) of the brain included hemorrhagic infarctions of the thalami, basal ganglia and lentiform nuclei. The authors conducted developmental follow-up examinations between 1-1/2 - 3 years following recovery from DKA coma. Although they noted significant recoveries over time, developmental disabilities persisted. The clinical courses and neuroradiographic findings of these patients are compatible with sequelae of central brain stem herniation and cytotoxic brain injury. Continued efforts are needed in the prevention and early detection of clinically significant cerebral edema during treatment of DKA.
Brain Diseases↗
In harm's way: toxic threats to child development.
Developmental disabilities result from complex interactions of genetic, toxicologic (chemical), and social factors. Among these various causes, toxicologic exposures deserve special scrutiny because they are readily preventable. This article provides an introduction to some of the literature addressing the effects of these toxicologic exposures on the developing brain. This body of research demonstrates cause for serious concern that commonly encountered household and environmental chemicals contribute to developmental disabilities. The developing brain is uniquely susceptible to permanent impairment by exposure to environmental substances during time windows of vulnerability. Lead, mercury, and polychlorinated biphenyls (PCBs) have been extensively studied and found to impair development at levels of exposure currently experienced by significant portions of the general population. High-dose exposures to each of these chemicals cause catastrophic developmental effects. More recent research has revealed toxicity at progressively lower exposures, illustrating a "declining threshold of harm" commonly observed with improved understanding of developmental toxicants. For lead, mercury, and PCBs, recent studies reveal that background-population exposures contribute to a wide variety of problems, including impairments in attention, memory, learning, social behavior, and IQ. Unfortunately, for most chemicals there is little data with which to evaluate potential risks to neurodevelopment. Among the 3000 chemicals produced in highest volume (over 1 million lbs/yr), only 12 have been adequately tested for their effects on the developing brain. This is a matter of concern because the fetus and child are exposed to untold numbers, quantities, and combinations of substances whose safety has not been established. Child development can be better protected by more precautionary regulation of household and environmental chemicals. Meanwhile, health care providers and parents can play an important role in reducing exposures to a wide variety of known and suspected neurodevelopmental toxicants that are widely present in consumer products, food, the home, and wider community.
Aggression↗
Early intervention: the professional views and referral practices of paediatricians in Victoria.
Early intervention services for young children with developmental disabilities have developed considerably in the past decade, yet little information is available about the referral practices and views of Australian paediatricians. During 1991, 100 paediatricians in Victoria completed a postal questionnaire designed to gain information regarding their attitudes to early intervention and referral practices. The results indicated that paediatricians had a positive view of early intervention, and perceived the standard and quality of the services in their region as comprehensive (16%) or adequate (54%). They were likely to make prompt referrals in the presence of an established disability (75%), but with suspected developmental delay, many (45%) were likely to wait until the delay was confirmed. Referrals were more often made for intervention for the child rather than for family support. However, paediatricians felt that early intervention had a beneficial effect on family functioning (81%). In general, the results indicate that there seem to be few barriers between paediatricians and the early intervention field.
Attitude of Health Personnel↗
Agenesis of the corpus callosum: clinical, neuroradiological and cytogenetic studies.
This study examined 35 patients with developmental disabilities who were referred for diagnostic evaluation that later revealed agenesis of the corpus callosum (ACC) by computerized tomography (CT). Sixteen had partial ACC, six had complete ACC, and one had a hypoplastic corpus callosum. In the other twelve cases, ACC existed, but the degree of callosal defect was not specified. Other intracranial defects were frequently present. Clinically, 15 patients (43%) had a history of seizures, 28 (82%) were mentally retarded or developmentally delayed and an additional five patients (15%) possessed borderline intelligence, and 10 (29%) had cerebral palsy. Ocular, spinal, and orofacial abnormalities were often present. Detailed summaries of these findings are given in Table I. Although several genetic causes of ACC have been identified, in the vast majority, the etiology is assumed to be multifactorial. In our study, two patients had trisomy 8 mosaicism and 11 (35%) had a family history of developmental disability. A review of the literature on chromosomal abnormalities in acalossal patients revealed 81 additional cases, which are discussed and outlined in Table II.
Adolescent↗
Neuropathology of the brainstem in age-dependent epileptic encephalopathy--especially of cases with infantile spasms.
Twenty-two autopsy cases with developmental disabilities with history of infantile spasms were studied with special regard to brainstem lesions. Eleven out of 22 cases were considered to be of prenatal origin, ten cases were perinatal and one case had suffered from acute encephalopathy at six months of age. Some common pathological findings were noticed throughout the cases despite their various etiologies; small size of the brainstem tegmentum, spongy state in and around the central tegmental tract, localized periaqueductal glial scar. Control study on another autopsy series of 76 cases with developmental disabilities showed a close connection between these findings in the brainstem tegmentum and history of infantile spasms.
Adolescent↗
A mental health clinic for toddlers with developmental delays and behavior problems.
A mental health clinic was developed for toddlers with developmental disabilities and significant behavior problems from families living in poverty. The clinic was a collaborative effort between a community-based Birth-to-Three agency and a university. The purpose of this clinic was threefold: to provide direct mental health services for these young children, to train graduate students to work with this population, and to begin to contribute to the limited research available in this area. This paper describes the clinical intake procedures and outcomes for the 81 children served by the clinic over a 2-year period. Referral concerns included tantrums, aggression, oppositional behaviors, hyperactivity, and self-injury. The children came from a diverse group of families living in poverty; single mothers with less than a high school education headed most of the households. The clinical intake included direct observations of parent-child interactions, child behavior assessments, and parental interviews and self-report measures. For the present sample, 77% of the children met the criteria for a developmental disability and nearly 70% also met the criteria for a psychiatric disorder. The most common diagnosis was oppositional defiant disorder. Discussion regarding the challenges inherent in working with families of toddlers with developmental delays and psychiatric disorders living in low-income circumstances is included.
Ambulatory Care Facilities↗
Convergent validity of the aberrant behavior checklist and behavior problems inventory with people with complex needs.
The current study aimed to replicate and extend Rojahn et al. [Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in Developmental Disabilities, 24, 391-404] by examining the convergent validity of the behavior problems inventory (BPI) and the aberrant behavior checklist (ABC) for individuals presenting with multiple complex behavior problems. Data were collected from 69 children and adults with severe intellectual disabilities and challenging behavior living in residential establishments. MANCOVA analyses showed that individuals with elevated BPI stereotyped behavior subscale scores had higher scores on ABC lethargy and stereotypy subscales, while those with elevated BPI aggressive/destructive behavior subscale scores obtained higher scores on ABC irritability, stereotypy and hyperactivity subscales. Multiple regression analyses showed a corresponding pattern of results in the prediction of ABC subscale scores by BPI subscale scores. Exploratory factor analysis of the BPI data suggested a six-factor solution with an aggressive/destructive behavior factor, four factors relating to stereotypy, and one related to stereotypy and self-injury. These results, discussed with reference to Rojahn et al. [Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in Developmental Disabilities, 24, 391-404], support the existence of relationships between specific subscales of the two instruments in addition to an overall association between total scores related to general severity of behavioral disturbance.
Adolescent↗
Reducing the use of restrictive procedures in a residential facility.
Restrictive procedures are frequently used in residential facilities for the mentally ill and developmentally disabled despite humanitarian, professional, and legal concerns. Administrators in a regional residential facility for the developmentally disabled instructed staff to reduce the use of seclusion, mechanical restraint, and psychotropic drugs in the facility and set clearly defined policies and procedures on the use of such restraints. Data were gathered on the prevalence of restrictive procedures before and after the new policies were implemented, and staff received frequent feedback. The data showed that in the two and a half years following the adoption of the new policies, the use of seclusion, mechanical restraint, and psychotropic drugs dropped significantly without a concomitant increase in violent incidents, staff turnover, or use of other restrictive procedures. The authors conclude that instructions and feedback are an effective and inexpensive way to reduce the use of restrictive treatment procedures and that the approach used in their facility merits further investigation.
Adolescent↗
Self-preservation ability and residential fire emergencies: replication and criterion-validity study.
In a previous study MacEachron and Janicki (1983) used the National Bureau of Standards approach to measuring self-preservation ability to estimate the prevalence of such skills in the New York State service population of 47,000 developmentally disabled persons. In the present study we replicated their results in another state serving 8,000 developmentally disabled persons. Moreover, we found that the operationalized National Bureau of Standards' measurement was a good predictor of a criterion measure of self-preservation ability. These results suggest the general feasibility of using these measurements to estimate prevalence, focus intervention strategies and capital expenditures to specific areas of need, and provide information to facilitate appropriate residential placement.
Accident Prevention↗
The processing of pseudohomophones by adults with a history of developmental language disabilities.
Psuedohomophones are nonwords that sound like real words (e.g., BRANE). These items were used to gauge phonological access in adults who have experienced developmental language processing deficits (DLD). The standard effect for these items in lexical decision is an increase in response times over nonpseudohomophone nonwords. This disadvantage reflects phonological processing. In our first experiment the DLD group did not produce this pseudohomophone effect whereas in a second experiment they showed semantic priming effects when pseudohomophones were used as primes in lexical decision. The results therefore indicate that phonological processing of nonwords by adults with DLD can be uncovered under certain carefully controlled experimental conditions.
Adult↗
Prevalence of cerebral palsy among ten-year-old children in metropolitan Atlanta, 1985 through 1987.
The Metropolitan Atlanta Developmental Disabilities Study was a population-based study (1985 through 1987) to determine the prevalence of five developmental disabilities among 10-year-old children. The disabilities included cerebral palsy, mental retardation, visual impairment, hearing impairment, and epilepsy. The prevalence of cerebral palsy (CP) and a description of the children with CP are reported here. Using a record review approach, we identified 204 10-year-old children with CP (resulting in a prevalence of 2.3 per 1000). The rate of CP was significantly higher among boys (prevalence odds ratio = 1.5; 95% confidence interval = 1.1, 2.0), and the rate was also higher among black children than white children (prevalence odds ratio = 1.3; 95% confidence interval = 1.0, 1.7). Thirty-three of the children (16%) acquired CP postnatally; these children were more likely to be black or male. The gender and racial differences found for acquired CP were greater than those for congenital CP. Approximately 75% of the children had one of the other four disabilities studied; 65% of the children were mentally retarded, 46% had epilepsy, and 15% had a sensory impairment. Our multiple-source method of identifying children with CP gave us a population-based sample from which to determine the prevalence of the condition and to study factors that are associated with CP.
Black People↗
Relationships between stress, coping resources, and satisfaction with family functioning in families of children with disabilities.
The purpose of the current descriptive correlational study was to examine relations between stress, coping resources, and satisfaction with family functioning in families caring for children with developmental disabilities at home. Fifty families who used the services of a respite care program were surveyed to examine relationships among child characteristics (behavioral problems and handicapping conditions); coping resources including mastery and health, esteem and communication, family hardiness, and social support; and the primary outcome variable of satisfaction with family functioning. Families of children with developmental disabilities experience significant stressors in terms of the severity of their child's handicapping conditions and behaviour problems. However, they reported satisfactory coping resources such as mastery and health, hardiness, and esteem and communication. Although they were lower than normative scores, social support scores for spouses and friends were related to satisfaction with family functioning. Implications for practitioners are discussed.
Adaptation, Psychological↗
Restoration of competency to stand trial: a training program for persons with mental retardation.
This article describes the development and use of a formal training tool for restoration of competency in clients with mental retardation who are incompetent to stand trial. The program was developed at Eleanor Slater Hospital within the Rhode Island Department of Mental Health, Retardation and Hospitals. This article describes the development of The Slater Method, the training tool format, the procedure for use of the Slater Method, and the duration of treatment to restore competency to stand trial in clients with mental retardation. Although the developmentally disabled population is not limited to persons with mental retardation, we have used the phrase mental retardation instead of developmentally disabled because the judicial system more commonly uses mental retardation.
Crime↗
Developmental language disability as a consequence of prenatal exposure to ethanol.
Two pre-school-aged patients with a history of prenatal exposure to ethanol had abnormal head size and developmental delay. Both children were strikingly similar in physical appearance, behavior, and cognitive dysfunction. Facial features were typical of fetal alcohol syndrome. Head circumference greater than 97th percentile without hydrocephalus and no evidence of prenatal or postnatal growth failure were unusual for ethanol teratogenicity. Each child had a similar pattern of verbal and behavioral dysfunctions characterized by (1) marked hypervigilence, (2) distractability, and (3) cognitive confusion manifested as anxiety and behavioral disorganization. It is suggested that a history of prenatal exposure to ethanol associated with (1) large head circumference, (2) facial features of fetal alcohol syndrome, and (3) early developmental delay, particularly in language acquisition, and impaired modulation of attention and arousal may represent a possible new effect of alcohol teratogenicity.
Child, Preschool↗
Cost of fetal alcohol spectrum disorders.
Fetal alcohol syndrome (FAS) is a common identifiable teratogenic cause of mental retardation, neurological deficit, mental disorders, and developmental disabilities. Accurate estimates of the cost of care for persons with FAS are essential for appropriate funding of health care, developmental disabilities services, special education, and other service systems, as well as prioritizing funding of public health prevention efforts. The cost of care for individuals with FAS can be conceptualized as the annual cost of care for one person or a population, or as the lifetime cost of care for an individual. Annual cost estimates for the United States range from $75 million in 1984 to $4.0 billion in 1998. Estimates of lifetime cost vary from $596,000 in 1980 to $1.4 million in 1988. After adjustments for changes in inflation and population, 2002 estimates of total annual cost and lifetime cost are higher. FAS is increasingly being recognized as a large public health problem with high potential for the prevention of future cases and for the prevention of excess disability and premature mortality in persons who are affected. Each day, from 6-22 infants with FAS are born in the United States, and as many as 87-103 more are born with other impairments resulting from prenatal alcohol exposure. Updated and improved cost data on FAS should be a research priority.
Alcohol Drinking↗
Psychoactive drug use in an institution for intellectually handicapped persons.
OBJECTIVE: To study the use of psychoactive drugs for the treatment of long-stay developmentally disabled individuals in an institution in New South Wales. SETTING: Three wards dedicated to the long-term care of developmentally disabled individuals situated on the premises of a large psychiatric hospital. SUBJECTS: All residents (n = 53) of these wards in August 1989. METHOD: All subjects were examined by the author. Charts and medication records were extensively reviewed. Mental retardation was classified by DSM-III-R criteria. Categorisation of problem behaviour was done with the assistance of nurses, who also supplied information on behavioural problems and functional level and completed checklists of self-injurious and stereotypic behaviour. A standardised neurological examination was performed and scales for abnormal involuntary movements completed. RESULTS: The most commonly used drugs were the neuroleptics, with 60.4% of subjects currently receiving one or more neuroleptic drug at relatively large doses. The use of these drugs was not associated with current or past psychiatric illness, but was more closely related with the severity of problem behaviour. Thirty-four per cent of the subjects receiving neuroleptics had dyskinetic movements suggestive of tardive dyskinesia, and 30% had mild tremor. Antidepressant, anxiolytic and sedative drugs were used less commonly. The management of epilepsy was considered to be suboptimal. CONCLUSION: Even though studies over the last two decades have consistently highlighted the problem of overmedication of intellectually handicapped individuals in institutions, the problem does not seem to have been redressed in at least some institutions.
Adolescent↗