Terminology And Distinction From Schizophrenia
As late as the mid-1970s there was little evidence of a genetic role in autism while in 2007 it was believed to be one of the most heritable psychiatric conditions. Although the rise of parent organizations and the destigmatization of childhood ASD have affected how ASD is viewed, parents continue to feel social stigma in situations where their child’s autistic behavior is perceived negatively, and many primary care physicians and medical specialists express some beliefs consistent with outdated autism research.
It took until 1980 for the DSM-III to differentiate autism from childhood schizophrenia. In 1987, the DSM-III-R provided a checklist for diagnosing autism. In May 2013, the DSM-5 was released, updating the classification for pervasive developmental disorders. The grouping of disorders, including PDD-NOS, autism, Asperger syndrome, Rett syndrome, and CDD, has been removed and replaced with the general term of Autism Spectrum Disorders. The two categories that exist are impaired social communication and/or interaction, and restricted and/or repetitive behaviors.
The Internet has helped autistic individuals bypass nonverbal cues and emotional sharing that they find difficult to deal with, and has given them a way to form online communities and work remotely.Societal and cultural aspects of autism have developed: some in the community seek a cure, while others believe that autism is simply another way of being.
Child Psychology And Psychiatry In Britain And The Introduction Of Autism Prior To 1959
As Gillian Sutherland, Deborah Thom, Nikolas Rose and others have documented, the 1920s and 1930s in Britain witnessed a vast expansion of charitable and governmental services to cater for the psychological problems of children . In 1913, the Mental Deficiency Act was passed in England and Wales which ensured institutional care for all children identified as mental defectives. In that same year, Cyril Burt was appointed as the first official government psychologist in the UK and tasked with assessing the levels of psychological disturbance in the child population. He worked with infant welfare centres, school medical inspection officers and reformatory and industrial schools in order to do this . In the late 1920s, the Commonwealth Fund, an American philanthropic body, began to provide funds for the purposes of improving child guidance services in Britain . Early child guidance clinics were used to direct child-rearing practices and to guide the behaviour of problem children . The expansion of psychological services offered growing opportunities for child psychological professionals to observe and assess infants and children.
Treatment/treatment Center/rehab Center/detox Center
Background: Treatment is defined by the American Society of Addiction Medicine as the use of any planned, intentional intervention in the health, behavior, personal and/or family life of an individual living with alcoholism or another drug dependency designed to achieve and maintain sobriety, physical and mental health and maximum functional ability. A treatment center is an establishment usually run by psychiatric or medical professionals.
NCDJ Recommendation:Treatment is an acceptable term for medical interventions, and treatment center is acceptable for the establishment in which such practices take place. Use treatment center in place of rehab or detox center. A person enrolled in a treatment center should be referred to as a patient.
AP style: Not addressed
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Psychology In Everyday Life: Combating The Stigma Of Abnormal Behaviour
Every culture and society has its own views on what constitutes abnormal behaviour and what causes it . The Old Testament Book of Samuel tells us that as a consequence of his sins, God sent King Saul an evil spirit to torment him . Ancient Hindu tradition attributed psychological disorder to sorcery and witchcraft. During the Middle Ages it was believed that mental illness occurred when the body was infected by evil spirits, particularly the devil. Remedies included whipping, bloodletting, purges, and trepanation to release the demons.
Until the 18th century, the most common treatment for the mentally ill was to incarcerate them in asylums or madhouses. During the 18th century, however, some reformers began to oppose this brutal treatment of the mentally ill, arguing that mental illness was a medical problem that had nothing to do with evil spirits or demons. In France, one of the key reformers was Philippe Pinel , who believed that mental illness was caused by a combination of physical and psychological stressors, exacerbated by inhumane conditions. Pinel advocated the introduction of exercise, fresh air, and daylight for the inmates, as well as treating them gently and talking with them.
The mass media has a significant influence on societys attitude toward mental illness . While media portrayal of mental illness is often sympathetic, negative stereotypes still remain in newspapers, magazines, film, and television.
Carrier Risk Based On Ethnicity And Residual Risk Assuming Negative Test Results
There are several types of spinal muscular atrophy based on age at symptom onset. Earlier onset is correlated with more severe manifestations. The most severe and most common form of the disease, type I , has symptomatic onset before 6 months of age and causes death from respiratory failure within the first 2 years of life. Type II spinal muscular atrophy is of intermediate severity, with typical onset before 2 years of age. Affected children are able to sit, but few are able to stand or walk unaided. Respiratory insufficiency is a frequent cause of death during adolescence however, the lifespan of patients with spinal muscular atrophy type II varies from age 2 years to the third decade of life. More than 80% of cases of spinal muscular atrophy are type I or type II, both of which are lethal forms. A milder form, type III , has typical symptomatic onset after 18 months of age. However, the symptom profile is quite variable. Affected individuals typically reach all major motor milestones, but function ranges from requiring wheelchair assistance in childhood to completely unaided ambulation into adulthood with minor muscular weakness. Many patients have normal life expectancies. Type IV has onset in adulthood. There is an additional Type 0 proposed, which has onset in the prenatal period.
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Vaccine Ingredients Do Not Cause Autism
- One vaccine ingredient that has been studied specifically is thimerosal. Thimerosal is a mercury-based preservative used to prevent germs from contaminating multidose vials of vaccines. Research shows that thimerosal does not cause ASD. In fact, a 2004 scientific review by the IOM concluded that the evidence favors rejection of a causal relationship between thimerosalcontaining vaccines and autism.Immunization Safety Review: Vaccines and Autism external icon
Since 2003, there have been nine CDC-funded or conducted studies that have found no link between thimerosal-containing vaccines and ASD. These studies also found no link between the measles, mumps, and rubella vaccine and ASD in children. Learn more about the CDC Studies on Thimerosal in Vaccines pdf icon.
Even before studies showed that thimerosal was not harmful, there was a national effort to reduce all types of mercury exposures in children. As precaution, thimerosal was removed or reduced to trace amounts in all childhood vaccines between 1999 and 2001. Currently, the only type of vaccine that contain thimerosal are flu vaccines packaged in multidose vials. There are thimerosal-free alternatives available for flu vaccine. For more information, see the Timeline for Thimerosal in Vaccines.
Besides thimerosal, some people have had concerns about other vaccine ingredients in relation to ASD. However, no links have been found between any vaccine ingredients and ASD.
Chapter Iii Early Identification Of Young Children With Possible Autism
Definition of developmental surveillance
Developmental surveillance is theterm that most accurately describes the approach currentlypracticed by many health care providers and other professionals forthe early detection of developmental problems. Developmentalsurveillance is a flexible, continuous process in whichknowledgeable professionals monitor a child’s developmental statusduring the provision of health care services.
Developmental surveillance may bedone using parent questionnaires and/or formal screening tests ofgeneral development to gather information. All of this informationgathered by parent questionnaires and/or screening tests of generaldevelopment is then reviewed by professionals involved with thedevelopmental process and discussed with the child’sparents.
An advantage of using parentquestionnaires is that these help to involve the parents inmonitoring their child’s development. The formal screening tests ofgeneral development are typically administered by professionals orparaprofessionals. Appendix D containsa table describing some of the more commonly used tests of generaldevelopment. An advantage of using standardized tests of generaldevelopment is that normative data is often available so that achild’s scores can be compared to those for typically developingchildren of the same age.
Identifying an increased concernbased on surveillance findings
Assessing developmentalmilestones that are relevant to autism
- 15 month developmental milestones
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Brain Injury/traumatic Brain Injury
Background: The Centers for Disease Control define traumatic brain injury as an injury that affects how the brain works.
NCDJ Recommendation: Use person with a brain injury or person with a traumatic brain injury rather than brain damaged, which is considered derogatory.
AP style: Addressed in entry for Trauma, suggesting that traumatic brain injury is an acceptable use of the word trauma.
Early Signs And Symptoms
Diagnostic features of ASD are present in very young children. Most families and caregivers report observing symptoms within the first 2 years of life and typically express concern by the time the child reaches 18 months of age.
Studies of children with ASD found the following:
- Parents of children with ASD reported first noticing abnormalities in their children’s developmentâparticularly in language development and social relatednessâat about 14 months of age on average .
- Infants at risk forâand later diagnosed withâASD showed a decline in eye fixation within the first 2â6 months of age. This pattern was not observed in typically developing infants .
- Children with autism used fewer joint attention gestures and behaviors as infants and toddlers than did age-matched peers who were typically developing .
- Children with autism showed subtle differences in sensoryâmotor and social behavior at 9 to 12 months of age when compared with typically developing peers .
- Children with autism showed lower rates of canonical babbling and fewer speech-like vocalizations across the 6- to 24-month age range than did typically developing peers .
- Infants at risk forâand later diagnosed withâASD used significantly more distress vocalizations than did children who were typically developing and children who were developmentally delayed this may reflect the difficulties that children with ASD have with emotional regulation .
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Screening Considerations For Cystic Fibrosis
As with all carrier screening, it is generally more cost effective and practical to perform initial carrier screening only for the patient. Cystic fibrosis carrier screening should be offered to all women who are considering pregnancy or are currently pregnant. If the patient is a cystic fibrosis carrier, then her partner should be tested. During pregnancy, concurrent screening of the patient and her partner is suggested if there are time constraints for decisions regarding prenatal diagnostic evaluation. Given that cystic fibrosis screening has been a routine part of reproductive care for women since 2001, it is prudent to determine if the patient has been previously screened before ordering repeat cystic fibrosis screening. If a patient has been screened previously, cystic fibrosis screening results should be documented, but the test should not be repeated. Although some mutation panels have been expanded over the past decade, the incremental yield of the addition of those mutations is small for most patients. Before repeat testing, the clinical scenario should be discussed with an obstetriciangynecologist or other health care provider with expertise in genetics.
The following are various carrier screening scenarios with associated management recommendations:
Both partners are cystic fibrosis carriers. Genetic counseling is recommended to review prenatal testing and reproductive options. Prenatal diagnosis should be offered for the couples specific, known mutations.
Postwar Conceptualizations Of Autism And Infant Psychopathology
After the war, the controversies over how to describe infantile thought continued. The diagnoses of schizophrenia, psychosis and autism in children were largely interchangeable during the 1940s and 1950s. In the USA, Bender and others employed a Kleinian model to understand infant and child psychopathology and focused on schizophrenia as the central psychopathological problem of childhood. Bender was an important figure in the development of perceptual tests for children. In 1947, she published a study on one hundred schizophrenics who had attended the Childrens Department at Bellevue during the period 193747. She defined childhood schizophrenia as
pathology in behavior at every level and in every area of integration or patterning within the functioning of the central nervous system, be it vegetative, motor, perceptual, intellectual, emotional or social.
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Ial Hearing Loss/partially Deaf
Background: Hard of hearing is the most common term for those who have a mild to moderate hearing loss that may or may not be corrected with amplification.
NCDJ Recommendation: Ask your sources what term they prefer. Otherwise, hard of hearing is almost always acceptable.
AP style: The stylebook recommends using partial hearing loss or partially deaf for those who have some hearing loss.
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Case Studies Of Fictional Characters
: Whats Eating Gilbert Grape?
Description of the ProblemArnie kills a grasshopper by cutting its head off in the mailbox and a little while after he kills it he gets very upset at himself and is sad that the grasshopper died. He has certain hand movements that he constantly does. He puts his hand to his mouth a certain way when he is in an uncomfortable situation. He has eye twitches and he blinks quite often. Arnie is always running off and hiding from Gilbert or climbing the water tower. Gilbert knows where Arnie is hiding but plays a game and pretends that he does not know Arnie is up in the tree and he thinks Gilbert has no idea where he is. When other people get hurt or when Arnie says mean things to others he thinks that it is very funny and usually laughs hysterically. He is arrested for climbing the water tower and when they put him in the cop car, all he is worried about is the cops turning on the lights and sirens. He is not able to take care of himself. For example, Gilbert puts Arnie in the bath and tells him that he is a big boy and can wash himself. Gilbert leaves and comes back the next morning to find Arnie still in the bathtub. Arnie repeats everything that people tell him to do and what they say in general. After the bathtub incident, Arnie is afraid of any kind of body of water. He gets very upset and starts to hurt himself when he tries to wake his mother and she never wakes up.
1. Social interaction
: Fly Away
Afflicted With/stricken With/suffers From/victim Of
Background: These terms carry the assumption that a person with a disability is suffering or has a reduced quality of life. Not every person with a disability suffers, is a victim or is stricken.
NCDJ Recommendation: It is preferable to use neutral language when describing a person who has a disability, simply stating the facts about the nature of the disability. For example: He has muscular dystrophy.
Conforms to AP style that suggests avoiding descriptions that connote pity.
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Americans With Disabilities Act
Background: The Americans with Disabilities Act is federal civil rights legislation that was signed into law in 1990 to address discrimination on the basis of disability in employment, public accommodations, transportation and telecommunications as well as state and local government services.
NCDJ Recommendation: Use Americans with Disabilities Act on first reference ADA is acceptable on second reference.
Conforms to AP Style
Autism And Hearing Loss Is There A Connection
Todays parents have an advantage over those of generations past with modern technology and medical practices, most parents now know a great deal about the health of their newborn child before they even leave the hospital. Oto-acoustic emissions testing, for example, can detect hearing loss within the first few days of life. Some disorders, such as autism, however, take longer to show up and diagnose.
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Cleft Palate Or Lip/harelip
Background: The University of Kansas Research & Training Center on Independent Living describes this as a specific congenital disability involving the lip and gum. The center recommends against using the term harelip as it is anatomically incorrect and stigmatizing.
NCJD Recommendation: Use person who has a cleft palate. Avoid harelip.
Conforms to AP style
American Sign Language /signer/interpreter
Background:American Sign Language is a complete language that utilizes signs made by moving the hands combined with facial expressions and postures of the body, according to the National Institute on Deafness and Other Communication Disorders. Many people in North America who are deaf or hard of hearing use it as a primary means of communication.
The terms signer and interpreter often are used interchangeably but mean different things. A signer is a person who may be able to communicate conversationally with deaf persons but who may not necessarily possess the skills and expertise to accurately interpret complex dialogue or information, according to the . To become an interpreter, an individual must not only display bilingual and bicultural proficiency but also have the ability to mediate meanings across languages and cultures, both simultaneously and consecutively. This takes years of intensive practice and professional training.
NCDJ Recommendation: Specify American Sign Language on first reference, capitalizing all three words. ASL is acceptable on second reference. Use interpreter only for those who have completed advanced training. The Registry of Interpreters of the Deaf has a searchable database of registered interpreters.
AP style: Not addressed
See also Deaf
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