Prognosis for survival and improvement in function in children with severe developmental disabilities

OBJECTIVE: To evaluate the feasibility and cost-effectiveness of using transient evoked otoacoustic emissions (TEOEs) to assess hearing in infants recovered from meningitis. METHODS: Recordings of TEOEs and visual reinforcement audiometry (VRA) were performed in a prospective study of 39 children aged 6 to 24 months recovering from a purulent meningitis. Patients with no TEOEs, or whose VRA findings were abnormal, were also tested by impedance audiometry and recording of auditory brain-stem responses (ABRs) after treatment of any secretory otitis media. Costs were compared with those of a previous protocol including VRA, impedance audiometry, and ABR for all children. RESULTS: A total of 29 children had TEOEs in both ears and normal VRA findings. Ten children lacked TEOEs in one or both ears; 9 of them had otitis media with effusion. Further examination by VRA and ABR led to the diagnosis of bilateral sensorineural hearing loss in 2.6% (1/39) of patients and unilateral sensorineural hearing loss in 7.7% (3/39) of patients. Cost analysis revealed that this protocol costs about half the previous one. CONCLUSION: Recording TEOEs appears to be a feasible and cost-effective hearing screening test for infants recovered from meningitis. If TEOEs are absent, impedance audiometry, ABR recordings, and audiometric evaluation techniques are needed to distinguish between conductive and sensorineural hearing loss and to assess hearing thresholds precisely.     

Disaggregating parental depression and family stress in assessing families of children with developmental disabilities: a multisample analysis

Thymic nurse cells are defined in vitro as multicellular complexes of epithelial cells and thymocytes. Although these structures have been implicated in the intrathymic differentiation of thymocytes, little is known about the biology of this cell complex and about the occurrence of the cells in the thymus in situ. Therefore, to clarify the matter, in this review we have presented characteristics of epithelial cells capable of forming complexes with thymocytes, in light of the literature data and the experience of the authors. The structure of cells within the complexes allowed us to distinguish three types of thymic nurse cells. Three-dimensional reconstruction of the thymus and observations employing TEM and SEM demonstrated the presence of distinct types of complexes in various topographic regions of the thymus. Where possible, the functional relevance of the morphological data was analyzed.     

Fathers and mothers of school-age children with developmental disabilities: parental stress, family functioning, and social support

Thirty pairs of fathers and mothers who had school-age children with mental retardation and other disabilities were compared with each other and with 32 father and mother pairs of parents of children without disabilities. Responses to family scales indicated that fathers and mothers of children with developmental disabilities did not differ from each other nor from fathers and mothers of children without disabilities in parental stress, family social support, or family functioning. However, parents of children with disabilities experienced a disproportionately greater level of stress relating to their children than did those of children without disabilities. Fathers' and mothers' stress was associated with aspects of family functioning as perceived by themselves and their spouses.     

Overview and implications of Medicaid managed care for people with developmental disabilities

The inclusion of people with developmental disabilities in managed care as part of general efforts by states to enroll and Medicaid recipients in such plans was reviewed. Managed care was defined and the processes by which managed care organizations deliver services were explained. Escalating costs and utilization were discussed as the primary reason for the shift to managed care. The use of Medicaid Section 1115 waivers by states to include Medicaid recipients was explored. The relation between acute health care and long-term care, and the utilization patterns in each, were briefly described. Finally, elements of managed care that are particularly important to people with developmental disabilities, such as care coordination, maintenance of quality, and individual and family support, were discussed.     

Comparison of the Interplak and manual toothbrushes in a population with mental retardation/developmental disabilities (MR/DD)

A still debated question in the field of the cytokine network in psoriasis is represented by contrasting data reported on the local amount of IL-1 beta amounts, of IL-1 in this dermatosis. In fact previous studies have suggested that there were decreased Il-1 alpha amounts at the lesional level but increased nonfunctional IL-1 beta concentrations as compared to the non-lesional and normal epidermis. However, recent data suggest that IL-1 alpha and, to a lesser extent, IL-1 beta amounts, are both increased and biologically active in the epidermal cell suspension of lesional psoriatic skin as compared to those of normal skin. The data reported in the present paper show that IL-1 alpha levels are decreased in psoriatic lesional extracts of whole skin (mean 2.9 +/- 2 pg/mg) as compared to non-lesional (mean 6.7 +/- 6.2 mg/mg; p = 0.02) or normal skin (mean 13.8 +/- 9.4 pg/mg; p = 0.0002). IL-1 alpha concentrations were also significantly lower in the non-lesional skin than in normal skin (p = 0.02). In contrast, the IL-1 beta levels (mean 1.2 +/- 0.74 pg/mg were higher in the lesional samples than in the non-lesional ones (mean 0.5 +/- 0.4 pg/mg; p = 0.0004) or in normal skin (mean 0.4 +/- 0.2 pg/mg; p = 0.004). No differences in IL-1 beta levels were observed between non-lesional and normal skin (p = 0.3). In addition both IL-1 alpha and IL-1 beta are directly correlated with the disease severity and each other. Our data, extending the Il-1 determination to the whole skin, seem to confirm the previously reported findings at the epidermis level and provide new light on possible interpretation of literature discrepancies.     

Functional disruption of the brain mechanism for reading: Effects of comorbidity and task difficulty among children with developmental learning problems.

Objective: The study investigated the relative degree and timing of cortical activation associated with phonological decoding in poor readers. Method: Regional brain activity was assessed during performance of a pseudoword reading task and a less demanding, letter-sound naming task by three groups of students: children who experienced reading difficulties without attention problems (N = 50, RD) and nonreading impaired (NI) readers either with (N = 20) or without attention-deficit/hyperactivity disorder (ADHD; N = 50). Recordings were obtained with a whole-head neuromagnetometer, and activation profiles were computed through a minimum norm algorithm. Results: Children with RD showed decreased amplitude of neurophysiological activity in the superior temporal gyrus, bilaterally, and in the left supramarginal and angular gyri during late stages of decoding, compared to typical readers. These effects were restricted to the more demanding pseudoword reading task. No differences were found in degree of activity between NI and ADHD students. Regression analyses provided further support for the crucial role of left hemisphere temporoparietal cortices and the fusiform gyrus for basic reading skills. Conclusions: Results were in agreement with fMRI findings and replicate previous MEG findings with a larger sample, a higher density neuromagnetometer, an overt pseudoword reading task, and a distributed current source-modeling method. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Independence as a goal and a value of people with physical disabilities: Some caveats.

Challenges the notion that the primary goal of rehabilitation should be to make people with physical disabilities as independent as possible. Some parameters of dependence (dependent, interdependent, dependable, and independent) are described as relationships with particular people in particular situations, and the advantages and disadvantages of playing each role are discussed. It is argued that rehabilitation is successful when the individual achieves the flexibility and skill to enter comfortably into a variety of dependence relationships. Emphasis is placed on the value of healthy dependency and the importance of facilitating changes in both the person and the culture to encourage people with disabilities to develop interdependent and dependable roles with others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

More positive or less negative? Trends in research on adjustment of families rearing children with developmental disabilities

Breast cancer is one of the most common forms of cancer observed in women, and endogenous estrogen is thought to play a major role in its development. Because of this, any conditions or exposures which enhance estrogenic responses would result in an increased risk for breast cancer. The role of xenoestrogenic compounds, such as DDT, in the etiology of breast cancer is still very controversial. In the following paper we discuss recently-published observations by ourselves and others which indicate that xenoestrogens may play a significant role in the development of breast cancer. Specifically, we hypothesize that during periods of high growth rates and during breast development the sensitivity of breast cells to estrogenic compounds is sufficiently great for xenoestrogens to significantly enhance risk for breast cancer.     

The prevalence, stability and significance of developmental language delay in preschool children

A sample of 937 children in Dunedin, New Zealand, was assessed at ages three and five years in order to estimate the nature, prevalence, stability and significance of developmental language delays in three-year-olds. Assessments included language development, intelligence, and fine and gross motor-co-ordination. Detailed results are given which described three types of language delay at age three: delayed verbal comprehension only, delayed verbal expression only, and delayed development in both aspects of language. Follow-up testing at age five indicated that the specific language delays were not highly stable, whereas delays in both aspects were highly stable. A large proportion of the latter children gained very low scores on the measures at age five, and they accounted for 84 per cent of all children with very low intelligence. The implications of the results for a screening programme to identify three-year-old children at high risk of later developmental delays are considered.     

Characteristics of hospitalizations for people with developmental disabilities: utilization, costs, and impact of care coordination

Hospitalizations and the impact of care coordination were studied in two large databases for people with developmental disabilities. Acute care admissions for alternate years between 1983 and 1991 were analyzed and compared to the data for the nondisabled population of New Jersey. The statewide dataset included 22,294 admissions; the coordinated dataset included 692 admissions to a community hospital. Under the diagnostic-related group reimbursement system, admissions for the general population remained constant, whereas hospital days and average length of stay dropped during the study period. Increases in admissions (56%) and days (42%) were found for people with developmental disabilities. Their total hospital charges rose 206%, almost twice the rate for the general population. Care coordination moderated all of these differences.     

Standardization of the Functional Assessment and Intervention Program (FAIP) with Children Who Have Externalizing Behaviors.

The purpose of this study was to develop standardization data for the Functional Assessment Intervention Program (FAIP; University of Utah, Utah State University, & Utah State Office of Education, 1999), a computerized, functional behavioral assessment expert system. Reliability, validity, and utility analyses were conducted with students serving in either regular or special education classrooms who were rated by their teachers as having externalizing problematic behaviors. Results suggest that the FAIP demonstrated evidence of good interrater agreement and test-retest reliability for both behavior function and overall agreement. The FAIP also shows evidence of concurrent validity when identified behavior functions are compared to behavior functions identified on the Motivational Assessment Scale (MAS; Durand & Crimmins, 1992) and the Functional Assessment Interview (FAI; O'Neill et al., 1997). Most users preferred the FAIP to the two other functional assessments (MAS and FAI), ranking it higher overall and on an item-by-item basis. Implications for school psychologists using the FAIP with students who exhibit externalizing behavior disorders are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Physical activity play in children with disabilities: a neglected opportunity for research?

Studies of the development of children with disorders of motor function afford opportunities, as yet unexploited, to understand the importance of motor function to overall child development. Pellegrini and Smith's review provides a challenge to developmentalists from many disciplines to use this natural model of developmental variation to move the field forward.     

Issues in the neuropsychological assessment of children with learning disabilities.

Describes an approach to the neuropsychological assessment of children with learning disabilities. Issues relating to the aims of the assessment, test selection, stylistic variables in assessment, test interpretation, and the rendering and implementation of recommendations are discussed. Some comparisons with other strategies and modes of approach (e.g., level of performance, pathognomonic sign, and differential score approaches) are included. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An efficient method of ensuring program quality for adults with developmental disabilities in community-based apartments.

Evaluated a supervision program that was designed to improve the quality of engagement of activities for adults with severe disabilities who are living in community based apartments. Ss were adults (aged 24–44 yrs) diagnosed with severe mental retardation, autism, childhood schizophrenia, personality disturbance, organic bipolar affective disorder, attention deficit disorder, or recurrent depression. A program involving feedback was implemented in a multiple-baseline design across individuals. Results show that after the supervision program was implemented, adult participation increased across activities related to learning short-term objectives as designated on the person's individualized habilitation plan, scheduled activities, activities promoting independence, and age-appropriate activities. Feedback provided once a week was equally as effective as feedback provided 3 times a week in the community-based settings. Follow-up done 1 yr later revealed maintenance of these gains in the community settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parents'' developmental expectations and child characteristics: longitudinal study of children with developmental delays and their families

Infection of isolated organs of the reproductive system by Trypanosoma cruzi has been described since Chagas' disease was first studied. A detailed histopathological analysis of mice acutely infected with T. cruzi CL strain showed colonization of male (preputial glands and skin, penis, testicular albuginea, epididymis, vas deferens, seminal vesicles, prostate, coagulative, bulbo urethral and urethral glands) and female (vagina, uterus, oviduct, ovary, mesovary, clitoris and mammary glands) structures of the reproductive system. The results presented herein demonstrated invasion of epithelial cells, pronounced colonization of the epididymis and male genital adnexa, but absence of parasitism in penile corpora cavernosa.     

Vibrational normal modes and dynamical stability of DNA triplex poly(dA). 2poly(dT): S-type structure is more stable and in better agreement with observations in solution

A normal-mode and statistical mechanical calculation was carried out to determine the vibrational normal modes, contribution of internal fluctuations to the free energy, and hydrogen bond disruption of DNA triplex poly(dA).2poly(dT). The calculation was performed on both the x-ray fiber diffraction model with a N-type sugar conformation, and a newly proposed model with a S-type sugar conformation. Our calculated normal modes for the S-type structure are in better agreement with observed IR spectra for samples in D2O solution. We also find that the contribution of internal fluctuations to free energy, premelting hydrogen bond disruption probability, and hydrogen bond melting temperatures for the Hoogsteen and Watson-Crick hydrogen bonds all show that the S-type structure is dynamically more stable than the N-type structure in a nominal solution environment. Therefore our calculation supports experimental findings that the triplex d(T)n.d(A)nd(T)n most likely adopts a S-type sugar conformation in solution or at high humidity. Our calculations, however, do not preclude the possibility of an N-type conformation at lower humidities.