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Results for “Developmental Disabilities”

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PubMed1981

Preliminary analysis of developmental observations in a survey of morbidity in infants.

Assessment of developmental status, particularly the identification of severe developmental disability, is an important outcome measure of the effect of many types of perinatal and early infant health programs. This report examines the feasibility of the use of a brief battery of developmental observations by a trained lay interviewer in the home as part of a large-scale survey of morbidity in one-year-old infants. A total of 4989 home visits was completed, and of these 3179 were to infants of low birthweight. The interviewers obtained a high degree of cooperation from the infants in this setting. Internal consistency, as measured by coefficient alpha and item-total score correlations, and inter-rater agreement for each observation on a small random sample (137) of revisits indicated reliability sufficient for research purposes for all except receptive language items. Good agreement was found between diagnostic and health are variables obtained through the interview with the mother and a developmental status classification based on the observations. While preliminary, these results are of importance in the design of infant follow-up programs.

Child Behavior↗

PubMed1996

Does neurological assessment still have a place in the NICU?

Comments at discharge from the neonatal intensive care unit tend to concern porencephalic cysts or ventricular dilatation rather than clinical neurological findings. This neglect in collecting clinical information can be understood during the acute stage of neonatal adaptation due to the non-specificity and lability of many neurological signs. However, it does not seem justified when the infant has recovered, can breathe on his/her own and can tolerate handling. To define optimal Central Nervous System function at 40 weeks (just born or corrected), a simple basic assessment composed of nine variables is proposed, with descriptions and illustrations. Rationale for the timing and selection of variables is discussed. The benefit of this clinical approach is to subdivide children with normal ultrasound imaging into two subgroups according to non-optimal or optimal responses. Prospective follow-up of children with non-optimal responses will reduce the number of late diagnoses of developmental disabilities. Rational optimism for the others will diminish parents' anxiety and neurologic clinics' overload.

Central Nervous System Diseases↗

PubMed1984

Compliance in the community with consultants' recommendations for developmentally handicapped children.

A cross-sectional analytical survey was carried out to determine the extent and associations of compliance with consultants' recommendations for developmentally handicapped children to parents and front-line community professionals. Non-compliance was found to be a substantial problem. Several significant associations were found between clients' attitudes and beliefs about the recommendations and their compliance with them. These findings may prove useful in identifying clients at risk for non-compliance, and in developing strategies to enhance compliance among clients of developmental disability consultation services.

Adolescent↗

PubMed1999

Multimodality evoked potential findings in infants with congenital heart defects.

Evoked potentials are sensitive prognostic tools in young infants at risk for developmental disability. The objective of this prospective study was to determine whether infants with congenital heart defects demonstrate evoked potential abnormalities prior to or following open heart surgery, and to examine the association between these abnormalities and developmental status 1 year following surgery. A consecutive series of newborns (less than 1 month old) and infants (1 month to 2 years old) were recruited. Somatosensory and brain stem auditory evoked potentials were carried out before or after cardiac surgery, or both. One year later, neurologic examination and standardized measures of motor performance and functional independence were carried out. Twenty-seven newborns and 31 infants underwent perioperative somatosensory evoked potential recordings. Results indicate that perioperative somatosensory evoked potential abnormalities were common in newborns (41%) but not in infants (13%) with congenital heart defects. Brainstem conduction times were within normal limits in all subjects; however, 32% presented with mild elevations in hearing thresholds. All newborns with abnormal somatosensory evoked potentials had abnormal neurologic examinations both perioperatively and again 1 year after open heart surgery. Moreover, standardized developmental assessments 1 year following surgery indicate that all newborns with somatosensory evoked potential abnormalities had developmental deficits in one or more domains. Somatosensory evoked potential abnormalities in the perioperative period are common in newborns with congenital heart defects, and are strongly predictive of persistent developmental delay later.

Brain↗

PubMed1998

Early intervention and early experience.

For 4 decades, vigorous efforts have been based on the premise that early intervention for children of poverty and, more recently, for children with developmental disabilities can yield significant improvements in cognitive, academic, and social outcomes. The history of these efforts is briefly summarized and a conceptual framework presented to understand the design, research, and policy relevance of these early interventions. This framework, biosocial developmental contextualism, derives from social ecology, developmental systems theory, developmental epidemiology, and developmental neurobiology. This integrative perspective predicts that fragmented, weak efforts in early intervention are not likely to succeed, whereas intensive, high-quality, ecologically pervasive interventions can and do. Relevant evidence is summarized in 6 principles about efficacy of early intervention. The public policy challenge in early intervention is to contain costs by more precisely targeting early interventions to those who most need and benefit from these interventions. The empirical evidence on biobehavioral effects of early experience and early intervention has direct relevance to federal and state policy development and resource allocation.

Child Development↗

PubMed1982

The hospitalization of children with developmental disorders.

Hospitalization is a difficult experience for a normal child. The hospitalization of a developmentally disabled child can be especially traumatic, both for the child who can not understand what is happening to him and for hospital personnel who are unaccustomed to dealing with such children. This article discusses the hospitalization of children with developmental disorders using the theoretical perspective of developmental psychology. The following issues are considered: 1) Does the child's disorder represent a delayed or a deviant course of development?, 2) Is the child's deficit global, affecting all areas of functioning, or specific, limited to one area?, and 3) Does a disorder early in development necessarily predict later problems, or are children able to compensate for certain deficits? Suggestions for improving the care of children with developmental disorders in hospitals are offered based on research and clinical observations.

Child↗

PubMed1992

Autistic social dysfunction: some limitations of the theory of mind hypothesis.

This study examined the extent to which the social disabilities found in autism can be accounted for by the "Theory of Mind" hypothesis. Items related to social development from the Vineland Adaptive Behavior Scales were administered to 29 CA-, MA- and IQ-matched pairs of young autistic and non-autistic, developmentally disabled children. These items were evaluated in relation to expected ages of acquisition based on the Vineland standardization database. Our results indicate that the social dysfunction in autism affects very basic and early emerging social behaviors which are typically present prior to the time at which even the earliest precursors of a theory of mind apparently emerge.

Age Factors↗

PubMedDate not supplied

Disabilities of arithmetic and mathematical reasoning: perspectives from neurology and neuropsychology.

Current research on brain-behavior relationships in disabilities of arithmetic and mathematical reasoning is reviewed from both a neurological and a neuropsychological perspective. Although no entirely satisfactory statement of the relationship between arithmetic skills and brain functions has yet emerged, investigators in this area have provided evidence regarding the involvement of some brain systems in processes of calculation. Also, the developmental importance of right- versus left-hemisphere integrity for the mediation of arithmetic learning and performance has been suggested. We propose that an account of brain-behavior relationships in children intended to explain and predict developmental disabilities of arithmetic learning needs to address several important content and processing distinctions in order to (a) encompass empirically derived subtypes of children with learning disabilities who exhibit difficulties with arithmetic and (b) provide adequate direction for future subtyping and intervention research.

Adult↗

PubMed1987

Early identification of children's special needs: a study in five metropolitan communities.

In a study of special education programs in five urban school systems, parent interview data for 1726 children revealed how early the children's problems were identified and how the medical system was involved in the diagnosis. Problems included speech impairment, learning disabilities, emotional disturbance, mental retardation, sensory disorders, and physical and health disabilities. Overall, 4.5% of the children's problems were identified at birth, and only 28.7% before the age of 5 years. Variation in age at identification depended on the condition: 1 year for Down syndrome and cerebral palsy versus a 6-year range for mental retardation. Although physicians were most likely to identify the less common, more severe handicaps, they also identified from 15% to 25% of learning disabilities, speech impairments, emotional disorders, hyperactivity, and "other" development problems. The type, severity, and complexity of the condition were significant predictors of physician identification. No racial, socioeconomic, or site biases were associated with whether a physician was first to identify. Age at identification was predicted by the complexity of the problem, the association with other health and developmental concerns, socioeconomic indicators, and whether a physician was involved in the diagnosis. In the absence of clear assumption of responsibility for early identification, much terrain remains uncharted by medical practitioners and the schools. A better systematic sharing of responsibility for the early identification of developmentally disabling conditions is needed.

Affective Symptoms↗

PubMedDate not supplied

Sports for the physically challenged child.

Participation in sports is important for the physical and emotional health of the physically challenged child. Sports can improve strength, endurance, and cardiopulmonary fitness while providing companionship, a sense of achievement, and heightened self-esteem. With interest in such participation increasing, it is necessary for the physicians, therapists, and families of children with special needs to understand the preparticipation evaluation, athletic options, specialized equipment, and sport-specific risks. Recommendations that provide guidelines for safe, effective participation in sports are currently available for common congenital and developmental disabilities such as Down syndrome, cerebral palsy, myelodysplasia, hemophilia, congenital amputations, and arthritic disorders.

Adolescent↗

PubMed1999

Simulating patient care.

In a pioneering program, medical students are introduced to the unique challenges of taking a medical history and examining patients who cannot speak because of severe developmental disabilities. Contact with patient simulators helps the medical students develop the interpersonal skills needed to elicit vital information directly from nonverbal patients.

Clinical Competence↗

PubMedDate not supplied

The Surgeon General's Report and special-needs patients: a framework for action for children and their caregivers.

The Surgeon General's Report, Oral Health in America, is the first comprehensive assessment of oral, dental, and craniofacial health in the history of our nation. The intent of this first-ever Report is to alert Americans to the full meaning of oral health and its importance to general health and well-being across the lifespan. Moreover, the Report has been released at a time in human history of enormous changes as well as opportunities. The convergence of public health policies, "quality of life" expectations, global informatics, a new century of biotechnology, the completion of the Human Genome Project, changes in the management of health care, and the acknowledgment of enormous health disparities herald a call to action. These profound dynamics particularly affect children and their caregivers and the multitude of social, economic, and health issues associated with special patients and developmental disabilities. This paper will highlight the issues, provide recommendations, and suggest a call to action.

Adolescent↗

PubMedDate not supplied

Self-injurious behavior as a challenge for the dental practice: a case report.

Patients who present self-injurious behavior (SIB) can be considered a treatment challenge in the dental office or hospital setting. Oral structures can play various roles in the process of self injury. In this paper, the authors report a case of SIB in the form of cheek-biting on an adolescent with a history of hydrocephalus and developmental delay, which was successfully treated with a modified standard maxillary orthodontic retainer. Early detection and intervention in SIB cases in patients with developmental disabilities influence the successful outcome of the therapeutic interventions, enhancing the patient's quality of life.

Adolescent↗

PubMed1989

[Developmental disorders in young children with Duchenne's muscular dystrophy: implications for diagnosis and treatment].

The article describes two toddlers having Duchenne muscular dystrophy. In addition to motor problems they also exhibit attention disorders, deficits in short-term memory, speech and language disorders, and poor achievement motivation. Similar problems are reported in older Duchenne children. The etiology of the developmental disabilities, the content of the assessment protocol and the necessity for early intervention are discussed.

Child, Preschool↗

PubMed2002

Aicardi syndrome: spectrum of disease and long-term prognosis in 77 females.

Aicardi syndrome is an X-linked-dominant condition characterized by infantile spasms, agenesis of the corpus callosum, and chorioretinal lacunae. We reviewed the Aicardi Syndrome Foundation's compilation of family-based, self-reported questionnaires for the year 2000. Information was obtained from 77 females with Aicardi syndrome regarding developmental milestones, seizure frequency, seizure classification, antiepileptic drug use, and medical problems. Patient ages ranged from 1 to 25 years (mean = 7.2 years). All patients were significantly developmentally delayed with milestones ranging from 2 to 36 months. Of the patients, 91% attained milestones no higher than 12 months. Seizures were reported in 92% of patients and occurred daily in 67%. Infantile spasms were the most common seizure type observed in 17%, although a variety of other seizure types were also reported. Multiple antiepileptic drugs were used in these patients with 73% of patients taking two or more antiepileptic drugs. Five patients had a vagal nerve stimulator implanted, and one patient underwent a hemispherectomy. The most common medical problems cited included scoliosis, constipation, gastroesophageal reflux, aspiration pneumonia, and otitis media, but overall health was perceived to be good. Our review demonstrates the spectrum of developmental disabilities, epilepsy severity, and prognosis in a large group of Aicardi patients.

Adolescent↗

PubMed1999

Developmental progress of children with congenital heart defects requiring open heart surgery.

Recent advances for infants requiring early open heart surgery have resulted in a dramatic decline in mortality and severe morbidity. The developmental progress of these new survivors is currently being defined. Causes contributing to brain injury are multifactorial, and may involve preoperative, intraoperative, and postoperative events. Before surgery, these children often exhibit hypotonia, poor state regulation, microcephaly, and developmental delays. These findings are particularly prevalent in newborns. In the acute postoperative period, neurodevelopmental deficits continue to manifest clinically. Long-term follow-up studies indicate that subtle neurological deficits and global developmental lags are characteristic of this population. Overall, severe neurological sequelae are uncommon; however, mild to moderate developmental disabilities are prevalent. Functional limitations, academic achievements, and health-related quality of life are areas that deserve further attention.

Achievement↗

PubMed1997

Application of an automated parcellation method to the analysis of pediatric brain volumes.

New techniques in quantitative imaging are needed to accelerate understanding of brain development and function in children. In this study we evaluate the reliability and validity of an automated parcellation method for the measurement of large and small brain regions in normal and developmentally disabled children. We utilized an adaptation of the Talairach atlas to semi-automatically quantify brain volumes from 10 children with fragile X syndrome, 10 age- and gender-matched controls and 10 adult controls comparing them to 'gold standard' manually delineated regions. Excellent sensitivity, specificity, intra-class correlation and positive predictive value were achieved for large structures although results were less satisfactory for smaller structures, illustrating the limits of resolution of the method. Statistically significant differences in regional brain volumes were shown between males and females, children and adults, and individuals with fragile X and matched controls. This study demonstrates an automated method which rapidly and accurately quantifies large neuroanatomical structures, but not smaller structures. This method is sufficiently accurate to demonstrate some known anatomical differences in individuals with fragile X; the results suggest that this method could be applied to the assessment of brain volume in other neurodevelopmental disabilities.

Adult↗

PubMed1998

Correlations between intestinal parasitosis, physical growth, and psychomotor development among infants and children from rural Nicaragua.

The correlations between malnutrition, parasitosis (especially helminth infections), and child development are complex, and studies of these interrelationships will allow health agencies to maximize screening and intervention strategies for developing countries. We examined these correlations in a cross-sectional program in Carazo State, Nicaragua. Nine hundred sixty-one children in two age strata (ages 0-24 months and ages 2-10 years) from one urban and three rural communities were screened for intestinal parasites (direct smear and ZnSO4 flotation), malnutrition, and developmental delays. Nutritional status was determined as weight-for-age (WFA), weight-for-height (WFH), and height-for-age (HFA). Developmental status (normal, suspect) was determined for the four subtests of the Denver II Screening Test. The prevalence of malnutrition was 14.6% (WFA), 8.4% (WFH), and 36.3% (HFA). Parasitosis was more prevalent in children less than 24 months of age with low HFA, whereas in older children low WFA was more closely associated with parasitic infections. Ascaris and Trichuris were more prevalent in malnourished children. On the Denver II, suspect test results in all four categories (language, social, gross motor, and fine motor) were associated with low WFA, and suspect language tests were associated with both intestinal parasites (P = 0.0003) and Ascaris infection in particular (P = 0.044). Developmental disabilities are a significant and frequently undetected health problem in developing countries, and malnutrition associated with intestinal helminth infections may be an important contributory factor for these disabilities.

Body Height↗