Augmentative communication, evolution, and progress for nonspeaking children.

Technology has provided a recent emergence of augmentative communications systems for nonspeaking children. The effective use of such systems is dependent on the knowledge and skills of physicians, speech-language pathologists, educators, parents, and other professionals working with the child. This article examines the components of an augmentative system including the mode of communication, which includes choices among manual, non-electronic, and electronic systems. The advantages of each mode are discussed. Another major component, the symbol selection process, follows an ascending hierarchy from a representational code involving actual objects to a complex symbolic code with spelling and numerals. Clinical application at the Child Development and Rehabilitation Center of the Oregon Health Sciences University points to the need for thorough interdisciplinary team evaluation during system selection or modification. Data obtained from assessment of 28 multihandicapped children reveal necessary changes, additions, and follow-up for both the mode and symbol system in the majority of children examined.

Pediatric diagnosis and management of children with developmental disabilities.

Mail surveys were conducted in 1976 and 1980 with Oregon primary care pediatricians to determine patterns of in-depth evaluations, followup, and availability of diagnostic and treatment services for children with developmental disabilities. It was assumed that changes might reflect the impact of recent federal legislation. Patterns of referral were related more to the type and disorder than to the location of the physician's practice. The majority of pediatricians referred children for evaluation for mental retardation, cerebral palsy, learning disabilities, autism, and multihandicapping conditions. Over half reported doing their own evaluations for convulsive disorders. Referrals were most often to multidiscipline teams except for learning disabilities and convulsive disorders. The present study emphasizes the pediatricians' utilization of specialized interdisciplinary centers for diagnosis of children with major developmental disabilities. There was little change in practice patterns during the study period, but some significant shifts in perceived service needs were observed. The most significant change seems to be a heightened awareness of these children's needs for services. Pediatricians continue to express a need for more training in diagnosis and care of developmental disabilities.

Adoption and foster care of handicapped children in the United States.

This paper reviews the current policies and programs of adoption and foster care of handicapped and other "hard-to-place" children in the United States. The results of a survey of 42 States revealed a variety of approaches and attitudes towards recruitment of parents and placement of handicapped children. It is concluded that successful programmes related directly to careful selection of families, to educating the parents and to adequate staff support.