Developmental disorders informants

Robinson JF et al (2010) Integrating genetic and toxicogenomic information for determining underlying susceptibility to developmental disorders. Birth Defects Res A Clin Mol Teratol 88 920-930. doi 10.1002/ bdra.20708... 

Within each cell, informants are listed in approximate order of importance and /or desirability. Parent should be understood broadly as primary care-giver(s), including residential center staff. Prepubertal children phase into the adolescent priorities about ages 10-12 years (transition from concrete operations to formal operations). For patients with mental retardation or pervasive developmental disorder, mental age and communication ability must be considered. ... 

Most structured interviews do not ascertain information about conditions that used to be on axis II or axis III pervasive developmental disorders, learning and language disorders, or medical or neurological disorders. 

Melatonin is widely used for sleep disorders in patients with a range of developmental disorders and neurodisabilities who also frequently have epilepsy. The current section examines published data to assess the evidence behind melatonin and seizure control. The literature survey revealed 26 papers apparently reporting an association between melatonin and epilepsy or seizures but seven of these did not provide relevant information. Of the three double-blind, randomised, controlled trials, two showed no overall worsening or improvement in seizures, and one recent trial reported a statistically significant reduction in seizures. 

This chapter is concerned with the neurochemical basis of developmental disability which is considered here in two forms the globally delayed or halted development seen in mental retardation, and the more circumscribed pattern of disordered development of autism. A range of deficits of important key aspects of consciousness are apparent in both conditions. Of particular relevance to consciousness are the cognitive and behavioural impairments in attention, concentration, memory, information processing and social behaviour which are commonly present. Consideration of aberrant neurotransmitter activities in these developmental deficits may provide insights into the role of neurotransmitters in consciousness. 

Unipolar and bipolar depressive disorders in children and adolescents are serious conditions. The pathophysiology of these disorders is poorly understood. The new tools available through neuroimaging techniques will help to unravel the neuroanatomical systems involved in the onset and recurrence of these disorders. There is a need for more developmentally informed predinical research and more studies of the normal development of the neural systems implicated in emotional regulation. 

Consideration of the use of medications in children requires a careful discussion with the child and the child s family of the risks and benefits potentially associated with the treatment. The AACAP Practice Parameters address the issue of informed consent, and how children, parents, and clinicians might reach a consensus on the use of medications (King, 1997). Children should have the opportunity to assent to the use of medications at a developmentally appropriate level. In general, pharmacotherapy should not be used as the sole intervention for a child s disorder but should be integrated into a comprehensive treatment plan. 

A third principle of this chapter is that the assessment process in child psychiatry has unique challenges, including the use and consideration of multiple informants and the developmental level of the child. These challenges lead to the fourth principle, which is that successful treatment requires education and collaboration with the family and others involved with the child. Treatment of developmental neurobiology affects the environment that surrounds the child, and treatment of the surrounding environment in turn affects developmental neurobiology. This interaction implies that early and effective intervention can alter the developmental trajectory of a child with a mental disorder. 

Additional information from the parent(s) or primary care taker(s) should include the child s medical and developmental history and the family s history of mental disorders and stressors. Reports of the direct observation of the youngster s behavior from the parent(s) or primary caretaker(s), school personnel, and others who have had contact with the child can help guide the definition of the most pressing target symptoms. 

A targeted biopsychosocial developmental history from key informants should be included in the initial assessment. In addition to the information contained in Figure 31.1, a history of stress and trauma should also be gathered. In children and adolescents this includes caretaker absence, neglect, physical, sexual, and emotional abuse, as well as transfer to a foster home, divorce, or psychiatric disorder in a close family member. 

Developmental Effects. Little information is available regarding developmental effects in humans and/or animals following inhalation, oral, or dermal exposure to barium. One study reported reduced survival, underdevelopment, lowered weight, decreased lability of the peripheral nervous system, and various blood disorders in offspring of female rats exposed by intermediate inhalation to barium (Tarasenko et al. 1977). The same study also reportedly observed increased mortality, increased... 

The number of individuals affected by reproductive disorders is difficult to assess, and few population-based data are available for either men or women. Noticeably absent are data on fecundity and fertility impairments affecting men and only limited information on male-mediated developmental outcomes exists. Population-based data for impaired female fertility are available for select endpoints from the National Surveys of Family Growth (NSFG), which are conducted periodically and most recently in 1995. Data from the NSFG show that 6.2 million women (10.2%) between the ages of 15 and 44 in the United States had impaired fertility in 1995 (Stephen 1996). This number was estimated to increase to 6.3 million women in 2000 (Stephen and Chondra 1998). Other reproductive disorders in females that impact fecundity include endometriosis and polycystic ovarian syndrome (PCOS). The prevalence of endometriosis in women of reproductive age is reported to be 10% (Houston 1984 Olive and Schwartz 1993), and no population-based prevalence data exist for PCOS. 

Very little information is available on the developmental effects of manganese in humans. The incidences of neurological disorders and the incidences of birth defects and stillbirths were elevated in a small population of people living on an island where there were rich manganese deposits (Kilbum 1987) however, the lack of exposure data, the small sample sizes, and the absence of a suitable control group preclude ascribing these effects to manganese. The route of exposure was assumed to be primarily oral, but inhalation exposure was not ruled out. 

Abnormalities in specific regions of the cerebral cortex and its corticospinal projections, associative cortex and myelination are likely to contribute to neurological impairments in both rats and humans afflicted with hypothyroid disorders. However, although these findings provided us with information about the role ofTH in brain development, they do not provide insight into the developmental timing of TH action on specific brain areas that may underlie the aforementioned observations in children. 

Wilson, P. H. McKenzie, B. E. (1998) Information processing deficits associated with developmental coordination disorder metaanalysis of research findings. Journal of Child Psychology and Psychiatry and Allied Disciplines 39,829-840. 

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