Of the necessary interplay of therapy and pedagogy in psychiatric hospitals for children with intellectual disability.

BACKGROUND: Mentally ill children with intellectual disabilities do not always receive the services they need for effective change at psychiatric hospitals, as their verbal limitations render standard procedures in diagnostics and therapy difficult or impossible, as their ability to transfer insights acquired in one setting to another is impaired and as their families and caretakers are often overwhelmed by their needs. This is why an integral vision for children with intellectual disabilities is presented. Drawing on three case reports, it is highlighted how an interdisciplinary approach, a changed hospital set-up and constant interplay between therapy and pedagogy, between services to the child and to its caregivers can help overcome these difficulties. METHOD: Case reports. CONCLUSIONS: Some children risk being mistakenly treated as intellectually disabled. If testing reveals, for example, autism with a mild learning disability, psychoeducation and the pedagogical training for (special school) personnel can help prevent underachievement and bring about a setting that can help the child flourish. Both sensitive care and pedagogical intervention that fit the developmental age of severely intellectually disabled children can prevent their receiving sedatives to treat aggressive behaviour. Substantial and lasting shifts in mood, even happiness can result if parents and caregivers get the pedagogical training and the assistance they need to take care of their children. Reliable and well-structured pedagogical training and environments can enhance and often substitute for unavailable therapeutic interventions for this specific group. With some profound intellectually and multiply disabled children, beginning medical treatment at home may not be safe. The (in)effectiveness of specific psychiatric medications needs to be monitored by observations however. For reliable results with intellectually disabled children, a clinical setting that resembles their everyday life is needed.

Impaired Odor Perception in Autism Spectrum Disorder Is Associated with Decreased Activity in Olfactory Cortex.

Autism Spectrum Disorders (ASDs) are characterized by atypical sensory functioning in the visual, tactile, and auditory systems. Although less explored, olfactory changes have been reported in ASD patients. To explore these changes on a neural level, 18 adults with ASD and 18 healthy neurotypical controls were examined in a 2-phase study. Participants were first tested for odor threshold and odor identification. Then, (i) structural magnetic resonance (MR) images of the olfactory bulb were acquired, and (ii) a functional MR imaging olfaction study was conducted. ASD patients exhibited decreased function for odor thresholds and odor identification; this was accompanied by a relatively decreased activation in the piriform cortex. In conclusion, these findings suggest, that the known alterations in olfaction in ASD are rooted in the primary olfactory cortex.

Diagnostic accuracy of the ADOS and ADOS-2 in clinical practice.

The Autism Diagnostic Observation Schedule is a semi-structured, standardized assessment tool for individuals with suspected autism spectrum disorders (ASD) and is deemed to be part of the gold standard for diagnostic evaluation. Good diagnostic accuracy and interpersonal objectivity have been demonstrated for the ADOS in research setting. The question arises whether this is also true for daily clinical practice and whether diagnostic accuracy depends on specialized experience in the diagnostic evaluation. The present study explores the diagnostic accuracy of the original and the revised version of the ADOS for Modules 1 through 4. Thus, seven cases of ADOS executions were recorded and coded by a group of experts of specialized outpatient clinics for ASD. In an extensive consensus process, including video analysis of every minute of the ADOS executions, a "gold standard" coding for every case was defined. The videos of the ADOS administration were presented to a large group of clinicians (from daily clinical routine care) and their codings (n = 189) were obtained and analysed. Variance of coding and congruence with the expert coding were determined. High variance was found in the codings. The accuracy of the coding depends on the experience of the coder with the ADOS as well as on characteristics of the cases and the quality of the administration of the ADOS. Specialization in the diagnostic of ASD has to be claimed. Specialized outpatient clinics for ASD are required which guarantee a qualified diagnostic/differential diagnostic and case management with the aim of demand-oriented supply of individual cases.

Down-regulation of the nocturnally elevated guanylyl cyclase activity in the rat pineal gland.

Previous studies have shown that in the rat pineal, the cytosolic and the particulate forms of guanylyl cyclase (GC) activity undergo a biphasic 24-h rhythm with two prominent peaks, one in the middle of the light phase and the other in the middle of the dark phase. In this study we investigated whether the well established photo-neural adrenergic regulatory processes identified for pineal melatonin synthesis also apply to the nocturnal elevation of GC activity. A 10-min light pulse given in the middle of the dark phase decreases the cytosolic and the particulate forms of GC. Administration of the beta-receptor blocker propranolol did not depress the nocturnally elevated GC activity. Sympathetic denervation of the pineal gland by means of superior cervical ganglionectomy did not noticeably affect nocturnal GC activity studied 6 days and 2 months after surgery. In vitro, administration of the nitric oxide synthase blocker NG-mono-methyl-L-arginine (NMMA) for 10 min did not change the cytosolic form of GC activity. The results obtained reveal that in the rat pineal, the down-regulation of the nocturnally elevated GC activity does not appear to be adrenergically mediated.