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Tonsillectomy/adenoidectomy is one of the most frequently performed operations in the United States. It is therefore likely that pediatric ENG surgeons will encounter autistic and developmentally delayed children in routine practice. Autistic children differ from normal children in that they exhibit severe deficits in language and social functioning; abnormal reaction to stimuli such as light, sound, touch, and pain; attachments to particular unusual objects and rigidly stereotyped routines. They are often mentally retarded. With the increasing importance of managed care and continuous quality improvement, knowledge of how to manage the operative course of such children is crucial for the practising surgeon. Based on research and clinical knowledge of these children, certain psychosocial and medical interventions are presented which may improve the operative course of this population. Using the parent as a consultant; decreasing separation from familiar caretakers, objects, and routines; pre-operative role-playing; tailoring anesthetic induction; and using post-operative distractors are suggested techniques.

This investigation attempts to clarify 3- and 4-year-old children's perceptions of ghosts and their relation to the hypothesis of the “floating ghost” as an early infantile remembrance. It appears to confirm the notion that young children's representation of ghosts results from an admixture of learned conscious ideas regarding ghosts and an ill-defined part which is based upon primitive unconscious ideas about the unknown stranger and the mysterious images of earlier nightly visits from mother and father.

Two related research problems are investigated. First, an empirical approach to classifying developmental disorder is presented. This approach induces types of developmental disorder defined in terms of functional criteria. The classifications derived are then used to validate the classificatory scheme and the set of play and language indicators. This second analysis demonstrates that both the classificatory scheme and the play/language indicators are correlated as hypothesized. In particular, linguistic capacity and peer play performance are the most important discriminators of developmental disorder. The clinical implications of the data analytic approach and the findings are also discussed.

A semistructured telephone interview designed to elicit data concerning the history of the treasured object and the history of attachment to other objects after age 2 was conducted with mothers of 54 developmentally disordered patients (21 mentally retarded, 33 pervasive developmental disordered). Results indicated a dramatically reduced frequency of treasured objects use among this population that is independent of both diagnosis and IQ. The proportion of developmentally disordered children who ever (after age 2) form an object attachment is also significantly reduced and does vary with both diagnosis and IQ. The type of object to which an attachment is formed differs according to diagnosis.

General psychiatrists' interest in childhood has been stimulated by the genetic aspect of dynamic psychiatry. The prospective developmental approach of child psychiatrists has been molded by developmental psychological theory, epidemiological approaches, and clinical experience with children who exhibit symptoms of psychopathology. The authors review follow-up data on children diagnosed as having attention deficit disorder, pervasive developmental disorder, autism, and conduct disorders. They also discuss the results of studies of subjects who, as children, were diagnosed as being hyperactive or neurotic, or who experienced language delay.

Thirty-six children ages 30 to 63 months diagnosed as autistic or as having Atypical Pervasive Developmental Disorder, Developmental Language Disorder, and Mental Retardation were videotaped with their mothers using a modification of the strange situation and coding devised by Ainsworth et al. (1978). Autistic and atypical children's manifested attachment behavior is not significantly different from the attachment behavior normal children display at a younger age. A majority (64%) of the developmentally disordered children manifest some behavior change upon separation, whereas almost half (44%) display negative mood change. Quality of attachment did not correlate with diagnosis, developmental quotients, mood change, or behavior change on separation in all the developmentally disordered group. Affective display on separation tended to correlate with security of attachment, although this did not reach statistical significance.

A study that explored children's understanding of the body and illness was conducted with 23 thalassemic outpatients and 27 healthy controls. The findings were supportive of a developmental progression in children's understanding that is reflective of their underlying cognitive maturity. Behavioral compliance was related to psychiatric adjustment. There was a trend toward poorer psychiatric adjustment in children with impaired understanding of their illness. These findings hold implications for both educational and psychiatric intervention with this group. Optimal health care of chronically ill children requires knowledge of the developmental course and interplay of children's cognition and their familial and personal adjustment.

An array of six photographs of the same woman was used to assess the ability of 18 autistic, 14 nonautistic mentally retarded, and 18 normal preschool subjects to use affect - and activity -related concepts in the solution of cognitive tasks. The Total Performance Level of the autistic and mentally retarded subjects did not differ significantly. Autistic subjects performed imitation, directed action, and description tasks less well in the affect mode. The findings are consistent with other studies, suggesting an impairment in the expression of emotion in autism.

Perceptions of diagnostic terms were investigated in a study of 30 mothers of developmentally deviant preschoolers, 24 psychiatrists, 24 pediatricians, and 15 therapeutic nursery school educators. Statistical analysis of ranking by severity revealed little concordance between mothers and professionals and among the three groups of professionals. Results indicated that the mothers tended to discard or reinterpret diagnostic terms to permit themselves to maintain hope. Professional awareness of the potential for miscommunication with parents is urged.