Brief report: a longitudinal examination of the communicative gestures deficit in young children with autism

OBJECTIVES: To provide Canadian physicians with a standard definition of hypertension in pregnancy, recommendations for laboratory investigations and tests for the assessment and management of hypertensive disorders in pregnancy, and a classification of such disorders. OPTIONS: To improve or not improve Canadian uniformity and standardization in the investigation and classification of hypertensive disorders in pregnancy. OUTCOMES: 1) Accuracy, reliability and practicality of diagnostic clinical criteria for hypertensive disorders in pregnancy. 2) Laboratory tests useful to determine severity and prognosis of disorders as measured by maternal and neonatal adverse outcomes. 3) A classification of disorders for use by Canadian physicians to facilitate uniformity and diffusion of research through a common language. EVIDENCE: Articles on hypertensive disorders in pregnancy published from 1966 to 1996, retrieved through MEDLINE search, related to definitions, tests, diagnostic criteria and classification, as well as documents on diagnosis and classification from authorities in the United States, Europe and Australia and from special interest groups. VALUES: High priority was given to the principle of preventing adverse maternal and neonatal outcomes through the provision of diagnostic criteria for severity and prognosis and through dissemination of reliable and pertinent information and research results using a common language. BENEFITS, HARMS AND COST: Higher degree of vigilance in diagnosing hypertensive disorders in pregnancy, allowing for earlier assessment and intervention, and more efficient dissemination of comparative information through common language. No harm or added cost is perceived at this time. RECOMMENDATIONS: (1) A diastolic blood pressure of 90 mm Hg or more should be the criterion for a diagnosis of hypertension in pregnancy and should trigger investigation and management. Except for very high diastolic readings (110 mm Hg or more), all diastolic readings of 90 mm Hg or more should be confirmed after 4 hours. (2) A regularly calibrated mercury sphygmomanometer, with an appropriate-sized cuff, is the instrument of choice. A rest period of 10 minutes should be allowed before taking the blood pressure. The woman should be sitting upright and the cuff positioned at the level of the heart. (3) Both Korotkoff phase IV and V sounds should be recorded, but the phase IV sound should be used for initiating clinical investigation and management. (4) A urine protein level of more than 0.3 g/d should be the criterion for a diagnosis of proteinuria; 24-hour urine collection should be the standard method for determining proteinuria. (5) Edema and weight gain should not be used as diagnostic criteria. (6) Hypertensive disorders diagnosed during pregnancy should be classified as pre-existing hypertension; gestational hypertension with or without proteinuria; pre-existing hypertension with superimposed gestational hypertension with proteinuria; and unclassifiable antenatally but final classification 42 days after delivery. VALIDATION: Except for expert opinions and reviews solicited for this project, these recommendations need to be field tested and validated in Canada. Guidelines endorsed by the Canadian Hypertension Society and the Society of Obstetricians and Gynaecologists of Canada.     

Is affect aversive to young children with autism? Behavioral and cardiac responses to experimenter distress

The aim of this study was to determine whether displays of negative emotions are more aversive to young children with autism than displays of neutral emotions. The attention, behavioral reactions, facial affect, and cardiac responses of 22 autistic and 22 mentally retarded 3-5-year-old children were compared when an experimenter pretended to hurt herself and showed strong distress in contrast to when the experimenter pretended to hurt herself but showed only neutral affect. The children in both diagnostic groups looked more at the experimenter and appeared more interested and concerned when she displayed strong distress than when she showed neutral affect. The heart rate of the mentally retarded children decreased during the distress condition relative to a baseline condition, but the heart rate of the children with autism did not change across conditions. In summary, the children with autism gave no evidence of being overly aroused by or avoiding the distressed experimenter.     

Toward the use of a standardized assessment for young children with autism: current assessment practices in the UK

Little is known about the progress of autistic children following specific interventions in England. Nor do we know how frequently standardized assessments are used to monitor progress or to evaluate specific educational interventions. The reports of 75 children with autism, for whom special educational provision had been determined by a local education authority, were reviewed. Parents were interviewed and educational psychologists were contacted for details of any norm-referenced assessments. Of these children, 39 percent had no standardized assessments before education authorities determined their provision, and only 9 percent had follow-up assessments that could be used to evaluate progress. Children with autism in the UK rarely have sufficient assessments to allow an objective evaluation of their progress. There is currently no standardized assessment protocol to prescribe a specific educational intervention, to evaluate the progress of children or to make comparisons between interventions. We recommend the development of such a protocol.     

Qualitative assessment of the effect of play materials in dyadic peer interactions of children with autism.

Investigated quality of play in child–child dyads, using 13 autistic, 13 behavior-disordered, and 13 normal children (aged 5–18 yrs) and 60 normal nontarget partners. Ss were observed with 4 different partners and with 4 different sets of play materials (functional, construction, dramatic, or rule-governed). Qualitative aspects of peer interaction were rated, including symmetry, fun, and complexity. Results indicate that rule-governed games were associated with more fun and more complexity for dyads in all diagnostic groups and that construction toys rated higher in complexity than functional or dramatic materials. Findings highlight the importance of structure in facilitating social behavior. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis and intervention with two topographies of challenging behavior exhibited by a young woman with autism

We determined whether tumour size in vivo and cell density in vitro modulate the expression of the mdr-1 gene in B16 melanoma cells. Cells were injected subcutaneously into syngeneic mice. Small (5 mm in diameter) and large (15-20 mm in diameter) tumours were harvested. Tumour cells from small subcutaneous tumours exhibited higher levels of mdr-1 mRNA (measured using Northern blot and in situ hybridization) and P-glycoprotein (P-gp) (measured using immunohistochemistry and fluorescent activated cell sorter analysis), as well as greater. In vitro resistance to doxorubicin (DXR) than cells from large subcutaneous tumours. immunohistochemical studies using an antibody against proliferating cell nuclear antigen revealed that the small subcutaneous tumours contained a larger fraction of proliferating cells than the large tumours. To determine whether cell proliferation correlated with expression of mdr-1, we plated B16-F10 cells to yield sparse and confluent monolayer cultures. The levels of mdr-1 mRNA and P-gp and resistance to DXR and phosphotyrosine activity were higher in the sparse cultures than in the confluent cultures. These results demonstrate an intratumoral heterogeneity for the expression of mdr-1 that directly correlates with intratumoral heterogeneity for cell division.     

Links between theory of mind and executive function in young children with autism: Clues to developmental primacy.

There has been much theoretical discussion of a functional link between theory of mind (ToM) and executive function (EF) in autism. This study sought to establish the relationship between ToM and EF in young children with autism (M = 5 years, 6 months) and to examine issues of developmental primacy. Thirty children with autism and 40 typically developing children, matched on age and ability, were assessed on a battery of tasks measuring ToM (1st- and 2nd-order false belief) and components of EF (planning, set shifting, inhibition). A significant correlation emerged between ToM and EF variables in the autism group, independent of age and ability, while ToM and higher order planning ability remained significantly related in the comparison group. Examination of the pattern of ToM-EF impairments in the autism group revealed dissociations in 1 direction only: impaired ToM with intact EF. These findings support the view that EF may be 1 important factor in the advancement of ToM understanding in autism. The theoretical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On developing self-concepts: a controlled study of children and adolescents with autism

This study employed the self-understanding interview of Damon and Hart (1988) to assess the self-concepts of two groups of children and adolescents: a group of individuals with autism and a group of nonautistic mentally retarded individuals who were matched for age and for verbal ability. On the basis of an hypothesis concerning the interpersonal origins of social and psychological self-concepts (Hobson, 1990; Neisser, 1988), it was predicted that the participants with autism would show a relative dearth of such concepts in their talk about themselves. In accordance with our predictions, there was a significant group difference in the number and quality of statements that fell into the social category of self-concept; contrary to our predictions, however, there was no group difference in the number of statements that fell into the psychological category. In addition, although there were not significant group differences in the overall production of verbally expressed concepts concerning self-attributes of a physical, active, or psychological kind, even within these categories individuals with autism made fewer references to social interactions or qualities. These results are discussed with regard to theories of self-concept development in typically developing as well as autistic and mentally retarded individuals, and with reference to the limitations of interpersonal understanding ("theory of mind") in people with autism.     

Effects of synthetic speech output and orthographic feedback on spelling in a student with autism: a preliminary study

The number of telephone surveys conducted has increased in Japan, with the telephone directory often used for sampling respondents in telephone surveys. As some subscribers request that their numbers not be listed, they are excluded. The Random Digit Dialing (RDD) survey method, however, not only makes possible smooth data collection, but also random sampling of all subscribers in telephone surveys. The authors conducted a telephone survey in Tokyo using the RDD method to investigate any differences in behavior and demographic or social attributes between listed and unlisted subscribers. These attributes included gender, age, family size, job, and residential area. The findings were as follows: 1) The listing rate in telephone directories was 65.8% among respondents. 2) Old age, large family size and certain residential areas correlated with higher listing rates. 3) Nevertheless, the relationship between listing in the telephone directory and residential area remains somewhat unclear due to the confounding attributes of age and family size. 4) Using Hayashi's second method of quantification, age, family size and occupation correlated with listing frequency. 5) There were also significant differences between listed and unlisted subscribers on questions of health maintenance and lifestyle.     

Opioid-immune interactions in autism: behavioural and immunological assessment during a double-blind treatment with naltrexone

The chemical derivatization of biologically active microbial metabolites continues to be a promising approach to the identification of new drugs. We recently synthesized the novel antiproliferative compound SDZ 281-977, 5-[2-(2,5-dimethoxy-phenyl)ethyl]-2-hydroxy-benzoic acid methylester, a derivative of the EGF receptor tyrosine kinase inhibitor lavendustin A. Here we report on our studies of the anticancer efficacy and the mode of action of SDZ 281-977. The growth of both the human pancreatic tumor cells MIA PaCa-2 and the human vulvar carcinoma cells A431 was inhibited in the low micromolar range. Tumors from these cells were induced in nude mice and were shown to respond to orally or intravenously administered SDZ 281-977. In contrast, no antitumor effect was detected in rats bearing dimethylbenzanthracene-induced mammary tumors. Studies in mice indicated that SDZ 281-977 was neither immunosuppressive nor hematosuppressive at doses effectively inhibiting tumor growth. Surprisingly, the mode of action of SDZ 281-977 apparently does not involve inhibition of EGF receptor tryosine kinase, because, in contrast to lavendustin A, SDZ 281-977 failed to inhibit this enzyme in a cell-free assay. The mechanism of the antiproliferative effect can be explained on a cellular level by the ability of the compound to arrest cells in mitosis. SDZ 281-977 is thus the first example of an antimitotic agent derived from the potent tyrosine kinase inhibitor lavendustin A. The therapeutic potential of SDZ 281-977 is enhanced by the fact that it is not subject to multidrug resistance, because tumor cells expressing the multidrug resistance phenotype were as sensitive to SDZ 281-977 as their nonresistant counterparts. In conclusion, SDZ 281-977 represents a novel lavendustin A derivative with potent antiproliferative properties in vitro and in vivo that may be explained on the basis of its antimitotic effects. SDZ 281-977 may be a candidate drug for the treatment of selected cancers, including those expressing the multidrug resistance phenotype.     

Peer-related social interactions of developmentally delayed young children: Development and characteristics.

Conducted a short-term longitudinal study of the peer-related social interactions of 111 developmentally delayed toddler and preschool age children. Initial analyses centered on 2 groups: one composed of younger and more severely delayed children (aged 1.8–6.6 yrs) and the other consisting of older and more mildly delayed children (aged 2.4–6.8 yrs). Observers coded a wide range of social and play behaviors during free-play interactions in individual classrooms, including ratings of social participation, constructiveness of play, and teacher behavior, as well as a series of sequential interactive measures. Similarities to normally developing children in the organization and developmental progression of peer interactions across the short term were noted for each of the groups. However, comparisons to normative expectations for preschool age children in relation to Ss' cognitive levels and cross-sectional analyses across CA suggested the existence of unusually marked deficits in peer interactions. These deficits may simply be a manifestation of a more basic and generalized social interaction deficit, or they may be related to the cognitive level-expressive language discrepancy characteristic of such children, or they may be due to the fact that such children are usually surrounded by other children with substantial deficits. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Participation of children with autism and nondisabled peers in a cooperatively structured community art program

Two groups (one younger, one older) of children with autism participated in monthly art activities with same-age nondisabled peers at a children's museum. The study sought to investigate the feasibility of offering a cooperatively structured art education class for students with autism and nondisabled students, and to evaluate the effect of joint participation on the students' interactions with one another. Results indicated that both groups of children with autism were targeted for interactions from nondisabled peers significantly more often during intervention than during baseline, even though positive social interaction bids by nondisabled peers were rarely reciprocated and hardly ever initiated by peers with autism.     

Hearing aid for and clinical picture of deaf children with multiple handicaps

The evolution and the frequency of early detection technics, as well as the choice made in noenatalogy increase to a considerable extent the number of children who show besides an already bad clinical picture in the development field important hearing deficiencies. We bring forward a few clinical reflections resulting from our experience in hearing aid of these children.     

The structure of intelligence in children and adults with high functioning autism.

Confirmatory factor analyses of the commonly used 11 subtests of the Wechsler child and adult intelligence scales were accomplished for 137 children and 117 adults with high functioning autism (HFA) and for comparable age groups from the standardization samples contained in the Wechsler manuals. The objectives were to determine whether the structure of intelligence in HFA groups was similar to that found in the normative samples, and whether a separate "social context" factor would emerge that was unique to HFA. Four-factor models incorporating a Social Context factor provided the best fit in both the autism and normative samples, but the subtest intercorrelations were generally lower in the autism samples. Findings suggest similar organization of cognitive abilities in HFA, but with the possibility of underconnectivity or reduced communication among brain regions in autism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing the output and the energy efficiency of electric arc furnaces with shaft heating of metal scrap

It is proposed to equip the electric arc furnaces with shaft heating of scrap that operate with continuous scrap melting in a liquid metal with powerful gas-oxygen burner units. When scrap is heated to 800°C at a gas flow rate of 15.5 m³/t and a bath is blown by oxygen at the slag-metal boundary, fuel-arc steelmaking units can successfully compete with the best modern electric arc furnaces in capacity and have ecological advantages.     

Imagining the outcome of pretend transformations: Assessing the competence of normal children and children with autism.

Children's grasp of make-believe transformations was studied. In Exp 1, children saw an adult enact a pretend change (e.g., sprinkling pretend talcum powder over a toy cat). They indicated the pretend outcome by choosing between a picture depicting no change (e.g., cat without talcum powder on its body) and a picture depicting the pretend change (e.g., cat covered with talcum powder). Older children (M?=?29 mo) chose correctly, but younger children (M?=?21 mo) did not. A similar age change emerged in Exp 2 despite the addition of a picture of an irrelevant transformation. Exp 3 showed that children with autism can imagine pretend transformations. Implications for children's imagination and the autistic syndrome are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing the efficiency of the process of the alumina production by the Bayer method with the aid of a computer model

The object of studies was an alumina plant operating according to the Bayer process; the basic tool of these studies was a computer model of alumina production which allows optimization. Methods have been developed, which make it possible to reveal the degree of the influence of the properties of raw materials and technological characteristics of production on the economic efficiency of the production. The greatest attention was given to the technological processes which form the Bayer cycle, i.e., to leaching, decomposition, thinning, and evaporation. The process of the passage of material flows through the entire Bayer cycle and the obtaining of qualitative and quantitative characteristics of these flows has been simulated. A model of phase diagrams which makes it possible to approximately determine the shape and position of the solubility isotherms of gibbsite depending on temperature has been constructed. The main result of this work is the development of an efficient tool which ensures conducting the optimization of the most important technological characteristics of alumina production on the basis of its complex technical and economic estimation.     

Primary care of infants and young children with Down syndrome

Down syndrome is caused by triplicate material of chromosome 21. The syndrome has a variable physical expression, but congenital cardiac defects, transient myelodysplasia of the newborn and duodenal atresia are highly specific for this chromosomal disorder. Routine health maintenance is important because infants and children with Down syndrome are more likely to have otitis media, thyroid disease, congenital cataracts, leukemoid reactions, dental problems and feeding difficulties. Since infants with this syndrome are prone to respiratory infections, immunization recommendations should be followed closely. Motor, language, social and adaptive skills should be assessed at each office visit. The psychosocial aspects of care should be discussed with the parents of an infant with Down syndrome. If necessary, the parents should be referred to family support and specialty resources. Institutionalization of infants with Down syndrome is now unlikely. With newer surgical techniques, early therapy to minimize developmental delay and proper health supervision, the functional prognosis for infants with Down syndrome is considerably improved.     

Treatment of children and young adults with early-stage non-Hodgkin's lymphoma

BACKGROUND: Children and young adults with early-stage non-Hodgkin's lymphoma have an excellent prognosis, but treatment is prolonged and is associated with many side effects. We performed two studies to determine whether therapy could be simplified. METHODS: Between 1983 and 1991, we conducted two consecutive trials in children and young adults (age, <21 years) with early-stage non-Hodgkin's lymphoma. In the first trial, patients were treated for 9 weeks with induction chemotherapy consisting of vincristine, doxorubicin, cyclophosphamide, and prednisone, followed by 24 weeks of continuation chemotherapy with mercaptopurine and methotrexate. Half the patients were randomly assigned to receive involved-field irradiation. In the second trial, after the 9 weeks of induction chemotherapy, the patients were randomly assigned to receive 24 weeks of continuation chemotherapy or no further therapy. RESULTS: A total of 340 patients were enrolled in the two trials, 12 of whom did not have complete remissions. One hundred thirteen patients received nine weeks of chemotherapy without radiotherapy, 131 received eight months of chemotherapy without radiotherapy, and 67 received eight months of chemotherapy with radiotherapy. At five years, the projected rates of continuous complete remission were 89, 86, and 88 percent for the three groups, respectively. At five years, event-free survival among the patients with early-stage lymphoblastic lymphoma was inferior to that among the patients with other subtypes of lymphoma (63 percent vs. 88 percent, P<0.001). Continuation therapy was effective only in patients with lymphoblastic lymphoma. CONCLUSIONS: A nine-week chemotherapy regimen without irradiation of the primary sites of involvement is adequate therapy for most children and young adults with early-stage, nonlymphoblastic non-Hodgkin's lymphoma.     

Play therapy with young children during the pregnancy of a novice therapist.

The therapist's pregnancy provided a content area of focus in separate play therapy sessions with a 4-yr-old boy and a 7-yr-old girl. In addition, the manner in which the children coped with termination issues associated with the pregnancy reflected the broader maladaptive coping mechanisms used by each child. The therapist's pregnancy highlighted aspects of each child's psychopathology, making them more accessible for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)