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The prevalence of refractive error and ocular disorders among infants and young children with severe behavioral problems and developmental disorders is not well defined, particularly in developing countries. We performed a retrospective review of ophthalmic examinations performed during a National Institutes of Health--funded cohort study of very young children in Peru with behavioral problems and at risk for developmental disorders. Two-hundred twenty-two children between the ages of 0 and 4 years (mean 2.2 ± 0.9 years) were examined and 100 (45.0%) had an abnormal ocular exam. Overall, the prevalence of refractive error was 33.3%, nystagmus was 12.2%, and strabismus was 10.9%. Among children with Down syndrome, refractive error ranged from 46.2% at age 2 to 85.7% at age 4. Refractive error and ocular disorders are highly prevalent even at a young age in children with behavioral problems and developmental disorders. Much of the visual impairment in this population is treatable; early identification and intervention can have a lifelong positive impact on neurodevelopment.

The managers of beach businesses were randomly assigned to receive no intervention or two newsletters per week for 6 weeks that presented economic consequences of damage to coastal water quality and how to contact politicians. The percentage of proenvironmental political contacts was significantly greater in the experimental (newsletter) group than in the control group. Logistical regression showed that contacts in the newsletter group were more than five times that of controls after adjusting for history of contacts and predisposition to take such action. Results suggest that the intervention can promote political action that could influence environmental policies and human health.

Before the 1990s, research on the early identification and prevention of severe behavior disorders (SBDs), such as aggression, self-injury, and stereotyped behavior, among young children with intellectual and developmental disabilities (IDD), was mostly done with children 3 years or older. More recent work suggests that signs of SBDs may occur as early as 6 months in some infants. The present study combined a cross-sectional and longitudinal approach to examine SBDs in 180 young children aged 4-48 months recruited through mass screening, then receiving an interdisciplinary evaluation and six-month follow-ups for one year. Twelve potential risk factors related to SBDs were examined. Eight of these risk factors, including age, gender, diagnosis, intellectual and communication levels, visual impairment, parent education, family income, were differentially related to scores for Aggression, SIB, and Stereotyped Behavior subscales on the Behavior Problems Inventory (BPI-01) at initial interdisciplinary evaluation. BPI-01 scores decreased over the year for 57% of the children and increased for 43%. The amount of decrease on each BPI-01 subscale varied with age, gender, and diagnosis.

Reliable and valid assessment of aberrant behaviors is essential in empirically verifying prevention and intervention for individuals with intellectual or developmental disabilities (IDD). Few instruments exist which assess behavior problems in infants. The current longitudinal study examined the performance of three behavior-rating scales for individuals with IDD that have been proven psychometrically sound in older populations: the "Aberrant Behavior Checklist (ABC)", the "Behavior Problems Inventory (BPI-01)," and the "Repetitive Behavior Scale-- Revised (RBS-R)." Data were analyzed for 180 between six and 36 months old children at risk for IDD. Internal consistency (Cronbach's alpha) across the subscales of the three instruments was variable. Test-retest reliability of the three BPI-01 subscales ranged from 0.68 to 0.77 for frequency ratings and from 0.65 to 0.80 for severity ratings (intraclass correlation coefficients). Using a multitrait-multimethod matrix approach high levels of convergent and discriminant validity across the three instruments was found. As anticipated, there was considerable overlap in the information produced by the three instruments; however, each behavior-rating instrument also contributed unique information. Our findings support using all three scales in conjunction if possible. (Contains 2 figures and 6 tables.)

Severe behavior problems among people with intellectual and developmental disabilities (IDD) are a major barrier to integration in the community. Recent research suggests that these behaviors often begin very early in life and might be prevented by early identification and intervention (Rojahn, Schroeder, & Hoch, 2008). The current article presents a method of mass screening for early signs of severe behavior problems among infants and toddlers in Peru. A Parental Concerns Questionnaire (PCQ), which asks 15 questions, each related to a risk factor for severe behavior problems, based on past research on IDD, was used by veteran parents to interview 341 new parents who had been solicited by TV, radio, and public service announcements across the country. Of these, 262 were recruited and enrolled in a longitudinal study in which they will be followed for 12 months to see if at-risk children actually will develop severe behavior problems. An extensive initial interdisciplinary evaluation was given to each child. Consumer satisfaction questionnaires were given to the parents as to their attitude toward the screening method. Data from the vaccines contributedEvaluations of the sample suggest a very high hit rate (96%) by the screening instrument (PCQ). Consumer satisfaction was 98%, suggesting that the method was tolerated well by parents. The PCQ is a brief and efficient method to screen infants and toddlers at risk for severe behavior problems. The data also suggest that parents suspect these problems at a very early age. Early intervention thus seems a feasible strategy to intervene before these problems become deeply ingrained as children develop. (Contains 3 tables and 4 figures.)

There is a very substantial literature over the past 50 years on the advantages of early detection and intervention on the cognitive, communicative, and social-emotional development of infants and toddlers at risk for developmental delay due to premature birth or social disadvantage. Most of these studies excluded children with severe delays or other predisposing conditions, such as genetic or brain disorders. Many studies of children with biological or sociodevelopmental risk suggest that behavior disorders appear as early as 3 years and persist into adulthood if not effectively treated. By contrast, little is known about the infants and toddlers with established risk for severe delays who make up a significant proportion of the population with dual diagnoses later in life. In the past decade, there has been a growing interest in early detection and intervention with children age birth to 3 years, for example, the Birth-Three population (Individuals with Disabilities Education Act, 1997), who may have disabilities and severe behavior problems, for example, aggression, self-injury, and repetitive stereotyped behaviors. The available research is scattered in the behavior analytic literature and in the child development literature as well as in the child mental health and psychiatry literature, the developmental disability literature, the animal modeling literature, and the genetics literature. The goal of this introductory overview is to integrate these literatures, by cross-referencing members of these various groups who have worked in this field, in order to provide the reader with an integrated picture of what is known and of future directions that need more research.

A combination of behavioral and medication-based interventions has been the most effective form of treatment for reducing problem behavior in individuals with intellectual and developmental disabilities. Evaluating the 2 types of interventions in combination and separately may require that researchers adapt methods traditionally used to evaluate drug interventions for individuals without disabilities. Some methodological difficulties that arise when evaluating drug treatments with this population include the withholding of treatment from control groups, identifying large homogeneous samples of participants, predicting individual clinical responsiveness, and many others. The purpose of this article is to summarize the methodological problems that arise when studying drug-behavior interactions among people with intellectual and developmental disabilities and to suggest alternative methods that may ameliorate these issues.

The objective of this study was to examine long-term adverse events of risperidone in 19 children, adolescents, and adults with Pervasive Developmental Disorders and intellectual disability, continuing risperidone for a mean of 186.5 weeks, following a 46-week risperidone study. Nineteen individuals continued long-term follow-up after our published risperidone placebo-crossover acute study (22 weeks) and 24-week maintenance phase on 40 participants. Long-term ratings included the Dyskinesia Identification Systems Condensed User Scale and Neuroleptic Side Effects Checklist. Weight and prolactin levels were also measured. A range of significant neurological side effects occurred: akathisia in 10%, 2 individuals developed tardive dyskinesia, 1 developed oculogyric crisis; withdrawal dyskinesia occurred in 2 of 9 individuals discontinuing risperidone. All 10 children and adolescents continued greater than 7% weight gain. Adults gained less weight, but 2 developed Type 2 diabetes. Prolactin (PRL) elevation continued in all 7 patients with PRL measures but normalized in 2 individuals after aripiprazole addition. Movement side effects were significant. Children and adolescents continued greater than 7% weight gain; PRL elevation continued. (Contains 3 tables.)

Risperidone has shown safety and efficacy for aggressive and destructive behaviors in short-term studies. This longer-duration study includes a broad sample. Forty subjects, aged 8-56 years (mean=22), all with mental retardation and 36 with autism spectrum disorders participated in this 22-week crossover study, with 24 weeks of open maintenance thereafter. Of 40 subjects, 23 (57.5%) responded fully (50% decrease in Aberrant Behavior Checklist-Community Irritability subscale score), while 35 subjects (87.5%) showed a 25% decrease. Gender, mood disorder, and antiseizure medications did not alter response. Increased appetite and weight gain were common. Low dose risperidone was effective for aggressive behavior in persons with MR. More long-term studies are needed, incorporating weight control interventions.

Stereotyped movements displayed by 6 participants and tics displayed by 6 children were evaluated using an antecedent behavioral analysis and a force sensitive platform. We found that tics occurred more often in an alone condition when compared to high preference toy and play conditions, whereas stereotyped movements were more variable across conditions. Using temporal measures and spectral analysis data from the force sensitive platform, we found that stereotyped movements tended to be longer in duration and displayed more rhythmic qualities when compared to tics. Results indicate that stereotyped movements and tics differ both quantitatively and qualitatively and support the use of new technologies, such as force plate technology, to more accurately evaluate these differences.

The atypical antipsychotic medication risperidone was evaluated using a double-blind, placebo-controlled design to treat destructive behavior in two males (ages 6 and 24) with autism. Destructive behavior during the demand condition was significantly reduced during the medication phases, whereas it continued to occur to obtain tangible items and attention. (Contains references.) (Author/CR)

Consumer satisfaction and social validity were measured during a double-blind, placebo-controlled evaluation of risperidone in treating aberrant behaviors of persons with developmental disabilities. A survey showed all 17 caregivers felt participation was positive. Community members (n=52) also indicated that when on medication, the 5 participants displayed fewer aberrant behaviors. (Contains references.) (Author/CR)

The efficacy of the atypical antipsychotic risperidone was evaluated in the treatment of aberrant behavior (e.g., aggression, self-injury) in 20 individuals with developmental disabilities. The study, a double-blind crossover design, identified 50 percent of participants as responders. Naturalistic observations of five participants showed that risperidone was effective in reducing aberrant behavior in four individuals. (Contains references.) (Author/DB)

This study reports marked reductions in self-injurious behavior and aggression of two adults with profound mental retardation treated with clozapine, who were non-responsive to all other behavioral and psychopharmacological interventions, including risperidone. The most effective dose was 200mg/day. Side effects were mild and the drug was tolerated well. (Contains references.) (Author/CR)

This study examines the reliability and validity of various behavior rating scales, side effects checklists, and an ecobehavioral observation system used to study self-injurious behavior among persons with mental retardation. Findings from testing with 30 adults suggest that further refinement is necessary to reliably and sensitively assess the drug effects, target behaviors, and numerous covariates associated with self-injurious behavior. (PB)

This discussion of planning for individuals with autism using a life-span perspective considers stages and transitions across life, noting the special difficulty these individuals have with transitions; changing perspectives on disability in the United States; and characteristics of comprehensive life-span programs (sophisticated diagnoses, strong educational programs, strong vocational/adult programs, and family involvement). (DB)

Annie Sullivan Enterprises, Inc. (Chapel Hill, North Carolina), a community resource network for the integration of children and youth with developmental disabilities and mental health problems, is described. A brokerage model is espoused for accessing and delivering services. Recommendations based on seven years of successful operation are offered. (Author/DB)