Long-term group psychotherapy for children with pervasive developmental disorders: evidence for group development

This article highlights the clinical progress of three long-term psychotherapy groups for children with pervasive developmental disorders. Unique aspects of working with such children are addressed as well as their movement through the phases of group development. Clinical observations suggested that these groups did in fact pass through observable phases of cohesion, differentiation, and intimacy. Further, these children demonstrated noticeable social development both inside and outside the groups. They identified strongly with their groups, and after the settling-in period, there was remarkably little resistance to participation, especially given the children's tendencies for social avoidance. Vignettes are provided to illustrate both group developmental phases and noteworthy psychological experiences of the clinical process with children who have been diagnosed with pervasive developmental disorders.     

The impact of group psychotherapy on social development in children with pervasive developmental disorders

Thirty-nine children with a diagnosed pervasive developmental disorder (PDD) participated in homogeneous psychotherapy groups. Their social development was assessed at home and at school both before and after treatment. Significant improvements in social functioning were observed in both settings, and these gains were not attributable to demographic variables or cognitive development. This research provides psychometric validation for the Vineland Adaptive Behavior Scale (VABS; Sparrow, Balla, & Cicchetti, 1984) and the Tyminski Social Skills Checklist (SSC), a new index designed to assess children's social functioning in educational settings. The results suggest that group therapy may be an important modality for better understanding and developing crucial social skills among the growing number of children diagnosed with a pervasive developmental disorder.     

Emergence of intra verbal antonyms in children with pervasive developmental disorder

In the type of intraverbal that consists of saying the opposite of a word, two intraverbals are related to one another because the response form of each intraverbal functions as part of a discriminative stimulus for the other (e.g., "cold" in response to "name the opposite of hot," and vice versa). Moreover, the contextual cue "Name the opposite of--" is the same in the two intraverbals. The purpose of the present research was to explore a procedure designed to promote emergence of intraverbals of this type. Two children with pervasive developmental disorder learned pairs of intraverbals. Thereafter, they were tested for emergence of intraverbals with reversed stimulus-response functions. Results indicate that, although the participants did not initially show emergence of intraverbals with reversed stimulus-response functions, repeated cycles of probing and teaching facilitated emergence of these relations.     

Toilet training for a young boy with pervasive developmental disorder

We employed a variation of the Azrin–Foxx ( 1971 ) procedure with a 3.5‐year‐old boy diagnosed with Pervasive Developmental Disability (PDD). Unique features of our design included tailoring to the in‐home environment, training without systematically increasing fluid intake, introduction under circumstances that facilitated generalization and transfer without special procedures, the elimination of some specialized equipment, and use of social and activity reinforcers. Training was successful and was reported to have generalized to the inclusive school environment. Copyright © 2004 John Wiley & Sons, Ltd.     

Exploratory and confirmatory factor analyses of the pervasive developmental disorders rating scale for young children with autistic disorder

In this study, the authors examined the construct validity of the Pervasive Developmental Disorder Rating Scale (PDDRS; R. C. Eaves, 1993), which is a screening instrument used to identify individuals with autistic disorder and other pervasive developmental disorders. The PDDRS is purported to measure 3 factors--arousal, affect, and cognition-that collectively make up the construct of autism. Using scores from 199 children (aged 1-6 years) diagnosed with autistic disorder, the authors submitted data to exploratory and confirmatory factor analyses. In the 1st series of analyses, the authors analyzed a user-specified 3-factor solution using principal axis factor analysis with a promax rotation to evaluate the assertion of a correlated 3-factor structure. Next, the authors analyzed 1-factor and 2-factor solutions to determine if they provided a better factor structure for the data. In the 2nd series, the authors conducted confirmatory factor analyses, which compared the theorized hierarchical 2nd-order factor model with 5 plausible competing models. The results of the exploratory analyses supported the 3-factor solution. With the confirmatory analyses, the 2nd-order factor model provided the best fit for the data. The exploratory and confirmatory analyses supported the theoretical assumptions undergirding the development of the PDDRS. The authors discuss theoretical implications, practical implications, and areas for further research.     

Effects of object complexity and type on the gaze behavior of children with pervasive developmental disorder

The looking behavior of children with pervasive developmental disorder (PDD) and age- and IQ-matched normal control children was studied using infrared oculography. Stimuli varying in complexity and topic were presented to test whether children with PDD have specific abnormalities in looking behavior to complex stimuli and/or to faces. All children showed more and longer fixations on the complex objects than on the simple objects, especially the complex nonsense figure, but group differences were not found. The results show no evidence for specific abnormalities in looking behavior to either faces or to complex stimuli in high functioning children with PDD.     

Development of a parent training program for children with pervasive developmental disorders

Parent delivered interventions based on applied behavior analysis (ABA) for children with Pervasive Developmental Disorders (PDDs) have been evaluated using primarily single‐subject design methodology or small case series. While the results of these evaluations are encouraging, an important next step is to standardize the interventions to allow for replication across sites, in studies with large samples and measures of long‐term, clinically meaningful outcomes such as improvements in children's functioning and their relationships with parents. Accordingly, the Research Units on Pediatric Psychopharmacology and Psychosocial Interventions (RUPP Autism Network) assembled a detailed manual for a structured behavioral parent training (PT) program, developed treatment fidelity and training procedures, and conducted a pilot, feasibility study. The PT program is part of a large scale, multisite study intended to determine the efficacy of combined pharmacological treatment and behavioral intervention to improve behavior and adaptive functioning in children with PDD. This paper discusses the rationale for this project. A companion paper provides the results of our feasibility study on the PT program. Copyright © 2007 John Wiley & Sons, Ltd.     

Role of visual-perceptual skills (non-motor) in children with developmental coordination disorder

The purposes of this study were to examine test-retest reliability of the Test of Visual-Perceptual Skills (Non-Motor)-Revised (TVPS-R), to explore motor-free visual-perceptual skills, and to categorize subtypes thereof in children with developmental coordination disorder (DCD). One hundred and seventy-eight children, aged 9 and 10 years, identified as having DCD with the Movement Assessment Battery for Children (M-ABC), were assessed, along with 200 typically developing children. The results showed good test-retest reliability for the total perceptual quotient scores of the TVPS-R, but not for all subtests. Children with DCD performed significantly poorer compared to typically developing children on the visual-perceptual test, but the deficits were not common to all children with DCD. This study supported the stance that we should consider the heterogeneous characteristics of children with DCD when designing experimental studies or developing educational interventions.     

Joining group psychotherapy: developmental considerations.

This article examines the experience of new members joining an ongoing psychotherapy group. The group's stage of development and the new member's personality development are suggested to be important variables in this significant event. The experience of joining is found to share some things in common with the beginning phase of group for the group as a whole, but also noted are some unique elements. The process of joining is viewed as a highly anxious event for the new member, with antecedents in the individual's life experience. The new member is compromised by not knowing the group members, nor their shared history, norms, and dynamics. Concurrently, the group may experience a range of fears, wishes, and anxieties about the new member. Developmental considerations for the new member and the stage of group help to inform intervention strategies.     

Activities and games for group psychotherapy with sexually abused children

As increasing attention is given to the practice of group psychotherapy with sexually abused children, clinicians are using games and activities designed to address issues related to sexual abuse and its prevention. This paper describes how specific games and activities can be used in group therapy with child victims. These games and activities include: prevention films, role plays, and communication board games. Benefits and risks associated with the use of these resources are also discussed.     

Sex differences in school-aged children with pervasive attention deficit hyperactivity disorder

This study investigated 54 children (37 boys and 17 girls) with cross-situational attention deficit hyperactivity disorder (ADHD) to determine whether there are sex differences in the expression of either the primary or secondary symptomatology of ADHD. Results indicated that the male and female ADHD groups were strikingly similar on all measures of primary (impulsivity, inattention, and overactivity) and secondary (learning problems, externalizing symptoms, internalizing symptoms, peer relationship difficulties, and self-perceptions) symptomatology included in this study. The lack of significant sex differences conflicts with prior reports in the literature, and these conflicting results are discussed in terms of differences in inclusion criteria. Implications for understanding the long-term outcome of ADHD in girls are also discussed.     

On the ability of children with developmental coordination disorder (DCD) to inhibit response initiation: the simon effect

The ability of children with developmental coordination disorder (DCD) to inhibit the initiation of an incorrect manual response urge was examined using a typical Simon task. While the size of the Simon effect was the same for both DCD (N = 20) and Control (N = 20) groups of children, showing no difference with respect to the time needed to complete the inhibition an unwanted response, children with DCD produced significantly more errors of the type which reflected a reduced ability to successfully effect the inhibition operation when it was required. This result is consistent with some earlier findings pointing to an inhibitory deficit for children with DCD (Wilson & Maruff, 1999).     

Procedural learning in children with developmental coordination disorder

Despite the fact that developmental coordination disorder (DCD) is characterised by a deficit in the ability to learn or automate motor skills, few studies have examined motor learning over repeated trials. In this study we examined procedural learning in a group of 10 children with DCD (aged 8-12 years) and age-matched controls without DCD. The learning task was modelled on that of Nissen and Bullemer. Children performed a serial reaction time (SRT) task in which they were required to learn a spatial sequence that repeated itself every 10 trials. Children were not aware of the repetition. Spatial targets were four (horizontal) locations presented on a computer monitor. Children responded using four response keys with the same horizontal mapping as the stimulus. They were tested over five blocks of 100 trials each. The first four blocks presented the same repeating sequence, while the fifth block was randomised. Procedural learning was indexed by the slope of the regression of RT on blocks 1-4. Results showed that most children displayed strong procedural learning of the sequence, despite having no explicit knowledge about it. Overall, there was no group difference in the magnitude of learning over blocks of trials - most children performed within the normal range. Procedural learning for simple sequential movements appears to be intact in children with DCD. This suggests that cortico-striatal circuits that are strongly implicated in the sequencing of simple movements appear to be function normally in DCD.     

Perceptual skills of children with developmental coordination disorder

The aim of this study was to investigate whether children with a Developmental Coordination Disorder (DCD) experience problems in the processing of visual, proprioceptive or tactile information. Different aspects of visual perception were tested with the Developmental Test of Visual Perception (DTVP-2), tactile perception was assessed with the Tactual Performance Test (TPT), and a manual pointing task was employed to measure the ability to use visual and proprioceptive information in goal-directed movements. Nineteen children with DCD and nineteen age and sex-matched controls participated in this study. Differences between groups were most pronounced in the subtests measuring visual-motor integration of the DTVP-2, and in two subtests measuring visual perception (visual closure and position in space). On average the children with DCD performed slightly below the norm for tactile perception, with only three children failing the norm. On the manual pointing task, children with DCD made inconsistent responses towards the targets in all three conditions (visual, visual-proprioceptive and proprioceptive condition). No significant differences between groups were found for absolute error. Inspection of the individual data revealed that only two children failed on the majority of perceptual tasks in the three modalities. Across tasks, no consistent pattern of deficits appeared, illustrating the heterogeneity of the problems of children with DCD.     

Static balance in children with developmental coordination disorder

The purpose of this study was to compare the postural sway profiles of 9/10-year-old children with developmental coordination disorder and balance problems (DCD-BP, n=64) with those of non-DCD children (n=71). We measured center of pressure excursions in conditions with and without vision for 30s while standing still on the dominant leg, the non-dominant leg, or both legs. Sway area, total path length, and Romberg's quotient were analyzed. Most measures differed significantly between groups, except sway area when the children stood with vision on either the dominant leg or both legs. When standing on the dominant leg or both legs, DCD-BP children demonstrated greater total path length in all conditions and a greater sway area in without-vision conditions. DCD-BP children showed more difficulty standing on the non-dominant leg with eyes both open and closed. While boys showed results similar to the total group, the girls with DCD-BP only exhibited significant differences in three conditions with eyes closed, but not with eyes open. Analysis of Romberg's coefficient also indicated that children with DCD-BP did not over-rely on visual information.     

Change during and after long-term analytic group psychotherapy

There are very few empirical studies of long-term, analytic group psychotherapy. Sixty-nine patients in long-term analytic group psychotherapy were evaluated from pretherapy to posttherapy, and one year after termination. The primary outcome measures were the Symptom Checklist-90 (Revised) and the Inventory of Interpersonal Problems. In addition, the Global Assessment of Functioning (GAF) was scored independently by two evaluators. The average time in treatment was 32.5 months. The patients improved significantly during treatment, up to 30 months, on all measures. The improvement continued during the follow-up period. Sixty to 86% of the patients were recovered or significantly changed at follow-up.     

Parent training for children with pervasive developmental disorders: a multi‐site feasibility trial

The primary purpose of this study was to evaluate the feasibility of a structured, manual‐based parent training (PT) program designed to reduce noncompliant behavior and enhance adaptive behavior in children with Pervasive Developmental Disorders (PDD) who were taking medication for irritability, tantrums, aggression, and self‐injury. Children (N = 17, mean age 7.7 ± 2.6 years) with PDD were enrolled in a 24‐week structured PT protocol. Parental attendance to sessions (93%), satisfaction with the program (92%), and adherence to PT assignments (80%) were excellent. The program was adequately implemented with a mean treatment integrity rate of 94%. Parent‐reported rates of noncompliance were reduced by 39%; irritability was reduced by 34%; and daily living skills were enhanced by 19%. Parenting stress was also reduced by 14%. However, these results must be interpreted with caution because the study did not include a control group. The study supports feasibility of the PT program, which will be used in an randomized clinical trials (RCT). Copyright © 2007 John Wiley & Sons, Ltd.