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PubMed2000

Responding to aggressive behavior: impact of training on staff members' knowledge and confidence.

The impact of a training program designed to help staff members prevent and effectively manage aggressive behavior was assessed with 109 staff members who worked in services for persons with developmental disabilities. Instruction in distraction and defusion strategies was provided as was nonaggressive physical intervention. We employed both a between- and within-participant design. Results indicated that the training significantly improved participants' knowledge of reactive behavior management and their confidence to work with aggressive individuals.

Adult↗

PubMed1996

Early intervention: professional views and referral practices of Australian paediatricians.

OBJECTIVE: To gather information from paediatricians concerning their attitudes to early intervention services for young children with developmental disabilities and to study their referral practices. METHODOLOGY: Two hundred and ninety-five Australian paediatricians completed a postal questionnaire. RESULTS: Paediatricians presented a positive view of early intervention, particularly for its beneficial impact on families, and perceived the quality of services to be comprehensive or adequate. There were few differences between States, or between country or metropolitan areas. Most paediatricians make prompt referrals to early intervention services when a child has an established disability. Referral is much less likely with suspected delay. CONCLUSIONS: Paediatricians are aware of the benefits of early intervention but additional information concerning the role of these services and their significant impact on families and children should be provided.

Australia↗

PubMed1989

A case of developmental right hemisphere dysfunction: implications for psychiatric diagnosis and management.

The authors present the case of an adult woman who was treated in the mental health system for many years for a syndrome of mixed anxiety and depression unresponsive to psychopharmacologic or psychotherapeutic treatment. A computed tomography scan revealed asymmetrical enlargement of the right temporal horn. This finding, as well as findings of severe difficulties in spatial relations together with mildly abnormal posturing of the left hand when walking (especially when the gait was stressed), suggested that the patient had a developmental disability of the right cerebral hemisphere. The authors conclude that because such patients might appear to have primarily psychiatric rather than neurologic problems, the diagnosis of right hemisphere dysfunction should be considered when the clinical presentation is indicative of atypical anxiety and affective disorders.

Anxiety Disorders↗

PubMed2004

Toward an optimal healing environment in pediatric rehabilitation.

Although recent scientific advances have enabled us to minimize disability and improve the quality of life for people with disabilities and their families, cure is still not possible for many rehabilitation patients. This inability to cure renders the field of rehabilitation medicine particularly well-suited to the philosophy of healing. In contrast to curing, which is aimed at removing or reversing a disease process, both rehabilitation and healing are meant to enhance all aspects of well-being, restore integrity to the person, and facilitate the creation of meaning. Pediatric rehabilitation represents the interface of rehabilitation medicine and pediatrics, and is associated with unique characteristics that provide a natural context for exploring the optimal healing environment. This paper describes those characteristics and argues for the systematic integration and evaluation of healing interventions among children with developmental disabilities and their caregivers (parents, health care practitioners, and teachers). The ultimate aim of these interventions would be to improve all levels of the children's functioning in their homes, schools, and community environments by reducing impairment and increasing activity and participation. The paper concludes with a discussion of research priorities and the challenges imposed by different research strategies.

Child↗

PubMed1993

Pediatric HIV infection: a neuropsychological and educational challenge.

Pediatric acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection will soon be the primary infectious cause of perinatally acquired developmental disabilities in the United States. HIV encephalopathy and a variety of opportunistic infections, neoplasms, and vascular changes associated with pediatric HIV infection create a high probability of neuropsychological impairment among preschool and school-age children infected perinatally. Although the use of antiretrovirals may moderate some of the functional difficulties faced by these children, specific neuropathological and neuropsychological deficits are likely to remain. Treatments that prevent the central nervous system (CNS) effects of HIV have yet to be identified. As the epidemic progresses among women of child-bearing age, well-controlled developmental studies are needed to further clarify the relationship between HIV and child development, and to aid professionals in developing appropriate, school-based educational plans.

AIDS Dementia Complex↗

PubMed2002

Construct validity of the Miller assessment for preschoolers and the pediatric examination of educational readiness for children.

The purpose of this study was to investigate the construct validity of the Miller Assessment for Preschoolers (MAP) and the Pediatric Examination of Educational Readiness (PEER), two assessment tools that occupational therapists and physical therapists can use for early identification of children with developmental disabilities. The sample included 84 Israeli children who were tested on the MAP (42 children with pre-academic problems and 42 typically developing children), and 70 children who were tested on the PEER (35 children with pre-academic problems and 35 typically developing children). Out of this pool of subjects, 30 typically developing children and 30 children with pre-academic problems were tested on both tests and the results were used for additional data analysis. We found differences between the groups' MAP and PEER total scores as well as their developmental indices scores. Children with pre-academic problems scored lower. The supplementary behavioral observations of the tests yielded less definite results. A strong correlation existed between the total scores of the MAP and the PEER, and the total scores of the tests correlated significantly with each of the sub-scores of the other test. The findings support the construct validity of both tests, thereby suggesting that either test can be used to identify children with pre-academic problems.

Case-Control Studies↗

PubMed1997

"Big" versus "little" science: comparative analysis of program projects and individual research grants.

Controversy about the amount and nature of funding for mental retardation research has persisted since the creation of NICHD. An issue that has aroused considerable debate, within the mental retardation research community as well as beyond, is distribution of funds between large group research grants, such as the program project (PO1) and the individual grant (RO1). Currently within the Mental Retardation and Developmental Disabilities Branch, more money is allocated to the PO1 mechanism than the RO1. We compared the two types of grants, focusing on success rates, productivity, costs, impact, publication practices, and outcome and conducted a comparative analysis of biomedical and behavioral research. Other related issues were considered, including review processes and cost-effectiveness.

Child↗

PubMed1977

"What's wrong with my baby?".

The birth of a child with any developmental disability is an occasion of marked trauma to parents. Early, honest and frank counseling is imperative, and the family physician can play a unique role in this counseling process. When the physician is not knowledgeable in a paretcular case, he or she should seek expert help and fully utilize available community services.

Communication↗

PubMed1985

Reducing behavior problems through functional communication training.

It is generally agreed that serious misbehavior in children should be replaced with socially appropriate behaviors, but few guidelines exist with respect to choosing replacement behaviors. We address this issue in two experiments. In Experiment 1, we developed an assessment method for identifying situations in which behavior problems, including aggression, tantrums, and self-injury, were most likely to occur. Results demonstrated that both low level of adult attention and high level of task difficulty were discriminative for misbehavior. In Experiment 2, the assessment data were used to select replacements for misbehavior. Specifically, children were taught to solicit attention or assistance or both verbally from adults. This treatment, which involved the differential reinforcement of functional communication, produced replicable suppression of behavior problems across four developmentally disabled children. The results were consistent with an hypothesis stating that some child behavior problems may be viewed as a nonverbal means of communication. According to this hypothesis, behavior problems and verbal communicative acts, though differing in form, may be equivalent in function. Therefore, strengthening the latter should weaken the former.

Adolescent↗

PubMed1987

Secondary diurnal enuresis: evaluation of cueing and reinforcement interventions with a sensory-impaired youth.

Secondary enuresis consists of sporadic urinary accidents in persons who, otherwise, possess toileting skills. The present study evaluated the behavioural treatment of secondary enuresis displayed by a 19-year-old, developmentally disabled female with multiple sensory impairments. Treatment consisted of external and self-cueing procedures combined with reinforcement for on-toilet urination. As evaluated in a multiple baseline design, intervention resulted in a decrease in wetting incidents and an increase in self-initiated toileting. Treatment effects were maintained through a 7-month follow-up assessment.

Adult↗

PubMed2001

The detrimental effects of physical restraint as a consequence for inappropriate classroom behavior.

Functional analyses produced inconclusive results regarding variables that maintained problem behavior for 2 students with developmental disabilities. Procedures were modified to include a contingent physical restraint condition based on in-class observations. Results indicated that tinder conditions in which physical restraint (i.e., basket-hold timeout) was applied contingent on problem behavior, rates of these behaviors increased across sessions for both subjects. Implications for the use of physical restraint in the classroom are discussed.

Adolescent↗

PubMed1990

The future of children is now.

A community resource network, Annie Sullivan Enterprises, Inc., is described as a system for community integration of children and youth who have developmental disabilities and mental health problems. A brokerage model is espoused for accessing and delivering services. The model is based on Hobb's (1975) view that organization of human services must be based primarily on the client's needs rather than on the needs of the service agency. Lessons and recommendations based upon 7 years of successful operation are described.

Autistic Disorder↗

PubMed2006

Classification of abnormal neurological outcome.

When we engage in the systematic follow-up of high-risk neonates it is important to avoid the temptation to assume that any variations in development in this population reflect 'abnormality.' In this chapter I first present some personal reflections and hobby horses to argue that we need to be aware of our possible biases toward interpreting developmental or functional differences in infants as evidence of developmental pathology. Second, I stress the challenges associated with making early 'diagnoses' of developmental disabilities. Instead I suggest that identification of differences and variations in development should be interpreted cautiously, taking account of natural variations in early development and the chance to observe children over time rather than needing to make a decision on the basis of a single assessment. Finally, I discuss cerebral palsy and illustrate the arguments I have presented with discussion of current thinking about diagnosis and classification of CP.

Cerebral Palsy↗

PubMed1987

A community model for physician, educator, and parent collaboration for management of children with developmental and behavioral disorders.

This article describes a model for physician, educator, and parent collaboration in the management of children with developmental and behavioral disorders. The results of implementing the model with 256 professionals and parents of developmentally disabled children are described and discussed. The benefits of using the model in school districts and/or communities seeking to improve interprofessional collaboration and work with families are presented. The model has been demonstrated to be effective in producing practical solutions for improving collaboration that is relevant to local community barriers and based on input from physicians, educators, and parents.

Child↗

PubMed2002

Evaluation of a treatment package to reduce rapid eating.

We replicated and extended treatment procedures described by Lennox, Miltenberger, and Donnelly (1987) designed to reduce rapid eating. The participant was a 17-year-old girl with developmental disabilities who engaged in dangerously high rates of food ingestion. The procedure involved an adjusting differential-reinforcement-of-low-rate-responding (DRL) schedule, response blocking, and prompts. We evaluated a continuation of the treatment despite initial negative side effects that were similar to those reported by Lennox et al. Results showed that the treatment package was effective and negative side effects eventually decreased.

Adolescent↗

PubMed2000

Fronto-ocular syndrome: newly recognized trigonocephaly syndrome.

We describe an apparently unique disorder, Fronto-Ocular syndrome, present in a mother and her two daughters, and comprising trigonocephaly due to coronal and metopic craniosynostosis, ocular hypotelorism, ocular proptosis and ptosis, epicanthal folds, hypoplastic supraorbital ridges, elevated nasal bridge, thin philtrum, high-arched palate and a narrow bifrontal region. Both daughters have glabellar capillary hemangiomas, a congenital heart defect and mild developmental disabilities. Review of the literature failed to disclose any syndrome with similar findings. It is likely that this disorder represents an autosomal dominant condition, that arose as a new mutation in the mother. Mutational analysis of fibroblast growth factor receptor (FGFR) 1 and FGFR2 failed to identify the molecular basis of the disorder.

Adult↗

PubMed2003

Cognitive underpinnings of pretend play in autism.

This article examines the cognitive underpinnings of spontaneous and prompted pretend play in 28 young children with autism, 24 children with other developmental disorders, and 26 typical children. The article compares theories that consider either theory of mind (ToM) or executive function (EF) to be causally important deficits in the development of pretend play in autism and important factors in pretend play. Each of these two theories posits a cognitive precursor to pretense, which would need to be present in typical development, and the absence of which could explain pretend play deficits in children with developmental disabilities such as autism. We tested which of these theories better predicts a child's production of pretend play. Children with autism were significantly delayed on pretend play scores. They also had significant deficits in our ToM measure, but not our EF measures. Regression analyses suggested a role for our measure of generativity, one of the EF measures.

Analysis of Variance↗

PubMed1998

Developmental-behavioural problems in general paediatrics.

OBJECTIVE: To determine the current role of private general paediatrics in the care of children with problems of development and behaviour. METHODS: We surveyed all general paediatricians registered with the Australian College of Paediatrics to assess their current role in developmental-behavioural (DB) problems--their rate of referrals, their role in the continuing management, and opinions regarding duration of training in this area. RESULTS: Of 394 questionnaires sent, 284 replies were received (72%). From these 284 we analysed results for all 172 who spent more than 25% of their time in private general paediatric practice. On average, 32% of new referrals were for DB problems. With 10 DB clinical vignettes presented, paediatricians chose to continue to manage in conjunction with allied health services in 65% of cases. Other management choices included referral to a multidisciplinary team (16%), referral elsewhere (10%) and manage alone (7%). For training to be a general paediatrician, they indicated 3 months should be spent during basic training in each of the three areas of; DB paediatrics, developmental disabilities and child psychiatry (separately or concurrently); and 6 months of each during advanced training. Free comments highlighted lack of public allied health and psychosocial services. CONCLUSION: Private community-based general paediatricians are deeply involved in this area of work. The results raise questions about services for training and for clinical collaboration between public and private child health providers.

Australia↗