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IgG are the most common isotype of Ig and include four subclasses which differ from one another in the following ways: their initial amino acid sequence, their physical and chemical properties and the different serum concentrations reached with age. Every subclass has a specific biological function: the response to proteic antigens is prevalently mediated by IgG1 and IgG3, while IgG2 mediates the response to polysaccharide antigens. It is still unclear whether IgG4 are protective or sensitising antibodies; IgG1 and IgG3 also have a major ability to bind to the cells that mediate the immune response, while only IgG4 activate the complement using an alternative route. Although low levels of IgG subclasses may be temporary, deficiencies are often associated with various diseases: 1) recidivating bacterial infections involving the respiratory and digestive tracts, primarily sustained by capsulated or pyogenic microorganisms; 2) IgA deficiency; 3) absence of immune response following vaccination; 4) allergic or autoimmune diseases; 5) diseases of the CNS. IgG subclass deficiencies must therefore be looked for every time these diseases are diagnosed, also because subjects may benefit from gammaglobulin replacement therapy.

The authors have studied the HLA genotypes in 17 Sicilian coeliac children, in their parents and in their healthy brothers. A positive association has been found between coeliac disease (C.D.) and HLA antigens; this was strongest firstly for DQW2 and than for DR7 and DR3. Those antigens however do not result specific for C.D., because they were present in healty-control population too and because one coeliac patient was DQW2, DR7 and DR3 negative. A distortion of vertical transmission of HLA haplotypes has been observed in the studied patients, and this occurred for DR3/DQW2 that was transmitted mainly by paternal way. Moreover, in the healty brothers of our coeliac subjects a significant reduction of HLA antigens DQW2, DR7 and DR3 has not been found. Those observation and the finding that in our families the responsible gene for C.D. seems to have a low penetrance, should induce to search others genetic markers for coeliac disease.

The Authors report a case of spondylo-costal dysostosis observed in a child 2 years and 1 month old. They recall its clinical and radiological findings and discuss genetic problems and differential diagnosis of this rare disease.

Self-injurious behavior is a serious problem that is not uncommon among individuals with mental retardation. Medical and developmental characteristics of 97 children, adolescents, and young adults (age range 11 months to 21 years, 11 months) assessed and treated for self-injurious behavior in a specialized, interdisciplinary inpatient unit between 1980 and 1988 were reviewed. This population differed from those reported in previous studies in that it was of school age and predominantly community based. Severe or profound mental retardation was present in 82.5% of our patients. The causative diagnoses associated with self-injurious behavior were similar to those of severe mental retardation alone. Associated disabilities represented at greater than expected frequencies included pervasive developmental disorders, visual impairment, and a history of infantile spasms. Most patients (81.4%) engaged in more than one type of self-injurious behavior. The most common topographies were head banging, biting, head hitting, body hitting, and scratching. Physical injury was documented in 77% of cases; the injuries most frequently reported were excoriations, scars/callus formation, hematomas, and local infection. As community placement of handicapped individuals continues to increase, pediatricians will be called upon to monitor patients who engage in self-injurious behavior.

Pediatric feeding disorders are estimated to occur in as many as one in every four infants and children, and when serious can require numerous, costly and sustained interventions. For over a decade research has cumulated evidence on the contributions of Behavior Analysis in understanding and remediating some types of pediatric feeding disorders. The systematic use of this body of evidence in conjunction with other approaches (medical, nutrition, occupational therapy, physical therapy, and so forth) is being carried out on an inpatient treatment unit at the Kennedy Krieger Institute. Key aspects are described here, including direct observation behavior assessment, approaches for increasing and decreasing feeding behavior, skill acquisition, transfer of treatment gains, and parent training. The results based on case studies and overall program evaluation indicate that medically complicated, severe feeding disorders can be treated successfully in a few months with a multidisciplinary approach which incorporates behavioral procedures.

Children with recurrent abdominal pain (RAP) are frequent users of medical care services, often seeking care for a variety of illnesses and symptoms. In a clinical replication series, we treated 16 children with RAP who were referred to a primary care-based pediatric psychology service. They received a multi-component targeted therapy, which included self-monitoring, limited parent attention, relaxation training, increased dietary fiber, and required school attendance. After treatment, improvement or resolution of pain symptoms was reported for 13 (81%) children, and school absences were significantly decreased. Medical care utilization significantly decreased after treatment, whereas a comparison group of untreated children with RAP showed no change in medical care visits over time. Brief targeted therapy delivered in a primary health care setting appeared to be effective in reducing a range of problems associated with RAP. A primary care service is an ideal setting for integrating behavioral medicine services into the health care system.

An Importance, Locus and Range of Activities Checklist, designed to assess self-perceived latitude of choice, a self concept and a life satisfaction scale were administered to 25 institutionalized and 25 noninstitutionalized elderly females. The checklist contained statements about 37 activities of daily living which subjects rated for personal importance and degree of choice available to them. The derived latitude of choice score was based jointly on importance and choice ratings for each activity. Institutionalized respondents, living in a relatively restrictive environment, earned significantly lower latitude of choice scores than did noninstitutionalized subjects. Latitude of choice, self concept and life satisfaction scores were significantly correlated. These findings attest to the appropriateness of the technique used to assess perceived latitude of choice. Modifications of the Importance, Locus and Range of Activities Checklist designed to provide a more profound measure of latitude of choice and to improve the applicability of the scale to different categories of respondents were discussed.

This study empirically tests three theoretical approaches to explaining specific support for a policy output among members of its target group. The utilitarian model posits support as a function of objective costs and benefits to the individual stemming directly from the policy. The attitudinal model relates specific support to diffuse predispositions rooted in socialization. The perceptual model holds that specific support derives from beliefs about the character of the political decision process by which the policy was formulated. Tests of these three approaches are based on survey data on specific support for school district desegregation plans among a large sample of black and white parents of public school children in Florida. In both subsamples, the utilitarian approach explained very little of the variance in support, but the attitudinal and perceptual models were corroborated. Implications of these findings are drawn for desegregation policy making and for public policy theory.

The popularity and reported success of biofeedback treatment for neuromuscular disorders has occurred despite a lack of research identifying the critical variables responsible for therapeutic gain. In this study, we assessed the degree to which severe neurological dysfunction could be improved by using one of the components present in all biofeedback treatment, contingency management. Three cases of orofacial dysfunction were treated by reinforcing specific improvements reliably detectable without the use of biofeedback equipment. The results showed that contingency management procedures alone were sufficient to improve overt motor responses but, unlike biofeedback treatment, did not produce decreases in the hypertonic muscle groups associated with the trained motor behavior. The findings suggest that sophisticated, expensive biofeedback equipment may not be necessary in treating some neuromuscular disorders and that important clinical gains may be achieved by redesigning the patient's daily environment to be contingently therapeutic, rather than only accommodating the disabilities of the physically handicapped.

Two experiments are reported in which the relationship between compliance with "do" and "don't" requests was examined with developmentally disabled children. In Experiment 1, a multiple baseline design across subjects with counterbalanced treatment conditions was used to evaluate a compliance training program composed of four phases: (a) baseline, during which no consequences were delivered for compliance, (b) reinforcement for compliance with one targeted "do" request, (c) reinforcement for compliance with one targeted "don't" request, and (d) follow-up with reinforcement on a variable ratio schedule for compliance with any "do" or "don't" request. Results of probes conducted before and after training within each condition indicated that generalized compliance occurred only with requests of the same type as the target exemplar ("do" or "don't"). In Experiment 2, these results were replicated in a classroom setting. Following collection of baseline probe data on student compliance, a teacher training program was successfully implemented to increase reinforcement of compliance first with one "do" and subsequently with one "don't" request of a target student. Results of multiple baseline probes across "do" and "don't" requests indicated that the teacher generalized and maintained reinforcement of compliance with other requests of the same type and to other students, with a resulting increase in student compliance with the type of requests reinforced. The impact of treatment on both teacher and student behavior was socially validated via consumer ratings. Implications of these findings with respect to response class formation and compliance training programs are discussed.

This paper reviews 33 individual case or group studies describing the application of behavior therapy techniques to the management of 41 electively mute children. Management strategies included stimulus fading, reinforcement, stimulus fading plus reinforcement, and escape or avoidance procedures. Reinforcement procedures proved most effective when a minimum operant level of speech existed in the treatment setting. In the absence of baseline speech, stimulus fading procedures were successful in transferring speech stimulus fading procedures were successful in transferring speech from settings in which the child spoke comfortably, to new individuals and situations. Response cost contingencies improved the efficacy of both reinforcement and stimulus fading plus reinforcement procedures. Among the 37 cases reporting individual observations at treatment termination, 57% (21) spoke spontaneously and 43% (16) responded to prompts or questions. Follow-up observations on 32 individual cases over intervals ranging ...

A combination of a reversal design and a multiple-baseline design across settings and tic behaviors was employed to determine the effectiveness of a treatment package consisting of self-monitoring, external reinforcement, and timeout in the control of a hyperactive child's multiple tic behaviors. In the clinic the treatment package was applied only to facial tics, with three other tics (shoulder shrugging, rump protrusion, and a vocal tic) observed but never treated. At home facial tics were initially treated, and then vocal tics. Shoulder shrugging, rump protrusion, and “other tics” were never directly treated. Treatment was effective in decreasing the occurrence of facial tics in the clinic to zero. Even though no intervention was placed on the other tics, they also decreased in frequency concomitant with the facial tics. The home data also demonstrated a decrease to zero when the treatment package was sequentially applied to facial and vocal tics, with a concomitant decrease in the untreated tic behaviors. A 32-week follow-up showed maintenance of the treatment effects.

Lead poisoning, a serious problem that can result in permanent neurological damage, often results from the ingestion of inedible substances that contain lead. The behavior of ingesting nonedible substances in termed pica. In this study, behavior modification procedures were used to eliminate pica in three young children with lead poisoning. Three kinds of procedures were used: (1) discriminate training, in which the subject was taught to recognize that paint and several objects were not edible; (2) reinforcement for the absence of pica; and (3) overcorrection for the occurence of pica. Pica was eliminated in all three subjects. While it was not always clear which component of the treatment was responsible for the decrease, the sequence used had the advantage of an effictive clinical technique proceeding from least to progressively more restrictive procedures.

Scientific and public interest in the effects of diet on behavior disorders has recently increased. This paper argues that (1) the experimental analysis of behavior offers an effective scientific methodology for assessing the effects of dietary substances on behavior problems, and that (2) such analysis permits behavioral consequences to be considered as an alternative treatment to dietary control. A case study of a 9-year-old retarded boy with autistic behaviors is presented. Suspected dietary substances were demonstrated not to be effective influences on the child's behavior, whereas a simple behavior modification program improved his problem behaviors. Also discussed are issues and problems which arise in research on dietary effects on behavior and in selection of effective and ethical treatments.

Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.

Epilepsy represents a serious medical and social problem. In the majority of cases, seizures are successfully managed by a variety of anticonvulsant medications, even though these drugs may potentiate significant physical and developmental side effects. A small group of studies to date have offered evidence that behavioral procedures can successfully manage some seizure disorders and are particularly desirable treatment choices when seizure disorders are intractable to drug management or when drug side effects are to be avoided. The present case adds to this small but growing group of studies in that it demonstrates the use of behavioral procedures in the analysis and treatment of high-rate myoclonic seizures. Seizures were evaluated on a hospital ward and in a controlled experimental setting. The data indicated a variable rate of seizures across days and activities and a reduction of seizure frequency in the controlled setting when time-out was made contingent on seizures. A program of “contingent rest” was then applied on the hospital ward that demonstrated a reduction in myoclonic seizure frequency and the apparent prevention of several grand mal episodes. An observer calibration procedure showed high correspondence between behaviorally and physiologically recorded seizures. A discussion of issues in behavioral medicine research follows.

Analyses of response relationships offer the potential for designing treatment procedures that are more economical and entail less risk for misuse than many we currently employ. The present study investigated whether previous results indicating the reduction of problem behaviors by reinforcing compliance in fact occurred because of the contingent relationship between compliance and the presumed reinforcing events. A clinic analogue procedure consisting of a standard set of adult requests was employed in a multiple baseline design across subjects with three children receiving three conditions — no reinforcement, noncontingent reinforcement, and reinforcement contingent on compliance — and a fourth child receiving the first and third conditions to assess possible order effects. The data indicated that: (1) compliance covaried inversely with some, but not all, of the problem behaviors measured; (2) sustained covariation occurred only when reinforcement was contingent on compliance; (3) substantially large but transient increases in compliance and decreases in problem behavior during noncontingent reinforcement occurred for those children who initially demonstrated high compliance and low levels of aberrant behavior during baseline; and (4) the problem behaviors that inversely covaried with compliance were idiosyncratic across children. The results suggest that treatment procedures based on response relationship strategies should consider that children's individual learning histories may determine which behaviors covary and the likelihood that large, initial changes can occur with noncontingent reinforcement.

The successful use of operant procedures to alter behaviors associated with various medical conditions suggests that such behaviors may be learned and that the principles of learning may be applied not only to treatment but also to the study of the pathogenesis of illness behavior. The present study, conducted within an ongoing neuromuscular research project, assessed the covariation of behaviors associated with chronic pain within and across behavioral and drug approaches to treatment. Problems of screaming and five other behaviors (including self-reports of pain) were measured across conditions of varying behavioral contingencies (noncontingent reinforcement vs the removal of reinforcement contingent upon screaming) and varying administration (time since medication and dosage) of Parsidol during attempts to treat the muscle pain of a 24-year-old male with a severe, chronic neuromuscular disorder diagnosed as dystonia musculorum deformans (DMD). Results indicated that: (a) pain behaviors covaried during behavioral and drug conditions even though the behavioral intervention only targeted screaming; (b) effects were greater on nontargeted behaviors during periods that followed rather than preceded drug administration; (c) in contrast to behavioral observation data, physiological measures of neuromuscular activity (EMG) did not differ across conditions. These results suggest that functional response-response relationships exist in patients as the result of their illness experience.

In the Person-Environment (P-E) Congruence model, psychological well-being is proposed to be a function of the degree of fit between the perceived environment and the important needs of the individual; and, that in more restricted environments, the relationship is stronger. The present study examined, cross-sectionally and longitudinally, the Congruence levels and well-being of elderly veterans (N = 165) in four microenvironments within a single instutition. Congruence was assessed using the multidimensional Environmental Perception, Preference and Importance Scale (EPPIS). Well-being was measured using the PGC Moral Scale, the Life Satisfaction Index A and a semantic differential self-concept scale. There were significant microenvironment differences on three of the 15 EPPIS dimensions; the P-E Congruence scores were predictive of well-being; and, the specific dimensions predictive of well-being varied across microenvironments, criterion of well-being and time. The data reinforces the notion that treatment programs must be individualized and that the P-E model, operationalized in the EPPIS, may serve as a viable clinical tool.

Self-injurious behavior has presented a clinical and academic challenge to both behavioral and biomedical researchers. Recent advances in biomedical research suggest a number of specific biological bases for self-injury. This research was reviewed with regard to the possibility that a specific biological explanation for self-injury could be advanced. Deficiencies in biochemicals necessary for normal brain functioning, inadequate neurological development of the central nervous system, isolation and pain related experiences early in development, altered neurological input particularly sensory irritation, neurological insensitivity to pain, and the body's ability to produce opiate-like substances (endogenous opiates) in response to pain and injury all offer leads as to the biological basis of self-injurious behavior. No single explanation has been definitively proven as a cause for self-injury in the retarded. However, consideration of behavioral treatment approaches in combination with biological explanations, especially those related to the biochemistry of pain, may provide the opportunity for important breakthroughs in the understanding and successful elimination of self-injurious behavior.

Since 1975, behavioral science solutions for important problems of pediatric practice have been well established. Analysis of current research trends in behavioral science indicates that this interdisciplinary collaboration is likely to expand greatly in three areas: the use of behavioral procedures to remediate routine behavior and developmental problems; the analysis of the medical setting and its effect on children; and the direct modification of biological conditions by behavioral means.

T HE PUBLIC SCHOOLS in many localities depend largely upon the referendum for their financial support. The act of voting in school referenda relates the citizen to public education more intimately than to most other major public services.1 Through this method of decision-making, the public by-passes the normal "conversion" processes of representative government and directly determines public policy. School bond or tax referenda can be defended normatively as an instance of "primary democracy," with the electorate deciding directly "how much" public education it wishes to purchase. Yet attacks have also been levelled at school finance referenda. They are said to frustrate optimal public resource allocation, effective planning and administration, and sometimes to force serious cutbacks in the level of educational services or even

A reversal design was utilized in which differential vs non-differential adult attention was made contingent upon the delusional speech of an 11-yr-old boy. Within this design, effects of verbalizing the contingency and the use of a pharmacological treatment were also studied. The results indicated that differential adult attention only to appropriate task related statements increased such statements while decreasing delusional speech, whereas non-differential attention to any type of statement resulted in a predominance of delusional speech. A trial of methylphenidate showed no difference relative to non-differential attention. Additionally, the results suggest that verbalizing the differential attention contingency may be an effective tactic for rapid behavior change. The results are discussed in relation to the necessity for comparing possible courses of treatment as a strategy for insuring effective treatment.

Three subjects diagnosed as having severe choreoathetoid cerebral palsy were trained in the use of EMG feedback procedures. Both between- and within-session controls, including reversals of baseline, attempted muscle control with feedback, and muscle control without feedback, were employed to analyze the contribution of feedback procedures to improvements in muscle control. The data (1) indicate that feedback enhanced muscle control and (2) provide evidence of generalization of feedback effects to no-feedback conditions and untrained muscles.

Recent clinical reports have suggested that electromyographic feedback offers promise as a palliative therapy for neuromuscular disorders. This study utilized a single-subject experimental analysis to evaluate the effects of EMG feedback training on a 20-year-old man with adult-onset idiopathic dystonia to achieve control of orofacial dysfunctions. Feedback training produced reductions in levels and variability of tension in facial and forearm muscles, as measured by EMG. Reliable blind observations of facial control indicated that feedback training enabled the patient to produce normal facial relaxation in extraclinical environments.

A new polymerization procedure of p-benzoquinone and hydroquinone has been investigated. The polymers have been characterized by IR, UV, NMR spectroscopies and their chemical properties compared with those of analogous polymers prepared according to literature reports. The conductivity of the pristine polymers ( σ = 10 −12 ohm −1 cm −1 ) is increased up to σ = 5×10 −2 ohm −1 cm −1 by doping with I 2 or σ = 1.5×10 −5 ohm −1 cm −1 by doping with FeCl 3 , both in tetrahydrofuran (THF).

Traditional clinical monitoring of children with epilepsy does not appear to be sufficiently sensitive to cognitive functioning and behavioral problems. Although subtle, these changes may alter a child's ability to perform well in school and in society. Physicians must prevent seizures without producing intolerable side effects, and ways of more appropriately assessing these side effects must be developed. In this double-blind, counter-balanced, crossover study of 21 children, the effects of phenobarbital and valproic acid on cognitive functioning and behavior were measured. There was no difference in seizure control between the drugs, and each medication was maintained in the therapeutic range for 6 months (mean phenobarbital level, 21.2 micrograms/mL; mean valproic acid level, 94.1 micrograms/mL). Children were treated with each drug for 6 months. Differences between the drugs were seen on measurements of cognitive function and behavior. On four tests of neuropsychologic function, children performed significantly less well while receiving phenobarbital (P less than .01). There was no evidence that the patients were sedated or less able to perform continuous performance tasks while receiving phenobarbital. Parental assessment of behavior indicated significantly worse behavior with the phenobarbital regimen for three items (P less than .01) and children were measurably more "hyperactive" (P less than .05). Routine clinical assessment of the patients did not reveal differences between the drugs with respect to routine laboratory measurements or side effects as assessed by history or physical examination. Although children may appear to tolerate a medication without clinically apparent problems, subtle but significant changes in intellectual function and behavior may be occurring. Additional, more sensitive, methods of monitoring patients while receiving these drugs is necessary.

School desegregation has become an increas ingly important issue in non-Southern metropolitan areas. The absence of significant residential desegregation in the suburbs and the concentration of the black population in central cities make effective school desegregation difficult, if not impossible, without consolidated planning for the entire metropolitan region. Cross-busing between central cit ies and suburbs may raise stiff resistance among white parents whose children would be transferred to city schools. An analysis of areawide desegregation in Duval County, Florida, suggests that suburban diffusion of the white population does not in itself constitute a barrier to consolidated planning. A judicious application of desegregation plan features for the entire metropolitan region can produce satisfactory and equitable results.

Bowel frequency was recorded, on a diary sheet basis, in 662 children from six Italian cities. There is a wide interindividual variability, showing a sharp decrease with age; we report the distribution of the percentiles in the different age groups. Among infants, the breast-fed ones pass significantly more stools than the formula-fed.

The Authors report two cases of pseudoachondroplasic dysplasia observed in a child aged 2 years and 5 months and in her father 31 years old. They recall the rarity of this disease, its characteristic and radiological findings and dwell upon differential diagnosis between this rare form of condrodysplasia and achondroplasia.

Two experiments compared the effects of biofeedback training to behavior modification in the treatment of 33 children aged 5 to 16 who had fecal incontinence secondary to myelomeningocele. Biofeedback involved providing visual feedback and rewards for successively stronger sphincter contractions during training sessions and requiring 50 sphincter contraction exercises daily. Behavior modification involved attempting to defecate immediately after the evening meal each day, receiving a reward for defecating in the toilet without an enema or suppository, and receiving an enema if unsuccessful for two consecutive days. In experiment I, eight children were offered biofeedback alone in an attempt to replicate previous studies. Biofeedback alone was found insufficient; addition of behavior modification was necessary. Experiment II systematically investigated the relative contribution of these two treatments. Overall, patients who received only behavior modification for three months showed as much clinical improvement as patients who received behavior modification plus biofeedback. This suggests that previous reports, because they have not controlled for nonspecific treatment effects, have overestimated the value of biofeedback in this population. However, a subgroup of patients (27%) were identified for whom biofeedback provided additional, specific benefit. These were children who had spinal cord lesions below L-2 and who initially had two or more bowel movements daily. The combination of behavior modification and biofeedback resulted in a greater than 50% reduction in the frequency of incontinence for 64% of patients, and results were well maintained at follow-up one year later.

The Authors report a case of tuberculous endobronchial granuloma observed in a two years old child affected by primary tuberculosis. The more important aspects of the case are its rarity, the pathogenesis, its differential diagnosis, and the determining importance of the surgical operation for diagnosis and therapy.

The authors report 3 cases of anular pancreas and consider the main clinical and differential diagnosis aspects of them. Afterwards they dwell upon the etiopathogenesis of this congenital malformation that is consequent not only upon extrinsic pancreatic compression but also upon a contemporary atresia or stenosis of duodenum. That however conditions the management; it will be apply to remove also the intrinsic obstruction of stenotic intestinal segment.