Developmental-Behavioral Disorders

"Child development" has always been a traditional component of well­ child care and a particular area of interest for pediatricians, child neu­ rologists, and psychologists. However, it was not until the early 1960s that children with developmental disabilities (i. e. , chronic handicapping disorders) became a major focus of public and professional attention. During this period, children with "special needs" were dramatically catapulted into the limelight and "exceptional" became the buzzword of the day. Public and professional awareness of these issues reached new peaks and recognition of the potential psychosocial impairments of chil­ dren with developmental disabilities created national anxiety. A variety of factors contributed to an unprecedented societal advocacy for chil­ dren with developmental problems: (1) a national concern generated by President Kennedy'S particular interest in mental retardation; (2) in­ creased activity and visibility of parent advocacy/lobbying groups (e. g. , the Association for Children with Learning Disabilities); (3) the enact­ ment of federal legislation designed to protect the rights of the handi­ capped (e. g. , PL94-142); and (4) the popularization of developmental­ behavioral disabilities by the various communications media. Cumulatively these events precipitated a redefinition of the real mean­ ing of "comprehensive health care for children," resulting in an empha­ sis on the child's neurodevelopmental, educational, psychological, and social needs. For the pediatrician, a myriad of new management respon­ sibilities were mandated, in addition to the traditional health care con­ cerns.

1: New Genetic Syndromes.- 1. Introduction.- 2. Genetic Syndromes.- 3. Summary.- References.- 2: Adolescents with Chronic Handicaps: Problems of Sexual and Emotional Development.- 1. Introduction.- 2. Factors in Social and Sexual Development of the Handicapped.- 2.1. Paucity of Research.- 2.2. Prevalent Myths.- 2.3. Societal Attitudes.- 2.4. Family Attitudes.- 2.5. Individual Issues.- 2.6. Narcissism and Self-Esteem.- 3. Case Studies.- 3.1. Case Study 1.- 3.2. Case Study 2.- 4. Sex Education for the Handicapped.- 4.1. Four Critical Areas of Sex Education.- 4.2. Research on Knowledge Base about Sex.- 5. Conclusion.- References.- 3: Divorce: A Developmental-Behavioral Disorder?.- 1. Introduction.- 2. External Stresses on Marriage.- 3. Internal Stresses on Marriage.- 4. Unresolved Conflicts Carried over into Marriage.- 5. Warning Signs and Symptoms of a Troubled Marriage.- 6. Conclusion.- References.- 4: The Learning-Disabled Child/Adolescent: Improving Self-Esteem.- 1. Introduction.- 2. Narcissism and Self-Esteem.- 3. Therapies.- 3.1. Strategy One: Use a Multidisciplinary-Team Approach.- 3.2. Strategy Two: Dr. Gordon’s Model for Improving Self- Esteem.- 3.3. Strategy Three: Dr. Rappaport’s Model for Improving Self-Esteem.- 3.4. Strategy Four: Suggestions for Working with Parents.- 3.5. Strategy Five: Other Office Management Suggestions.- 4. Conclusion.- References.- 5: Military and Civilian Developmental Medicine: Bridging the Gap.- 1. Introduction.- 2. Background on the Army’s Special Situations.- 3. Recent Changes to Meet the Needs of Army Families.- 4. Army Fellowship Programs in Developmental Pediatrics.- 5. Civilian Health and Medical Program of the Uniformed Services.- 5.1. The Basic Program.- 5.2. Program for the Handicapped.- 6. Suggestions for Civilian Health Care Providers.- 7. Summary.- References.- 6: Hospitalization of Children: Its Impact, Use, and Abuse.- 1. Introduction.- 2. Literature Review.- 2.1. Effects of Hospitalization on Children and Families.- 2.2. Impact of Research on Hospitalization Practices.- 3. The Effects of Recurrent Hospitalization.- 3.1. Recurrent Life-Threatening Episodes in Infancy.- 3.2. Chronic Asthma.- 4. Hospitalization in Crises Intervention.- 4.1. Chronic Nonspecific Gastrointestinal Symptoms.- 4.2. Conclusion.- References.- 7: The Physician in the Courtroom: How and How Not To Act.- 1. Introduction.- 2. The Lawyer’s Concerns.- 3. The Witness’ Concerns.- 4. Anatomy of Testimony.- 5. Techniques of Cross-Examination and Guidelines for Witnesses during Depositions and at Trial.- 6. Conclusion.- 8: Office Management of the Oppositional Child.- 1. Diagnostic Criteria and Parent Rating Scales.- 2. Prevention of Oppositional Behavior.- 3. Cognitive Development of Children.- 3.1. The Effect on the Parent.- 3.2. The Effect on the Child.- 3.3. How to Teach Young Children.- 4. Disciplining Oppositional Children.- 5. Oppositional Behavior.- 6. Concluding Remarks.- References.- 9: Promoting the Development of Children in Busy Primary Health Care Settings.- 1. Introduction.- 2. Primary Prevention.- 2.1. Parent Counseling.- 2.2. Denver Developmental Activities.- 3. Secondary Prevention.- 4. The Denver Approach to Developmental Screening.- 5. First-Stage Screening.- 5.1. The Revised Denver Prescreening Developmental Questionnaire.- 5.2. The Denver Developmental Screening Test.- 6. Second-Stage Screening.- 7. Tertiary Prevention through Diagnosis and Treatment.- 8. Conclusion.- References.- 10: Chronic Otitis Media, Speech/Language Disorders, and Learning Disabilities: Is There a Link?.- 1. Introduction.- 2. Epidemiologic Considerations.- 3. Chronic Otitis Media: Neurodevelopmental Sequelae.- 3.1. Speech and Language Development.- 3.2. Academic Competence.- 3.3. Central Auditory-Processing Function.- 3.4. Controversial Aspects.- 4. Summary.- References.- 11: The Latchkey Child: A New Psychosocial Challenge in Developmental-Behavioral Pediatrics.- 1. Introduction.- 2. Brief Historical Considerations.- 3. Epidemiologic Considerations.- 4. The Latchkey Experience: Advantages versus Disadvantages.- 4.1. Effects on Children.- 4.2. Effects on Parents.- 4.3. Effects on Community.- 5. Possible Management Strategies.- 6. Summary.- References.- 12: Emotional and Behavioral Milestones in Infancy and Early Childhood.- 1. Introduction.- 2. Maladaptive Patterns and Preventive Therapeutic Implications.- 3. Emotional Health Checklist: Charting Emotional Milestones for Infants and Children.- 3.1. General Parenting Patterns.- 3.2. General Infant Tendencies.- 3.3. Outline of Developmental Milestones by Age.- 3.4. Guidelines for Categorizing Patterns and for Recommending and Conducting Comprehensive Evaluations.- References.- Suggested Reading.- 13: Accepted and Controversial Neuromotor Therapies for Infants at High Risk for Cerebral Palsy.- 1. Introduction.- 2. Neuromotor Therapies.- 2.1. Neurodevelopmental Treatment Approach: Bobath.- 2.2. Sensorimotor Treatment Approach: Rood.- 2.3. Sensory Integration Approach to Treatment: Ayres.- 2.4. Vojta Approach to Treatment.- 2.5. Patterning Therapy: Doman-Delacato.- 3. Similarities and Differences among the Therapy Approaches.- 4. Controversies.- 5. Clinical Implications.- 6. Directions for Future Research.- 7. Summary.- References.- 14: Child Abuse and Neglect.- 1. Introduction.- 2. Etiology.- 2.1. Characteristics of Abusive Parents.- 2.2. Characteristics of Abused Children.- 2.3. Chronic Stress and Crises.- 3. Psychological Symptoms of Abused Children.- 4. Clinical Manifestations.- 4.1. Physical Abuse.- 4.2. Mental Abuse.- 4.3. Sexual Abuse.- 4.4. Neglect.- 5. Diagnosis.- 6. Treatment.- 6.1. Therapy with Parents.- 6.2. Therapy with Children.- 7. Prevention.- References.- 15: Ideas from Our Evolutionary Past: Implications for the Care of Children at the End of the Twentieth Century.- 1. Introduction.- 2. Support for the New Mother and Infant.- 3. The Role of Body Contact.- 4. Breastfeeding.- 5. Support during Labor.- 6. Support and Mother-Infant Interaction.- 7. Early Father-Infant Contact and Interaction.- 8. Early and Extended Postpartum Mother-Infant Contact.- 9. The Central Nursery.- 10. Conclusion.- References.- 16: Developmental Disabilities: The Military Experience.- 1. Background.- 2. The Exceptional Family Member Program Treatment-Team Network.- 3. Developmental Pediatrics in the Army.- 4. The Expanding Role of the Exceptional Family Member Program.- References.- 17: Learning Disabilities: A Neurologist’s Perspective.- 1. Introduction.- 2. Neurologic Basis of Learning Disabilities.- 3. Clinical Process.- 3.1. History.- 3.2. General Physical Examination.- 3.3. Neurologic Examination.- 3.4. Laboratory Tests.- 4. Failing to Learn.- 5. Treatable Disorders Associated with Learning Disabilities.- 6. Treatable Medical Contributors to Learning Disabilities.- 7. Treatable Neurologic Contributors to Learning Disabilities.- 7.1. Why Seizures Can Interfere with Learning.- 7.2. Why Headaches Can Interfere with Learning.- 8. Failing to Learn: Does the Physician Make a Difference?.- 9. The Learning-Disabled Child: Physician’s Roles.- 10. Summary.- Suggested Reading.- 18: Epilepsy: Developmental and Behavioral Sequelae.- 1. Definitions.- 2. Epidemiologic Considerations.- 3. Classification.- 4. Predisposing Factors.- 5. Treatment Options.- 6. Seizure Control in Childhood Epilepsy.- 7. Seizure Recurrences.- 7.1. Seizure Recurrence after First Unprovoked Seizure.- 7.2. Risk of Recurrence of Postnatal, Nonfebrile Seizures.- 7.3. Risk of Recurrence for Newly Treated Childhood Epilepsy.- 7.4. Stopping Medication in Children with Epilepsy.- 8. Prognosis in Childhood Epilepsy.- 8.1. Epilepsy and Intelligence.- 8.2. Epilepsy and Learning Problems/Disabilities.- 8.3. Epilepsy and Emotional-Psychiatric-Behavioral Disorders.- 9. Potential Contributors to Cognitive Impairment, Learning Problems, and Affective-Behavioral Disorders in the Child with Epilepsy.- 9.1. Epilepsy-Related Factors.- 9.2. Epilepsy-Associated Factors.- References.- Suggested Reading.- 19: Childhood Headaches.- 1. Introduction.- 2. Epidemiologic Considerations.- 2.1. Pain-Sensitive Structures.- 2.2. Referral of Pain.- 2.3. Mechanisms of Headache.- 3. Laboratory Studies in Childhood Headache.- 4. Summary.- References.- Suggested Reading.- 20: Neurologic Aspects of Autism and Rett Syndrome.- 1. Autism.- 1.1. Criteria for Diagnosis.- 1.2. What is the Basis of Autism?.- 1.3. Interventions and Outcome.- 2. Rett Syndrome.- 2.1. Diagnostic Criteria.- 2.2. Exclusion Criteria.- 2.3. Clinical Stages.- 2.4. Additional Clinical Features.- 2.5. Frequency.- 2.6. Neuropathology.- 2.7. Neurochemistry.- 2.8. Neuroimaging.- 2.9. Electroencephalography.- 2.10. Genetics.- 2.11. Neurophysiology and Neuropharmacology.- 2.12. Therapy.- References.- Suggested Reading.- 21: Adolescent Alcohol Abuse: A Review.- 1. Introduction.- 2. Scope of the Problem.- 3. General Characteristics.- 3.1. Where Does the Drinking Occur?.- 3.2. Beverage Choice.- 3.3. Quantity Consumed.- 4. Contributing Factors.- 4.1. Parental Influences.- 4.2. Peer Influence.- 4.3. The Role of Culture.- 4.4. Personality Characteristics.- 5. Relationship between Problem Drinking and Other Problem Behavior.- 5.1. The Use of Illicit Drugs.- 5.2. Antisocial or Delinquent Behavior.- 5.3. Alcohol and Traffic Accidents.- 6. The Stages of Alcohol Abuse.- 6.1. Stage 0: Curiosity in a “Do-Drug” World.- 6.2. Stage 1: Learning the Mood Swing.- 6.3. Stage 2: Seeking the Mood Swing.- 6.4. Stage 3: Preoccupations with the Mood Swing.- 6.5. Stage 4: Doing Drugs or Alcohol to Feel Okay.- 7. Etiology.- 8. Diagnosis.- 9. Treatment.- 10. Summary.- References.- 22: The Controversial Therapies Proposed for Treatment of the Child with Learning Disabilities and/or Attention Deficit Disorder.- 1. Introduction.- 2. Clinical Interventions.- 2.1. Neurophysiologic Retraining.- 2.2. Orthomolecular Medicine.- 3. Discussion.- References.