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He was then charged with another serious offence, arson, and faced the prospect of even more years in prison. The programs can include those to improve social skills and encourage friendships with peers who do not engage in or encourage criminal acts; anger management training; treatment of an underlying anxiety disorder to reduce the compulsive nature of the special interest; resolution of past injustices; and guidance in relationships and sexuality. Part of the sentencing requirements can be participation in these programs and therapies. When a custodial sentence is imposed, prison and probation authorities must consider how the diagnosis will affect the person, and ensure there are appropriate safe guards and support while in prison and on probation. For those who could be detained under a mental health act, there is an alternative to a secure forensic psychiatry hospital. The unit has programs in life skills and emotion management and access to relevant expertise. This can eventually lead to long-term feelings of persecution and the expectation that people will have malicious intent. One of the concerns of clinicians is differentiating between the anticipated conse quences of an impaired or delayed Theory of Mind, and the paranoia and persecutory delusions associated with schizophrenia. An incident such as being ignored by a friend could be conceptualized in terms of the situation (he did not see you, was in a hurry, etc.

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He is interested in computers and this might be an area for possible training and employment in the future. His poor judgement and inflexibility have had a disruptive effect on the lives of his parents and siblings. He has poor eye contact when talking to people outside his family, and does not follow social rules for personal space and touching. Raj loves to work independently on the computer and is a Star Trek fan, but he has poor group leisure skills. He has few friends at school because other students find his behaviour strange, even threatening. Raj has serious problems with social judgment, cannot handle money wisely (will give it to anyone who asks), and becomes anxious when routines at home or school are changed. For example, when his normal bus route to school was changed, he refused to get off the bus and recited Star Trek dialogue until the principal came onto the bus and talked him into the school. He often tries to start conversations in the middle of a story plot and does not understand when other people do not know the stories. Information recorded by teachers and family members should be relevant information that can be used to enhance instruction, management of behaviour, or personal care of the student. Teachers and parents can work together to make a list of key questions and decide on how frequently they need to be reported, and how the communication book will travel back and forth. The following example is adapted from an individualized communication book for a Grade 3 student. Some strategies may need to take place in other settings, but for students who are receiving their programs and services in integrated class placements, a chart like the one below may help teachers plan. The most effective cues are those natural to the situation in which the desired behaviour is to occur.

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In addition, we so consider anyone with demonstrable photographic memory or similar prodigy of memory. These criteria are somewhat arbitrary, but derive from our clinical experience and if anything probably underestimate the true incidence. Results Incidence of familial psychiatric disorder by group Metabolic (n = 761) Autistic (n = 566) Chi square Depression 4. Families with individuals having major affective disorder by group Psychiatric and Occupational Histories in Families of Children with Autism 229 Autism group Fathers Mothers 1. Academic/Occupational Achievements of Parents Psychiatric and Occupational Histories in Families of Children with Autism 231 5. Discussion this study confirms once again that the incidence of familial psychiatric disorder, especially major affective disorder, is increased in the families of children with idiopathic autistic spectrum disorder. More strikingly it demonstrates a pronounced increase in the incidence of special intellectual or academic gifts in family members, especially fathers, of children with idiopathic autism. In these respects it corroborates our earlier open studies showing strong correlation among idiopathic autism, familial major affective disorders, and special intellectual ability. However, the families of the genetic/metabolic group were aware that their child had a genetic disorder and thus were presumably motivated to consider family history seriously. As it turned out, the incidences of major affective disorders in the control families approximated published population incidences, thus tending to give greater confidence in the results. The larger number of relatives in the genetic/metabolic group as compared to the autism group (761 versus 566), for an equivalent number of families is unexplained. It is unlikely to be caused by less intense questioning of the autism families; if anything, we would suspect the opposite. It may be suggested that the higher incidence of familial psychiatric disorder may have the effect of decreasing fertility, or that higher educational status may yield the same result. The data about academic achievement and occupations of parents, especially fathers, require scrutiny. Although a difference between the two groups was not surprising, the magnitude of the difference was astounding. Several possible contributing factors must be considered: 1) Referral bias: Our Autism Clinic is situated in an area of dense academic and research concentration (Research Triangle Park); but the Genetics clinic is in the same institution. Both clinics draw patients from the same geographic area, and both accept both private and staff patients indiscriminately. Though we have no definite information about this, outside providers may refer children to our Autism Clinic whom they consider to be favorable candidates for pharmacotherapy, which could result in an increased concentration of a certain subgroup of autistic children. Likewise, more educated families may be more insistent on further referral or more vigorous treatment efforts.


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They may result in minimal clini cal manifestation or they can result in lethal disease in early infancy. The incidence increases significantly once patients are wheelchair dependent, especially after 3 years, when the incidence is close to 60%. Thirty-five percent of patients have spinal deformity before the age of 8 years, and 90% do so by the age of 20 years [15]. The incidence increases greatly between the ages of 13 and 15 years, which correspond closely with the adolescent growth spurt in boys. Thirty-five percent of patients with facioscapulohumeral dystrophy had spinal deformity, of whom 15% had scoliosis alone. Individuals with the childhood onset type had a 44% incidence while those with the late onset and pelvofemoral types had only a 6% incidence. Lonstein, Department of Orthopedics, University of Minnesota, Twin Cities Spine Center, Minneapolis (Table 2). Furthermore there is no association between etiology, pattern of weakness, and curve pattern. Close to 90% of them will develop scoliosis as their weakness progresses quickly, and it occurs prior to cessation of growth coupled with loss of ambulation at an early age. The Scoliosis Research Society has classified neuromuscular scoliosis into neuropathic types and myopathic types (Table 3). Neuromuscular Scoliosis Chapter 24 669 Clinical Presentation History As in any ailment, obtaining a detailed history is fundamental in the establish ment of the correct diagnosis of scoliosis. Clues suggestive for neuromuscular scoliosis are: birth anoxia delayed developmental milestone acquired or familial neuropathies and/or myopathies early onset (less than 7 years old) painful scoliosis the patient should be asked about maternal diabetes, specific bowel and bladder Detailed perinatal history functions, and muscle endurance since these insignificant details can lead to a and family history is diagnosis of sacral agenesis or then again to that of a tethered cord. Subjective warranted if neuromuscular complaints of patchy numbness and weakness must be elicited as well as symp scoliosis is suspected toms consistent with radiculopathy, myelopathy, or recurrent headaches, which mayallbesymptomsofasyringomyelia(Table 4). Spine Coronal imbalance Neuromuscular scoliosis resembles a kyphoscoliotic deformity, in contrast to the is frequent in lordoscoliosis found in adolescent idiopathic scoliosis. Patients with neuromuscular is also frequent scoliosis can develop pressure sores on the sacrum, the ischia, and the greater trochanter and these should be looked for. Neuromuscular Scoliosis Chapter 24 671 a c d Case Study 1 A 12-year-old boy with congenital myopathy (a) presented at our neuromuscular clinic with his older brother (b), who was also diagnosed with neuromuscular scoliosis. Over time the brother developed additional deformity above and below and crankshaft deformity across the instrumented segment. The patient has severe coronal imbalance with a significant pelvic obliquity (d, e).

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