Early Detection of Autism in Infants and Toddlers

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At this very moment, thousands of infants and toddlers throughout the United States exhibit worrisome behavior. They are being managed by perplexed parents and remain unclassified by family practioners, but the developmental outcome of these very young children may brighten as the early diagnosis and consequential expedience of intervention becomes a reality. Anecdotal reports imply that children diagnosed with autism display characteristics of abnormal behavior at an early age, possibly from birth, and in fact, this early onset of such behaviors (prior to thirty-six months) is a diagnostic criterion (Young, Brewer, & Pattison, 2003). According to Trevarthen & Aitken, (2001) fifty percent of parents of children with suspected autism report a strong suspicion of abnormal development prior to the age of one. However, as Kalb asserts, most children will not even be seen by specializing clinicians until they have reached their second birthday with many of these waiting on the appropriate diagnosis until at least the age of three (2005). Further research suggests that anywhere between thirty-one and fifty-five percent of children with autistic disorder show at least some defining behavioral characteristics in the first year of life, and seventy-five to eighty-eight percent have some of these abnormal responses by the first two years of life (Young et al. 2003). For example, in this same data analysis conducted, it was determined that despite these qualitative and quantitative differences in development, the average age of diagnosis for children living in the United Kingdom in 1994 was not until forty-four months even when parents became first concerned about their child’s development at an average age of seventeen months (Young et al. 2003). Additional research has demonstrated a lag between twenty-four and thirty months from the first expression of apprehension by parents about their child’s development to the actual obtainment of a diagnosis.

Over the past decade, researchers have been working toward increasing the accuracy and sensitivity for the interpretation of minute behavioral characteristics in distinguishing autism from the typically developing population. As part of a ten year plan, the National Institute of Mental Health has set the goal of actually “reducing the frequency of autism in school-aged children through early diagnosis and intervention,” (Volkmar, Chawarska, & Klin, 2005). To do this, diagnostic criteria must be tweaked to accommodate the earliest observable behaviors of this disorder. The current definition outlined by the DSM-IV-TR was not researched for children under the age of three, and therefore, is clearly not applicable to toddlers and infants, particularly involving criteria for peer relationships and conversational skills (Klin, Charwarska, Paul, Rubin, Morgan, Wiesner, & Volkmar, 2004). As stated by Young et al. “Many of the behaviors included in [this] classification system relate to secondary behaviors often developed to compensate for underlying neurological deficits,” (2003). For example, stereotyped behaviors such as adherence to routines and rituals are much more common in older children and are rarely noted in children under two years of age. In this paper I will review the observed signs and symptomology reported by parents, observed during clinical diagnostics, and investigated within in the research setting of very young children with suspected autism spectrum disorders.

Parental Observations of Early Symptomology

Parents are often the first to become aware of behavioral deviations their children display from the expected norm, and as a result, these observations become critically vital for the development of early diagnostic tools in clinical evaluation. In a study conducted by Young et al. in 2003, the researcher found the mean age in which parents first notice abnormal developmental signs to be approximately 15. 1 months with a standard deviation of 11. 2 months. Ninety-five percent of these same parents noted anomalies in social development by the age of two. By their first birthdays, children have been noted by their parents to show patterns of extreme reactivity, either getting upset when a new toy or activity is presented or barely noticing this novelty at all. In case reports of classic autism, parents often report their babies have failed to coo or babble by their first birthday or words that they have developed inexplicably disappear (Kalb, 2005). A substantial proportion of others also exhibit repetitive behaviors characteristic of autism such as rocking back and forth or becoming fixated on an object, as well as unusual preoccupations and stereotypy emerging around twenty to thirty months (Kalb, 2005). Parents predominantly report that speech delays or worries about hearing are common concerns, and also may worry that their child is too well behaved or is highly irritable (Volkmar et al. 2005). Additionally, infants with autism may display limited eye contact, diminished social responsiveness, and show little facial expression. Children may be less likely to engage in motor or vocal imitation and are more likely to exhibit difficulties in regulating arousal levels and organizing sensory responses.

By thirty months, Volkmar et al. determined that differences from typical peers in areas of “both person-to-person behaviors (anticipatory postures, turn taking, intensity of eye contact)” and “behaviors in which an object is the focus of joint interest (joint attentional skills such as pointing to materials, following a point of another person, or giving objects),” (2005) have become readily apparent to many adults the children interact with, particularly parents. A minority of children with autism, however, (approximately one in five) show a normal course of development during infancy but begin to lose or regress in social and communication skills and instead manifest autistic symptoms of attention and preservative behavior between the ages of eighteen and thirty-six months (Osterling, Dawson, & Munson, 2002). This and other variations in the acquisition of symptomology of infants and toddlers with autism present significant difficulties in relying solely on parental observation, and thus require further evaluation and scientific study by trained clinicians.

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Fourier Transform Infrared Spectroscopy (FTIR)

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Fourier Transform Infrared Spectroscopy (FTIR) is an extremely useful form of infrared spectroscopy that utilizes an interferogram to collect all of the frequencies to be collected simultaneously. This can be used easily for substance identification by comparing the resultant spectra with a library of known substances. The frequencies are initially passed through an interferogram, which then undergoes a Fourier transformation that combines to produce a spectrum. This spectrum is essentially identical to a normal infrared spectrum for the same compound, except it is produced much faster.

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Premarital Cohabitation’s Influence Upon Stability and Satisfaction in Subsequent Marriages (Part 5)

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Premarital Cohabitation’s Influence Upon Stability and Satisfaction in Subsequent Marriages (Part 4)

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This discovery contradictions a common sense expectation that would determine a higher degree of both communication and dyadic adjustment due to a screening of potential partners that occurs during cohabitation as well as an assumption that adjustment problems common in the first year of marriage for noncohabitors have been previously resolved during premarital cohabitation. Discrepancies from the predicted and actual outcomes in terms of martial satisfaction and communication may in part be due to the fact that once partners marry, often a spouse will expect more out of the marriage and seek a more traditional dynamic than before, thus leading to conflict. Finally, because selectivity predicts that cohabitors view divorce as more favorable than those who marry at the outset, Brown and Booth (1996, p. 671) find it plausible that “they would be less willing to accept a unit decline in relationship quality than married persons, implying a greater willingness to reject the status quo. ” In other words, those who have cohabitated prior to marriage may utilize a different scale to determine happiness within a relationship than those who did not premaritally cohabitate, and consequentially report essentially equal levels of happiness but view these levels with contrasting minimal expectations. Despite these explanations, there is strong evidence of a correlation between premarital cohabitation and lower levels of martial satisfaction as a whole.

Limitations

Constraints on previously conducted research hinder a greater understanding of martial outcome as predicted by premarital cohabitation based on methods of research, a lack of diversity in sample sizes, and perceived biases by researchers on the constructs of relationships maintained during analysis. The interpretation of cohabitation as a form of trial marriage in addition to the superficial living arrangements which mock that of married couples has produced a tendency for researches to interpret couple behaviors within the constructs of marriage instead of independently as a distinct institution. Criteria for the selection of research participants may exclude relationship factors, specifically as noted by Brines and Joyner (1999) where only legal marriages and cohabitating arrangements that survived at least one year were included in results. Additionally, individuals in their mid-thirties to late forties were excluded from much of the research and thus, because long-term cohabitation tends to delay age of marriage, the use of younger cohort samples may have produced an “upward bias in the positive effect of marital cohabitation on the risk of divorce,” (Brines & Joyner, 1999, p. 342). Also most of the data I was able to find provided no information pertaining to the development of relationship skills within cohabitation and marriage, and in the work of Teachman (2003), no evaluation of the premarital relationship histories of husbands in the analysis of effects of premarital relations on marital stability were included. Lastly, most data that I came across was confined to correlational studies on college student relationships or was based on large scale national surveys that limited the availability of attitudinal, behavioral, and basic sociodemographic variables.

Conclusion

Although a strong argument has been presented that cohabitation acts as a selective agent for people more willing to break social norms and less committed to marriage, it can be inferred that during the subsequent decades of the twenty-first century due to a rapid increase of premarital cohabitation, this institution will become less selective of people possessing specific characteristics related to martial stability. However, problems created during cohabitation pertaining to communication and division of finances and labor may continue to extend into marriage, creating an instability and dissatisfaction despite a hypothesized virtual elimination of selective agents. Overall, an emphasis on non-traditional experiences within the confines of premarital cohabitation, concrete differences in relationship dynamics that arise from marriage following cohabitation, and therefore a less predictable transition into marriage continue to shape successive satisfaction and stability.

References

Brines, J. & Joyner, K. (1999). The ties that bind: principles of cohesion in cohabitation

and marriage [Electronic version]. American Sociological Review, 64, 333-355.

Brown, S. & Booth, A. (1996). Cohabitation versus marriage: a comparison of relationship

quality [Electronic version]. Journal of Marriage and the Family, 58, 668-678.

DeMaris, A. & Gerald, L. (1984). Cohabitation with future spouse: its influence upon martial

satisfaction and communication [Electronic version]. Journal of Marriage and the Family,

46, 77-84.

Duvander, A. (1999). The transition from cohabitation to marriage: a longitudinal study of

the propensity to marry in Sweden in the early 1990s [Electronic version]. Journal of

Family Issues, 5, 698-717.

Hall, D. (1996). Marriage as a pure relationship: exploring the link between premarital

cohabitation and divorce [Electronic version]. Journal of Comparative Family Studies, 27,

1-11.

Hall, D. & Zhao, J. (1995). Cohabitation and divorce in Canada: testing the selectivity

hypothesis [Electronic version]. Journal of Marriage and Family, 57, 1-11.

Nicole, F. & Baldwin, C. (1995). Cohabitation as a developmental stage: implications for

mental health counseling [Electronic version]. Journal of Mental Health Counseling, 17,

1-8.

Stafford, R. Backman, E. & Dibona, P. (1977). The division of labor among cohabiting and

married couples [Electronic version]. Journal of Marriage and the Family, 39, 43-57.

Teachman, J. (2003). Premarital sex, premarital cohabitation, and the risk of subsequent

martial dissolution among women [Electronic version]. Journal of Marriage and Family,

65, 1-16.

Woods, L. & Emery, R. (2002). The cohabitation effect on divorce: causation or selection?

[Electronic version]. Journal of Divorce and Remarriage, 37, 101-121.

Wu, Z. (1999). Premarital cohabitation and the timing of first marriage [Electronic version].

Canadian Review of Sociology and Anthropology, 36, 1-18.

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Premarital Cohabitation’s Influence Upon Stability and Satisfaction in Subsequent Marriages (Part 3)

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In addition to the rationale that cohabitation takes time to experience, a delay from informal union into marriage for cohabiting couples is also a factor relative to the coresidential experience. Using data from the 1990 General Social Survey, it becomes evident that cohabitational experience delays the timing of a first marriage by approximately twenty-six percent for women and nineteen percent for men even when selective factors have been controlled for (Wu, 1999). Finally a lack of joint investment as a general mechanism to bind couples together has been proven to be relevant in the experience of cohabitation and subsequent marital dissolution. Economic division of income and resources works against a theory that suggests that through both partners’ joint investment in the relationship, each become increasingly dependent on one another as gain from the current relationship exceeds prospective gains from any alternative (Brines & Joyner, 1999).

Although less research has been conducted pertaining to the thesis of a causal effect of cohabitation upon martial success, significant empirical support emphasizes a generated hypothesis that martial outcome may in fact be due to a combination of the working factors of selectivity in partners for a cohabitating experience. Often partners who enter into a premarital coresidential relationship with previously described personal qualities and individualistic tendencies learn that these functionings of self are well maintained in the constructs of cohabitation through experiences encountered during the relationship, thus further reinforcing this distinctive behavior. In couples where no cohabitation prior to marriage has taken place, the adults may enter into marriage with an independent and individualistic view, but these traits may transition into interdependence as the individual adapts to a more traditional view of marriage due to societal pressures and conformity norms.

Division of Resource

As a result of preselectivity, effects from certain experiences within cohabitation or a combination of both these factors working simultaneously, a variety of contrasts between concrete dynamics in married versus cohabitating relationships may lead to eventual marital termination. In keeping with this argument, Brines and Joyner (1999, p. 339) define a “distinction between the individualistic ethos of cohabitors and the more collectivist orientation of married partners” which contributes to an expression of different patterns in resource management. Couples who share households outside of marriage often do not share joint ownership of these homes or joint bank accounts, thus reducing any risk through avoidance of investment activity in the relationship. Due to a higher degree of emphasis on equality as theorized by selective factors, premaritally cohabitating partners contribute nearly equal earnings into joint purchases and living expenses. Among couples with an employed male, Duvander (1999) found that female cohabitors earned on average ninety percent of their partner’s salary versus a wife’s earnings of just over sixty percent of her husband’s salary. Because the female member of a relationship provides an increased level of income during cohabitation in comparison to her previously married peers, when she herself enters marriage, an expectation for her to continue bringing in this income is apparent. However often times while these women contribute a significant percentage to the overall income, they continue to perceive themselves as being overburdened at home, causing large numbers of women who are no longer economically dependent on men to question the benefits of being legally married (Nicole & Baldwin, 1995). However, some data published by Stafford, Backman, and Dibona (1977) suggests that cohabiting couples share more household tasks than married couples, and thus, this breakdown of tasks may be carried over into marriage. Furthermore, Stafford, Backman, and Dibona (1977) determined that married men without cohabitating experience do less cooking, cleaning and laundry than those who cohabitated prior to marriage. This finding places a high degree of importance on equality of division of tasks for eventual marital success in couples who have previously cohabitated and thus share an equal level of employment.

Perceived Quality of Communication, Satisfaction and Stability

In addition to a reassignment of traditional division of task and resource, premarital cohabitation may also contribute to an eventual decrease of overall satisfaction in many aspects of a relationship following marriage in comparison to those who do not cohabitate prior to wedding. In a study based on the data analysis from the 1987-1988 National Survey of Family and Households measuring relationship quality across the five dimensions of disagreement, fairness, happiness, conflict, management, and interaction, it was determined that those who cohabitate experience disagreement with a higher frequency than their married counterparts, thus providing implications that such disagreement may continue into marriage if this level in relationship is achieved (Brown & Booth, 1996). Also determined from this data, people in marriages that were preceded by cohabitation have significantly lower levels of martial interaction and higher levels of disagreement and instability than those who had never cohabitated outside of the confines of marriage. Such an increase in the frequency of disagreements amongst couples who cohabitated before marriage may be attributed to the fact that, “many couples fail to develop conflict resolution abilities during the early stages of their relationship and encounter trouble later when they face problems that are complex and serious enough to require a high degree of such skill,” (Nicole & Baldwin, 1995, p. 6). Additionally, spouses who cohabitated before marriage reported lower levels of commitment to marriage as an institution, providing further evidence for instability within their individual relationships.

A previous empirical study conducted approximately twelve years prior to the analysis of the National Survey of Family and Households revealed similar results, finding that premarital cohabitation was associated with significantly lower perceived quality of communication for wives and significantly lower marital satisfaction for both spouses after controlling for sex-role traditionalism, church attendance, and other significant sociocultural factors (DeMaris & Gerald, 1984).

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Premarital Cohabitation’s Influence Upon Stability and Satisfaction in Subsequent Marriages (Part 2)

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” in a search to differentiate their premarital from their martial relationship.

Although accounting for similarities of adjustment experienced during the initial sharing of households among both groups, an inference has been made that very different principles bind cohesiveness in cohabitating versus married couples. This governing assumption predicts that couples who reside together prior to marriage will engage in a less traditional marriage dynamic following legal union in keeping with previous masculine and feminine roles established during premarital cohabitation. According to Brines and Joyner (1999), the greater the financial “equal-power” ratio experienced between partners during premarital cohabitation, the lower the likelihood of dissolution in this informal institution of union due to a separation of economic resources. Cohabitors who engage in a traditional division of labor are 2. 75 times more likely to end their relationship in dissolution than those who engage in more equal labor practices. However, once a marriage has been entered into, a pooling of resources is most often expected, and thus discrepancies may occur in wage earning. The less traditional roles adopted by those in a premarital cohabitation as demonstrated by the above data may offer an explanation of instability and lower satisfaction once married.

Selectivity as a Factor of Instability

Contrasting theories pertaining to individual processes occurring during cohabitation offer an explanation of lower stability and satisfaction once a transition from cohabitation to marriage has been initiated. A main focal point on the first theory emphasizes the proposal that men and women in weak marriage-market bargaining positions are more likely to cohabitate prior to marriage, producing a selective factor towards a lower quality and consequentially less stable outcome. Numerous studies provide evidence that selectivity either through direct measurement of differences on important characteristics, including age and religion, or “the use of statistical procedure that adjust for unmeasured heterogeneity” (Teachman, 2003, p. 5) distinguish outcomes between cohabitors and noncohabitors. Brines and Joyner (1999, p. 335) suggest that when couples choose cohabitation prior to marriage, “the choice signals uncertainty and a short-term time horizon, prescribing a cautious approach to the relationship that might produce patterns of sharp bargaining between partners. ” These conditions of uncertainty allow cohabitating couples a certain degree of freedom to experiment with organization forms that are “less responsive to external norms or contractual obligations and more responsive to the needs of each partner” (Brines & Joyner, 1999, p. 5), however, at the expense of incentives to jointly invest in the relationship. As Nicole and Baldwin (1995) state, cohabitation allows for a relatively safe period during which a couple can investigate deeper levels of compatibility, disclose needs, feelings, and vulnerabilities without pressure for a life-long commitment. Conversely, when a couple with individualistic tendencies concentrated on the maintenance of equality enters into marriage, frequent monitoring of each partner’s holdings may create constant friction between husband and wife. Additionally, as a result of an egalitarian and unconventional viewpoint, cohabitants are more individualistic in partner selection and thus less concerned with age and religious homogamy (Hall, 1996), key components explained as crucial by Hall and Zhao (1995). Finally, those who are prone to relationship dissatisfaction in accordance with data provided by Woods and Emery (2002) are more likely to select partners who are vulnerable to divorce as well.

Moreover, evidence supports the notion that cohabitors and married persons differ substantially in terms of what they seek from the relationship, even those who cohabitate with eventual intentions to marry. As discussed previously, cohabitors are more likely to embrace individualism and seek personal autonomy and equity in terms of household contributions between partners. Once a definite marriage commitment has been established, fear is often generated that individual enterprises may be eliminated based on the evidence that marriage may reduce activities related to an individual’s career, friendships, hobbies or family of origin that defined a certain degree of importance in the individual’s life (Hall, 1996). A drop-off of these activities following the transition from cohabitation into marriage may further perpetuate a sense of martial dissatisfaction.

Finally, personality problems as well as behavioral and social adjustment problems, difficulty expressing emotions, alcohol and drug abuse, financial irresponsibility, legal problems, and unstable employment history are common characteristics of those who seek to cohabitate premaritally as they view themselves to be poor marriage material. Additionally, Woods and Emery (2002) determine that cohabitors tend to resemble high self-monitors, and thus alter their behavior depending on the situation and person with who they are interacting within any given instance. These tendencies lead to the report of lower trust levels, less faithfulness and loyalty, and an overall decrease in commitment for any individual relationship, which can subsequently lead to martial conflict and undermine martial stability.

Experience as a Factor of Instability

An alternative to the theory of selectivity is the asscertation that the actual experience of cohabitation influences martial outcome and overall levels of satisfaction within the relationship. In this theory, it is argued that a causal effect is exhibited as a result of having lived with a romantic partner prior to marriage. According to Wu (1999, p. 2), “because most cohabiting relationships are short-lived, the ephemeral nature of cohabitation as observed in everyday life may undermine the notion that intimate relationships are lasting and permanent. ” Additionally the experience of cohabitation may foster less conventional attitudes regarding marriage, perhaps resulting in a subsequent increase in approval of divorce. Data by Hall (1996) provides evidence of a small but significant effect on the frequency of divorce when considering cohabitation in the absence of personal characteristics in finding that eighteen percent of those who had cohabitated prior to marriage ended their relationship in divorce in comparison to the eleven percent of noncohabitors that endured the same outcome.

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Premarital Cohabitation’s Influence Upon Stability and Satisfaction in Subsequent Marriages

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In my examination of premarital living arrangements, I seek to explain cohabitation as a predictive factor for subsequent martial stability and satisfaction based on the analysis of selectivity into such a relationship, the experience of cohabitation itself and the contrasting characteristics of which cohabitating and married couples exhibit in their individual relationships. Evaluating marriage and cohabitation from a utilitarian perspective which focuses on the cohesiveness of each couple as a function of partners’ joint investments in the relationship, I intend on determining whether the principles governing stability and satisfaction contrast by the type of union and thus address the implications of these disparities upon theory through numerous research studies of modern couples.

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Introduction

In the midst of turbulent family patterns that have become progressively normative by twenty-first century standards, several explanations compete to explain why some couples are able to remain together post cohabitation through marriage while others experience marital dissolution. According to Nicole and Baldwin (1995) although the rates for first marriages and remarriages have been declining, the rates of cohabitation and divorce have been steadily climbing, thus providing speculation as to whether each of these relationship steps or statuses influence one another. At the onset of coresidential unions the perspective upon which partners view their cohabitation and the goals established to be achieved from this sharing of households strongly affect the outcome of these relationships. Cohabitation may be envisioned as a trial marriage in a process of a prolonged marriage search to effectively “weed out” incompatible partners, thus, one would predict a regression in later divorce statistics between these groups; however, this is not always the case due to selective or experience factors. In this way, cohabitation may act as an additional step in the transition from singlehood to marriage, offering a “functional developmental tool for those who are uncertain about marriage,” (Nicole & Baldwin, 1995). The following paper reviews assertions as to whether cohabitation represents such a developmental tool for a stronger, more egalitarian union that lessens the likelihood of subsequent divorce.

Rationale for Premarital Cohabitation

Societal movements since the early 1970s have produced modifications in the rates of cohabitation, marriage, and divorce, challenging traditional conceptions of what exactly binds heterosexual couples together in a specific union (Brines & Joyner, 1999). Numerous national surveys predict that the convergence in martial and family forms has occurred as a function of the global capitalist system which has given rise to an increased emphasis on individuation, a selective factor to be examined in depth shortly. According to Hall (1996, p. 1) “by improving the status of women and undermining patriarchal authority, the process of capitalist industrialization encourages the growth of informal and unstable martial patterns across cultures. ” Further evidence to support this prediction is found in the favorable attitudes toward cohabitation as expressed by women based on their levels of formal education and labor force participation, while negative attitudes towards this informal cohesiveness in relationships are associated with the traditional values of religion and desire for children (Hall, 1996). Additionally, the increasing emergence of sexuality from the confines of reproductive purpose has produced plastic sexuality, “sexuality that is largely freed from reproduction as well as institutional, normative, and patriarchal control,” (Hall, 1996, p. 2). Because this sexuality has evolved as unbounded by the limits of legal union, plastic sexuality has been identified as malleable and able to be defined even so informally as that of a personality trait on an individual basis (Hall, 1996). This significant emergence of plastic sexuality as a determinate relevant to eventual martial satisfaction functions as a powerful catalyst for the evolving transformation of the human intimacy in relationships that are “organized and sustained primarily from within the relationship itself, not materially supported by, nor anchored in external social criteria such as norms, traditions, or formal institutions,” (Hall, 1996, p. 2). These relationship classifications are more democratic and egalitarian in economic, sexual, and household task duties, thus providing a more compatible relationship structure for the work force participation of both partners. Improved birth control methods and more permissive societal attitudes toward premarital sexual intercourse in addition to a “greater unconventionality in family ideology, economic insecurity, and less commitment to religion” are cited by Woods and Emery (2002, p. 102) as fundamental reasons as to why couples may choose to live together in the absence of marriage. I hypothesize through these literary findings that the desire for egalitarian constructs as a result of an evolving societal movement act as a significant factor in addition to several others towards the dissolution of marriages with cohabitation prior to wedding.

Data

Empirical research on the linkage between premarital cohabitation and subsequent martial stability and satisfaction remains surprisingly consistent, suggesting that premarital cohabitation is indeed associated with an increased risk of martial dissolution. According to the data presented by Teachman (2003, p. 1), “marriages preceded by a spell of cohabitation are as much as 50% more likely to end in divorce at any marital duration than marriages not preceded by cohabitation. ” Evidence suggests that the progression of cohabiting couples for adaptation into this union of shared household follows along an identical pathway in comparison to marital adjustment. Couples establish mutually satisfactory affectional and sexual relationships, separate from families of origin, and develop a couple identity in the first few months of cohabitation, either within the confines of marriage or outside of them (Nicole & Baldwin, 1995). This statement provides a hypothesis that while individuals who first share a household following marriage enter into this legal union with an exciting prospect of joining together to resolve these issues, those who have cohabitated prior are exempted from this process, and therefore, may be left wondering “now what?

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Tourette’s Syndrome: Cause, Onset, Symptoms, and Treatment Options (Part 6)

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lexis-nexis. com>

“Tourette Syndrome, ADD and ADHD Information Center. ” Tourette Syndrome Online.

19 Nov. 2004 http://www. tourette-syndrome. com

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Tourette’s Syndrome: Cause, Onset, Symptoms, and Treatment Options (Part 5)

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Neuroleptics is a specific class of drugs primarily used to treat motor and phonic tics and include Primozide, Fluphenazine, Thiothixene, Chlorpromazine, Triflueoperazine, Thioridazine which alter the effects of dopamine in the central nervous system while possessing anticholinergic and alpha-adrenergic blocking activity. Risperidone, another neuroleptic drug, acts as a dopamine and serotonin receptor antagonist to decrease motor and phonic tics. Clonazepam, an anticonvulsant, produces sedative effects in central nervous system with a high affinity for the y-gamma aminoburic acid (GABA) receptor, increasing synaptic serotonin. This medication decreases aggressive behavior, emotionally labile behavior, and tics. Clonidine, an antihypertensive alpha blocker, stimulates the alpha adrenergic receptors in the central nervous system to inhibit cardioacceleration and vasoconstriction. This medication is an adrenergic agonist that decrease tics while increasing attention levels. Finally, the drug Nifedipine, an antihypertensive calcium channel blocker, acts upon slow calcium channels invascular smooth muscle and myocardium to produce vasodilation in decreasing tic symptoms (Tourette Syndrome Online). Overall, many pharmacological advances have been effective in decreasing symptoms; however, more research is needed on a medication that could cure Tourette’s syndrome.

Tourette’s syndrome is a very complex disorder resulting in vocal and motor tics, aggressive behavior and is often associated with Attention Deficit Hyperactivity Disorder and Obsessive Compulsive Disorder. Although behavioral therapeutic, surgical, pharmacological, and other treatments are available, continued research will be needed to determine the exact cause of this syndrome and improve treatments.

Works Cited

Brunn, Ruth Dowling and Bertel Brunn. A Mind of Its Own: Tourette’s Syndrome: A

Story and a Guide. New York: Oxford University Press, 1994

Chae, Jeong Ho, Ziad Nahas, Xingbao Li, Gopalan Sethuraman, Donald Gilbert, Floyd R.

Sallee, and Mark S. George. “A Pilot Safety Study of Repetitive Transcranial

Magnetic Stimulation in Tourette’s Syndrome. ” Cognitive and Behavioral Neurology.

Jun. 2004. Academic Universe. Lexis-Nexis. University of North Carolina Lib.

Chapel Hill. 18 Nov. 2004 <http://www. lexis-nexis. com>

Chang, Hsueh Ling, Ming Je Tu, and Huei Shyong Wang. “Tourette’s Syndrome:

Psychopathology in Adolescents. ” Psychiatry and Clinical Neurosciences. Aug. 2004.

Academic Universe. Lexis-Nexis. University of North Carolina Lib. Chapel Hill. 18

Nov. 2004 <http://www. lexis-nexis. com>

Cohen, Donald J. Ruth D. Brunn, and James F. Leckman. Tourette’s Syndrome and Tic

Disorders: Clinical Understanding and Treatment. New York: John Wiley and Sons,

1988

Curtis, David. “Genome Scan of Tourette Syndrome in a Single Large Pedigree Shows

Some Support for Linkage to Regions of Chromosomes 5, 10, and 13. ” Psychiatric

Genetics. Jun. 2004. Academic Universe. Lexis-Nexis. University of North Carolina

Lib. Chapel Hill. 18 Nov. 2004 <http://www. lexis-nexis. com>

“Diagnosing and Treating Tourette Syndrome. ” Tourette Syndrome Association, Inc. 19

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Tourette’s Syndrome: Cause, Onset, Symptoms, and Treatment Options (Part 4)

June 15th, 2010 Comments off

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Because tics change in severity often weekly and are exhibited in differing bouts throughout a single day, it is important initially for the doctor to observe the patterns so that he or she may decide upon the most effective treatment regime. Additionally, it is extremely important to treat Tourette’s syndrome as early as possible to reduce ridicule and rejection by peers, exclusion from activities and prevention from enjoying normal interpersonal relationships due to the perception of those in the child’s immediate environment who may observe the bizarre behavior and become frightened. To avoid such psychological harm, early diagnosis and treatment is key (Tourette Syndrome Association). While many children with Tourette’s syndrome of school age have similar IQs to the majority of the school population, many will have special educational needs which must be addressed to optimize learning. Tape recorders, typewriters, or computers for reading and writing problems, un-timed exams to reduce stress and anxiety which aggravate tics, and permission to leave the classroom when tics become noticeable and embarrassing to the child are affective methods of gaining control of symptoms in the school environment (Tourette Syndrome Association). In terms of professional assistance, habit reversal therapy, or making a patient aware of tics or the urge to tic building up and training and then training him or her to “engage in a response that would be muscularly competing or incompatible with tic” (Packer) as well as the similar exposure response-prevention therapy in which patients are instructed to suppress their tics have mixed results. Relaxation techniques may also be utilized, instructing patients in a simple breathing-based approach to train themselves to relax as a way of decreasing the incidence of tics in stressful situations. Moreover, neurofeedback can be performed using the biofeedback of an EEG machine where “individual receives immediate feedback about a physiological or biological process, with hopes that the immediate feedback and reinforcement will enable the individual to modulate a physiological process that is usually not easily modifiable. ” (Packer). One megahertz of transcranial magnetic stimulation over the prefrontal cortex or motor cortex delivered to the primary motor area have reduced the frequency of tics during stimulation as well (Chae et al. The most dramatic treatments those found in surgical operations when all other treatments have failed. Lesioning of the brain known as stereotactic zona incerta and ventrolatral/lamella medialis thalamotomy may provide a significant long term decrease in motor tics if further developed. A less risky surgery with fewer side effects was recently attempted by a neurosurgical team at University Hospitals of Cleveland where the use of deep brain stimulation, similar to the device used to treat Parkinson’s disease and tremor, was attempted. Electrodes placed around cells inside the thalamus portion of the brain, a structure which forms part of the circuit connecting the basal ganglia to the cerebral cortex, deliver continuous high frequency electrical stimulation, thus producing messages that are rebalanced through movement centers in the brain (News Medical). Within hours of surgery and activation, the patient noticed a disappearance of jerking motions, muscle tics, and grunting symptoms associated with Tourette’s. With the discovery of the streptococcal factor involved in Tourette’s syndrome, clinical researchers have explored experimental methods such as plasmapheresis (plasma exchange, PEX) and intravenous injection of immunoglobin (IVIG) to treat PANDAS related symptoms themselves. However, neither of these treatments have been proven to be effective. Also significant improvement has been documented in the symptoms of Tourette’s patients supposedly affected by PANDAS after undergoing tonsillectomies or adenotonsillectomy for recurrent streptococcal pharyngitis (Packer).

The great majority of people diagnosed with Tourette’s syndrome are not significantly impaired by their symptoms and thus do not re quire medication, but when medication becomes necessary, many options are available. To achieve maximum control of symptoms, dosages of specific drugs vary significantly from patient to patient and must be carefully monitored. In most circumstances, doctors prescribe medications in small doses and gradually increase these doses until a maximum alleviation of symptoms with minimal side effects are achieved. Some undesired side effects incurred during treatment include weight gain, muscle rigidity, fatigue, motor restlessness and social withdrawal. Most drugs administered to treat this disorder are dopamine agonists and antagonists which can often reduce abnormal movements and vocal tics in Tourette’s syndrome (Hershey et al.

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