ISSN 1188-3936                                               Vol. 16 - No. 4 Winter 2005

                                          of the

  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.


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.

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).

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

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.


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

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.


     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,

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

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:

               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

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

"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

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.

                                    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
   •   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

   •   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,

   •   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,

   •   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

For a thorough listing of Resources & Websites, go to our website section:,resources&sites.htm

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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:; 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.


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