Professor Emeritus, Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry
Director, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences (2005 - 2013)
Director, Stanford Autism Center at Packard Children's Hospital, Lucile Packard Children's Hospital Stanford University School of Medicine (2005 - Present)
Boards, Advisory Committees, Professional Organizations
Board Member, Stanford New Schools, Stanford School of Graduate Education (2006 - Present)
Community and International Work
elected member of Nominating Committee, American Academy of Child and Adolescent Psychiatry
promoting advocacy and leadership in American Child and Adolescent Psychiatry
Opportunities for Student Involvement
Board Member, AchieveKids
education and treatment for children with developmental disabilities or autism spectrum disorders
children and adolescents with developmental disabilities and autism spectrum disorders
Opportunities for Student Involvement
Current Research and Scholarly Interests
Autism and Asperger's Disorder.
Genetically-based neurodevelopmental disorder, including Velocardiofacial Syndrome, Smith-Magenis Syndrome, Williams Syndrome, and Fragile X Syndrome.
Intellectual Disability (mental retardation) and psychiatric disorders.
Developmental Language Disorder and Learning Disabilities.
Sensory impairment in children, including visual and hearing impairment.
Psychiatric aspects of medical illness and disability in children.
Graduate and Fellowship Programs
Child Psychiatry (Fellowship Program)
The Potential of Repetitive Transcranial Magnetic Stimulation for Autism Spectrum Disorder: A Consensus Statement.
View details for PubMedID 30103951
Feasibility Testing of a Wearable Behavioral Aid for Social Learning in Children with Autism
APPLIED CLINICAL INFORMATICS
2018; 9 (1): 129–40
Recent advances in computer vision and wearable technology have created an opportunity to introduce mobile therapy systems for autism spectrum disorders (ASD) that can respond to the increasing demand for therapeutic interventions; however, feasibility questions must be answered first.We studied the feasibility of a prototype therapeutic tool for children with ASD using Google Glass, examining whether children with ASD would wear such a device, if providing the emotion classification will improve emotion recognition, and how emotion recognition differs between ASD participants and neurotypical controls (NC).We ran a controlled laboratory experiment with 43 children: 23 with ASD and 20 NC. Children identified static facial images on a computer screen with one of 7 emotions in 3 successive batches: the first with no information about emotion provided to the child, the second with the correct classification from the Glass labeling the emotion, and the third again without emotion information. We then trained a logistic regression classifier on the emotion confusion matrices generated by the two information-free batches to predict ASD versus NC.All 43 children were comfortable wearing the Glass. ASD and NC participants who completed the computer task with Glass providing audible emotion labeling (n = 33) showed increased accuracies in emotion labeling, and the logistic regression classifier achieved an accuracy of 72.7%. Further analysis suggests that the ability to recognize surprise, fear, and neutrality may distinguish ASD cases from NC.This feasibility study supports the utility of a wearable device for social affective learning in ASD children and demonstrates subtle differences in how ASD and NC children perform on an emotion recognition task.
View details for DOI 10.1055/s-0038-1626727
View details for Web of Science ID 000428690000006
View details for PubMedID 29466819
View details for PubMedCentralID PMC5821509
Asperger syndrome and DSM-5: a dilemma for a college freshman.
Journal of developmental and behavioral pediatrics
2013; 34 (7): 529-532
Angela is an 18-year-old college freshman who made an appointment with her pediatrician because of academic and social difficulties at college. She was diagnosed with Asperger disorder at age 6 based on difficulties relating to adults and peers, perseverative patterns of interest, and normal language development.She received special education services in middle school to help follow directions and complete assignments. She reports feeling very isolated during this time. In freshman year of high school, she insisted on discontinuing special education and managed with weekly private individual psychotherapy.In sophomore year, Angela learned strategies to get additional help from her teachers about assignments, and her grades improved. Socially, she formed a close friendship with a classmate who was also on the autistic spectrum, and she found a group of friends through this individual. As a senior with an upward grade trajectory and good SAT scores, she was admitted to a competitive 4-year college. In a precollege consult 6 months ago, she was anxious about fitting in.Angela began college classes without accommodations, but she now describes a challenging semester. She has not made many friends. She finds her courses difficult and does not fully understand assignments. She believes her peers dislike her. She thinks she would benefit from receiving note-taking and other services and asks you to document her disability for the college so that she might obtain accommodations.You point out that the DSM-5 eliminates the Asperger category. Angela is concerned. She does not believe that her profile is consistent with autism spectrum disorder, and she fears that being labeled as autistic will be prejudicial at school. Yet she is worried about retaining eligibility for services on the basis of a disability. How do you counsel her?
View details for DOI 10.1097/DBP.0b013e3182a399a6
View details for PubMedID 24042084
Salience Network-Based Classification and Prediction of Symptom Severity in Children With Autism
2013; 70 (8): 869-879
IMPORTANCE Autism spectrum disorder (ASD) affects 1 in 88 children and is characterized by a complex phenotype, including social, communicative, and sensorimotor deficits. Autism spectrum disorder has been linked with atypical connectivity across multiple brain systems, yet the nature of these differences in young children with the disorder is not well understood. OBJECTIVES To examine connectivity of large-scale brain networks and determine whether specific networks can distinguish children with ASD from typically developing (TD) children and predict symptom severity in children with ASD. DESIGN, SETTING, AND PARTICIPANTS Case-control study performed at Stanford University School of Medicine of 20 children 7 to 12 years old with ASD and 20 age-, sex-, and IQ-matched TD children. MAIN OUTCOMES AND MEASURES Between-group differences in intrinsic functional connectivity of large-scale brain networks, performance of a classifier built to discriminate children with ASD from TD children based on specific brain networks, and correlations between brain networks and core symptoms of ASD. RESULTS We observed stronger functional connectivity within several large-scale brain networks in children with ASD compared with TD children. This hyperconnectivity in ASD encompassed salience, default mode, frontotemporal, motor, and visual networks. This hyperconnectivity result was replicated in an independent cohort obtained from publicly available databases. Using maps of each individual's salience network, children with ASD could be discriminated from TD children with a classification accuracy of 78%, with 75% sensitivity and 80% specificity. The salience network showed the highest classification accuracy among all networks examined, and the blood oxygen-level dependent signal in this network predicted restricted and repetitive behavior scores. The classifier discriminated ASD from TD in the independent sample with 83% accuracy, 67% sensitivity, and 100% specificity. CONCLUSIONS AND RELEVANCE Salience network hyperconnectivity may be a distinguishing feature in children with ASD. Quantification of brain network connectivity is a step toward developing biomarkers for objectively identifying children with ASD.
View details for DOI 10.1001/jamapsychiatry.2013.104
View details for Web of Science ID 000322833600013
View details for PubMedID 23803651
- Helping Children Exposed to War and Violence: Perspectives from an International Work Group on Interventions for Youth and Families CHILD & YOUTH CARE FORUM 2013; 42 (4): 371-388
Introduction: Joseph Noshpitz (1922-1997)
JOURNEY OF CHILD DEVELOPMENT: SELECTED PAPERS OF JOSEPH D. NOSHPITZ
View details for Web of Science ID 000294827200002
JOURNEY OF CHILD DEVELOPMENT: SELECTED PAPERS OF JOSEPH D. NOSHPITZ
View details for Web of Science ID 000294827200006
- Stranded, Part II: Velocardiofacial Syndrome, Behavioral Neurogenetics, and the Study of Developmental Psychopathology JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY 2009; 48 (11): 1049-1050
Psychiatric Phenotypes Associated with Neurogenetic Disorders
PSYCHIATRIC CLINICS OF NORTH AMERICA
2009; 32 (1): 15-?
Advances in understanding the human genome and clinical application have led to identification of genetically based disorders that have distinctive behavioral phenotypes and risk for serious psychiatric disorders. Some patients have unrecognized genetic disorders presenting as psychiatric symptoms. Practitioners must be knowledgeable about the association between symptoms and underlying genetic bases. Treatment of neurogenetic disorders includes providing information about causes and prognoses. Patients are served best if they remain long term with a multidisciplinary team of providers who recognize the realities of a lifetime course, the high risk for symptom recurrence, and the need for providing information and support to families and coordinating medical and psychiatric care.
View details for DOI 10.1016/j.psc.2008.12.001
View details for Web of Science ID 000264534100003
View details for PubMedID 19248914
Social phenotypes in neurogenetic syndromes
CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA
2007; 16 (3): 631-?
Many of the known genetically based neurodevelopmental disorders are associated with a distinctive behavioral phenotype. As these behavioral phenotypes have been elucidated by clinical research, distinctive profiles of social traits have emerged as prominent syndromic features. This article reviews social phenotypic findings for fragile X syndrome, Down syndrome, Prader-Willi syndrome, Smith-Magenis syndrome, Turner syndrome, Williams syndrome, and velocardiofacial syndrome. An analysis of these social profiles raises several questions regarding the relationship between identified social impairments and autism and the relationship between social impairments in neurodevelopmental disorders and those found in normative child populations. The unique profile of certain of the known behavioral phenotypes also serves to distinguish several dimensions of sociability that are not readily observed in typical populations.
View details for DOI 10.1016/j.chc.2007.03.006
View details for Web of Science ID 000247944400008
View details for PubMedID 17562583
Risk factors for the emergence of psychotic disorders in adolescents with 22q11.2 deletion syndrome
AMERICAN JOURNAL OF PSYCHIATRY
2007; 164 (4): 663-669
The 22q11.2 deletion syndrome is the most common known genetic risk factor for the development of schizophrenia. The authors conducted a longitudinal evaluation of adolescents with 22q11.2 deletion syndrome to identify early risk factors for the development of psychotic disorders.Sixty children, 31 with 22q11.2 deletion syndrome and 29 comparison subjects with idiopathic developmental disability matched for age and IQ, underwent a baseline evaluation between 1998 and 2000; of these, 51 children (28 and 23 in the two groups, respectively) underwent follow-up evaluation between 2003 and 2005. A standardized comprehensive psychiatric, psychological, and adaptive functioning evaluation was conducted in both waves. Participants with 22q11.2 deletion syndrome were also genotyped for the catechol O-methyltransferase (COMT) Met/Val polymorphism and underwent magnetic resonance imaging scans.The two groups had similar baseline neuropsychiatric profiles. At follow-up, 32.1% of subjects with 22q11.2 deletion syndrome had developed psychotic disorders as compared with 4.3% of comparison subjects. In the 22q11.2 deletion syndrome group, baseline subthreshold psychotic symptoms interacted both with the COMT genotype and with baseline symptoms of anxiety or depression to predict 61% of the variance in severity of psychosis at follow-up evaluation. Lower baseline verbal IQ was also associated with more severe psychotic symptoms at follow-up evaluation.Genetic, cognitive, and psychiatric risk factors for the evolution of psychotic disorders in 22q11.2 deletion syndrome during adolescence were identified. Early intervention in the subgroup of children with subthreshold signs of psychosis and internalizing symptoms (especially anxiety symptoms) may reduce the risk of developing psychotic disorders during adolescence.
View details for Web of Science ID 000245402600022
View details for PubMedID 17403981
Psychotic symptoms in children and adolescents with 22q11.2 deletion syndrome: Neuropsychological and behavioral implications
2006; 84 (2-3): 187-193
Individuals with 22q11.2 deletion syndrome (22q11DS) are at increased risk for developing schizophrenia: half of affected adolescents report transient psychotic experiences and up to 30% of adults are diagnosed with schizophrenia. Prospective studies have shown that psychotic symptoms in childhood are predictive of later schizophreniform disorders. The current study aimed to define the prevalence and correlates of psychotic symptoms (PS) in young children and adolescents with 22q11DS. Forty-three children and adolescents with 22q11DS (mean age = 10.62+/-11.19) participated in this study. The occurrence of PS and their neuropsychological and behavioral correlates were investigated through semi-structured interviews and standardized measures. Psychotic symptoms were reported in 28% of the total sample and 17% of pre-adolescent children, and associated with decreased verbal IQ scores [F(1) = 4.41, p = 0.042]. Compared to young patients without PS, young patients with PS were perceived by their parents as more anxious-depressed [F(1) = 4.76, p = 0.035] and withdrawn [F(1) = 7.63, p = 0.009], with reduced adaptive socialization skills [F(1) = 6.88, p = 0.012]. Results suggest that psychotic manifestations are present earlier than typically reported in youngsters with 22q11DS and are accompanied by reduced verbal IQ performance and decreased adaptative social skills. The symptomatic, neuropsychological and behavioral characteristics observed in the current study may constitute central markers of increased risk for psychosis in 22q11DS.
View details for DOI 10.1016/j.schres.2006.01.019
View details for Web of Science ID 000238160500001
View details for PubMedID 16545541
- The Neurobiology of Williams-Beuren Syndrome Williams-Beuren syndrome : research, evaluation, and treatment 2006
COMT genotype predicts longitudinal cognitive decline and psychosis in 22q11.2 deletion syndrome
2005; 8 (11): 1500-1502
Although schizophrenia is strongly hereditary, there are limited data regarding biological risk factors and pathophysiological processes. In this longitudinal study of adolescents with 22q11.2 deletion syndrome, we identified the catechol-O-methyltransferase low-activity allele (COMT(L)) as a risk factor for decline in prefrontal cortical volume and cognition, as well as for the consequent development of psychotic symptoms during adolescence. The 22q11.2 deletion syndrome is a promising model for identifying biomarkers related to the development of schizophrenia.
View details for DOI 10.1038/nn1572
View details for Web of Science ID 000232966600023
View details for PubMedID 16234808
Psychiatric problems in children, adolescents and young adults with velo-cardio-facial syndrome
EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER. 2004: 95S–96S
View details for Web of Science ID 000220948200342
- Developmental disorders of learning, motor skills, and communication Textbook of Child and Adolescent Psychiatry 2004: 351-379
Responses and sustained interactions in children with mental retardation and autism
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
2003; 33 (2): 115-121
Sustained interactions and responses to social bids made by children with autism and verbal-age-matched children with mental retardation were recorded in two naturalistic settings. Children with autism produced fewer positive responses and more "no responses" than children with mental retardation; both groups were more likely to make positive responses to adults and not to respond to other children. Furthermore, although the frequency of conversations was not different for the two groups, children with autism were significantly less likely to engage in sustained play compared to children with mental retardation. Results suggest that children with autism are able to master the more rote and need-oriented social skills, such as simple conversation, but may not develop other forms of social interactions, like play.
View details for Web of Science ID 000181763600002
View details for PubMedID 12757350
Psychiatric disorders and behavioral problems in children with velocardiofacial syndrome: Usefulness as phenotypic indicators of schizophrenia risk
2002; 51 (4): 312-318
Velocardiofacial syndrome (VCFS), a genetic deletion condition with numerous cognitive sequelae, is associated with a high rate of psychiatric disorders in childhood. More recently, VCFS has been identified as a high-risk factor for developing adult onset schizophrenia. However, it has never been demonstrated that the childhood psychiatric disorders found in children with VCFS differ from those found in children with a similar degree of cognitive impairment. Identification of a specific behavioral (psychiatric) phenotype in childhood VCFS offers the potential for elucidating the symptomatic precursors of adult onset schizophrenia.Twenty-eight children with VCFS and 29 age- and cognitively matched control subjects received a standardized assessment of childhood psychiatric disorders and behaviors measured by the Child Behavior Checklist (CBCL). Findings from the two groups were compared.The rates and types of psychiatric disorder and behavior problems in VCFS and cognitively matched control subjects were very high, but showed no significant differences.Psychopathology in children with VCFS may not differ from that found in cognitively matched control subjects. Another explanation is that subtle phenotypic differences in behavior found in VCFS can not be observed using standard symptom inventories. The high rate of psychopathology in children with VCFS is not a useful phenotypic indicator of high risk for adult onset schizophrenia.
View details for Web of Science ID 000174281200006
View details for PubMedID 11958782
Oxytocin and autistic disorder: Alterations in peptide forms
2001; 50 (8): 609-613
Oxytocin (OT) is synthesized as a prohormone that is sequentially processed to peptides. These peptides are the bioactive amidated form (OT) and the C-terminal extended peptides, OT-Gly, OT-Gly-Lys and OT-Gly-Lys-Arg, which are designated together as OT-X. As an extension of our previous study finding decreased plasma OT in autism, studies were conducted to determine whether there were changes in OT peptide forms in autistic children.Twenty eight male subjects (97 +/- 20 months; range, 70-139 months), diagnosed with DSM-IV autistic disorder through observation and semi-structured interview, were compared with 31 age-matched nonpsychiatric control subjects (106 +/- 22 months; range, 74-140 months). Using OT antisera with different specificity for the peptide forms, we measured plasma OT and OT-X in each group.T tests showed that there was a decrease in plasma OT (t = 4.4, p <.0001), an increase in OT-X (t = 2.3, p <.03) and an increase in the ratio of OT-X/OT (t = 4.5, p <.0001) in the autistic sample, compared with control subjects.The results suggest that children with autistic disorder show alterations in the endocrine OT system. Deficits in OT peptide processing in children with autism may be important in the development of this syndrome.
View details for Web of Science ID 000171812700007
View details for PubMedID 11690596
The fragile X syndrome: bridging the gap from gene to behavior
CURRENT OPINION IN PSYCHIATRY
2001; 14 (5): 443-449
View details for Web of Science ID 000170676900004
Predictors and correlates of adaptive functioning in children with developmental disorders
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
2001; 31 (2): 219-230
Autism is a developmental disorder marked by impairments in socialization, communication, and perseverative behavior and is associated with cognitive impairment and deficits in adaptive functioning. Research has consistently demonstrated that children with autism have deficits in adaptive functioning more severe than their cognitive deficits. This study investigates the correlates and predictors of adaptive functioning as measured by the Vineland Adaptive Behavior Scales in high- and low-functioning children with autism and their age and nonverbal IQ matched controls. Thirty-five 9-year-old children with high-functioning autism (HAD) were compared with 31 age-matched children with developmental language disorder (DLD), and 40 9-year-old children with low-functioning autism (LAD) were compared with 17 age-matched children with low IQ on adaptive functioning, IQ, autistic symptomology, and tests of language and verbal memory. Results indicate that both groups with autism were significantly impaired compared to their matched controls on Socialization and Daily Living, but not Communication and that these impairments were more pronounced in the HAD group than in the LAD group. Adaptive behavior was strongly correlated with autistic symptomology only in the HAD group. Regression analyses indicated that IQ was strongly predictive of adaptive behavior in both low-functioning groups, but tests of language and verbal memory predicted adaptive behavior in the higher functioning groups. Results suggest that IQ may act as a limiting factor for lower functioning children but higher functioning children are impaired by specific deficits, including autistic symptomology and impaired language and verbal memory.
View details for Web of Science ID 000169606100012
View details for PubMedID 11450820
Autistic disorder versus other pervasive developmental disorders in young children: same or different?
EUROPEAN CHILD & ADOLESCENT PSYCHIATRY
2001; 10 (1): 67-78
Eighteen preschool children diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders Third Edition Revised (DSM III-R) as having Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) were compared to 176 children with DSM III-R Autistic Disorder (AD), and to 311 non-autistic children with developmental language disorders (DLD) (N = 201) or low IQ (N = 110). All children were partitioned into "high" and "low" cognitive subgroups at a nonverbal IQ of 80. Within cognitive subgroups, the 18 PDD-NOS children did not differ significantly from either the DLD or the AD children in verbal and adaptive skills and obtained scores intermediate between those of these groups. The PDD-NOS did not differ from the AD children in maladaptive behaviors. Both the PDD-NOS and AD children had many more of these behaviors than the non-autistic comparison groups. Children in the "high" and "low" cognitive subgroups of AD, but not of PDD-NOS, differed substantially on most measures, with the children with lower cognitive scores significantly more impaired on all measures. Similarity of PDD-NOS children to AD children in maladaptive behaviors and an intermediate position between autistic and non-autistic groups on virtually all measures explains the difficulty clinicians encounter in classifying children with PDD and raises questions about the specificity of these diagnostic subtypes of the autistic spectrum.
View details for Web of Science ID 000167825700009
View details for PubMedID 11315538
Executive functioning in high-functioning children with autism
JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY
2001; 42 (2): 261-270
Executive functioning was investigated in 34 children (24 boys and 10 girls) with developmental language disorder (DLD) and 21 children (18 boys and 3 girls) with high-functioning autistic disorder (HAD) matched on Full Scale IQ, Nonverbal IQ, age (mean age 9 year, 1 month), and SES. The DLD group had a Verbal IQ that was 10 points higher than the HAD group. These children were given the Wisconsin Card Sorting Test (WCST), the Mazes subtest from the WISC-R, the Underlining test, and the Rapid Automatized Naming test. In addition, these children were given the Vineland Scales of Adaptive Functioning and the Wing Diagnostic Symptom Checklist in order to assess severity of autistic symptomatology. Results indicated that the only significant difference between the two groups on the cognitive tasks was perseverative errors on the WCST; there was no significant difference on total number of categories achieved or total number of errors on the WCST or on the other executive function measures. There was also significant overlap in the scores between the two groups and the difference in perseverative errors was no longer significant when Verbal IQ was partialled out. Executive functioning was strongly related to all IQ variables in the DLD group and particularly related to Verbal IQ in the HAD group. Although there was a relationship in the HAD group between executive functioning and adaptive functioning, as well as between executive functioning and autistic symptomatology, these relationships were generally no longer significant in the HAD group after the variance due to Verbal IQ was accounted for. The results are interpreted to indicate that although impaired executive functioning is a commonly associated feature of autism, it is not universal in autism and is unlikely to cause autistic behaviors or deficits in adaptive function.
View details for Web of Science ID 000168461100011
View details for PubMedID 11280422
The velocardiofacial syndrome in psychiatry
CURRENT OPINION IN PSYCHIATRY
2000; 13 (5): 485-490
View details for Web of Science ID 000089143900004
Young children with Velo-Cardio-Facial syndrome (CATCH-22). Psychoiogical and language phenotypes
EUROPEAN CHILD & ADOLESCENT PSYCHIATRY
2000; 9 (2): 109-114
This is the first clinical description of a detailed psychological, speech, and language phenotype of four young children (< 5 years) with Velo-Cardio-Facial syndrome (VCFS) due to a deletion on chromosome 22 (22q11.2). The reported elevated risk of developing schizophrenia or bipolar disorder in adolescence for individuals with this chromosomal deletion led us to examine the psychiatric and cognitive status of young children with VCFS. Our observations suggest a phenotype comprised of a borderline to mildly retarded level of intellectual functioning, a language delay, a general deficit in social initiation, difficulties with attention/concentration, and a perturbed train of thought.
View details for Web of Science ID 000088098300005
View details for PubMedID 10926060
Subgroups of children with autism by cluster analysis: A longitudinal examination
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
2000; 39 (3): 346-352
A hierarchical cluster analysis was conducted using a sample of 138 school-age children with autism. The objective was to examine (1) the characteristics of resulting subgroups, (2) the relationship of these subgroups to subgroups of the same children determined at preschool age, and (3) preschool variables that best predicted school-age functioning.Ninety-five cases were analyzed.Findings support the presence of 2 subgroups marked by different levels of social, language, and nonverbal ability, with the higher group showing essentially normal cognitive and behavioral scores. The relationship of high- and low-functioning subgroup membership to levels of functioning at preschool age was highly significant.School-age functioning was strongly predicted by preschool cognitive functioning but was not strongly predicted by preschool social abnormality or severity of autistic symptoms. The differential outcome of the 2 groups shows that high IQ is necessary but not sufficient for optimal outcome in the presence of severe language impairment.
View details for Web of Science ID 000085580800017
View details for PubMedID 10714055
Subtypes of pervasive developmental disorder: Clinical characteristics
1999; 5 (1): 1-23
View details for Web of Science ID 000078845600001
Memory for faces in children with autism
1998; 4 (3): 187-198
View details for Web of Science ID 000077655100003
Autism: The point of view from fragile X studies
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
1998; 28 (5): 393-405
The relationship between the fragile X syndrome (FXS) and autism is reviewed. Shortly after the FXS was first described, it was noted that certain behaviors commonly found in afflicted individuals resemble certain features of autism. Research concerning a possible relationship between these conditions is summarized. The outcome of this research indicates that FXS is not a common cause of autism, although the number of individuals with FXS who meet diagnostic criteria for autism is higher than can be accounted for by chance. The major focus of this paper highlights that FXS is a well-defined neurogenetic disease that includes a cognitive behavioral phenotype, and has both a known biological cause and an increasing well-delineated pathogenesis. Autism is a behaviorally defined syndrome whose syndromic boundaries and biological causes are not known. These profound differences complicate comparisons and causal discussions. However, the behavioral neurogenetic information available about FXS suggests certain pathways for future research directed at elucidating the syndrome of autism.
View details for Web of Science ID 000076763600004
View details for PubMedID 9813775
Plasma oxytocin levels in autistic children
1998; 43 (4): 270-277
Social impairments are central to the syndrome of autism. The neuropeptide oxytocin (OT) has been implicated in the regulation of social behavior in animals but has not yet been examined in autistic subjects.To determine whether autistic children have abnormalities in OT, midday plasma samples from 29 autistic and 30 age-matched normal children, all prepubertal, were analyzed by radioimmunoassay for levels of OT.Despite individual variability and overlapping group distributions, the autistic group had significantly lower plasma OT levels than the normal group. OT increased with age in the normal but not the autistic children. Elevated OT was associated with higher scores on social and developmental measures for the normal children, but was associated with lower scores for the autistic children. These relationships were strongest in a subset of autistic children identified as aloof.Although making inferences to central OT functioning from peripheral measurement is difficult, the data suggest that OT abnormalities may exist in autism, and that more direct investigation of central nervous system OT function is warranted.
View details for Web of Science ID 000072174900005
View details for PubMedID 9513736
- Pitocin induction and autism AMERICAN JOURNAL OF PSYCHIATRY 1997; 154 (3): 438-439
Psychiatric disorder in mentally retarded children and adolescents - The challenges of meaningful diagnosis
CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA
1996; 5 (4): 827-?
View details for Web of Science ID A1996VP55800007
Diagnosis and classification in autism
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
1996; 26 (1): 59-86
This study compared four systems for the diagnosis of autism (DSM-III, DSM-III-R, DSM-IV, and ICD-10) with two empirically derived taxa of autism, and with three social subgroups of autism (Aloof, Passive, and Active-but-Odd) in 194 preschool children with salient social impairment. There were significant behavior and IQ differences between autistic and other-PDD groups for all four diagnostic systems, and a significant association was found (a) for Taxon B, diagnoses of autism, and the Aloof subgroup, and (b) for Taxon A, other-PDD, and the Active-but-Odd subgroup. Findings offer support for two major overlapping continua within idiopathic Pervasive Developmental Disorder.
View details for Web of Science ID A1996TY56800006
View details for PubMedID 8819771
Social initiations by autistic children to adults and other children
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
1995; 25 (6): 579-595
Social initiations made by autistic and verbal-matched retarded children were recorded in two naturalistic situations. Frequencies of initiation to adults did not differ between groups, but the retarded children initiated much more frequently to peers. Most interactions for both groups were positive, but the autistic children engaged in more ritualized, and the retarded children more playful, initiations. The autistic children monitored the social environment more when forced into proximity with peers, whereas the retarded children initiated more in the unstructured situation. Autistic initiation to peers was unrelated to severity of autism, but was related to cognitive skills, including vocabulary and comprehension of affect, whereas retarded children's initiations were unrelated to cognitive level. Results are discussed in terms of the differences between adults and children as social stimuli, prerequisite skills for initiation to peers, and the relationship between social cognition and social behavior. It is suggested that autistic and retarded children differ in the quantity of their initiations to peers, and the quality of their initiations to adults, and that initiations to peers may be a particularly useful index of social development in autistic children. Results confirm the need of autistic children for highly structured social environments, and suggest an important role for the remediation of specific cognitive skills such as comprehension of others' affects.
View details for Web of Science ID A1995TM43300002
View details for PubMedID 8720028
IS THERE A NEED FOR OBSERVATIONALLY BASED ASSESSMENT OF AFFECTIVE SYMPTOMATOLOGY IN CHILD AND ADOLESCENT-PSYCHIATRY
1995; 30 (118): 483-489
There is growing dissatisfaction with current methods for rating affective symptoms in child and adolescent psychiatry. The need for additional reliable methods of evaluating mood disorders is significant. This annotation reviews the relative limitations of self-report and interview assessment techniques as contrasted with observationally based rating scales which offer additional advantages for assessment.
View details for Web of Science ID A1995RF29900020
View details for PubMedID 7676882
- THERAPEUTIC APPROACHES TO DELINQUENCY - THE NEGATIVE IDEAL AMERICAN JOURNAL OF PSYCHOTHERAPY 1994; 48 (3): 328-329
ADOLESCENT ADJUSTMENT TO CHRONIC PHYSICAL DISORDERS .1. COMPARING NEUROLOGICAL AND NONNEUROLOGICAL CONDITIONS
JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES
1993; 34 (7): 1153-1171
Early research on child adjustment to chronic illness assumed that each condition had a unique impact. Recently researchers have suggested that all chronic conditions influence adjustment in similar ways. To compare these models, data were collected on 165 adolescents having chronic conditions with and without brain involvement, and 49 healthy controls. Adolescents with brain-based conditions had more behaviour problems, less autonomous functioning and poorer school achievement. Children with conditions having no brain involvement differed from controls only in reporting less work experience and having lower math achievement scores. These findings support a modified perspective that involves both general factors and effects specific to brain-based conditions.
View details for Web of Science ID A1993MA48800007
View details for PubMedID 8245139
AN OBSERVATIONALLY BASED RATING-SCALE FOR AFFECTIVE SYMPTOMATOLOGY IN CHILD-PSYCHIATRY
JOURNAL OF NERVOUS AND MENTAL DISEASE
1990; 178 (12): 750-754
There is growing dissatisfaction with current methods for rating affective symptoms in children. We report findings from a preliminary psychometric study of an alternative approach, that of direct observational ratings. The Emotional Disorders Rating Scale (EDRS) is an observation-based instrument containing 59 items divided into eight subscales. The results of this study indicate that measurement of nonverbal components of affective symptoms in children is feasible. Interrater reliability and internal consistency of the EDRS subscales were high. The EDRS also has potential as a measurement of state-related changes in affective behavior and as a technique for examining treatment response.
View details for Web of Science ID A1990EN64200004
View details for PubMedID 2246649
A CASE-REPORT OF NALTREXONE TREATMENT OF SELF-INJURY AND SOCIAL WITHDRAWAL IN AUTISM
1989 ANNUAL MEETING OF THE EASTERN PSYCHOLOGICAL ASSOC
PLENUM PUBL CORP. 1990: 169–76
The endogenous opiate release theory of self-injurious behavior (SIB) was investigated through double-blind placebo-controlled administration of naltrexone hydrochloride (Trexan) to a 14-year-old autistic and mentally retarded male for treatment of severe SIB. Results yielded a marked decrease in SIB during two phases of active drug treatment, though SIB did not revert to originally observed placebo levels during a second placebo phase. An increase in social relatedness also was observed during phases of active drug treatment. Opiate theories of self-injury and the possible interrelationship of self-injury with pituitary-adrenal arousal and with social relatedness are discussed.
View details for Web of Science ID A1990DE71600002
View details for PubMedID 2189867
SOCIAL RELATEDNESS AND AUTISM - CURRENT RESEARCH, ISSUES, DIRECTIONS
RESEARCH IN DEVELOPMENTAL DISABILITIES
1990; 11 (3): 303-326
Social relatedness has recently become a primary focus of investigators in the field of autism. This shift to regarding disturbances in social relatedness as one of the defining manifestations of the disorder marks the movement of research on autistic disorder back to its origins, when Kanner first noted the "social and affective" symptoms of autism as pathognomonic. Currently, social impairment in autism is viewed as more pervasively characteristic of the disorder than any other single symptom. Further, there has been a recent proliferation of research designed to document the nature of social deficit in autism, and whether it is primarily affective, communicative, or cognitive in nature, or involves some combination of these three variables. This review summarizes recent research focusing on social relatedness in autism and discusses the implications of these findings.
View details for Web of Science ID A1990DT49700004
View details for PubMedID 2204968
EFFECTS OF NALOXONE AND NALTREXONE ON SELF-INJURY - A DOUBLE-BLIND, PLACEBO-CONTROLLED ANALYSIS
AMERICAN JOURNAL ON MENTAL RETARDATION
1989; 93 (6): 644-651
The effects of naloxone hydrochloride (Narcan) and naltrexone hydrochloride (Trexan) on the pervasive self-injury of a 12-year-old autistic and mentally retarded girl were examined. Using separate multiple schedule (A1/B/B') and withdrawal (A-B-A1B-A1) single-subject experimental designs, we investigated the effects of both opiate antagonists in serial fashion under double-blind, placebo-controlled conditions. Results of the two studies showed that self-injury increased during the naloxone trial, whereas a decrease to near zero rates of self-injury was observed following treatment with naltrexone. The differential effect produced by the two drugs was discussed in terms of drug half-life and the operant conditioning theory of extinction. Follow-up data showing near zero rates of self-injury for 22 months following the conclusion of active treatment with naltrexone indicated that the intervention produced a durable result.
View details for Web of Science ID A1989U440400013
View details for PubMedID 2655671
EFFECTS OF FENFLURAMINE ON SOCIAL-BEHAVIOR IN AUTISTIC-CHILDREN
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
1988; 18 (4): 617-625
Deficit in social interaction is a primary component of infantile autism. However, in the majority of drug studies, social interaction has not been measured consistently over time. Therefore, we examined, in a crossover design, the effect of fenfluramine on the social interactions of seven autistic children. Social interaction was measured one to three times per week, while the children were in open placebo, placebo, or drug phases of the study. The results demonstrated that the effect of fenfluramine on social interaction was inconsistent across children, with two children possibly demonstrating a tolerance to the behavioral effects of the drug. The results are discussed with respect to genetic and pharmacologic factors.
View details for Web of Science ID A1988R608100012
View details for PubMedID 3215887
- MENSTRUALLY RELATED MOOD DISORDER IN DEVELOPMENTALLY DISABLED ADOLESCENTS - REVIEW AND CURRENT STATUS CHILD PSYCHIATRY & HUMAN DEVELOPMENT 1988; 18 (4): 239-249
The measurement of behavioral autonomy in adolescence: the autonomous functioning checklist.
1988; 15: 432-462
View details for PubMedID 3239647
THE ASSESSMENT OF MOOD AND AFFECT IN DEVELOPMENTALLY DISABLED-CHILDREN AND ADOLESCENTS - THE EMOTIONAL DISORDERS RATING-SCALE
RESEARCH IN DEVELOPMENTAL DISABILITIES
1988; 9 (2): 109-121
There is an unmet need for a reliable method of evaluating disorders of mood and affect in developmentally disabled children and adolescents. Such a measure is required for both accurate diagnosis and treatment monitoring in this population. An extensive review of existing assessment techniques confirms that: (a) current techniques for the evaluation of emotional disorders in cognitively normal individuals are inappropriate for most children with developmental disabilities; and (b) current instruments designed for the assessment of developmentally disabled children pay inadequate attention to affective symptoms. In this paper, the preliminary version of a new instrument, the "Emotional Disorders Rating Scale for Developmental Disabilities" (EDRS-DD), designed to evaluate mood and affect in children and adolescents with developmental disabilities, is presented. A pilot study indicates that interrater agreement is good.
View details for Web of Science ID A1988P010400001
View details for PubMedID 3043572
- SOCIAL AND EMOTIONAL ADJUSTMENT IN DEAF ADOLESCENTS AFTER TRANSFER TO A RESIDENTIAL SCHOOL FOR THE DEAF JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY 1987; 26 (2): 237-241
- SUICIDAL-BEHAVIOR IN MENTALLY-RETARDED ADOLESCENTS - AN OVERLOOKED PROBLEM CHILD PSYCHIATRY & HUMAN DEVELOPMENT 1987; 18 (2): 90-94
Observations from clinical work with high school aged, deaf adolescents attending a residential school.
1987; 14: 461-477
View details for PubMedID 3618933
DETERMINATION OF A REFERENCE RANGE FOR WHOLE-BLOOD SEROTONIN IN A PEDIATRIC POPULATION USING HIGH-PRESSURE LIQUID-CHROMATOGRAPHY WITH ELECTROCHEMICAL DETECTION
1986; 19 (6): 359-363
Whole blood serotonin (5HT) concentrations were measured in a group of children and adolescents to determine a reference range for this population. Blood was collected after at least a 6-hour fast, mixed with ascorbic acid and EDTA, and frozen at -70 degrees C until analysis. 5HT was determined by HPLC with electrochemical detection. Matrix-matched whole blood standards and controls were used to determine 5HT concentrations, and monitor performance of the assay. 5HT concentrations in boys ranged from 0.53 to 3.13 mumol/L (mean = 1.27, SD = 0.47) while the range for girls was 0.63 to 2.46 mumol/L (mean = 1.21, SD = 0.47). There was no significant difference in 5HT concentrations between boys and girls, nor was there any significant change in 5HT concentration with age. The nonparametric central 95 percent reference range for boys and girls was determined to be 0.64-2.45 mumol/L.
View details for Web of Science ID A1986G214800009
View details for PubMedID 3581469
AUTISM AND GENETIC-DISORDERS
1986; 12 (4): 724-738
The syndrome of autism has been documented as occurring in association with a wide variety of genetic conditions. Autistic patients with a coexistent genetic condition, however, are not behaviorally or developmentally distinct from autistic patients for whom there is no known etiology or associated organic condition. This report reviews the literature linking autistic behavior with genetic conditions. Genetic, neurodevelopmental, and neuropathological findings in three genetic conditions which frequently give rise to autism are presented in detail. On the basis of this review, two hypotheses are supported: autism is a behaviorally defined phenotype which arises from diverse causes of central nervous system (CNS) damage, and the autistic phenotype represents only one point along a continuum of psychological dysfunction resulting from CNS damage. Current theories of genetic influences on brain development are reviewed, with emphasis on the relationships among qualitative, quantitative, and temporal abnormalities of CNS maturation and behavioral dysfunction. A hypothesis of abnormal brain development resulting from dysfunctional myelination is proposed as a potential etiologic factor in autism.
View details for Web of Science ID A1986F065000014
View details for PubMedID 3810072
PSYCHIATRIC DISABILITY ASSOCIATED WITH THE FRAGILE-X CHROMOSOME
AMERICAN JOURNAL OF MEDICAL GENETICS
1986; 23 (1-2): 393-401
Fragile X (or Martin-Bell) syndrome, a common, genetic, mental retardation disorder is increasingly being recognized as a major cause of cognitive disability and psychiatric illness in boys. Here, we present a study in which relatives in 4 generations of a large family with the fra(X) chromosome were given comprehensive psychiatric evaluations in order to further describe the psychopathology associated with this condition. Three of 4 males with the fra(X) chromosome were found to have autistic behavior. An adult fra(X) male had a chronic schizoaffective disorder and mental retardation. In female relatives, a relationship was found between the fra(X) carrier status and psychopathology including schizoaffective and major affective disorders.
View details for Web of Science ID A1986AYQ1600029
View details for PubMedID 3953657
- AUTISM ASSOCIATED WITH WILLIAMS SYNDROME JOURNAL OF PEDIATRICS 1985; 106 (2): 247-249
DEVELOPMENTAL TASKS AND TRANSITIONS OF ADOLESCENTS WITH CHRONIC ILLNESSES AND DISABILITIES
REHABILITATION COUNSELING BULLETIN
1985; 29 (2): 69-80
View details for Web of Science ID A1985AVT8500002
- DEPRESSIVE SYMPTOMATOLOGY IN A CHILD PSYCHIATRIC OUTPATIENT POPULATION - CORRELATIONS WITH DIAGNOSIS COMPREHENSIVE PSYCHIATRY 1984; 25 (4): 379-391
EARLY ADOLESCENT DEAF BOYS - A BIOPSYCHOSOCIAL APPROACH
1983; 11: 147-162
In this chapter I have reviewed observations from clinical consultation and group-therapy work with early adolescent deaf boys in a special day school for the deaf. I have stressed how problems in communication exert a profound effect on the lives of these youngsters, both by virtue of their past and present influence on family life and by their ongoing effect on peer-group processes and academic adjustment. Primary consideration was given to certain "here and now" aspects of these boys' lives: ongoing problems in the social fabric of their home and school; narcissistic vulnerabilities and defenses against shame; and language-processing difficulties. The ways in which these problems undermine the supportive effect of the peer group at a time when it plays a particularly important role in development were reviewed. By emphasizing current sources of difficulty, using a biopsychosocial approach, I hope to point out fruitful opportunities for significant psychiatric intervention in a psychiatrically vulnerable population whose needs for professional service have never been met.
View details for Web of Science ID A1983SJ76200010
View details for PubMedID 6677150
VENTRICULAR ENLARGEMENT IN CHILD PSYCHIATRIC-PATIENTS - A CONTROLLED-STUDY WITH PLANIMETRIC MEASUREMENTS
AMERICAN JOURNAL OF PSYCHIATRY
1983; 140 (4): 453-456
Data from adult schizophrenic patients suggest that patients with enlarged ventricles have a poorer premorbid history and may have an earlier onset of their illness than patients with ventricles of normal size. The authors examined a group of child psychiatric patients to discover whether these children at risk for major psychopathology had enlarged ventricles. Twenty psychiatric patients showed significantly enlarged ventricles compared with 19 control patients. There were no clear relationships between the children's psychiatric diagnosis and ventricular size.
View details for Web of Science ID A1983QJ40400014
View details for PubMedID 6837784
- INDUCED INTOXICATION AND VIDEOTAPE FEEDBACK IN ALCOHOLISM TREATMENT QUARTERLY JOURNAL OF STUDIES ON ALCOHOL 1972; 33 (2): 408-?
Effect of Wearable Digital Intervention for Improving Socialization in Children With Autism Spectrum Disorder: A Randomized Clinical Trial.
Importance: Autism behavioral therapy is effective but expensive and difficult to access. While mobile technology-based therapy can alleviate wait-lists and scale for increasing demand, few clinical trials exist to support its use for autism spectrum disorder (ASD) care.Objective: To evaluate the efficacy of Superpower Glass, an artificial intelligence-driven wearable behavioral intervention for improving social outcomes of children with ASD.Design, Setting, and Participants: A randomized clinical trial in which participants received the Superpower Glass intervention plus standard of care applied behavioral analysis therapy and control participants received only applied behavioral analysis therapy. Assessments were completed at the Stanford University Medical School, and enrolled participants used the Superpower Glass intervention in their homes. Children aged 6 to 12 years with a formal ASD diagnosis who were currently receiving applied behavioral analysis therapy were included. Families were recruited between June 2016 and December 2017. The first participant was enrolled on November 1, 2016, and the last appointment was completed on April 11, 2018. Data analysis was conducted between April and October 2018.Interventions: The Superpower Glass intervention, deployed via Google Glass (worn by the child) and a smartphone app, promotes facial engagement and emotion recognition by detecting facial expressions and providing reinforcing social cues. Families were asked to conduct 20-minute sessions at home 4 times per week for 6 weeks.Main Outcomes and Measures: Four socialization measures were assessed using an intention-to-treat analysis with a Bonferroni test correction.Results: Overall, 71 children (63 boys [89%]; mean [SD] age, 8.38 [2.46] years) diagnosed with ASD were enrolled (40 [56.3%] were randomized to treatment, and 31 (43.7%) were randomized to control). Children receiving the intervention showed significant improvements on the Vineland Adaptive Behaviors Scale socialization subscale compared with treatment as usual controls (mean [SD] treatment impact, 4.58 [1.62]; P=.005). Positive mean treatment effects were also found for the other 3 primary measures but not to a significance threshold of P=.0125.Conclusions and Relevance: The observed 4.58-point average gain on the Vineland Adaptive Behaviors Scale socialization subscale is comparable with gains observed with standard of care therapy. To our knowledge, this is the first randomized clinical trial to demonstrate efficacy of a wearable digital intervention to improve social behavior of children with ASD. The intervention reinforces facial engagement and emotion recognition, suggesting either or both could be a mechanism of action driving the observed improvement. This study underscores the potential of digital home therapy to augment the standard of care.Trial Registration: ClinicalTrials.gov identifier: NCT03569176.
View details for PubMedID 30907929
- Exploratory study examining the at-home feasibility of a wearable tool for social-affective learning in children with autism NPJ DIGITAL MEDICINE 2018; 1
Neural circuits underlying mother's voice perception predict social communication abilities in children
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA
2016; 113 (22): 6295-6300
The human voice is a critical social cue, and listeners are extremely sensitive to the voices in their environment. One of the most salient voices in a child's life is mother's voice: Infants discriminate their mother's voice from the first days of life, and this stimulus is associated with guiding emotional and social function during development. Little is known regarding the functional circuits that are selectively engaged in children by biologically salient voices such as mother's voice or whether this brain activity is related to children's social communication abilities. We used functional MRI to measure brain activity in 24 healthy children (mean age, 10.2 y) while they attended to brief (<1 s) nonsense words produced by their biological mother and two female control voices and explored relationships between speech-evoked neural activity and social function. Compared to female control voices, mother's voice elicited greater activity in primary auditory regions in the midbrain and cortex; voice-selective superior temporal sulcus (STS); the amygdala, which is crucial for processing of affect; nucleus accumbens and orbitofrontal cortex of the reward circuit; anterior insula and cingulate of the salience network; and a subregion of fusiform gyrus associated with face perception. The strength of brain connectivity between voice-selective STS and reward, affective, salience, memory, and face-processing regions during mother's voice perception predicted social communication skills. Our findings provide a novel neurobiological template for investigation of typical social development as well as clinical disorders, such as autism, in which perception of biologically and socially salient voices may be impaired.
View details for DOI 10.1073/pnas.1602948113
View details for Web of Science ID 000376784600059
View details for PubMedID 27185915
Brain State Differentiation and Behavioral Inflexibility in Autism†.
2015; 25 (12): 4740-4747
Autism spectrum disorders (ASDs) are characterized by social impairments alongside cognitive and behavioral inflexibility. While social deficits in ASDs have extensively been characterized, the neurobiological basis of inflexibility and its relation to core clinical symptoms of the disorder are unknown. We acquired functional neuroimaging data from 2 cohorts, each consisting of 17 children with ASDs and 17 age- and IQ-matched typically developing (TD) children, during stimulus-evoked brain states involving performance of social attention and numerical problem solving tasks, as well as during intrinsic, resting brain states. Effective connectivity between key nodes of the salience network, default mode network, and central executive network was used to obtain indices of functional organization across evoked and intrinsic brain states. In both cohorts examined, a machine learning algorithm was able to discriminate intrinsic (resting) and evoked (task) functional brain network configurations more accurately in TD children than in children with ASD. Brain state discriminability was related to severity of restricted and repetitive behaviors, indicating that weak modulation of brain states may contribute to behavioral inflexibility in ASD. These findings provide novel evidence for a potential link between neurophysiological inflexibility and core symptoms of this complex neurodevelopmental disorder.
View details for DOI 10.1093/cercor/bhu161
View details for PubMedID 25073720
View details for PubMedCentralID PMC4635916
DIGITAL RECTAL EXAMINATION, SERUM PROSTATE-SPECIFIC ANTIGEN, AND PROSTATIC ULTRASOUND - HOW EFFECTIVE IS THIS DIAGNOSTIC TRIAD
JOURNAL OF SURGICAL ONCOLOGY
1994; 56 (1): 32-38
Ninety-nine of 105 consecutive men who underwent transrectal prostatic ultrasound (TRUS) at Highland Park Hospital had the results correlated with digital rectal examination (DRE), serum prostate specific antigen (PSA), and biopsy results. Ninety-six cases had evaluable ultrasound studies. Thirty-two of the 99 who underwent biopsy had primary carcinoma of the prostate. Prostate volume, predicted PSA, a ratio of observed/predicted PSA, and Gleason score were examined. There was no correlation between age and prostate volume, volume and the presence of carcinoma, or PSA and Gleason score. Thirty-one point six percent of the abnormal DREs, 36.6% of the abnormal TRUSs, and 40.6% of the elevated PSAs occurred in men with prostatic carcinoma (PCa). If PSA was normal (less than or equal to 4.0 ng/ml) and either DRE or TRUS was abnormal, then the risk of carcinoma was 2.9%. If PSA was elevated, regardless of the other two tests, the risk of finding PCa was at least 38%. If all three tests were abnormal, the risk of carcinoma was 38% in our series and 68% in a meta-analysis. Many men with PSA values between 4 and 10 ng/ml have benign biopsies. However, close future follow-up with consideration of repeat biopsy should be strongly considered.
View details for Web of Science ID A1994NL78700007
View details for PubMedID 7513772
SCREENING STRATEGIES TO INHIBIT THE SPREAD OF AIDS
SOCIO-ECONOMIC PLANNING SCIENCES
1990; 24 (4): 249-260
In this paper we explore the costs and benefits of screening programs for the human immunodeficiency virus (HIV). Because of the low prevalence rate of the virus among the general population, the cost per detected case of a program to screen the population at large is very high. We show how this cost changes with the prevalence rate, and how screening high risk groups reduces the cost per detected case. Screening has little point, however, unless there are follow-up activities to reduce the continued spread of the virus. To this end, we present a modeling framework for determination of optimal policy alternatives after screening.
View details for Web of Science ID A1990EU46800002
View details for PubMedID 10113538
- ATTITUDES TOWARD DEINSTITUTIONALIZATION - NATIONAL SURVEY OF FAMILIES OF INSTITUTIONALIZED PERSONS WITH MENTAL-RETARDATION MENTAL RETARDATION 1987; 25 (5): 267-274
STAGING ERRORS IN PROSTATIC-CANCER
JOURNAL OF UROLOGY
1984; 132 (6): 1125-1126
There is some question on the accuracy of staging in large epidemiological studies of prostatic cancer that rely on hospital tumor registry data. In an effort to assess the accuracy of tumor registry information in our institution registry staging was compared to surgical staging in 100 consecutive prostatic cancer patients. The tumor registry data had a 30 per cent understaging error. Other institutions may have the same problems.
View details for Web of Science ID A1984TU33500012
View details for PubMedID 6502801
The Woodhaven short-term model reconsidered: a study of developmental growth and criteria for discharge.
Evaluation & the health professions
1981; 4 (1): 49-58
This article concerns the issues surrounding discharge of mentally retarded clients from a short-term, intensive residential service setting. The Temple University Woodhaven Center is designed as a two-year setting for about 270 clients. They require intensive assistance in acquiring behaviors necessary for independent functioning and in learning appropriate social behavior, so that they can adapt to and thrive in a less restrictive, more integrated setting. Woodhaven, however, serves clients at all levels of retardation. The question arises: How is it decided who is to be discharged and when? Upon entry to Woodhaven, a contract is written with the family and client, specifying what behavioral changes are expected as preconditions for discharge. In this approach, a client should be discharged upon attainment of contract goals. A second approach uses adaptive behavior skills as a criterion of progress, and attempts to determine the level of skills displayed by other, similar clients who are already living in the community. This second, criterion-referenced approach is important not only for discharge decisions from one facility, but for broad service system planning as well. The results of the present study supported the notion of a two-year intensive residential program.
View details for PubMedID 10250587