ABSTRACT
The purpose of this study was to investigate the hypothesis that self-injurious behavior (SIB) maintained by environmental factors will be more effectively treated by behavioral treatments than by haloperidol. Fifteen subjects were enrolled in this study. The efficacy of both haloperidol and a behavioral treatment was assessed. At the onset of treatment, subjects were randomized to receive either haloperidol or a placebo. During each day of treatment, data were collected during sessions with a behavioral treatment and sessions without a behavioral treatment. Behavioral treatment resulted in a statistically significant decrease in SIB, but haloperidol did not. Eighty-three percent of subjects were classified as responders to the behavioral treatment whereas only 25% of the subjects were responders to haloperidol (p = .019). We conclude that individuals with operant SIB are more likely to respond to behavioral treatments than to haloperidol.
Subject(s)
Behavior Therapy , Conditioning, Operant , Haloperidol/therapeutic use , Intellectual Disability/therapy , Self-Injurious Behavior/prevention & control , Adolescent , Adult , Child , Child, Preschool , Conditioning, Operant/drug effects , Female , Humans , Intellectual Disability/psychology , Male , Reinforcement, Social , Self-Injurious Behavior/psychology , Treatment OutcomeABSTRACT
OBJECTIVES: The objectives of this study were (1) to show prediagnostic abnormalities in social and communicative behaviors on home videos of children who later received a diagnosis of one of the pervasive developmental disorders (PDD) and (2) to demonstrate that prediagnostic abnormalities in social and communicative behaviors for children with PDD not otherwise specified will be less prominent than those in children with autistic disorder but still distinguishable from those of typically developing peers. STUDY DESIGN: Parents of children with PDD each submitted home videos of social events that were made when their child was between the ages of 12 and 30 months, before diagnosis. Two independent observers, unaware of the subjects' diagnoses or purpose of the study, scored the rates of specific anomalies in social and communicative behavior. Two additional observers scored the percentage of time the children were engaged socially or with objects. Data from the experimental group were compared with those of 25 age-matched children with no developmental disabilities. RESULTS: Significant differences were found between the rates of social engagement and 8 of the 25 specific behaviors of the children in whom PDD was later diagnosed and those of the typical children. The children later given the diagnosis of PDD not otherwise specified had mean frequencies of some social interactions and communicative skills that fell between those of children later given the diagnosis of autistic disorder and those of children with typical development. CONCLUSION: In our sample children in whom PDD was later diagnosed could be differentiated from their typically developing peers on the basis of specific anomalies noted in their social and communicative behaviors, especially joint attention. In our sample children with PDD not otherwise specified could have been further differentiated on the basis of the rates of social interaction. Careful assessment of social interaction and communicative behaviors may help to identify children with PDD before the age of 30 months.
Subject(s)
Child Development Disorders, Pervasive/diagnosis , Videotape Recording , Autistic Disorder/diagnosis , Child Development Disorders, Pervasive/classification , Child, Preschool , Communication , Female , Humans , Infant , Male , Social BehaviorABSTRACT
We investigated the separate and combined effects of a behavioral intervention and methylphenidate (Ritalin) on disruptive behavior and task engagement in 3 children with severe to profound mental retardation. The behavioral intervention involved differential reinforcement of appropriate behavior and guided compliance. All 3 children demonstrated decreased disruptive behavior and improved task engagement in response to the response to the behavioral intervention. Two of the 3 children demonstrated similar improvement in response to methylphenidate. Although both interventions were highly effective for these 2 participants, the relative efficacy of the interventions varied between the 2 children. There was no evidence of an additive or synergistic effect of the two interventions, but the high efficacy of each intervention alone limited our ability to detect such effects.
Subject(s)
Behavior Therapy/methods , Child Behavior Disorders/therapy , Intellectual Disability/therapy , Methylphenidate/therapeutic use , Aggression/drug effects , Attention/drug effects , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit Disorder with Hyperactivity/therapy , Child , Child Behavior Disorders/psychology , Combined Modality Therapy , Dose-Response Relationship, Drug , Humans , Intellectual Disability/psychology , Male , Patient Admission , Personality Assessment , Reinforcement Schedule , Social Environment , Treatment OutcomeABSTRACT
We conducted a functional analysis of breath-holding episodes in a 7-year-old girl with severe mental retardation and Cornelia-de-Lange syndrome. The results showed that breath holding served an operant function, primarily to gain access to attention. The intervention, consisting of extinction, scheduled attention, and use of a picture card communication system, resulted in decreased breath holding.
Subject(s)
Behavior Therapy/methods , Intellectual Disability/therapy , Respiration Disorders/therapy , Child , De Lange Syndrome/psychology , Female , Humans , Intellectual Disability/psychology , Oximetry , Respiration Disorders/psychology , Token EconomyABSTRACT
The authors report two patients with marginal ambulation skills whose severe behavioral problems prevented participation in physical therapy. The problem behavior also limited the patients' participation in activities of daily living and social interaction. Because of the risks of loss of ambulation to overall health, an aggressive behavioral intervention was implemented to decrease problem behavior and to increase participation in physical therapy. With the use of the behavioral interventions, the authors demonstrated concomitant increases in compliance to requests to ambulate, distances ambulated, and decreases in the rates of self-injury and aggression.
Subject(s)
Behavior Therapy/methods , Movement Disorders/therapy , Self-Injurious Behavior/therapy , Walking , Adolescent , Aggression , Child , Female , Humans , Patient Compliance , Physical Therapy ModalitiesABSTRACT
Autism and pervasive developmental disorder, not otherwise specified represent a complex developmental disability in which clinical signs include language delay, social unrelatedness, and unusual or restricted interests. Gradually a better understanding of these disorders as being neurologically-based developmental disorders with multiple etiologies has replaced the idea of emotional disturbance. Although pervasive developmental disorders are rare, the potentially devastating effects make early recognition by pediatricians imperative. Yet, despite promising treatment advances in education, communication technology, behavior treatments, and pharmacology, the prognosis for these disorders remains guarded.
Subject(s)
Autistic Disorder , Autistic Disorder/complications , Autistic Disorder/diagnosis , Autistic Disorder/etiology , Autistic Disorder/therapy , Child , Diagnosis, Differential , Female , Humans , Male , PrognosisABSTRACT
Pulmonary interstitial air in the premature infant, a complication of hyaline membrane disease and respiratory supportive treatment, is usually described as representing freely dissecting air that has escaped from terminal air spaces to dissect along the bronchovascular bundles of the lung. By inflating the lung and fixing it in this state, the interstitial air is identified within the lymphatics of the interlobular septae and visceral pleura. On a radiography, this lymphatic air is seen as a pattern of fine linear lucencies involving a lobe or an entire lung. With increasing distension, oval and cystic lucencies are seen representing air in dilated septal lymphatics and lymphatics of the visceral pleura. Pneumothorax results from rupture of these collections into the pleural space.