Table Of ContentTextbook of
Developmental
Pediatrics
Textbook of
Developmental
Pediatrics
Edited by
Marvin I. Gottlieb, M. D., Ph. D.
Director, Institute for Child Development.
Hackensack Medical Center
Professor, Department of PeEliatrics
University of Medicine and Dentistry of New Jersey-New Jersey Medical School
Hackensack, New Jersey
and
John E. Williams, M. D.
Chief, Section of Developmental Pediatrics
Associate Director, Institute for Child Development
Hackensack Medical Center
Clinical Assistant Professor, Department of Pediatrics
University of Medicine and Dentistry of New Jersey-New Jersey Medical School
Hackensack, New Jersey
Plenum Medical Book Company
New York and London
Library of Congress Cataloging in Publication Data
Textbook of developmental pediatrics.
Includes bibliographies and index.
1. Developmental disabilities. I. Gottlieb, Marvin I. II. Wi1Iiams, John E. (John Edward),
1951- . [DNLM: 1. Child Behavior-in infancy & childhood. 2. Child Development
Disorders-in infancy & childhood. 4. Nervous System Diseases-in infancy & childhood. 5.
Speech Disorders-in infancy & childhood. WS 350.6 T355]
RJl35.T47 1987 618.92 86-30411
ISBN-13: 978-1-4612-9006-3 e-ISBN-13: 978-1-4613-1797-5
DOl: 10.1007/ 978-1-4613-1797-5
© 1987 Plenum Publishing Corporation
Softcover reprint of the hardcover 1st edition 1987
233 Spring Street, New York, N.Y. 10013
Plenum Medical Book Company is an imprint of Plenum Publishing Corporation
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechani~l, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Contributors
William C. Adamson, MD. • Professor, Department of Mental Health Sciences,
Hahnemann University, Philadelphia, Pennsylvania 19102
Lorian Baker, PhD. • Associate Research Psycholinguist, UCLA Neuropsychiatric
Institute, Los Angeles, California 90024
George W. Brown, MD. • Director, Los Lunas Hospital and Training School, Los
Lunas, New Mexico 87031
Dennis P. Cantwell, MD. • Joseph Campbell Professor, UCLA Neuropsychiatric
Institute, Los Angeles, California 90024
Arnold J. Capute, M.D., M.P.H. • Vice President for Medical Affairs, The Kennedy
Institute for Handicapped Children, Department of Pediatrics, The Johns Hopkins Univer
sity Medical Institutions, Baltimore, Maryland 21205
Herbert J. Cohen, M.D. • Professor, Departments of Pediatrics and Rehabilitation
Medicine, Director, Rose F. Kennedy University Affiliated Facility and Children's Eval
uation and Rehabilitation Center, Albert Einstein College of Medicine, Bronx, New York
10805
Sylvia M. Davis, PhD. • Professor, Department of Communication Disorders, Loui
siana State University Medical Center, New Orleans, Louisiana 70112
Marion P. Downs, M.A., D.H.5. • Professor Emerita, Department of Otolaryn
gology, University of Colorado Health Sciences Center, Denver, Colorado 80262
Bill R. Gearheart, Ed.D. • Professor, Department of Special Education, University of
Northern Colorado, Greeley, Colorado 80639
Gerald S. Golden, MD. • Shainberg Professor, Department of Pediatrics, Professor
and Acting Chairman, Departments of Pediatrics and Neurology, University of Ten
nessee Center for the Health Sciences, Memphis, Tennessee 38105
Marvin I. Gottlieb, M.D., PhD. • Director, Institute for Child Development,
Hackensack Medical Center, and Profe~sor, Department of Pediatrics, University of Med
icine and Dentistry of New Jersey-New Jersey Medical School, Hackensack, New
Jersey 07601
Roger L. Hiatt, MD. • Professor and Chairman, Department of Ophthalmology, Uni
versity of Tennessee Center for the Health Sciences, Memphis, Tennessee 38163
v
vi CONTRIBUTORS
Paul King, MD. • Clinical Assistant Professor, Child and Adolescent Psychiatry,
Director, Adolescent Services, Charter Lakeside Hospital, University of Tennessee Cen
ter for the Health Sciences, Memphis, Tennessee 38103
Marcel Kinsbourne, M.D. • Adjunct Professor, Department of Psychology, Brandeis
University, and Director, Department of Behavioral Neurology, Eunice Kennedy Shriver
Center for Mental Retardation, Waltham, Massachusetts 02254
Dorothy Kletzkin, EdD. • Chief, Section of Learning Disabilities, Institute for Child
Development, Hackensack Medical Center, Hackensack, New Jersey 07601
Theresa E. Laurie, PhD. • Education Director, TRANSACT Health Systems, Forbes
Regional Health Center, Monroeville, Pennsylvania 15146
Craig B. Liden, MD. • Medical Director, TRANSACT Health Systems, Forbes Re
gional Health Center, Monroeville, Pennsylvania 15146
Frederick B. Palmer, MD. • Developmental Pediatrician, The Kennedy Institute for
Handicapped Children, Associate Professor, Department of Pediatrics, The Johns
Hopkins University Medical Institutions, Baltimore, Maryland 21205
Donald L. Rampp, Ph.D. • Professor and Head, Department of Communication Dis
orders, Louisiana State University Medical Center, New Orleans, Louisiana 70112
Bruce K. Shapiro, MD. • Developmental Pediatrician, The Kennedy Institute for
Handicapped Children, Associate Professor, Department of Pediatrics, The Johns
Hopkins University Medical Institutions, Baltimore, Maryland 21205
Rachel E. Stark, PhD. • Associate Professor, Department of Neurology, John F.
Kennedy Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland,
21205
Emily A. Tobey, PhD. • Assistant Professor, Department of Communication Disor
ders, Louisiana State University Medical Center, New Orleans, Louisiana 70112
Abby L. Wasserman, MD. • Director, Division of Psychiatry and Psychology, St.
Jude Children's Research Hospital, Memphis, Tennessee 38101
John E. Williams, MD. • Chief, Section of Developmental Pediatrics, Associate
Director, Institute for Child Development, Hackensack Medical Center, and Clinical
Assistant Professor, Department of Pediatrics, University of Medicine and Dentistry of
New Jersey-New Jersey Medical School, Hackensack, New Jersey 07601
Peter W. Zinkus, PhD. • Director, Child Psychology Division, Le Bonheur Chil
dren's Medical Center, Memphis, Tennessee 38103
Preface
Child/adolescent development and behavior have been a traditional "concern" of prima
ry health care providers. However, it was not until the mid-1960s that attempts were made
to consolidate developmental-behavioral issues into an identifiably distinct fund of medi
cal knowledge. During the ensuing two decades, developmental-behavioral pediatrics
was recognized as a clinical and research subspecialty, within the framework of compre
hensive health care for children. The influence of public advocacy groups, topic-dedicated
journals, national professional specialty societies, subject-related continuing education
programs, and federal legislation (PL94-142) has served to crystallize developmen
tal-behavioral pediatrics as a specialized field of study. As a consequence, during the past
ten years significant modifications have restructured medical student and pediatric resi
dent education, providing an emphasis on developmental-behavioral issues. The focus on
neurodevelopmental, educational, and psychosocial issues reflects changing priorities in
traditional health care for children. The postgraduate training of pediatric fellows, in two
and three-year training programs, was initiated to accommodate professional manpower
needs in both academic and practice settings.
Many of the problems in childhood development and behavior frequently span the
traditional areas of child neurology, child psychiatry, and general pediatrics. As a result
there has been some confusion in demarcating professional responsibilities in diagnosis
and management, as well as poorly defined terminology and classification schemas. With
the birth of developmental pediatrics as a pediatric specialty, a more cohesive fund of
knowledge has been accumulated and more meaningful strategies have been designed for
prevention, diagnosis, and management. Although originally an "offshoot" of profes
sional interest in mental retardation, developmental-behavioral pediatrics has signifi
cantly broadened its clinical perspective to include such topics as: learning disabilities,
communication handicaps, cognitive disorders, neuromotor problems, behavioral prob
lems (e.g., hyperkinesis), and adjustment reactions-to mention only a few.
Within this framework, these disorders are of critical concern to the developmental
pediatrician. Although confusions in terminology and classification persist, a "working"
definition of developmental-behavioral disorders might best be conceptualized as any
disorder which is potentially capable of producing a chronic handicap that adversely
affects the quality of the child/adolescent's life. Perhaps the key component of this
definition of developmental-behavioral disorders relates to the recognition that, in asso
ciation with most of the problems for which intervention is not provided, there is a
negative effect on the child's self-concept, self-esteem, and self-confidence. Poor self
concept can in turn jeopardize the course of childhood, adolescence, and adult life. As
vii
viii PREFACE
these negative psychosocial variables persist, they may significantly impede neurodevel
opment and behavior. Often the superimposed personality and behavioral disorder can
present a greater management problem than the original pathology. For the child, the
family, the educational system, the community, and the professional team, developmen
tal-behavioral problems generally encompass problems associated with emotional and
financial strains. These variables further impact on the course of the neurodevelopmental
or neurobehavioral disorder. Because of their special skills, pediatricians have been
assigned a significant and critical role in developmental-behavioral medicine. However,
the complex nature of these disorders generally necessitates a well-coordinated interven
tion by an interdisciplinary team.
The scope of developmental concerns has been dramatically expanded during the
past decade. To cover all of the developmental-behavioral disorders in depth would
require a work encyclopedic in nature, perhaps consisting of several volumes. Therefore,
we have not made an attempt to cover the broad area of developmental-behavioral
pediatrics entirely in this book. We have, instead, compiled what we feel to be many of
the essential and timely topics that confront the pediatric health care provider in the area
of child development and behavior. Effort has been made to present this information in a
concise text, with a more extensive appendix that includes useful tables and information
for quick reference. Although we hope that medical students, pediatric residents, fellows,
and practitioners will find this book particularly useful, we have dedicated this work to all
professionals who help families and their children who have developmental disabilities.
Marvin 1. Gottlieb
John E. Williams
Hackensack, New Jersey
Contents
I. Neurological Aspects of Developmental Pediatrics
1. Developmental Disabilities: A Pediatrician's Perspective 3
Herbert J. Cohen
2. Cerebral Palsy: History and State of the Art . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Bruce K. Shapiro, Frederick B. Palmer, and Arnold J. Capute
3. Common Neuromotor Disorders 27
Gerald S. Golden
4. Common Seizure Disorders 41
Gerald S. Golden
II. Psychoeducational Aspects of Developmental Pediatrics
5. Specific Learning Disabilities and Attention-Deficit Disorder with
Hyperactivity ................................................... , 53
Marcel Kinsbourne
6. Dyslexia: An Ophthalmologist's Perspective 85
Roger L. Hiatt
7. Learning Disabilities: New Perspectives from an Educational Specialist 93
Dorothy Kletzkin
8. Psychological Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 113
Peter W. Zinkus
9. Major Variations in Intelligence .................................... 127
Marvin I. Gottlieb
III. Speech and Language Disorders
lO. Neurological Correlates of Speech .................................. , 153
Emily A. Tobey and Donald L. Rampp
ix
x CONTENTS
11. Receptive and Expressive Language Disorders . . . . . . . . . . . . . . . . . . . . . . . .. 167
Rachel E. Stark
12. Overview of Articulation and Fluency Disorders ....................... 189
Sylvia M. Davis and Donald L. Rampp
13. Behavioral/Psychiatric Aspects of Children with Speech and Language
Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 211
Lorian Baker and Dennis P. Cantwell
IV. Behavioral Disorders
14. Common Behavioral Disorders of Childhood .......................... 235
Abby L. Wasserman
15. Emotional Disorders of Childhood .................................. 255
William C. Adamson
16. Juvenile Delinquency ............................................. 289
Peter W. Zinkus and Paul King
17. The Hyperactive Child ............................................ 303
Marvin I. Gottlieb
V. Office Management of Developmental Disabilities
18. Visual Problems in Childhood 333
Roger L. Hiatt
19. Hearing Problems in Childhood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 349
Marion P. Downs
20. Role of the Physician in the School Life of the Child ................... 357
Craig B. Liden and Theresa E. Laurie
21. Educational Strategies for Children with Developmental Disorders ........ 385
Bill R. Gearheart
22. Guidelines for Physicians ........................................ " 399
John E. Williams
23. Controversial Therapy 431
George W. Brown
Appendixes
A. Psychoeducational Testing .......................................... 453
B. Speech/Language and Hearing ..................................... " 460
