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The concept of developmental disabilities as a group of problems with origins in the stages of human development has been broadened by recent legislation to include mental retardation, cerebral palsy, epilepsy, autism, dyslexia, and other neurological impairments. The debate continues on whether or not specific disability categories should be named, but the functional aspects of the problems seem to be generally accepted. Potential implications of this legislation for occupational therapy are discussed in this paper. Numerous programs supported by a variety of governmental units and private agencies will need qualified professionals. This paper concludes with a brief list of six developmental disability programs of the University of Michigan University Affiliated Facility and an outline of three models of field placement in developmental disabilities for occupational therapy students.
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PMID:Developmental disabilities. 7 85

Alpha rhythm is classically described as a bilateral posterior rhythm of substantially constant frequency in the range of 8-13 Hz which is enhanced by mental relaxation and blocked by attention. Since the full expression of alpha rhythm has been shown to occur coincident with puberty, it is possible that the establishment of alpha rhythm is subject to neuroendocrine influences which govern psychosexual maturation. There is ample evidence to indicate that the pineal gland is implicated in cerebral maturation and psychosexual development. Nocturnal plasma melatonin levels have been shown to decline progressively throughout childhood reaching a nadir at puberty. Since administration of melatonin has been reported to block alpha rhythm, it is proposed that the progressive decline in melatonin secretion during childhood facilitates the maturation of the alpha rhythm. Consequently, the presence of alpha rhythm could be used as a neurophysiological marker for the activity of the pineal gland and disorders associated with absent or delayed maturation of the alpha rhythm such as autism, dyslexia, personality disorders, epilepsy, Tourette's syndrome, and schizophrenia might be related to disturbances of pineal melatonin functions in early life. Moreover, since the EEG patterns associated with cerebral immaturity (i.e., slowing, absence of alpha activity) are more pronounced in the left hemisphere, this hypothesis implies differential influence of the pineal gland on hemispheric maturation potentially accounting for the vulnerability of the left hemisphere to cerebral insults.
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PMID:Alpha rhythm and the pineal gland. 130 57

A body of medically important work has accumulated in the field of developmental neurolinguistics in the 30 years since Lenneberg set forth a research agenda for that field, consisting of the following: (1) the physiologic specialization or endowment for speech; (2) the genetic origin or natural history of vocalization and speech; (3) the nature of prelinguistic behavior, making possible the detection of any environmental (social) influences; (4) the development of motor-speech organization from birth; and (5) the limiting effects of deficient intelligence, hearing, and environmental stimulation. Subsequent study of these questions has established a genetic, neuroanatomic, and functional basis for such outwardly disparate disorders as dyslexia, stuttering, autism, and delayed language. Studies of emergent motor behavior suggest that babbling may index a state of neural maturation favoring expression of spoken languages. Based on studies of the congenitally deaf, mentally retarded, and other clinical populations it is now considered possible to detect early warning signs of developmental language disorders during the first year of life based on analyses of vocal turn-taking, gesturing, and utterance complexity.
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PMID:Thirty years of research on developmental neurolinguistics. 138 11

Developmental language and learning disabilities in children can take many different forms and can result from a variety of causes. Research to date has focused primarily on specific disabilities in learning, which are characterized by a significant delay or disorder in one aspect of learning against a background of otherwise normal development. Learning disabilities affecting language and/or reading acquisition (developmental dysphasia and dyslexia) have been studied most thoroughly. Verbal learning disabilities occur more frequently in boys than in girls, and there is a higher than expected incidence of left-handedness among affected children. Although there are many reasons why a child may have delayed or disordered language development, differential diagnosis of specific developmental language or reading disorders calls for ruling out mental retardation, peripheral auditory or visual dysfunction, autism, frank neurological impairments such as hemiplegia or seizure disorder, and severe social deprivation or lack of educational opportunity. The typical profile of a developmentally dysphasic or dyslexic child is one who shows a marked discrepancy between nonverbal (performance) IQ and verbal IQ, with a history of delayed or disordered speech, language and/or reading development. Such a child usually performs quite normally on visual spatial tasks, while demonstrating severe deficits in tasks of auditory temporal processing, motor sequencing, phonological processing and memory, language, reading and spelling. This characteristic neuropsychological profile may suggest left hemisphere dysfunction or a failure to develop normal cerebral lateralization. The etiology of these developmental learning disorders is unknown, but there is evidence of familial aggregation, indicating a potential genetic basis. Although these children respond to remediation, longitudinal studies have shown that the symptoms often persist into adulthood (see Tallal, 1988, for a more detailed discussion).
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PMID:Hormonal influences in developmental learning disabilities. 196 40

The relationship between cognitive deficits in high-level autism and those in learning disabilities has received little attention. To determine whether high-functioning autistic patients and individuals with severe dyslexia display different cognitive characteristics, 10 nonretarded men (mean age 26 years) with infantile autism, residual state, were compared with 15 severely dyslexic men (mean age 22 years) and 25 matched controls on a neuropsychological test battery. The two clinical groups were dissociated by a reduced digit span seen in the dyslexics and by impaired problem-solving skills (Wisconsin Card Sort and selected subtests from the Binet) seen in the autistic group. These results suggest different localization of brain dysfunction and different educational/habilitative needs.
J Autism Dev Disord 1990 Jun
PMID:Neuropsychological divergence of high-level autism and severe dyslexia. 234 17

On the basis of work reported by colleagues, as well as our own clinical research studies of patients with the aforementioned syndromes, there are now some useful guidelines for appropriate remediation based on accurate initial diagnosis. Still, there is more to be learned about each of these syndromes. Furthermore, they represent but a small sample of a very large total. Recent literature has described the speech patterns of many more syndromes, as well as the genetic aspects of the more common speech and language disorders such as language delay, dyslexia, autism, and stuttering [72-78]. The most common recognizable birth defect is Down syndrome and there is, fortunately, a large body of information detailing the varied language, speech, and hearing aspects [79]. Those of us who work with children with Down syndrome have been alerted to the anticipated receptive and expressive language delays; the conductive and sometimes mixed hearing losses; the hoarse and raucous voices that are probably the result of a combination of anatomic, neurologic, and mucosal variations; the interesting disfluencies, and the amalgam of developmental and deviant articulatory errors. We know that although the tongue protrudes, it is rarely the true macroglossia which we would find in Beckwith syndrome, for example, but rather a hypotonic posture and a logical adaptation to an airway restricted by enlarged tonsils and adenoids and recurrent rhinitis.
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PMID:The effect of syndrome diagnosis on speech remediation. 293 Nov 38

Two paradoxes can occur when neuropsychologists attempt to assess the reliability of a dichotomous diagnostic instrument (e.g., one measuring the presence or absence of Dyslexia or Autism). The first paradox occurs when two pairs of examiners both produce the same high level of agreement (e.g., 85%). Nonetheless, the level of chance-corrected agreement is relatively high for one pair (e.g., 70) and quite low for the other (e.g., .32). To illustrate the second paradox, consider two examiners who are in 80% agreement in their overall diagnosis of Dyslexia. Assume, further, that they are in 100% agreement in the proportion of cases they both diagnose as Dyslexic (20%) and as Non-Dyslexic (80%). Somewhat paradoxically, the level of chance-corrected interexaminer agreement for this pair of examiners calculates to only .37. In distinct contrast, a second set of examiners also in 80% overall agreement, is in appreciable disagreement with respect to diagnostic assignments. Thus, the first neuropsychologist: (a) classifies 65% of the cases as Non-Dyslexic, as opposed to 45% so diagnosed by the second neuropsychologist; and (b) classifies the remaining 35% as Dyslexic, as compared to the 55% so classified by the second examiner. Despite these phenomena, this second pair of examiners produces a much higher level of chance-corrected agreement than did the first pair, that is, a value of .61. The underlying reasons for both of these paradoxes, as well as their resolution, are presented.
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PMID:When diagnostic agreement is high, but reliability is low: some paradoxes occurring in joint independent neuropsychology assessments. 322 17

In the differential diagnosis as well as in the rehabilitation of hearing impaired children other disorders affecting language aquisition and speech development need to be taken into account. The rehabilitation programme is highly dependent on the early diagnosis of these additional disorders such as dysphasia, mental retardation of various degrees, cognitive disorders such as dyslexia and dysgraphia, dyspractic and dysarthric disorders of speech production, cleft palate and other anomalies of articulatory organs, autism and other abnormal features of psychic and personality development. In addition children with multiple disorders like malformations, visual disorders, epilepsy, CP and other diseases and handicaps, even though they may not influence language and speech development directly, may still be deprived of possibilities to aquire adequate verbal stimulation. The paper presents a material of 200 children whose hearing loss was diagnosed at the preschool age. Major associated handicaps were found in 35.5% of cases and in 26% they were complicating rehabilitation and development of the child. The frequency of associated disorders and their effect on language and speech development, learning ability and social development is being more closely analysed and discussed.
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PMID:Associated handicaps in children with hearing loss. 322 82

Abnormalities of functional connection between specialized areas in the human brain may underlie the symptoms which constitute the schizophrenia syndrome. Callosal and intrahemispheric fibres may be equally involved. The clinical emergence of symptoms in the later stages of brain maturation may be dependent on myelination of these fibre groups, both of which have extended myelination cycles. Ontogenetically earlier variants of the same mechanism could theoretically result in dyslexia and the syndromes of Kanner and Gilles de la Tourette. As new and unique extensions of specialized function emerge within the evolving brain, biological trial and error of connection both within and between them may produce individuals possessing phylogenetically advanced abilities, or equally, others possessing a wide range of abnormalities including those which comprise the schizophrenia syndrome. A dormant phenotypic potential for schizophrenia may exist in individuals who never develop symptoms during the course of a lifetime though some of these may become clinically apparent under the influence of various precipitating factors. It is concluded that abnormal functional connection and its normal and "supernormal" counterparts may be natural, essential, and inevitable consequences of brain evolution, and that this may have been so throughout the history of vertebrate brain evolution.
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PMID:Schizophrenia, abnormal connection, and brain evolution. 687 13

Five areas of research concerned with language acquisition--cognitive processes, semantics, pragmatics, phonology, and syntax--are reviewed in terms of their contribution to understanding language disorders. Two views of cognitive processes are discussed. One of these, emphasizing cognitive mechanisms such as short-term memory, is seen as providing possible explanations for some types of language deficits. The other, a concern with conceptual knowledge, is subjected to a critical analysis questioning how complete an explanation it is able to offer for some aspects of language acquisition. Problems of definition are also discussed when semantic aspects of language are considered. Problems in the pragmatic component of language are seen as providing an explanation for particular aspects of language disorder in some autistic children. The importance of focusing on phonology as a central grammatical process is discussed and linked to dyslexia and to spelling disorders. Finally, it is argued that the acquisition of syntactic structure is not yet understood. Impairments such as a hierarchical planning order deficit may affect syntactic ability and lead to disordered language, as found in some types of developmentally aphasic children. It is concluded that it is important to study all five areas of the title, and their interrelationships, if various language disorders are to be adequately understood.
J Autism Dev Disord 1981 Mar
PMID:Developmental language disorders: cognitive processes, semantics, pragmatics, phonology, and syntax. 692 99


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