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Biomedical subjects

C K Conners

Publications and source records attributed to C K Conners.

At least 19 recordsLinked to original sources

Complete evaluation of the child identified as a poor listener.

With increasing awareness among educators of the importance of early identification of hearing impairment, growing numbers of children are being referred for evaluation when a teacher or day care supervisor perceives that a child is having difficulty listening. Some children who manifest difficulty listening in a pre-school play group or the classroom may have conductive or sensorineural hearing loss, while others have normal hearing with an underlying and yet-to-be-detected behavioral or psychoeducational disorder. This report presents suggestions for evaluation of the child referred for difficulty listening. The otologist should consider that a child may have an attention deficit disorder when results of initial audiologic assessment indicate there is no hearing loss or when the degree of hearing loss appears to be small in relation to the degree of inattentiveness that has been observed. The features of Attention-deficit Hyperactivity Disorder (ADHD) and Specific Developmental Disorder (SDD) are described, and illustrative case studies are presented. Clues to diagnosis are provided and a distinction between overlapping disorders is made.

Attention

National survey of problems and competencies among four- to sixteen-year-olds: parents' reports for normative and clinical samples.

We compared parent-reported problems and competencies for national samples of 2,600 4-16-year-olds assessed at intake into mental health services and 2,600 demographically matched nonreferred children assessed in a home interview survey. Parents responded to the ACQ Behavior Checklist, which includes 23 competence items, three competence scales, 216 problem items, eight syndrome scales, Internalizing, Externalizing, and total competence and problem scores. Most items and scales discriminated significantly (p less than .01) between referred and nonreferred samples. There were important sex and age differences in problem patterns, but regional and ethnic differences were minimal. Somewhat more problems and fewer competencies were reported for lower- than upper-socioeconomic-status children. Referral rates were similar in the most urban and rural areas, but they were significantly higher in areas of intermediate urbanization. Correlations of problem scores with those obtained 10 years earlier in a regional survey and with surveys in other countries showed considerable consistency in the rank order of prevalence rates among specific problems. Apparently owing to its more differentiated response scales, the ACQ was susceptible to respondent characteristics that reduced its discriminative power below that of the Child Behavior Checklist. Comparisons of procedures for discriminating between the normal and the clinical range supported the value of a borderline category for children who are neither clearly normal nor clearly deviant. Interview data from the survey sample yielded significantly higher ACQ problem scores for children who had fewer related adults in their homes, those who had more unrelated adults in their homes, those whose biological parents were unmarried, separated, or divorced, those whose families received public assistance, and those whose household or family members had received mental health services. Children who scored higher on Externalizing than Internalizing problems tended to have unmarried, separated, or divorced parents and to come from families receiving public assistance. However, among children whose household or family members had received mental health services, there were greater proportions of both Externalizing and Internalizing patterns than among other children.

Adolescent

Replication of empirically derived syndromes as a basis for taxonomy of child/adolescent psychopathology.

To advance the empirical identification of child/adolescent syndromes, principal components analyses were performed on four sets of parents' ratings of 8,194 6- to 16-year-olds referred to American and Dutch mental health services. The following syndromes replicated well for both sexes at ages 6-16: Aggressive, Anxious/Depressed, Attention Problems, Delinquent, Somatic Complaints, and Withdrawn. For both age ranges, a syndrome designated as Socially Inept replicated well among boys, and one designated as Mean replicated well among girls. Evidence was also found for a Schizoid syndrome in all sex/age groups and a Sex Problems syndrome among girls at ages 6-11. Syndrome scores discriminated well between nationwide normative and clinical samples. The replicated syndromes contribute to the empirical basis for a taxonomy of the kinds of disorders commonly seen between the ages of 6 and 16.

Adolescent

Disturbances of brain maturation and neurodevelopment during chronic renal failure in infancy.

Fifteen infants with moderate to severe congenital renal disease were prospectively studied by serial renal, neurodevelopmental, neurophysiologic, and anthropometric assessments. The observation period ranged from 3 to 25 months (mean = 10.9). Eight patients maintained a Mental Development Index (MDI) above the 16th percentile (greater than -1 SD) and comprised group 1. Of the remaining seven patients (group 2), three had an MDI less than 16th percentile when first studied and four had serial decreases of the MDI to less than 16th percentile. Although motor development was more delayed in group 2 at study entry, there were no significant changes of motor performance levels for either group during the study period. Group 2 patients had smaller length (p less than 0.05) and head circumference (p less than 0.05) standard deviation scores in comparison with group 1, and they had higher serum creatinine values (mean = 3.8 vs 1.3 mg/dl, respectively; p less than 0.01). By spectral electroencephalography, the expected progressive increase of the frequency of cerebral cortical background activity with age was demonstrated in group 1 but was not seen in group 2 (multivariate analysis of variance p less than 0.03). This increase of faster-frequency activity was primarily manifested in the left cerebral hemisphere of group 1 patients (p less than 0.01), a finding that was also absent in group 2. The frequent occurrence of neurodevelopmental abnormalities in infants with renal failure is possibly a consequence of impaired dominant hemispheric maturation in the first several years of life, which is clinically manifested as deterioration of cognitive function.

Cephalometry

The independence of hyperactivity from conduct disorder: methodological considerations.

It has been claimed that the childhood behavioural factors "hyperactivity" and "conduct disorder" are highly correlated. The fact that hyperactive symptoms load heavily on the conduct disorder factor has also been used to support the notion that hyperactivity is not an independent behavioural dimension. The present study employs a large sample of combined clinic and normal children to demonstrate that both of these observations are artifacts of methodological technique. When factor score coefficients are used to interpret factors, the hyperactive symptoms do not load on the conduct disorder factor. If factor scores are defined by the use of unit weights, as in previous studies, then the intercorrelation between the hyperactive and conduct disorder factors is high. The use of factor score coefficients to define factors, on the other hand, produces uncorrelated factors. The results support the idea that hyperactivity and conduct disorder are independent behavioural dimensions.

Adolescent

Piracetam and dyslexia: effects on reading tests.

Previous research has suggested that dyslexics treated with piracetam have shown improvements in reading skills, verbal memory and verbal conceptualizing ability, feature analysis, and processing of letter-like stimuli. Two hundred twenty-five dyslexic children between the ages of 7 years 6 months and 12 years 11 months whose reading skills were significantly below their intellectual capacity were enrolled in a multicenter, 36-week, double-blind, placebo-controlled study. Children of below average intelligence, with abnormal findings on audiologic, ophthalmologic, neurologic, psychiatric, and physical examinations, who were emotionally disturbed or educationally deprived and who had recently been treated with psychoactive medication were excluded from the trial. Piracetam was well tolerated, with no serious adverse clinical or laboratory effects reported. Piracetam-treated children showed significant improvements in reading ability (Gray Oral Reading Test) and reading comprehension (Gilmore Oral Reading Test). Treatment effects were evident after 12 weeks and were sustained for the total period (36 weeks).

Child

Piracetam and event-related potentials in dyslexic males.

The effect of piracetam on visual event-related potentials (ERP) was investigated in a double-blind placebo-controlled study. Eight- to 12-year-old dyslexic males were randomly assigned to 3.3 g/day of piracetam or matching placebo in two divided doses over a 12-week period. Children performed a vigilance task in which they pressed a key when two alphabetic letters or shapes occurred in sequence. ERPs to letters and shapes, for active and passive responses, were recorded at the vertex and left and right parietal areas of the scalp. Performance measures included letter- and form-hits, misses, commission errors and reaction times. Piracetam increased the amplitude of a late positive component (believed to correspond to P300) at the vertex for letter-hits. Piracetam also increased the latency of this component in both hemispheres, but only for active responses (letter-hits) in the left hemisphere and passive responses (correct rejections and misses) in the right hemisphere. Although piracetam did not significantly affect performance, reaction time to letter-hits was significantly correlated with the latency of the P300 component, suggesting that letters created increased effort or attentional demand on the subjects compared with forms. An early ERP component (P225) also showed increased amplitude to piracetam in both hemispheres and effects were limited to form-hits. These effects were thought to possibly reflect slow negative potentials arising from stimulus anticipation in the CNV-like paradigm. In view of the small sample size, the results were cautiously interpreted as indicating a facilitation of verbal processing mechanisms responsible for analyzing the verbal significance of visual stimuli.

Brain

Nutrient-behavior research with children: methods, considerations, and evaluation.

Diet-behavior research with children formerly focused on effects of diet regimens, as with additive-free diets for hyperactivity. However, an important new area of investigation includes studies of the immediate effects of individual nutrients, such as sugar, on the behavior and cognition of children. Studies of this type use methods from a variety of disciplines. Competence in the fields of nutrition, behavior, neurochemistry, and metabolism is required to perform the studies. Important components of nutrient-behavior studies include the study hypothesis and subject description (including recruitment and selection). Aspects of the food challenge to consider are challenge formulation, dosage, carrier, background dietary variables, and challenge administration schedule. Dependent measures that are used frequently in the studies include observations of behavior, rating scales, activity monitoring, biochemical measures, laboratory tests of performance and attention, tests of cognitive function, and measures of mood. Familiarity with each of the components and use of specific evaluation guidelines will enable nutrition professionals to critically evaluate the studies.

Body Weight

The effects of piracetam in children with dyslexia.

Following previous research which suggests that piracetam improves performance on tasks associated with the left hemisphere, a 12-week, double-blind, placebo-controlled study of developmental dyslexics was conducted. Six study sites treated 257 dyslexic boys between the ages of 8 and 13 years who were significantly below their potential in reading performance. Children were of at least normal intelligence, had normal findings on audiologic, ophthalmologic, neurologic, and physical examination, and were neither educationally deprived nor emotionally disturbed. Piracetam was found to be well tolerated in this study population. Children treated with piracetam showed improvements in reading speed. No other effects on reading were observed. In addition, improvement in auditory sequential short-term memory was observed in those piracetam-treated patients who showed relatively poor memory at baseline. It is suggested that longer term treatment with piracetam may result in additional improvements.

Adolescent

Imipramine and EEG sleep in children with depressive symptoms.

Depression in children is currently an area of considerable controversy, as is the use of potent psychopharmacologic agents in children. Since EEG sleep techniques have proven to be useful in understanding the mechanisms of depression in adults and in predicting their response to antidepressants, a pilot study employing these techniques was undertaken in a population of hospitalized children. The EEG sleep of 12 children with significant depressive symptomatology was first examined after a two-week drug-free period and again approximately three weeks later when an optimum dose of imipramine had been maintained for at least 7 -- 10 days. Changes in sleep continuity, as reflected in increased wakefulness and a decreased sleep efficiency, as well as an increase in Stage 2 and a decrease in Stage 4 sleep, were observed throughout the entire sample. REM suppression was also noted, but tended to be most pronounced in those children who improved on imipramine.

Adolescent

The acute effects of caffeine on evoked response, vigilance, and activity level in hyperkinetic children.

Seventeen hyperkinetic children who had previously responded to sympathomimetic amines were given three different dosages of caffeine in counterbalanced order (placebo, and low and high doses equivalent to one and three cups of coffee). One hour following ingestions they were tested, double-blind on measures of visual evoked response, alpha time, vigilance, and activity level. There was a significant effect on evoked response. The behavioral measures tended to be affected in a dose-related manner but not to a statistically significant degree. It is concluded that although centrally active, caffeine does not show the congruence between behavioral and central effects that other stimulants useful in behavioral management have shown.

Alpha Rhythm