ABSTRACT
We provided inpatient rehabilitation treatment and return-to-school guidance to a junior high school student with medulloblastoma and pervasive developmental disorder (autism spectrum disorder). Here we describe the rehabilitation treatment for patients with physical and developmental disabilities. A 13-year-old boy who was diagnosed with pervasive developmental disorder at 4 years of age was able to perform activities of daily living independently and attend junior high school. However, he was admitted to our hospital with new-onset ataxia. Magnetic resonance imaging revealed a cerebellar tumor. After total tumor excision was performed, pathological analysis revealed medulloblastoma, which was treated initially with radiation therapy and then chemotherapy for 1 year. Rehabilitation was initiated 2 days post-surgery. We evaluated his communication abilities. He showed stereotypical behavior owing to the autism spectrum disorder；therefore, we performed low-intensity repetitive exercises. The functional independence measure score at discharge was 67/126 (motor 44/91, cognitive 23/35). We taught his teachers how to properly assist him, and he successfully returned to school post-discharge. Although this was a case in which the child had multiple disabilities, ataxia caused by the medulloblastoma aggravated his developmental disability. Thus, understanding the characteristics of communication and its strengths was vital in determining a treatment plan that enabled his return to school.
ABSTRACT
We provided inpatient rehabilitation treatment and return-to-school guidance to a junior high school student with medulloblastoma and pervasive developmental disorder (autism spectrum disorder). Here we describe the rehabilitation treatment for patients with physical and developmental disabilities. A 13-year-old boy who was diagnosed with pervasive developmental disorder at 4 years of age was able to perform activities of daily living independently and attend junior high school. However, he was admitted to our hospital with new-onset ataxia. Magnetic resonance imaging revealed a cerebellar tumor. After total tumor excision was performed, pathological analysis revealed medulloblastoma, which was treated initially with radiation therapy and then chemotherapy for 1 year. Rehabilitation was initiated 2 days post-surgery. We evaluated his communication abilities. He showed stereotypical behavior owing to the autism spectrum disorder；therefore, we performed low-intensity repetitive exercises. The functional independence measure score at discharge was 67/126 (motor 44/91, cognitive 23/35). We taught his teachers how to properly assist him, and he successfully returned to school post-discharge. Although this was a case in which the child had multiple disabilities, ataxia caused by the medulloblastoma aggravated his developmental disability. Thus, understanding the characteristics of communication and its strengths was vital in determining a treatment plan that enabled his return to school.
ABSTRACT
Background: Common childhood psychiatric problems like attention deficit hyperkinetic disorder (ADHD), Pervasive developmental disorder (PDD) and learning disability (LD) often co-exists with each other and form a constellation of behavioural manifestations that require extra attention from the caregivers. Having a differentially-abled child is challenging and most parents have to learn to restructure their lives around that of the child. There is a difference in the attitudes of both the parents as far as parenting a disabled child is concerned. Mothers often shoulder the primary caregiving role however the psychological costs borne by women go unrecognized. The study aims to assess the care giver burden (BOC) and perceived stress (PS) and quality of life (QOL) in mothers of children with ADHD, PDD and LD.Methods: It was a cross-sectional study with 336 child mother pairs. The mothers were asked to rate their burden and stress symptoms on the perceived stress scale and Burden of care scale. The mothers were also asked to rate their quality of life on the quality of life scale.Results: The mean PS score was highest in the PDD group. The mean BOC was lowest in the LD group. The QOL score was highest in the LD group. There is statistically significant difference in the PS, BOC and QOL scores among the three groups.Conclusions: There is a hidden lacuna of psychological stress in mothers of children with common psychiatric problems. The study also establishes that these mothers have poorer quality of life. It is necessary to address these psychological issues of the mother at every visit and equip them with coping strategies so that they can look after both themselves and their special needs child.
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OBJECTIVES: The objective of this study was to investigate the concordance of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM-5) diagnostic criteria for autism spectrum disorder (ASD). METHODS: We retrospectively reviewed the medical records of 170 subjects (age range: 3–23, 140 boys) with developmental delay or social deficit from January 2011 to July 2016 at the Department of Psychiatry of Asan Medical Center. The Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS), and intelligence tests were performed for each subject. Diagnosis was reviewed and confirmed for each subject with DSM-IV Pervasive Developmental Disorder (PDD) and DSM-5 ASD criteria, respectively. RESULTS: Fifty-eight of 145 subjects (34.1%) who were previously diagnosed as having PDD in DSM-IV did not meet DSM-5 ASD criteria. Among them, 28 (48.3%) had Asperger's disorder based on DSM-IV. Most algorithm scores on ADOS and all algorithm scores on ADI-R were highest in subjects who met both DSM-IV PDD criteria and DSM-5 ASD criteria (the Convergent group), followed by subjects with a DSM-IV PDD diagnosis who did not have a DSM-5 ASD diagnosis (the Divergent group), and subjects who did not meet either DSM-IV PDD or DSM-5 ASD criteria (the non-PDD group). Intelligence quotient was lower in the Convergent group than in the Divergent group. CONCLUSION: The results of our study suggest that ASD prevalence estimates could be lower under DSM-5 than DSM-IV diagnostic criteria. Further prospective study on the impact of new DSM-5 ASD diagnoses in Koreans with ASD is needed.
Subject(s)
Appointments and Schedules , Asperger Syndrome , Autism Spectrum Disorder , Autistic Disorder , Diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Intelligence , Intelligence Tests , Medical Records , Prevalence , Prospective Studies , Retrospective StudiesABSTRACT
Pervasive developmental disorders (PDD) is a developmental neurological disorders. PDD consist of Autism, Asperger syndrome, Pervasive developmental disorder not otherwise specified Rett's disorder and childhood di sintegrative disorder. The incidence of the disease has been increased in past one decade when compared to earlier, which is due to increased awareness of the disease. The diagnosis of the PDD mainly by diagnostic and statistical manual of mental disorder(DSM) published by American psychiatric association. DSM V the pervasive development disorders were considered into single autism like spectrum of disorders. Autism spectrum disorder is not completely curable and hence requires lifelong management Educational and behavioral interventions are more successful when compared to medications alone. Early interventions have more positive results. The present review articles describes regarding the Pervasive developmental disorders, prevalence of autism worldwide, individual countries ,their characteristic features, diagnosis by DSM IV and DSM V, causative factors involved and management.
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OBJECTIVES: The purpose of this study was to investigate the effectiveness of a day-hospital treatment program designed to help development of children with pervasive developmental disorder (PDD) and mental retardation (MR). METHODS: Retrospective review of the charts of 32 children (28 with PDD, 4 with MR), who participated in a day-hospital treatment program of Seoul Metropolitan Eunpyeong Hospital, from October 2008 to February 2012, was conducted. Development level of each patient was evaluated according to the Psycho-Educational Profile-Revised (PEP-R), Social Maturity Scale (SMS), and Childhood Autism Rating Scale (CARS). Evaluation was done at two points, before participation and after 1 year participation. RESULTS: Children who participated in the day-hospital treatment program showed significant improvement in all categories of PEP-R, SMS, and CARS. CONCLUSION: Day-hospital treatment program is effective for helping development of children with PDD and MR.
Subject(s)
Child , Humans , Autistic Disorder , Intellectual Disability , Retrospective Studies , SeoulABSTRACT
Se eligió para el análisis del tratamiento desde el modelo neurofisiológico creado por J. E. Azcoaga (1964, 1970, 1973, 1979, 1987, 2000, 2010) un caso de trastorno generalizado del desarrollo -no especificado- (DSM-IV), de un niño dos años cinco meses al momento de la evaluación. Tanto el trastorno como la edad del paciente permiten describir las etapas y el tratamiento para la organización y desarrollo de todas las funciones cerebrales superiores: gnosias, praxias y lenguaje, y de los dispositivos básicos del aprendizaje: motivación, atención, percepción y memoria, así como las llamadas funciones ejecutivas y capacidades sociales. Y otras funciones más avanzadas como la lectura, la escritura y las matemáticas...
Was chosen for the analysis of the treatment from the Neurophysiologic Model created by J. E. Azcoaga (1964, 1970, 1973, 1979, 1987, 2000, 2010) a case of pervasive developmental disorder -not specified- (DSM-IV) of a child that was assessed when he was two years five months. Both, the type of disorder and the patient's age, aloud to describes the stages of the treatment for the organization and development of all higher brain functions: gnosis, praxis and language, and learning basic devices: motivation, attention, perception and memory; the executive functions and the social skills. As well as others, more advanced functions, such as reading and writing. It was important to place as central core of this disorder the difficulty in acquiring skills and inter-subjective symbolic capacities, in which language has a preponderate influence with its various functions...
Subject(s)
Humans , Male , Child , Neurophysiology , Child Development Disorders, Pervasive/diagnosis , Child Development Disorders, Pervasive/rehabilitationABSTRACT
Este artigo apresenta sessões conjuntas com os pais e sua filha de três anos, com transtorno global do desenvolvimento (posteriormente definido como Síndrome de Rett), incluindo traços autísticos. A criança, apática e hipotônica, com movimentos estereotipados das mãos, respondia pouco às solicitações dos adultos. Nas intervenções, procurou-se estabelecer redes de sentido que pudessem significar seu estado isolado e que resgatassem as funções parentais. Destaca-se o investimento subjetivante do analista no trabalho com crianças com transtornos autísticos. O trabalho se desenvolve a partir do setting de intervenção nas relações iniciais pais-bebê, dos conceitos de estados autísticos, de reclamação, de subjetivação e de construção da parentalidade.
This paper presents joint sessions with parents and their three year-old daughter, who shows a Pervasive Developmental Disorder (later defined as Rett Syndrome) which includes autistic features. The apathetic and hypotonic child, with stereotyped hand movements, responded very poorly to requests from adults. During the interventions, there was an effort to establish networks of meaning capable of signifying her isolated condition and which could rescue parental functions. The analyst's subjectivating investment in the work with children who have autistic disorders is highlighted. The paper develops from the intervention setting in parent-infant initial relationships and from the concepts of autistic conditions, reclamation, subjectivation and parentality construction.
Este trabajo presenta sesiones conjuntas con dos padres y su hija de tres años, con trastorno global de desarrollo (posteriormente definido como Síndrome de Rett), incluyendo trazos autísticos. La niña, apática e hipotónica, con movimientos estereotipados de las manos, respondía poco a las solicitudes de los adultos. En las intervenciones se busca establecer redes de sentido que pudieran significar su estado de asilamiento y que rescaten las funciones parentales. Se destaca la inversión subjetivante del analista en el trabajo con niños con trastornos autísticos. El trabajo se desarrolla a partir del setting de intervención en las relaciones iniciales padres-bebé, de los conceptos de estados autísticos, de reclamación, de subjeti-vación y de construcción de la paternidad.
ABSTRACT
O conceito de morte é adquirido paralelamente ao desenvolvimento cognitivo e afetivo da criança, sendo descritos três estágios, paralelos aos estágios piagetianos. O objetivo deste trabalho foi verificar se o conceito de morte em portadores da síndrome de Asperger é similar ao observado em pessoas sem psicopatologia, ou se tem relação com o observado em portadores de deficiência intelectual leve. Para tanto, foram avaliados indivíduos com síndrome de Asperger, indivíduos com deficiência intelectual leve e indivíduos sadios, sem doenças mentais e/ou neurológicas, utilizando-se o Instrumento de Sondagem do Conceito de Morte elaborado por Wilma Torres. Os resultados apontam deficits na aquisição do conceito de morte por indivíduos com síndrome de Asperger, possivelmente relacionados aos deficits na teoria da mente, função executiva e fraca coerência central.
The concept of death is acquired in parallel with cognitive and affective development of children. The objective of this work was it verify if the concept of death in people with Asperger syndrome is similar to that observed in people without psychopathology, or whether it is related to that observed in people with mild mental retardation. For this purpose, individuals with Asperger syndrome, mild mental retardation and healthy individuals without mental and/or neurological diseases were evaluated using the Instrument of Investigation of the Concept of Death developed by Wilma Torres. The results indicated impairment in acquisition of the concept of death in Asperger syndrome cases, possibly related to deficits in the theory of mind, executive function, and weak central coherence.
Subject(s)
Humans , Asperger Syndrome , Attitude to Death , Autistic DisorderABSTRACT
A case of a hyperactive child with impaired speech, perceptual-motor capacity and interpersonal skills is presented. Presumptive diagnoses are discussed according to the international classifications most often used. The nature of pervasive developmental disorders is examined based on the concepts of theory of mind and theory of executive dysfunction.
Subject(s)
Humans , Female , Child , Executive Function , Theory of Mind , Child Development Disorders, Pervasive/psychologyABSTRACT
Due to co-morbidities and treatment resistant nature of pervasive developmental disorder (PDD), diverse combinations of regimens have been tried. This retrospective study aimed to explore adjunctive use of aripiprazole in children with PDD. Changes in illness severity were measured by Clinical Global Impression of Severity (CGI-S) and Clinical Global Impression of Improvement (CGI-I) in 14 aripiprazole-treated patients with PDD. Improvement of illness severity was observed after aripiprazole add-on (5.8+/-0.8 to 4.9+/-1.0, Z=-2.75, p=0.001). Mean dosage was 7.7 mg/day [standard deviation (SD) 3.3, range 5-15]. A higher mean dosage was observed in group with improvement in symptoms (t=-2.33, df =12, p=0.004). The target symptoms most effectively improved after using aripiprazole were positive psychotic symptoms (mean CGI-I: 2.0+/-1.4, 3 responders/4 patients, 75% response) followed by aggressive behavior (2.5+/-1.7, 3/4, 75%), self-injurious behavior (2.0+/-1.0, 2/3, 67%), stereotypic behavior (2.7+/-1.2, 2/3, 67%), tic (2.8+/-1.0, 2/4, 50%), irritability (3.5+/-2.1, 1/2, 50%), obsessive behavior (2.5+/-2.1, 1/3, 33%), hyperactivity (3.4+/-1.6, 3/7, 43%) and mood fluctuation (3, 0/1, no response). Five patients (35%) discontinued aripiprazole due to treatment-emergent adverse effects (akathisia, insomnia, withdrawal). The results of this study suggest that aripiprazole augmentation may be used safely in maladaptive behaviors of some populations of PDD. However, future studies are required to con-firm these preliminary findings.
Subject(s)
Child , Humans , Autistic Disorder , Obsessive Behavior , Piperazines , Quinolones , Retrospective Studies , Self-Injurious Behavior , Sleep Initiation and Maintenance Disorders , Tics , AripiprazoleABSTRACT
Esta investigación consiste en el diseño, ejecución y evaluación de un programa de intervención psicoeducativa basado en imágenes, aplicado a nueve niños con Trastorno Generalizado del Desarrollo (TGD) de tipo autista, cuyas edades fluctuaban entre los 3 y 8 años de edad en Temuco. El programa se enfocó para activar el desarrollo de las dimensiones de anticipación y flexibilidad en niños con TGD. Con el propósito de determinar el perfil de desarrollo inicial de los participantes, se les aplicó el Inventario de Desarrollo de Espectro Autista IDEA. Una vez ejecutado el programa se les evaluó nuevamente con el mismo instrumento, evidenciándose diferencias significativas en las dimensiones de anticipación t = 0,039 (P<0.05), complementariamente se encontraron resultados no esperados, en la escala de trastorno de desarrollo social t = 0,040 (P<0.05). No hubo evidencias significativas en la dimensión de sentido de actividad propia, obteniéndose un resultado de t = 0, 57 (P>0, 05). Los resultados reflejan la efectividad de la aplicación del programa de intervención con imágenes cuyo propósito es aportar a la sistematización del trabajo con niños que padecen algún trastorno generalizado del desarrollo.
This investigation is about the design, execution and evaluation of a psycho-educative intervention program based on the use of images, tested on nine children with autistic type of Pervasive Developmental Disorder (PDD) from 3 to 8 years old in Temuco, Chile. This program was implemented to activate de development in the anticipation and flexibility dimensions en children with PDD. In order to determine the initial participants profile, the autism spectrum disorders development inventory IDEA was applied. After the program was finished, this instrument was also used, showing significant differences in the anticipation dimension with t = 0,039 (P<0.05). As a non expected result in the social development dimension there was found that t = 0,040 (P<0.05). There was no significant change in the own activity self perception dimension, obtaining a t = 0, 57 (P>0, 05). These results show the effectiveness of the image based intervention program applied which purpose is to make a contribution to systematize the work with children suffering some Pervasive Developmental Disorder.
Subject(s)
Humans , Male , Female , Child , Patient Education as Topic/methods , Imagery, Psychotherapy , Child Development Disorders, Pervasive/psychology , Child Development Disorders, Pervasive/therapy , Outcome Assessment, Health Care , Personality Inventory , Psychotherapy/methods , Asperger Syndrome/psychology , Asperger Syndrome/therapy , Treatment Outcome , Autistic Disorder/psychology , Autistic Disorder/therapyABSTRACT
CONTEXTO: Atualmente, a comorbidade transtorno do déficit de atenção e hiperatividade (TDAH) e transtornos invasivos do desenvolvimento (TID) não pode ser estabelecida por meio dos critérios da DSM-IV. Entretanto, diversos pesquisadores questionam esta impossibilidade descrevendo quadros clínicos de pacientes que apresentam características de ambos os transtornos. Esta revisão busca estes achados e propõe uma reflexão sobre o assunto. OBJETIVO: Revisar, de modo seletivo, estudos mais significativos da literatura para compilar uma atualização sobre a comorbidade transtorno do déficit de atenção e hiperatividade (TDAH) e transtornos invasivos do desenvolvimento (TID). MÉTODO: Por meio de busca no sistema Medline, selecionaram-se todos os artigos em inglês, publicados entre 2000 e 2005, sobre sintomas de TDAH em pacientes com TID, sintomas autistas em pacientes com TDAH e duplo diagnóstico TDAH/TID, utilizando-se os termos "ADHD", "pervasive", "autism", "ADD", "Asperger" e "PDD". RESULTADOS: Encontraram-se 10 artigos que atendiam aos critérios. Embora haja poucos estudos com amostras pequenas, diferentes autores identificaram um subgrupo distinto de pacientes com TID e maior freqüência e gravidade de sintomas de desatenção e hiperatividade, que aparentemente apresentam menor resposta ao tratamento com estimulantes. CONCLUSÃO: Embora o diagnóstico duplo TDAH e TID não seja corroborado pelo DSM-IV, alguns resultados sugerem que essa comorbidade não deva ser desconsiderada.
BACKGROUND: Nowadays, the attention-deficit hyperactivity disorder/pervasive developmental disorder (ADHD/PDD) comorbidity is not accepted by DSM-IV criteria. However, researchers from both areas put in check this impossibility and describe patients who have both clinical aspects from attention-deficit hyperactivity disorder (ADHD) and pervasive developmental disorder (PDD). In this article we search for this findings proposing new insights on this assumption. OBJECTIVE: To perform a selective review of the most significant studies in order to compile an update on comorbidity ADHD and PDD. METHOD: All papers from 2000 to 2005 in English obtained through Medline search, covering ADHD symptoms in patients with PDD, autistic symptoms in patients with ADHD and the double diagnosis of ADHD and PDD using the terms "ADHD", "pervasive", "autism", "ADD", "Asperger" e "PDD". RESULTS: Ten papers attending the criteria were found. Although there are only few studies with small samples, different authors have identified a subgroup of patients with PDD portraying more severe symptoms of ADHD, who apparently respond less well to stimulants CONCLUSION: Although DSM-IV criteria do not allow the diagnosis of this comorbidity, some results suggest that this possibility should not be discarded.
Subject(s)
Humans , Male , Female , Child , Developmental Disabilities/diagnosis , Attention Deficit Disorder with Hyperactivity/diagnosis , ComorbidityABSTRACT
This study was conducted to evaluate the effects of the program for the autistic children which was designed to promote mother-child attachment. The subjects of this study were consisted of 11 pairs of mother and child( 7 for participant group:PG, 4 for non-participant group: NPG), who were diagnosed as Pervasive Developmental Disorder. The intervention was consisted with play activity centered mother-child interaction, educational activity for mothers, lecture, video-feedback, and supports. The main data were collected by video-taping and analyzed by Wilcoxon Rank Sign Test, and Content Analysis. The results obtained were as follows, 1. Before the program, there were no significant group differences on the children's and the mother's characteristics. After the program, total score on the attachment of PG was higher than that of NPG, but not significant. Only proximity-seeking behaviors and contact-maintaining behaviors were higher significantly(p<.05). Then the characteristics on contact- maintaining behaviors of PG were lasting longer and reciprocal than those of NPG. 2. After the program, the score on mother's nurturing behavior of PG was significantly more increased. The mother's behaviors to her child of PG became more child- centered, positively responsive, expressive supportively. But there were pretty big individual difference. It can be concluded that Mother-child Attachment Promotion Program is effective. Thus it can be recommended to be a early intervention model for autistic children.
Subject(s)
Child , Humans , Early Intervention, Educational , Education , Individuality , Mother-Child Relations , MothersABSTRACT
Though Fragile X syndrome is one of the most common inherited causes of mental retardation, it is not much detected yet in Korean population. One of the reason may be that the syndrome is not well known to the special education teachers as well as to the clinicians in this country. Thus, molecular test was undertaken to screen out fragile X syndrome in 122 children of two Korean schools for emotionally severely handicapped children. The subjects were all boys, previously known as having pervasive developmental disorder with or without mental retardation. Southern blot analysis of peripheral blood showed the abnormally enlarged (CGG)n repeat sequence associated with fragile X syndrome in two children. This finding suggests that the DNA testing for fragile X syndrome is warranted for Korean high risk population and that more concern about this syndrome is needed for the professionals who work for mentally handicapped children. The issues involved in genetic counseling for fragile X syndrome are discussed.
Subject(s)
Child , Humans , Blotting, Southern , Disabled Children , Disabled Persons , DNA , Education, Special , Fragile X Syndrome , Genetic Counseling , Intellectual Disability , Korea , Persons with Mental DisabilitiesABSTRACT
Objective: Exploring the epidemiological state of pervasive developmental disorder in 2-6 year-old children in Beijing. Methods: A total of 21866 children aged 2-6 year-old were recruited from permanent residents of Beijing by 2-phase cluster sampling.The Clancy Autism Behavior Scale was used for screening.The Childhood Autism Rating Scale and DSM-Ⅳ were used for diagnosis.Results: 16 children were diagnosed as pervasive developmental disorder (14 with autistic disorder, 1 with atypical autistic disorder, 1 with Rett syndrome).The false negative rate was 0.80 ‰.The prevalence of pervasive developmental disorder was 0.73 ‰, the adjusted prevalence was 1.53 ‰,the average annual detective rate was 0.11‰.The prevalence rate had no difference in distribution between urban-rural, among different age groups, sex and nations(?2=0.11~1.85,P=0.739-0.173).The low family income was related to high prevalence significantly ( tendency ?2=4.70,P=0.030 ).25% children with pervasive developmental disorder had not been identified by parents or had not been to clinics.80% children with pervasive developmental disorder had not get intervention.All children had demand to get intervention. Conclusions: The prevalence of pervasive developmental disorder in 2-6 year-old children in Beijing was not low.Low family income is the risk factor.The rate of intervention was low.The government should pay close attention to the children with pervasive developmental disorder and their needs.