Six month follow-up: the crucial test of multidisciplinary developmental assessment.

Participation of parents in the developmental assessment process is thought to be beneficial in promoting understanding of their child's disability, and improving consensus between parents and professionals about appropriate intervention programmes. If costly multidisciplinary assessments are to be justified, it is necessary to establish long-term benefits for the child. This highlights a need for research identifying how families use services after diagnostic assessment and what they understand to be important for their child. Poor parent-professional agreement about diagnosis may be a factor contributing to low compliance with recommendations. The major purpose of the current study was to follow-up families 6 months after developmental assessment, in order to investigate use of recommended intervention services. In addition, mothers' opinions about diagnostic findings, recommendations and early intervention services were examined. Subjects were 40 pre-school children who presented for developmental assessment, and their mothers. The majority were diagnosed with developmental problems in multiple domains. Results indicated that most mothers recalled and agreed with their child's diagnosis, but underestimated the severity of developmental delay. Families had not accessed the range of multidisciplinary intervention programmes recommended, given the complexity of their children's disabilities. Speech therapy was considered the service of highest priority by mothers, and was the treatment most frequently received. Mothers recognized a need for more therapeutic interventions for their child. An unexpected finding was the high prevalence of families who organized nonprescribed therapies. Possible explanations of the findings and implications for service delivery are discussed.

Childhood asthma complicated by anxiety: an application of cognitive behavioural therapy.

OBJECTIVE: To identify characteristics within the patient and the environment that might be instrumental in triggering and maintaining an episode of asthma in children whose objective lung function tests suggested a less severe exacerbation than the subjective report and behaviour indicated, and also to investigate the efficacy of a cognitive behavioural intervention, using the paradigm of a panic anxiety disorder. METHODOLOGY: A retrospective investigation of 23 case records and psychosocial histories, focusing on the characteristics of the sample and the number of presentations and admissions before and after the intervention, which is described. RESULTS: Children aged 10-12 years predominated. A precipitating event triggered a fear that their condition had deteriorated in the context of a growing understanding that asthma in a child could be fatal. A reduction in presentations and admissions post-intervention is shown. CONCLUSIONS: The paradigm of panic disorder is useful to understand the sudden onset of apparent deterioration in the severity of asthma when objective lung function tests do not support the subjective experience.

The onset of anorexia nervosa.

In a retrospective study of case notes a number of experiential and psychological factors were discerned of possible importance to the psychogenesis of anorexia nervosa. These factors included issues of dependence and independence, sexual challenge, concern about obesity, and a variety of other, less specific stresses. Attempts to confirm the findings by means of a prospective study were impeded by difficulties in defining the onset of the illness. While in some patients the occurrence of anorexic type behaviour led immediately to weight loss, in others there was a significant delay between the onset of behavioural change and consequent emaciation.