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Results for “Developmental Disabilities”

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PubMed1995

Evaluation of diagnostic criteria for autism using latent class models.

OBJECTIVE: To illustrate the use of latent class models for comparing alternative diagnostic criteria for autism. The models are based on the notion that the "true" classification of an individual is unknown but does exist at some unobserved, or "latent," level. Estimates of sensitivity and specificity are obtained for each set of diagnostic criteria through maximum likelihood techniques in relation to the latent standard. METHOD: In this paper, latent class models are used to compare DSM-III, DSM-III-R, and ICD-10 criteria for autism in a sample of 342 individuals with autism or other developmental disabilities. The diagnoses were made by one or more child psychiatrists who evaluated each patient and assigned a diagnosis of autism based on their own expert clinical judgment. In addition, the raters also determined whether criteria were met for the various diagnostic systems. RESULTS: The results indicate that the ICD-10 criteria agree best with the latent standard and a diagnosis based on expert opinion. CONCLUSION: It is suggested that latent class models can be usefully applied to the evaluation of other psychiatric disorders as well and represent an important new tool in evaluating diagnostic criteria by providing a way of dealing with data lacking an observable gold standard.

Adolescent↗

PubMed2005

Lexical training through modeling and elicitation procedures with late talkers who have specific language impairment and developmental delays.

Late talkers with specific language impairment and developmental delay make up a large portion of our early childhood caseloads; therefore, an understanding of best clinical practices for these populations is essential. Early lexical learning was examined in 2 interactive treatment approaches with 29 late-talking preschoolers with language and developmental disabilities. Children were randomly assigned to either a mand-elicited imitation (MEI) condition in which elicitations and imitative prompts were used or to a modeling with auditory bombardment (Mod-AB) condition in which auditory bombardment and play modeling were incorporated with no response demands on participants. Lexical production of target vocabulary words already comprehended was measured during a 10-session training period and then during two 50-min play interactions with a parent/caretaker in the home after treatment was completed. Results indicated that the MEI procedure was relatively more effective in facilitating frequency and rate of target word learning in the treatment setting, but no significant differences were found between conditions in the number or percentage of target words generalized to the home setting. Mod-AB children produced more target words that were limited to the home setting than did MEI children, whose productivity was more balanced across settings. Treatment by aptitude regression analyses indicated that none of the preintervention language, cognitive, or total development aptitude scores were predictive of child performance in 1 treatment condition or the other, although Battelle Developmental Inventory communication scores and sizes of preintervention lexicons were predictive of child performance across conditions. Empirical and clinical issues pertaining to the efficacy of modeling- and elicitation-based procedures for late-talking preschoolers are discussed.

Child, Preschool↗

PubMed1996

Parents' perspectives on quality in family support programs.

Support services for families who have a member with developmental disabilities are a growing component of many state mental health systems. Family empowerment is a key principle of these programs, but parents and the staff who work with them are often challenged in their efforts to have parents participate in policy development, program management, and evaluation of programs. The use of nominal group techniques is described as a means of identifying factors parents believe characterize quality family support programs. Parents' identified factors are then compared with factors from a theoretical framework for quality. Parents stressed access to information, adherence to empowerment philosophy, and the importance of interpersonal relationships with staff. Parents placed less emphasis on factors generally found in accreditation criteria.

Adolescent↗

PubMed1997

Functional analysis and treatment of elopement.

Elopement is a dangerous behavior because children who run away may encounter life-threatening situations (e.g., traffic). We conducted functional analyses of the elopement of 3 children who had been diagnosed with developmental disabilities. The results identified a maintaining reinforcer for the elopement of 1 child, but the data were difficult to interpret for 2 of the children. Subsequent reinforcer assessments were used to help to clarify the reinforcers for elopement for these 2 children. Results of the functional analyses and reinforcer assessments then were used to develop successful treatments to reduce elopement. The findings are discussed in terms of (a) the application of functional analysis methodology to elopement, (b) the use of reinforcer assessments to identify potential reinforcers when standard functional analyses are undifferentiated, and (c) the utility of assessment-based treatments for elopement.

Behavior Therapy↗

PubMed2005

Descriptive analyses of caregiver reprimands.

We conducted descriptive observations of 5 individuals with developmental disabilities and severe problem behavior while they interacted with their caregivers in either simulated environments (an inpatient hospital facility) or in their homes. The focus of the study was on caregiver reprimands and child problem behavior. Thus, we compared the frequency of problem behavior that immediately preceded a caregiver reprimand to that immediately following a caregiver reprimand, and the results showed that the frequency of problem behavior decreased following a reprimand. It is possible that caregiver reprimands are negatively reinforced by the momentary attenuation of problem behavior, and the implications for long- and short-term effects on caregiver behavior are discussed.

Adolescent↗

PubMed2004

Evaluation of a group intervention to assist aging parents with permanency planning for an adult offspring with special needs.

More than three-fourths of older adults with developmental disabilities and mental illness live in the community with aging parents, the majority of whom do not complete plans for the residential, financial, and legal future of their offspring. The authors used a true experimental design to evaluate the effectiveness of a six-week psychoeducational group intervention with 27 older mothers. Data collected in pre- and posttest telephone interviews were analyzed with repeated measures MANCOVA to test five hypotheses. Significant multivariate effects were found for mothers' knowledge and awareness about permanency planning, confidence and competence to plan, planning activities, and stage of planning. Findings support use of group interventions with older parents and underscore the need for professional education about planning for adults with special needs.

Adult↗

PubMed2000

Parametric analysis of overcorrection duration effects. Is longer really better than shorter?

Positive practice overcorrection (PPOC) has long played a significant role in the behavioral treatment of serious self-stimulatory behavior. Three experiments comparing the effectiveness of 30-second, 2-minute, and 8-minute PPOC on reduction of stereotypic hand behavior of adults with severe to profound developmental disabilities were conducted to resolve inconsistencies in previously reported findings concerning the role of PPOC duration in response suppression. Experiment 1, which used an alternating treatments--multiple baseline design, suggested that the different durations were equally effective in reducing the stereotypic behaviors to near-zero levels. Experiment 2, which used a reversal design, supported the findings of Experiment 1. Experiment 3, which used a reversal design to test the shortest and longest durations, generally confirmed the results of the first two experiments. This study therefore failed to support the oft-claimed superiority of long-duration PPOC. The possible factors underlying these findings and their implications for future research and practice are discussed.

Adult↗

PubMed1986

Marginal glioneuronal heterotopias in nine cases with and without cortical abnormalities.

Nine cases of marginal glioneuronal heterotopias over the cerebral cortex were reviewed from the morphological point of view. There were developmental disabilities in all cases except one (case 8), who was stillborn. All subjects died before 1 year of age except one (case 5). The common features of small glioneuronal heterotopias and abundant heterotopic glioneuronal proliferation are described. The correlation of glioneuronal heterotopias with polymicrogyria and other cortical malformations, as well as their appearance over a normal cortex, are described. The glioneuronal heterotopias are considered to be a separate type of malformation that could arise during the second half of intrauterine life. A breach of the neuropial border seems to be the most acceptable pathomechanism for our presented cases. Their morphological features indicate that damage to this barrier leads to involvement of glioneuronal heterotopias in fusion of opposite cortical convolutions.

Brain Neoplasms↗

PubMed1998

Use of noncontingent reinforcement in the treatment of challenging behavior. A review and clinical guide.

Recently, noncontingent reinforcement (NCR) has been used to reduce challenging behavior in persons with developmental disabilities. In this context, NCR involves reinforcement on a fixed-time schedule irrespective of behavior. The present article reviews studies involving NCR for the treatment of challenging behavior. Based on this review, a clinical guide for the implementation of NCR is delineated. NCR appears to depend on ensuring that reinforcement matches the function of the challenging behavior. Initially, noncontingent reinforcement should be provided on a continuous basis. The schedule can then be faded from continuous reinforcement to a more appropriate level in a number of ways. NCR can also be combined with additional educationally oriented interventions to promote skill development. Given its ease of implementation and other potential advantages, NCR would appear particularly relevant for applied settings. The clinical guide may offer some assistance to practitioners.

Adult↗

PubMed2001

Identifying possible contingencies during descriptive analyses of severe behavior disorders.

Contingencies of reinforcement involve, in part, relations between behavior and subsequent environmental events. In this study we observed 11 individuals with developmental disabilities and severe behavior problems while they interacted with their primary care providers in simulated environments (hospital therapy rooms). We compared the probability of obtaining attention, escape from instructional demands, or access to materials following instances of problem behavior with the background probability of those events. However, the focus of our analysis was the evaluation of comparative probabilities ("contingency values") in the context of relevant establishing operations such as diverted attention, instructional demands, and restricted access to materials. Results showed that the method was useful in identifying relations between behavior and subsequent environmental events. Implications for linking descriptive and functional analyses are discussed, and difficulties in identifying naturally occurring contingencies are considered.

Aggression↗

PubMed1999

Is maternal age a risk factor for mental retardation among children?

The purpose of this study was to determine whether older or very young maternal age at delivery is associated with mental retardation in children. Ten-year-old children with mental retardation (an intelligence quotient of 70 or less) were identified in 1985-1987 from multiple sources in the metropolitan Atlanta, Georgia, area. These children were subdivided into two case groups according to whether they had concomitant developmental disabilities or birth defects affecting the central nervous system (codevelopmental retardation) or did not have such disabilities (isolated retardation). Control children were randomly chosen from the regular education files of the public school systems in the study area. Data on sociodemographic variables were gathered from birth certificates. Children of teenaged mothers were not at increased risk for either form of retardation and children of mothers aged > or =30 years were not at increased risk for isolated retardation, in comparison with children of mothers aged 20-29 years. A markedly elevated risk of codevelopmental retardation was seen among black children of mothers aged > or =30 years that was not attributable to Down syndrome. A modest increase in risk for codevelopmental retardation was observed among white children born to older mothers, but it was entirely due to Down syndrome.

Adolescent↗

PubMed1991

HIV liability & disability services providers: an introduction to tort principles.

Mental health and developmental disability services providers are concerned that liability issues regarding worker and client exposure to HIV have not been adequately addressed. By developing policy specifically in the areas of education, infection control practices, and confidentiality, providers may minimize findings of liability and protect patient rights.

Centers for Disease Control and Prevention, U.S.↗

PubMed1984

Social support and negative life events of mothers with developmentally delayed children.

The purpose of this study was to obtain an understanding of social support and its relationship to negative life events experienced by mothers of developmentally delayed children. The subjects were 91 mothers of children age 6-months to 3-years-old with developmental disabilities. Questionnaires were completed anonymously by the respondents and returned by mail to the investigator. The measure of social support, the Personal Resource Questionnaire, provided three estimates of support: the availability of a number of resources, the satisfaction with help obtained during problem life situations, and perceived support. The Life Experience Survey provided the estimate of negative life events. The findings of this study indicated that the mothers with a high impact of negative events over the past year felt less supported as measured by perceived support and felt less average satisfaction with the help obtained during problems. The relationship between negative life events was maintained whether negative life events were measured subjectively (impact) or objectively (number). Thus, the more struggles these mothers had, the less they felt supported.

Adaptation, Psychological↗

PubMed1999

The descriptive epidemiology of infantile spasms among Atlanta children.

PURPOSE: To determine the population-based epidemiology of infantile spasms (IS) among Atlanta children. METHODS: By using data from a cross-sectional, population-based surveillance system that included 21 EEG laboratories, we identified children born in 1975-1977 in metropolitan Atlanta with IS. Cumulative incidence up to age 2 years was estimated from the number of children with IS born in the study area in 1975-1977, and age-specific prevalence was calculated from the number of children previously diagnosed with IS who lived in the study area at age 10 years. Data regarding coexisting disabilities were available from the surveillance system for developmental disabilities. RESULTS: The cumulative incidence of IS was 2.9/10,000 live births; half of the children with IS had cryptogenic IS. The age-specific prevalence of IS was 2.0/10,000 among 10-year-old children. Eighty-three percent of 10-year-old children with a history of IS had mental retardation (MR, IQ < or =70); 56% of children with a history of IS had profound MR (IQ <20). Developmental outcome did not differ between the children with cryptogenic IS and those with symptomatic IS. Among the 10-year-old children with profound MR who were living in Atlanta at age 10 years, 12% had a history of IS. Fifty percent of children with IS developed Lennox-Gastaut syndrome (LGS) before age 11 years. CONCLUSIONS: The syndrome of IS is rare in the general population, yet a significant percentage of all children with profound MR and severe childhood epilepsy syndromes in the general population have a history of IS.

Age Factors↗

PubMed2005

Clinical peer review: description of a comprehensive model in behavioral healthcare.

This article describes a comprehensive model of clinical peer review that was established at a large behavioral healthcare organization serving children, adolescents, and adults with developmental disabilities. The purpose of peer review is to provide routine evaluation of practice standards that will produce the highest quality of habilitative care. The major components of peer review address (a) clinical support and administration, (b) intervention policies and procedures, (c) case consultation, (d) utilization of extraordinary procedures, (e) performance improvement projects, and (f) communication at all levels of the organization. This article discusses implementation of the model, including examples and illustrations, and factors that contribute to positive outcome. This approach to peer review represents a systems methodology that can be adopted by behavioral healthcare and human service organizations to build an in-house program of clinical quality improvement. It is a necessary first step in the large-scale implementation of behavioral services.

Adolescent↗

PubMed2003

Social and cardiac responses of young children with autism.

The behavioral and heart rate responses of 22 children with autism and 22 children with other developmental disabilities were compared whilst they were watching videotapes of a baby either playing or crying. We expected both groups to show arousal as increased heart rate when watching the video of the crying baby, and the children with autism to attend less than the other children to both videos. However, the children with autism were as attentive to the videos as the other children, and both groups showed heart rate slowing compared with a baseline condition. There was no change in heart rate during interactions with a stranger or separation from mothers. The findings suggest that the lack of social attention often demonstrated by children with autism does not stem from increased arousal in social situations. An alternative explanation is considered.

Arousal↗

PubMedDate not supplied

Interrater reliability of the Peabody Developmental Motor Scales: fine motor scale.

OBJECTIVE: The interrater reliability of the Peabody Developmental Motor Scales (PDMS) fine motor scale was examined in 23 children with developmental disabilities who were between 2 years and 5 years of age. METHOD: Three occupational therapists viewed videotapes of the children and scored each child's performance on the fine motor section of the test. Data were analyzed with the intraclass correlation (ICC) approach; ICC values ranged from 0.90 to 0.97 for the subskills of Grasping, Hand Use, Eye-Hand Coordination, and Manual Dexterity. RESULTS: The ICC interrater reliability value for the total fine motor score was 0.99. Reliability values were additionally computed with the PDMS fine motor scale age-equivalent scores and Z scores. The ICC values for these methods of scoring the PDMS were 0.99 and 1.00, respectively. CONCLUSION: The PDMS fine motor scale can be used consistently to evaluate fine motor delays in this population of young children.

Child, Preschool↗

PubMed2000

The adult with cerebral palsy.

Important aspects of eliciting a proper history, obtaining a review of systems, and performing a physical examination in adults with cerebral palsy are presented. Information regarding diagnosis, etiology, and epidemiology of cerebral palsy as well as suggestions for performing examinations and procedures on uncooperative and extremely dysmorphic patients are included. A MEDLINE search of all English-language publications related to cerebral palsy from 1985 to 1999 was conducted. Other older references also were obtained from articles published during this period. Our personal experiences in caring for a group of approximately 300 adults with cerebral palsy and other developmental disabilities in specialized centers for nearly a decade are used frequently throughout this review. Emphasis is given to studies of adults. Studies of children are included because there is a lack of data on adults. These studies are identified as such in the text, with extrapolation to adults only where there is a sound clinical or scientific basis. The number of adults with cerebral palsy is increasing. This growth is due to increased survival of low-birth-weight infants and increased longevity of the adult population. Depending on clinical status and the age at which survival is calculated, 65% to 90% of children survive until adulthood. Despite these observations, there is a lack of information in the literature and a lack of relevant post-graduate training programs for physicians in the adult health care system.

Adult↗