Pediatric Annals

editorial 

Developmental Disabilities: What to Do?

Stanford T Shulman, MD

Abstract

It is an astonishing statistic, that about one in six U.S. children is affected by a developmental disorder, including cognitive and/or motor disabilities, developmental language disorder, and autistic spectrum disorder. Each year, that would be about 670,000 of the approximate four million U.S. birth cohort. This huge group of patients requires coordinated healthcare services from a wide variety of providers, with the primary physician expected to provide some measure of coordination of these services.

In this issue of Pediatric Annals, Maris Rosenberg has assembled a collection of articles related to developmental disabilities that can provide some assistance to primary care providers. The informative articles on occupational therapy and physical therapy by Kornhaber and colleagues and that on feeding disorders in children by Ayoob and Barresi include a number of useful and practical tips. Lisa Shulman (no relation, even though she is one of the few "Shulmans" without the accursed "c" in the last name) and her co-authors do an excellent job of explaining the Early Intervention mandate and its implications for children, parents, and pediatricians. Nancy Tarshis (also no relation, my stepfather's and brother's last name, but with a "c") and her co-authors do an excellent job detailing approaches to speech and language disorders, with some excellent tables that include when to refer a child for a possible language disorder. Merryl Schechtman nicely reviews the variety of unproven therapies for patients with autistic spectrum disorder and notes some of the unproven etiologies of this condition. Of course, it is imperative that all providers of care for children understand that there is no credible evidence at all to implicate immunization or thimerosol in the etiology of autism.…

It is an astonishing statistic, that about one in six U.S. children is affected by a developmental disorder, including cognitive and/or motor disabilities, developmental language disorder, and autistic spectrum disorder. Each year, that would be about 670,000 of the approximate four million U.S. birth cohort. This huge group of patients requires coordinated healthcare services from a wide variety of providers, with the primary physician expected to provide some measure of coordination of these services.

In this issue of Pediatric Annals, Maris Rosenberg has assembled a collection of articles related to developmental disabilities that can provide some assistance to primary care providers. The informative articles on occupational therapy and physical therapy by Kornhaber and colleagues and that on feeding disorders in children by Ayoob and Barresi include a number of useful and practical tips. Lisa Shulman (no relation, even though she is one of the few "Shulmans" without the accursed "c" in the last name) and her co-authors do an excellent job of explaining the Early Intervention mandate and its implications for children, parents, and pediatricians. Nancy Tarshis (also no relation, my stepfather's and brother's last name, but with a "c") and her co-authors do an excellent job detailing approaches to speech and language disorders, with some excellent tables that include when to refer a child for a possible language disorder. Merryl Schechtman nicely reviews the variety of unproven therapies for patients with autistic spectrum disorder and notes some of the unproven etiologies of this condition. Of course, it is imperative that all providers of care for children understand that there is no credible evidence at all to implicate immunization or thimerosol in the etiology of autism.

In the interesting piece entitled "Attention-deficit Hyperactivity Disorders and Integrative Approaches," Asma Sad/q reviews the experience with complementary and alternative therapies for ADHD. It must be emphasized that the majority of the studies referenced in this article are not of great scientific rigor. Thus, the concìusìons are only suggestive at best, and additional well-designed and scientifically sound studies are clearly needed.

Dr. Sadiq's article includes a quote from each of the following historical figures: Hippocrates, Moses Maimonides, and Albert Einstein. Because there are no ADHD or developmental stamps, I have chosen two stamps for each of these three illustrious men. Hippocrates of the Greek island of Cos (460-377 B.C.) is depicted on the two light brown Greek stamps (see page 446 and page 447) and, of course, is considered the "father of medicine." His extensive writings were collected in the third century B.C. in Alexandria, Egypt. Hippocrates is considered to have given Greek medicine its "scientific spirit and its ethical ideals," as stated by Garrison in his "History of Medicine."

Moses Maimonides (1135-1204) of Cordova, Spain (who was forced to flee to Egypt), was a great physician, rabbi, and philosopher at the pinnacle of the Arabic- Jewish age of medicine and is depicted on the two stamps from Lesotho and Uruguay. He was the court-physician to the emperor Saladin and his sons and wrote important works, including his "Guide for the Perplexed" and the "Treatise of Personal Hygiene," the latter for Saladin. Maimonides strongly endorsed the concept of preventative medicine and wrote that only one of a thousand persons dies a natural death, the rest succumbing early in life to "ignorant or irregular behavior." One supposes he's referring to adult deaths in that era.

Albert Einstein (1879-1955) has been honored by the yellow stamp from the Republic of Congo and the white stamp from Israel (see page 446). The latter highlights Einstein's "Annus Mirabilis," the extraordinary or miracle year, 1905, when he published four monumental articles in the Annalen der Physik. The four articles provided the foundation for modem physics, changing scientific views of space, time, and matter. These papers, which dealt with the photoelectric effect, Brownian movement, special relativity, and matter and energy equivalence, were written while Einstein worked as an examiner in the Patent Office in Bern, Switzerland. The Wikipedia article on Annus Mirabilis has more detail on these topics than you really want, suspect. Interestingly, the term Annus Mirabilis has also been applied to Newton's best year (1665-1666) and is the title of a poem by John Dryden, also written in 1666.

10.3928/0090-4481-20070801-01

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