摘要:

The purpose of the study was to evaluate children's perceptions of their participation as research subjects in a minimal risk research study (a methylphenidate population pharmacokinetic study conducted 8 months earlier). We identified 115 children of an original 189, aged 6 to 19 years, who were responding well to regular methylphenidate for attention-deficit hyperactivity disorder. By using a structured format, telephone interviewers unconnected to the original study questioned the children about what it had been like to be a subject in terms of voluntariness, accuracy of informed consent, reasons for participating, and satisfaction with their experience. Children overwhelmingly perceived their involvement as voluntary (89%) and the information about the study as accurately presented (80%), and they reported a high level of satisfaction with their participation (97%). Self-interest was the most frequently reported reason for participation (47%). In a subsample of 25 children, the percentage of agreement of a 1-week test-retest equaled or exceeded 72% for all answers.

ISSN:0196-206X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This study evaluated the relationships between maternal smoking during pregnancy and 10-year-old children's performance on measures of learning, memory, and problem-solving. In this prospective cohort study, mothers were recruited from an urban prenatal clinic in 1982 and 1983 and observed from their fourth prenatal month until the time of the study. At the 10-year visit, 593 children and mothers were evaluated. The prevalence of tobacco use was high in this cohort: 54.3%, 53.3%, and 60% of the women smoked in the first trimester, third trimester, and 10-year assessment, respectively. After controlling statistically for other prenatal substance use, current tobacco, other substance use variables, and multiple sociodemographic covariates, prenatal tobacco exposure was significantly associated with deficits in learning and memory. Specifically, prenatal tobacco exposure was associated with deficits in verbal learning and design memory, as well as slowed responding on a test of eye-hand coordination. In addition, these children demonstrated a reduced ability for flexible problem solving and more impulsivity, as indicated by an increase in perseverative responses on a card-sorting test. Prenatally exposed children did not show attention deficits or increased activity on a continuous performance test.

ISSN:0196-206X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Few objective data are available regarding infants' night waking behaviors and the development of self-soothing during the first year of life. This cross-sectional study examined 80 infants in one of four age groups (3, 6, 9, or 12 mo) for four nights by using videosomnography to code nighttime awakenings and parent-child interactions. A large degree of variability was observed in parents' putting the infant to bed awake or asleep and in responding to vocalizations after nighttime awakenings. Most infants woke during the night at all ages observed. Younger infants tended to require parental intervention at night to return to sleep, whereas older infants exhibited a greater proportion of self-soothing after nighttime awakenings. However, even in the 12-month-old group, 50% of infants typically required parental intervention to get back to sleep after waking. Results emphasize the individual and contextual factors that effect the development of self-soothing behavior during the first year of life.

ISSN:0196-206X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Chronic fatigue syndrome (CFS) is a controversial diagnosis with unknown cause. Adult studies indicate high rates of psychosocial dysfunction and psychiatric comorbidity. The authors compared three groups of pediatric patients selected by diagnosis-(1) CFS (n = 15), (2) juvenile rheumatoid arthritis (n = 15), and (3) mood disorders (n = 15)-across many psychological measures. CFS subjects had dramatic elevation of the Somatic Complaints subscale (mean T score = 75), whereas the mood disorders group had higher externalizing scores (mean T score = 68) on the Child Behavior Checklist. The CFS subjects missed significantly more school compared with the two control groups. After the onset of CFS, 13 of 15 of the CFS patients required significant educational accommodation. Only 4 of the 15 CFS patients had an Axis I psychiatric diagnosis, as determined by the Computerized Diagnostic Interview for Children. Despite a low rate of psychiatric diagnosis in the CFS sample, these data attest to their psychosocial and school dysfunction.

ISSN:0196-206X    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0196-206X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Frankie is an 8-year-old boy seen in consultation because of school difficulties in second grade and "odd behavior." His family has been concerned about him for the past 2 years, and he has had psychological testing at school. His parents are seeking another evaluation now because they are concerned that his school performance is declining and his self-confidence is decreasing.Frankie was born at term weighing 7 lb, 3 oz. Delivery was complicated by the "cord around the neck," but Apgar scores were 8 and 9, and he had no difficulties in the neonatal period. He went home with his mother. As an infant he was easily soothed and liked to be held. He sat at 6 months, crawled at 8 months, and walked alone at 14 months. He spoke three intelligible words at 1 year and was speaking in sentences by 2 years. He was fully toilet trained by 2 years, 9 months. He had no significant medical illnesses.His parents began to be concerned about Frankie when his preschool teacher noted a concern about his fine motor skills. She remarked also that, although he had no problems socially, he seemed happy to play alone. From a very early age, he liked ropes and often carried around a length of rope as some children carry a blanket. He was never a difficult child or disruptive at home or in his preschool. The only problem his parents have had is that he tends to get extremely involved in a particular activity (watching TV, building with LEGO blocks), and it is very difficult to turn his attention away from that activity to a family task. At the same time, he is also noted to be easily distracted from tasks in which he has less investment.Frankie's father is said to have attention-deficit hyperactivity disorder (ADHD) and learning disabilities, and he is being treated with a selective serotonin reuptake inhibitor (SSRI) for depression. He works as a successful carpenter and builder. A maternal uncle had Down syndrome and died at the age of 17 years as a result of heart disease. There is no other contributory family history. A 12-year-old sister is successful academically and socially. Frankie's mother is a librarian. The grandparents live nearby and share the parents' concerns about Frankie.He was evaluated a year earlier by his pediatrician and thought to have attention deficit disorder, primarily because of distractibility and easy frustration. He is not oppositional but does have emotional outbursts and cries easily when frustrated. He was noted to carry with him a piece of rope and to play with it repetitively. A trial of methylphenidate was considered unsuccessful. An occupational therapy evaluation revealed low muscle tone and difficulty with visual-motor skills and handwriting. He was said to have "sensory integration problems," and twice-weekly occupational therapy interventions were recommended. His parents requested our opinion about this recommendation.Frankie's academic work was considered average by his teacher in all areas, though weakest in spelling and reading. He was particularly strong in oral expression and noted to have excellent vocabulary and knowledge. He hesitated to participate in group activities and frequently needed considerable encouragement. On the other hand, he was noted to be liked by his peers and was not disruptive. His main weaknesses were considered to be in organization and attentional skills. Handwriting is difficult and slow, and thus written work is a particular challenge.His parents noted that Frankie remembers "everything" in detail. He is very talkative and has a great sense of humor. He loves to speak in groups and is "a ham" when given a microphone. He enjoys crafts of all sorts and playing with LEGO blocks. He likes music. His favorite TV programs are educational ones, from which he seems to learn a lot of information easily. He has made several extensive presentations to his class based on what he has learned from such programs. Relationships among all members of the family are said to be excellent. Frankie continues to enjoy playing with ropes and similar objects, and his parents have made some rules to keep this from interfering in family activities. He participates in family and classroom activities.The Behavioral Assessment System for Children (BASC) checklist was completed by both his teacher and his mother. The teacher's responses suggested concerns in the subscales of Anxiety/Depression, Attention, Adaptability, and Atypicality. Social Skills were a notable strength. The mother's responses suggested concerns in Attention, Adaptability, and Social Withdrawal.Frankie's parents and teacher completed a checklist based on the DSM-IV criteria for ADHD. Both parents noted three items among the hyperactivity cluster and five among the inattentive cluster to be "often or very true" for Frankie. His teacher noted four inattentive items and two hyperactivity items to be true.The Woodcock-Johnson Battery revealed a standard score of 100, with particular strength in Short Term Retrieval and relative weaknesses in Auditory Processing and Processing Speed. Math skills, reading, and written language were average, whereas knowledge in all areas was in the superior range. On the WISC-III, Frankie's Verbal IQ was 104 and Performance was 97. The highest subscales were Vocabulary (13) and Similarities (12); the lowest were Coding (6) and Symbol Search (6).On evaluation, Frankie was a pleasant and cooperative young man who participated in all tasks and related appropriately. His neurological examination was normal. He held a pencil or crayon tensely and wrote slowly and laboriously with tremendous pressure. He did not appear to be anxious during the evaluation. He kept a short piece of rope with him at all times and occasionally fiddled with it. He complied with all requests passively and did not initiate conversation or activities. He had no difficulty making transitions from one activity to another even when specifically challenged.There are several discrete conditions that may be applied in this case. Is it in the child's best interest to define which diagnosis fits him best? Is it acceptable to provide the parents and teachers with some guidelines for helping Frankie to succeed in school and at home, and to "wait and see" how he develops over time? Would some practitioners initiate a trial of a pharmacological intervention?

ISSN:0196-206X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Quality of life (QoL) is central to pediatric practice. Where it is possible to manage but not cure a disease, it is important to determine how far treatment and disease compromise the child's QoL. In this way, informed judgments can be made about whether or not treatment is appropriate, and, where there is a choice, which choice might be the best option for the child. In this review, we consider different approaches to measuring child QoL, report a methodological review of measures currently available, evaluate the quality of these measures, and finally consider the implications for the future development and use of QoL measures. Computer searches identified 269 potentially relevant articles, of which 137 were included in the review. Of these, 43 were primarily concerned with the development of a new measure of QoL, 79 reported subsequent development of these same measures, and 15 used a battery approach to measure QoL. All currently available measures have limitations (e.g., limited psychometric data, lack of parallel forms for children and proxy raters, and insufficient attention to children's ability to complete paper-and-pencil measures). However, recommendations are made on the basis of those considered to be most satisfactory. It is essential that attempts be made to use QoL measures in research (e.g., evaluation of clinical trials and alternative treatments) to gain experience that will guide development of a second generation of more sophisticated measures. Despite the practical difficulties identified, measurement of QoL remains of central interest to all those concerned with the well-being of children.

ISSN:0196-206X    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0196-206X    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0196-206X    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0196-206X    

出版商:OVID    

年代:2001

数据来源: OVID