VIEWS: 14 PAGES: 15 POSTED ON: 3/21/2011
ISSN 1188-3936 Vol. 16 - No. 4 Winter 2005 CLINICAL BULLETIN of the DEVELOPMENTAL DISABILITIES DIVISION Parental Perception of Sleep Problems in Children of Normal Intelligence with Pervasive Developmental Disorders: Prevalence, Severity and Pattern Jennifer L. Couturier, M.D., M.Sc., Kathy N. Speechley, Ph.D., Margaret Steele, M.D., Ross Norman, Ph.D., Bernadette Stringer, Ph.D., & Rob Nicolson, M.D. First printed in full in The Journal of the American Academy of Child and Adolescent Psychiatry 2005;44:815-822. Sleep problems in children can be defined as sleep behavior that is disturbing to the child, the child’s family, or both. These behaviors might include long sleep latency, night waking, nightmares, night terrors, sleepwalking, and co-sleeping with parents, which some, but not all, parents and children may find disturbing. Sleep problems may be divided into two categories: dyssomnias and parasomnias. The dyssomnias include difficulties with the timing of sleep whereas the parasomnias include nightmares/ terrors, and sleepwalking. In children with Pervasive Developmental Disorders (PDD), the prevalence of sleep problems has been reported to be between 44% and 83%. In terms of sleep pattern, studies have generally reported problems with sleep onset and maintenance. Poor quality of sleep, early waking, and difficult sleep routines have also been found. One group reported that children with autistic disorder exhibited long sleep latencies, night waking, and shortened night sleep, while another group found more difficulties with bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night waking and parasomnias (a disruptive physical act that occurs during slumber) in those PDD children who were thought to have a sleep problem by their parent. Studies done to date suggest that sleep problems may be quite prevalent in children with PDD. However, valid and reliable scales have not been used to measure prevalence of sleep problems in this population. Similarly, previous studies have included subjects with intellectual disabilities (ID). There have been no studies looking at PDD in the absence of co-morbid ID, making it difficult to determine if current sleep difficulties were secondary to PDD, ID, or both. The objective of this study was to compare the prevalence, severity and pattern of sleep problems in children of normal intelligence (i.e., without ID) with PDD to a normative comparison group of children. Method Subjects PDD and normative comparison children were obtained from a region in Southwestern Ontario, Canada with a total population of 584,008 according to 2001 census data. This region consists of large metropolitan areas and many rural areas. PDD children were selected based on contact with a PDD assessment and treatment centre in this region, whereas normative comparison children were obtained from the school board servicing this same geographic area. Children with PDD were included if they had been diagnosed with a PDD, were between the ages of 5 and 12, resided in the area of Oxford, Middlesex, or Elgin Counties in Ontario, and had a performance IQ of 70 or above. Children in the normative comparison group were included if they lived in the same region as the patients, were between the ages of 5 and 12, and demonstrated satisfactory academic progress. Children in this group were excluded from participation if they had received a psychiatric diagnosis at any time in the past or if they were taking prescription medication. In order to ensure that patients and controls had a similar socioeconomic status, controls were recruited from similar schools as those of the participating patients using a centralized database. Measures The Child’s Sleep Habits Questionnaire (CSHQ) is a 45 item parent questionnaire used to retrospectively assess sleep-related behavior in children. It was designed for children 4 to 12 years old, to screen for the most common sleep problems in this age group. It yields a total sleep disturbance score and eight subscale scores, reflecting major medical and behavioral sleep disorders. The key domains include bedtime behavior and sleep onset, sleep duration, anxiety related to sleep, behavior during sleep, night wakenings, morning wakening, and daytime sleepiness. Parents are asked to recall events occurring over the past week or during a “typical” week (if the past week was unusual), and to rate the events on a three point scale Data Analysis The severity of sleep problems was compared between the PDD and normative comparison group using the mean total score from the CSHQ and a paired t-test (two- tailed). The pattern of sleep problems was compared between the children with PDD and comparison children using the means for the subscales on the CSHQ and paired t- tests (two-tailed). Results Sample Characteristics 23 patients with PDD and 23 control children participated. The socio-demographic characteristics of the two samples were similar. The majority of respondents were biological mothers who were married. The mean age was 9.4+2.0 years in the PDD group, and 9.5+2.0 years in the comparison group. Ninety-six percent of the children in each group were male. In the PDD group, 13 (57%) were diagnosed with autistic disorder, 8 (35%) with Asperger’s disorder, and 2 (9%) with PDD NOS. Seventy percent of children in the PDD group were taking prescription medication. Prevalence of Sleep Problems Eighteen out of 23, or 78%, of children with PDD were reported by their parents as having a sleep problem by attaining a score of 41 or above on the CSHQ. Within the comparison group, 6 out of 23, or 26%, were deemed by their parent to have a sleep problem. Severity of Sleep Problems Children in the PDD group scored significantly higher on the CSHQ with a mean score of 48.2+8.4 compared to the comparison group with a mean score of 39.0+5.6. Pattern of Sleep Problems The pattern of sleep problems was compared between the PDD and comparison groups using paired t-tests of the mean scores on the eight subscales of the CSHQ. There were four subscales that were significantly higher in the PDD group than in the comparison group: sleep onset delay, sleep duration, sleep anxiety, and parasomnias. The remaining subscales: bedtime resistance, night wakings, sleep disordered breathing, and daytime sleepiness were not significantly different between the PDD and comparison groups. Discussion Seventy-eight per cent of the children with PDD in this study were deemed by their parents to have a current sleep problem according to the CSHQ. This is a higher prevalence than found in other studies that compared children with PDD to typically developing children, perhaps due to the use of more standardized instruments. Parents also rated the severity of sleep problems to be significantly greater in the PDD group in this study compared to the comparison group. This is consistent with previous studies. The pattern of sleep problems observed in this study indicated significant differences between the PDD and normative comparison samples in the domains of delayed onset of sleep, decreased sleep duration, higher levels of sleep anxiety, and increased parasomnias. Thus, the nature of the sleep problem is diverse with difficulties in both the areas of dyssomnias and parasomnias. A comparison of the results of previous studies and our study suggests children of normal intelligence with PDD appear to have similar sleep patterns to those children with PDD with below average IQ. The results of this study support a hypothesis that sleep problems are not only related to intellectual disability, but also occur at similar rates, severity and patterns in children of normal intelligence who have PDD. This may suggest that common pathological processes result in PDD and sleep problems. While we are unable to determine from this study the causal relationship between sleep problems and PDDs, it is possible that neurochemical changes in PDD may be related to sleep problems, that biological abnormalities associated with autism may predispose people to sleep disturbances, or that the sleep problems seen in PDDs are related to abnormalities of arousal and anxiety. Limitations The results presented here must be interpreted within the context of a few study limitations. One limitation includes the validity of parent report measures of childhood sleep problems. As parents may or may not be sleeping at the same time as their child, it is difficult to know whether their perceptions of their child’s nighttime behavior are accurate. Discrimination of specific sleep problems may be particularly difficult in a child with PDD, given the presence of impairments in communication and behavioral problems. Potential response bias is another limitation of this study as it is possible that particular subsamples of parents, such as those whose child has a sleep problem, may be more likely to respond than other parents. Another consideration in interpreting these results is that 70% of children in the PDD group were taking medication, including stimulants, that might worsen their sleep. However, excluding children taking stimulants confirmed a higher proportion of children with sleep problems in the PDD group. Many were also taking medication that would cause sedation, such as antipsychotics. Many of these medications are prescribed in order to help with sleep, so it would be difficult to know whether the medications had helped or worsened the sleep problem. While limiting the study to those children not on medication would allow one to assess sleep problems without this possible confounder, it would reduce the eligible sample to a minority of children with PDD and thus, limit the generalizability of the results. In addition, PDD subjects had a variety of psychopathology, and were not divided into subgroups based on symptoms such as hyper-activity, or obsessive-compulsive behaviors. This would be an interesting area of future research, but was not practical in this study due to the small sample size. Future studies may also wish to compare sleep problems in children with PDD, to other comparison groups, such as those with other neuropsychiatric problems. A normative comparison group was chosen in this study in order to reduce confounding variables of IQ and medical problems. Although the majority of children in the PDD group were within the average range for performance IQ, it is possible that the PDD sample was skewed toward the low average range. Without obtaining IQ tests in the comparison group, the accuracy of the matching is not known. Future studies could match subjects based on an exact determination of IQ in both the PDD and comparison group. Furthermore, not all sleep-related pathology was investigated in this study, such as sleep problems related to seizure disorders, or periodic limb movements. Future studies may investigate these additional issues. Clinical Implications In summary, parents report that, in comparison to normally developing children, sleep problems in children of normal intelligence with PDD are more prevalent, and severe. In addition, a diverse pattern of sleep problems is reported including dyssomnias and parasomnias. Clinicians should be aware of the high prevalence of sleep problems in children with PDD, and should ask parents about these problems. Perhaps investigating and treating sleep problems could result in less disruption to families who have children with PDD. Sleep problems in children with PDD warrant further investigation. Future research might focus on determining an etiology for sleep problems in children with PDD, perhaps aided by sleep EEG. References available in The Journal of the American Academy of Child and Adolescent Psychiatry 2005;44:815-822 Note: Jennifer Couturier won the 2003 annual UWO Department of Psychiatry Academic Day Award for graduate students or residents for this paper. See also March 2004, CLINICAL BULLETIN of the DEVELOPMENTAL DISABILITIES DIVISION, VOL. 15 - NO. 1 The Relationship Between Sleep Disturbances and Aberrant Behaviours in Persons with Intellectual Disabilities Dr. Jay Rao, University of Western Ontario, Department of Psychiatry, Dr. Colin Shapiro, University of Toronto, Department of Psychiatry, and Raphael Lencucha, OT, RMHC-London Clinical experience and some research indicate that sleep problems are common among adults and children with intellectual or developmental disabilities (mental retardation). Disordered sleep in those with intellectual disabilities has an estimated prevalence of 13% to 86%. Bartlett et al. (1985), in a study of 214 children with mental handicap under 16 years of age, found that 86% of those under six years old, 81% of 6- 11 year olds, and 77% of the 12-16 year olds were reported by parents as having sleep problems. Clements et al. (1986) found sleep problems in 34% of their sample of 155 children under the age of 15. Quine (1991), in a 3-year longitudinal survey of 200 children with severe mental retardation, found that 51% of the children had settling difficulties, while 67% reported frequent night waking. In one of the few studies to include a control group of typically developing children, Richdale et al. (2000) found sleep disorders in 58.6% of children. A between-group analysis revealed that both past (66.7%) and present (57.7%) sleep disorders were more common in children with developmental disabilities than in typically developing children. There are fewer studies of sleep problems in adults with developmental disabilities. In one of the few studies of sleep patterns and sleep problems amongst people with mental handicap, Espie and Tweedie (1991) found approximately 15% had sleep problems. However, Brylewski and Wiggs (1999) found that nearly 30% of 205 people with intellectual disability aged 18 years or over, living in the community, had sleep problems such as settling difficulties (26.8%), night waking (55.6%), parasomnias (14%) and sleep related breathing problems (15%). Poindexter and Bihm (1994) identified 39% of 103 individuals with profound mental handicap living in an institution as having “short sleep.” Full article available at: http://www.psychiatry.med.uwo.ca/ddp/bulletins/04marbul.htm RMHC/DDD physician recognized for outstanding service to patients with Tourette Syndrome Congratulations to Dr. Jay Rao, physician leader for RMHC’s Developmental Behavioural Management (DBM) program, who was recently awarded the Tourette Syndrome Foundation of Canada National Award for outstanding service to individuals with Tourette syndrome (TS). Tourette Syndrome is a neurodevelopmental disability and occurs in both the intellectually disabled and those who are not intellectually disabled. It is under- or misdiagnosed in the people with intellectual disabilities. These individuals are seen in the DBM program in consultation. As well, referrals province-wide are made to Dr. Rao's clinics. This award, recipients of which have been nominated by patients, recognizes doctors who have made significant contributions to the Tourette Syndrome community in terms of either research or treatment. Dr. Rao is also an Associate Professor in the University of Western Ontario Department of Psychiatry & Family Medicine, and Director of Post Graduate Education of the Developmental Disabilities Division. Photo: Dr. Jay Rao is pictured here with his award plaque and certificates. Assessing Developmental Disabilities: A Medical Student’s Perspective Betty Lee, UWO Medical Student, Year 3 - Class of 2006 Betty’s essay won 2nd place in the 2005 DDD Essay Award for UWO Medical Undergraduates. "Is he autistic?" the mother asked. "The school wants to know. They can get extra funding if he is." "Well, we'll have to do an assessment to see," the child psychiatrist replied. The boy was 6 going on 7 years old, with bright brown eyes and an expressive smile. He appeared small for his age. His community physician had referred him to be assessed in regards to his behavioral issues. "He's been biting children at school," the mother said. The daycare was threatening to expel him if the behaviour continued. As curious clinical clerks, we listen to his story with interest and observed his actions intently. The delivery had been problematic when he was born. Soon after, he was thought to have cerebral palsy and perhaps a seizure disorder. He was the youngest of two sons. His older brother was healthy and did very well in school even though he had been diagnosed with ADHD. His family history was also significant for two paternal cousins who had intellectual disabilities. Growing up, his developmental milestones were delayed. In fact at the age of nearly 7, he was still non-verbal and was not toilet trained. His mother worried aloud about what she would do when he outgrows all the available diaper sizes for children. Though non- verbal, he was still able to communicate his wishes. Earlier in the day, when he first arrived in the child psychiatrist's office, he spied a toy truck that he wanted to play with. He pointed to the truck vehemently and was not appeased until the truck was handed to him and he had it in his arms. Through the daycare, he also utilized a picture board to communicate his needs but the use of this board was limited. "Has his hearing ever been tested?" his mother was asked. "I think he can hear, though sometimes I wonder," she replied. A hearing assessment had been attempted a while ago but not completed, as he was not able to cooperate. He did appear to respond to his name and seemed to react appropriately to questions and simple commands. To watch him play, he had no apparent motor difficulties. He was able to walk and to run, and had good manual dexterity. However, he appeared to have the intellectual age of a 2-year-old. "How is he socially?" the psychiatrist asked. The little boy happily pushed the coveted toy truck to his interviewer and delighted when the truck as pushed back to him. His joy was so infectious that as this exchange continued, we found ourselves laughing and smiling along with him. He's so smart, we remarked to each other. His mother stated that he liked to play with his brother and would play with any other children that would play with him. However, if he became frustrated or could not get his way, he was known to 'act out'. This meant becoming aggression with biting and hitting behaviour. He also had a history of being physically cruel to the family cat. Despite this, he loves his brother and the cat very much, his mother told us in a reassuring tone. Of course, this aggressive behaviour was highly problematic, it meant that he had to be watched constantly and the prospect of being expelled from his daycare for his aggression would be devastating to his family. "I work full-time and I'm a single mom," his mother recounted. The stress of caring for a child with developmental disabilities had been too taxing for her marriage and led to her divorce. The father could not fully come to terms with issues his son faced and the level of care that his son needed. As a result, in addition to her responsibilities as a mother of 2 young children, one son with ADHD, and the other with developmental disabilities, she had to juggle a high powered, full-time job in administration to support her family. Through all of this, her main social support was her own mother, who often helped look after the children for her. The children's father was still in contact and had his scheduled visits, but overall, did not provide a great deal of assistance in the day-to-day routine of their lives. As we listened, we silently gasped. We were shocked and in awe of the challenges that the boy's mother faced. How did she do it, we wondered? She had our utmost respect and admiration. Sometimes, as students when we are attempting to learn about medical conditions, we can become so preoccupied with remembering the presenting signs and symptoms that we can lose focus on how these conditions affect the lives of patients and those around them. I'm sure that on some level, we were all aware of the struggles that parents of children with developmental disabilities deal with, but hearing a first person account of them, somehow made the issues more real. As we empathized with the mother, we glanced over to the little boy. He was enthralled with a box of toys in the middle of the room. Diligently, he investigated each object in the box. Systematically, he picked up each toy from the box, put it in his mouth briefly and then placed the object on the floor. He didn't seem to actually be playing with the toys, just examining them. He continued to explore everything in the room. At one point, he even borrowed his mother's keys and attempted to play with a doorknob in the room, mimicking the action of unlocking the door. Though the door was already unlocked, we were all impressed at his ability to associate the keys with unlocking a door. He appeared quite able and content in entertaining himself, though additionally at times throughout the interview, he periodically approached his mother for comfort. Observing their relationship was heartwarming, as we saw how loving and patient his mother was to him and in return, his affection for her. Indeed, even though he was able to play independently, he also seemed to enjoy the company of others. He was more than happy to have the interviewer join him in a game of action figures and toy cars! He interacted appropriately and smiled brightly throughout the play. When asked which toy car was faster, he eagerly raced the cars across the carpeted floor. With the assessment nearing to an end, his mother expressed that her goals were that her son be given a diagnosis to reflect his presentation with hopes that this would ensure that he would receive the proper care and support to help manage his behaviour. As such, appropriate referrals were made to community support services and arrangements for future assessments were completed. She had realistic expectations and highly motivated to do everything she could to help her son. Despite living more than an hour away from the facility, she was more than willing to make the commute for follow-up appointments with the child psychiatrist, and was pleased at the prospect that he would receive continued care here. As we were saying goodbye to the little boy and his mother, he then remembered the toy truck he had grown fond of earlier in the day. It was only with much coaxing and goading by his mother that he relented and returned the prized truck to the psychiatrist. And with that the little boy looked over and waved goodbye. Soon afterwards, we gathered as a group and discussed the assessment that we had watched that day. 'I don't think he was autistic', we each said. The little boy had been so engaging throughout the interview; pointing at objects he was interested in, smiling brightly at those around the room, and initiating social contact with people. We fondly recalled how he had enjoyed himself when others joined in the game of action figures and toy cars. We knew that he was developmentally disabled - he appeared to have the intellectual ability of a two-year-old, still we were impressed with the level of awareness he had of his surroundings. He had explored the room quite adventurously and exhibited some problem-solving skills and the ability to mimic during his play. As well, despite being non-verbal, he seemed to understand simple commands and some questions that were asked of him. He did his best to communicate his wishes to others with his gestures and emotional expressions; though would become visibly frustrated when he was not fully understood or if his requests were denied. We had not observed any of the aggression behaviour for which he had been referred, but we knew that the issue was a source of major distress to his mother and others. We wondered what would happen in the future if his behaviour continued and he was no longer a little boy who could be so easily removed from a situation if he became aggressive. Once again, we remarked how we greatly respected and admired his mother for handling all the trials in her life with such grace. Being a parent to a child with developmental disabilities is not a simple task and their story helped us realize the day- to-day realities that these families face. Through the struggles though, there can also be great joy. The caring and affection she had for her son was quite apparent, and whenever he smiled the whole room smiled. Everyone delighted in his little triumphs and discoveries. As we reflected on what we had seen and learned that day, we worried and wondered about the challenges the little boy had and would face in the future, and yet felt reassured in knowing that he would always have his family's love. WORKSHOPS & CONFERENCES Check out our website’s Events Section for a thorough listing of workshops and conferences http://www.psychiatry.med.uwo.ca/ddp/ OADD 17th Annual Conference The New Frontier: Honouring the Past, Working Towards the Future April 5, 6, 7 / 2006, Kempenfelt Centre, outside of Barrie Ontario OADD is planning its 17th annual conference on developmental disabilities as well as celebrating the 20th Anniversary of incorporation. We are exploring themes related to behavioural approaches and dual diagnosis, motivational issues, and humour in the workplace. http://www.oadd.org RESOURCES & WEBSITES Some excellent articles on aging, dementia and related, in the June 2005, Vol. 2, No. 2 issue of Journal of Policy and Practice in Intellectual Disabilities http://www.blackwell-synergy.com • Comparative Program Options for Aging People with Intellectual Disabilities (p. 75) Christine Bigby • Design and Implementation of a Multicenter Trial of Vitamin E in Aging Individuals with Down Syndrome (p. 86) Paul S. Aisen, Arthur J. Dalton, Mary Sano, Ira T. Lott, H. F. Andrews, W.-Y. Tsai, the International Down Syndrome and Alzheimer's Disease Consortium • Comparing Dementia Diagnostic Methods Used with People with Intellectual Disabilities (p. 94) Diana B. Burt, Sharon Primeaux-Hart, Katherine A. Loveland, Lynne A. Cleveland, Kay R. Lewis, Jary Lesser, Pamela L. Pearson • A Proactive Psychological Strategy for Determining the Presence of Dementia in Adults with Down Syndrome: Preliminary Description of Service Use and Evaluation (p. 116) Sunny Kalsy, Sharna McQuillan, Dawn Adams, Tarvinder Basra, Eva Konstantinidi, Murielle Broquard, Simone Peters, Vicki Lloyd, Chris Oliver • Assessment of Aging Individuals with Down Syndrome in Clinical Trials: Results of Baseline Measures (p. 126) Mary Sano, Paul S. Aisen, Arthur J. Dalton, Howard F. Andrews, Wei-Yann Tsai, the International Down Syndrome and Alzheimer's Disease Consortium • A Revised Stress and Coping Framework for Staff Carers of Persons with Intellectual Disabilities and Dementia (p. 139) Mary McCarron, Philip McCallion • Life Events in Older Adults with Intellectual Disabilities: Differences Between Adults with and Without Down Syndrome (p. 149) Paul J. Patti, Karen B. Amble, Michael J. Flory • Practitioner-Raised Issues and End-of-Life Care for Adults with Down Syndrome and Dementia (p. 156) Karen Watchman *** In the November 2005 issue of the American Journal on Mental Retardation: • Intensive Behavioral Treatment for Children With Autism: Four-Year Outcome and Predictors (p. 417) Glen O. Sallows and Tamlynn D. Graupner • Longitudinal Assessment of Stereotypic, Proto-Injurious, and Self-Injurious Behavior Exhibited by Young Children With Developmental Delays (p. 439) David M. Richman and Steven E. Lindauer • Life Course Impacts of Mild Intellectual Deficits (p. 451) Marsha Mailick Seltzer, Frank Floyd, Jan Greenberg, Julie Lounds, Mary Lindstromm and Jinkuk Hong • Psychometric Evaluation of a Self-Report Measure of Depression for Individuals With Mental Retardation (p. 469) Anna J. Esbensen, Marsha Mailick Seltzer, Jan S. Greenberg and Betsey A. Benson • Repetition Priming in Adults With Williams Syndrome: Age-Related Dissociation Between Implicit and Explicit Memory (p. 482) Sharon J. Krinsky-McHale, Phyllis Kittler, W. Ted Brown, Edmund C. Jenkins and Darlynne A. Devenny *** The 2005 NADD Bulletin, Vol. 8, Nos. 1 thru 6: Volume VIII - Number 1 In memory of John Jacobson, Ph.D. • Dual Diagnosis in Children and Adolescents: Issues and Opportunities H. Thompson Prout, Ph.D • On the Mitigating Nature of Intellectual Disability (ID) in the Offender with Developmental Disability George S. Baroff, Ph.D. • Autism Spectrum Disorders in British Columbia: A Short History of the Creation of a New Program Vikram Dua, M.D. Volume VIII - Number 2 • Some Lessons I Learned About People with Autism Spectrum Disorders - Lauren Charlot, Ph.D. • How to Become More Emotionally Thick-Skinned: Part I Martin Lyden, Ph.D. • Treatment of Mood Disorders in People with Mental Retardation: A Selective Review. Peter Sturmey, Ph.D. Volume VIII - Number 3 • Impulse Control Difficulties in Persons with an Intellectual Disability: Role in Behavioral and Psychiatric Disorders - William I. Gardner, Ph. D. • The Spectrum of Tourette Disorder, Obsessive Compulsive Disorder, and Pervasive Developmental Disorders: Two Case Studies - Jarrett Barnhill, MD Director Volume VIII - Number 4 • How to Become More Emotionally Thick-Skinned, Part II Martin Lyden, Ph.D., Director • Facilitating Health Care and Mental Health Care Access of Persons with Intellectual Disabilities: One Element of Systematic Change • Sources for Information on Screening/ Assessment of Mental Health/Psychiatric Information in Children and Adolescents with Developmental Disabilities Ann R. Poindexter, M.D. Volume VIII - Number 5 • The Crisis Service Crisis Michael Mayer, Ph.D. • A Comprehensive Service Network to Address Emergent Behavioral Crises Experienced by Individuals with Dual Diagnoses and Their Caregivers Al Pfadt, PhD; Ray DeNatale, MA Volume VIII - Number 6 • Components of Crisis Links as Submitted In Queens Options For People Through Services (OPTS) Proposal - Mobile Crisis Intervention Team (MCIT) • Use of the Mediated Learning Experience and the Working Alliance: A Single Case Overview - Patti Hagarty, B.A., B.CR., M.C. (Psych) Provisional Psychologist • Development of a Typology of Recommendations Posed by a Multi-Disciplinary Consultation Outreach Team for Clients with a Dual Diagnosis - Heather L. King-Andrews & Susan J. Farrell *** 2005 Mental Health Aspects of Developmental Disabilities: January/February/March 2005 - Vol. 8, No. 1 • An Unusual Case of Recurrent Emesis in a Patient With Autistic Disorder Klara Curtis, M.D. • Body Dysmorphic Disorder: A Subset of Self-Injurious Behaviors With Intellectual Disability? Jarrett Barnhill, M.D. • Psychiatry in Mental Retardation and Developmental Disabilities: A Training Program for Psychiatry Residents Stephan A. Schwartz, Ph.D., Stephen L. Ruedrich, M.D. & Johnathan E. Dunn, M.D. • Group Dynamics in the Treatment of People With Intellectual Disabilities: Optimizing Therapeutic Gain Nancy J. Razza, Ph.D. & Daniel J. Tomasulo, Ph.D. • Premenstrual Syndrome and Premenstrual Dysphoric Disorder in Individuals With Intellectual Disability Van R. Silka, M.D. & Anne DesNoyers Hurley, Ph.D. April/May/June 2005 - Vol. 8, No. 2 • Quality of Life and Psychosocial Profile Among Young Women With Fetal Alcohol Spectrum Disorders Therese Grant, Ph.D., Janet Huggins, Ph.D., Paul Connor, Ph.D. & Ann Streissguth, Ph.D. • Early Onset Schizophrenia in a Young Woman With Mild Intellectual Disability and Unbalanced Chromosomal Translocation Rachel Boulding, M.D., FRCP(C), Robin I. Friedlander, M.B., ChB (UCT) M.Med (Psych) FFPsych (SA) FRCP(C), Stanya Jurenka, M.D., FRCP(C), MSC, Monica Hrynchak, M.D., FRCP(C), CCMG & William Honer, M.D., FRCP(C) • A Multidisciplinary Approach in Treatment of Major Depressive Disorder With Psychotic Features and Mild Intellectual Disability Anna Fernandez, M.A., LMFT, Soleng Tom, M.D., Mary Stadler, M.A., MFTI, Heather Cain, B.A. & Susan Knudsen, Ph.D., MFT • Diagnosis and Treatment of Adjustment Disorders in People With Intellectual Disability Andrew S. Levitas, M.D. & Anne DesNoyers Hurley, Ph.D. • The SSRI Controversy Andrew S. Levitas, M.D. & Anne DesNoyers Hurley, Ph.D. July/August/September 2005 - Vol. 8, No. 3 • Specialized Inpatient Mental Health Units in Ontario: Their History and Program Characteristics Susan Morris, BSW, MSW, RSW • The Psychosexual Assessment & Treatment Continuum: A Tool for Conceptualizing the Range of Sexuality-Related Issues and Support Needs of Individuals With Developmental Disabilities Jeanne Matich-Maroney, Ph.D., LCSW-R, Pamela S. Boyle, MS, FAACS & Michael M. Crocker, MA, LCSW-R • Pseudohallucinations in People With Intellectual Disabilities: Two Case Reports Max Pickard, MRCpsych & Dimitrios Paschos, MRCpsych • The Abnormal Involuntary Movement Scale (AIMS) and Tardive Dyskinesia in Persons With Developmental Disability: The Benefit of Videotaped Exams by Stephen Ruedrich, M.D., Linda Diana, RN, Christopher F. Rossvanes, M.A., Q.M.R.P. & James Toliver, M.D. • Specialized Inpatient Mental Health Care for People With Intellectual Disabilities Lauren R. Charlot, Ph.D. & Joan B. Beasley, Ph.D. The DDD staff can provide single copies of article for self-education upon request at email@example.com For a thorough listing of Resources & Websites, go to our website section: http://www.psychiatry.med.uwo.ca/ddp/resources&sites/main,resources&sites.htm BULLETIN DONATIONS: Dear Reader: We seek contributions to cover the cost of printing and mailing the paper version of the Clinical Bulletin four times a year. There are no annual subscription costs for the Bulletin, however, if you are able, an amount of $15 Cdn. (or $15 U.S. for U.S.A. readers) on an annual basis would be appreciated. Contributors to the Clinical Bulletin will receive tax donation receipts if requested. Please send a cheque payable to: "The University of Western Ontario" and mail to: UWO Developmental Disabilities Division, 850 Highbury Ave, Room P260, London ON CANADA N6A 4H1 MAILING LIST Write, phone, fax, or email: UWO Developmental Disabilities Division 850 Highbury Ave, Room P260 London ON CANADA N6A 4H1 E-mail: firstname.lastname@example.org; Phone (519) 455-5110, ext 47694; Fax (519) 457-7310 Editor: Maria Z. Gitta, M.A. Psychology Submissions welcome. Articles published or precised in this Bulletin do not necessarily reflect the opinions of The University of Western Ontario or the Developmental Disabilities Division. email@example.com
"CLINICAL BULLETIN of the DEVELOPMENTAL DISABILITIES DIVISION "