Biomedical subjects

David W Dunn

Publications and source records attributed to David W Dunn.

At least 19 recordsLinked to original sources

PubMed2005

Media violence exposure and executive functioning in aggressive and control adolescents.

The relationship between media violence exposure and executive functioning was investigated in samples of adolescents with no psychiatric diagnosis or with a history of aggressive-disruptive behavior. Age-, gender-, and IQ-matched samples of adolescents who had no Diagnostic and Statistical Manual of Mental Disorders-fourth edition (DSM-IV; American Psychiatric Association, 1994) diagnosis (N = 27) and of adolescents who had DSM-IV Disruptive Behavior Disorder diagnoses (N = 27) completed measures of media violence exposure and tests of executive functioning. Moderate to strong relationships were found between higher amounts of media violence exposure and deficits in self-report, parent-report, and laboratory-based measures of executive functioning. A significant diagnosis by media violence exposure interaction effect was found for Conners' Continuous Performance Test scores, such that the media violence exposure-executive functioning relationship was stronger for adolescents who had Disruptive Behavior Disorder diagnoses. Results indicate that media violence exposure is related to poorer executive functioning, and this relationship may be stronger for adolescents who have a history of aggressive-disruptive behavior.

Adolescent↗

PubMed2004

Measuring stigma in children with epilepsy and their parents: instrument development and testing.

PURPOSE: The goal of this work is to describe psychometric properties of two scales measuring perceived stigma in children with epilepsy and their parents. METHODS: Data were collected for the parent scale in two samples: parents of 173 children with epilepsy and of 224 children with new-onset seizures. The child scale was tested in the chronic sample. Content validity, internal consistency reliability, and construct validity were tested. RESULTS: Both scales had strong internal consistency reliability and construct validity. Higher scores were associated with greater seizure severity scores. In the parent scale, lower scores were associated with more positive mood, less worry, and more family leisure activities. In the child scale, higher scores were correlated with more negative attitude, greater worry, poorer self-concept, and more depression symptoms. CONCLUSIONS: Both scales were found to have strong psychometric properties. They are short, and items are easy to understand. These scales have potential for use in research and in the clinical setting to measure stigma.

Adolescent↗

PubMed2004

Maternal adaptation to a child's epilepsy.

Mothers of children with epilepsy are at risk for problems in adapting to their child's condition; however, factors associated with maternal adaptation to a child's epilepsy have not been well articulated. The purpose of this study was to investigate the associations among maternal and child characteristics, maternal beliefs, and maternal adaptation outcomes. A conceptual model was formulated based on the literature. Maternal beliefs were proposed to mediate the relationships between maternal and child characteristics and maternal adaptation outcomes. A sample of 156 maternal-child dyads provided data via structured telephone interviews. Multiple regression analysis was used to test for additive and mediated relationships. Mediation was not supported statistically. Child behavior problems, maternal satisfaction with family, and maternal learned helplessness had the strongest associations with maternal outcomes, suggesting that maternal adaptation to a child's epilepsy is complex and includes multiple factors in addition to the child's seizure condition.

Adaptation, Psychological↗

PubMed2004

Differential diagnosis and treatment of psychiatric disorders in children and adolescents with epilepsy.

Behavioral problems, such as the inattentive form of attention-deficit hyperactivity disorder (ADHD), anxiety, and depression, are common in children and adolescents with epilepsy and especially associated with central nervous system damage, family dysfunction, and severe seizures. This article discusses the risk factors to be considered when focusing on the prevalence of behavioral problems, the family factors that influence their incidence, as well as the differential diagnosis of behavioral disorders commonly associated with epilepsy. It also considers the assessment of these behavioral disorders and their treatment with psychotherapy, education, and a variety of psychopharmacological agents.

Adolescent↗

PubMed2004

Behavioral issues involving children and adolescents with epilepsy and the impact of their families: recent research data.

OBJECTIVE: Using data from a larger study on new-onset seizures, we reported preliminary findings concerning relationships between family factors and child behavioral problems at baseline and 24 months. We also explored which baseline and changes in family factors were associated with changes in child behavioral problems over the 24-month period. METHODS: Subjects were 224 children and their primary caregivers. Data were collected using structured telephone interviews and analyzed using multiple regression. RESULTS: Deficient family mastery and parent confidence in managing their child's discipline were associated with behavior problems at baseline and at 24 months; they also predicted child behavior problems over time. Decreasing parent confidence in disciplining their child was associated with increasing child behavior problems. Decreases in parent emotional support of the child were associated with increases in child internalizing problems. CONCLUSION: Child behavior problems, family environment, and parenting behaviors should be assessed when children present to the clinical setting with new-onset seizures.

Child↗

PubMed2004

Neuropsychological predictors of academic underachievement in pediatric epilepsy: moderating roles of demographic, seizure, and psychosocial variables.

PURPOSE: Academic underachievement is common in pediatric epilepsy. Attempts to identify seizure and psychosocial risk factors for underachievement have yielded inconsistent findings, raising the possibility that seizure and psychosocial variables play a complex role in combination with other variables such as neuropsychological functioning. This study cross-validated a neuropsychological measurement model for childhood epilepsy, examined the relation between neuropsychological functioning and academic achievement, and tested the degree to which demographic, seizure, and psychosocial variables moderate that relation. METHODS: Children with chronic epilepsy (N = 173; ages 8 to 15 years; 49% girls; 91% white/non-Hispanic; 79% one seizure type; 79% taking one medication; 69% with active seizures) completed a comprehensive neuropsychological battery. Children diagnosed with mental retardation were excluded. RESULTS: Structural equation modeling identified a three-factor measurement model of neuropsychological function: Verbal/Memory/Executive (VME), Rapid Naming/Working Memory (RN/WM), and Psychomotor (PM). VME and RN/WM were strongly related to reading, math, and writing; PM predicted writing only. Family environment moderated the impact of neuropsychological deficits on writing (p < or = 0.01) and possibly for reading (p = 0.05); neuropsychological deficits had a smaller impact on achievement for children in supportive/organized homes compared with children in unsupportive/disorganized homes. CONCLUSIONS: These findings lend partial support for our theoretical model showing direct effects of neuropsychological function on achievement and the moderating role of family factors. This study suggests that a subgroup of children with epilepsy (those who have not only neuropsychological deficits but also disorganized/unsupportive home environments) are particularly at risk for adverse academic outcomes. Implications for intervention are discussed.

Adolescent↗

PubMed2004

Development of syndrome severity scores for pediatric epilepsy.

PURPOSE: A severity rating for each of the pediatric epilepsy syndromes can contribute to a more comprehensive understanding of seizure condition severity. We describe the development of the Epilepsy Syndrome Severity Scores-Child (ESSS-C). METHODS: The Delphi Technique was used to establish severity scores for pediatric epileptic syndromes as defined by the International League Against Epilepsy (ILAE). Pediatric neurologists with expertise in epilepsy were asked to rate the severity of each syndrome on a scale of 1 to 10, considering: (a) response to medical treatment, (b) seizure severity, and (c) long-term prognosis. Syndrome severity ratings took place in four different rounds. Experts provided initial scores in rounds 1 and 2. RESULTS: Of the 18 experts who agreed to participate in the development of the scale, 12 completed all four rounds. The median served as the syndrome severity score if the mean and median agreed within 0.5. Otherwise, whichever of these two numbers was closest to the mode was selected. Syndromes that were rated with high severity scores (9 or 10) or low severity scores (1 or 2) had unanimous or near unanimous ratings. The syndromes with scores in the middle range (4 to 8) had a wider range of ratings. CONCLUSIONS: If further studies provide empirical support for the validity of these epileptic syndrome severity scores, then the ESSS-C has potential for use both clinically and in future research in the prediction of outcomes of treatments.

Age Factors↗

PubMed2004

Diagnosis and management of depression and psychosis in children and adolescents with epilepsy.

The neurologic dysfunction underlying epilepsy can predispose patients to psychiatric disorders, and the incidence of both depression and psychosis is increased in people with epilepsy. Depressive disorders are the most frequently recognized psychiatric comorbidities in people with epilepsy, but depression in children can be particularly difficult to recognize. Clinicians need to inquire about not only classic symptoms of depression such as anhedonia but also less obvious symptoms such as unprovoked irritability, unsubstantiated complaints of lack of love from family members, somatic complaints, and problems with concentration and poor school performance. The diagnosis of depressive disorders in children with epilepsy and mental retardation is even more difficult. Physicians need to be alert for the presence of iatrogenic depression, which may result from antiepileptic drugs or epilepsy surgery. People with epilepsy are also at increased risk for psychosis, which can be interictal, postictal, or (rarely) an expression of ictal activity. This psychosis can be related to seizure remission (ie, alternative psychosis) or iatrogenic (eg, related to antiepileptic drugs or following temporal lobectomy). Although both antidepressants and antipsychotic drugs have the potential to lower the seizure threshold and increase seizures, careful drug selection, dosing, and slow titration can minimize this risk, allowing treatment to proceed.

Adolescent↗

PubMed2003

Depression in children and adolescents.

Depression is a common problem in children and adolescents. The disorder may be overlooked because of the prominent irritability seen in children with depression and because of the perception that moodiness is a normal phase of childhood. Depression frequently is associated with other psychiatric problems and neurologic disorders. Therapy consists of psychotherapy and medication, with SSRIs the first choice for pharmacotherapy.

Adolescent↗

PubMed2003

Attention-deficit/hyperactivity disorder in children and adolescents.

ADHD is a common developmental disorder frequently associated with additional neurologic and psychiatric disorders. Stimulant medication is an effective first-line therapy for most children with ADHD. Current research is defining the genetic and neurobiologic basis for this disorder.

Adolescent↗

PubMed2003

Learning disorders.

Three broad areas of LDs are recognized in the DSM-IV (RD, mathematics disorder, and disorder of written expression), and many atypical LDs (such as NVLD) also may be found in children with academic underachievement. These disorders are defined by a significant discrepancy between a child's intellectual (learning) ability and specific area of academic achievement, based on individual psychologic testing. Interventions for these disorders begin with careful evaluation and testing, followed by meetings at the school and development of an IEP. The recommendations of the IEP are performed in the school setting, whereas additional interventions may be sought at private learning clinics. Specific treatments for RD have been well defined, whereas those for other LDs must be tailored to match the strengths and weaknesses of the child. Although it is rare for individuals to completely outgrow the academic weaknesses characteristic of an LD, their performance in the area of weakness often can be improved markedly with appropriate interventions.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

A prospective study of teachers' ratings of behavior problems in children with new-onset seizures.

The purpose of this study was to explore the association between seizures and behavior problems in children with new-onset seizures using teachers' ratings of behavior. Subjects were 209 children with new-onset seizures and 93 children with asthma. Teacher ratings of behavior were collected prospectively over 24 months to determine differences between children with recurrent seizures, children without recurrent seizures, and children with asthma. During the 2-year period, 155 (74%) children had at least one recurring seizure. Data were analyzed using repeated-measures analysis of variance both with and without covariates. Controlling for covariates, children experiencing recurrent seizures had higher Total (P=0.002) and Internalizing (P=0.018) Behavior Problems scores across all times than those not experiencing recurrent seizures. Children with asthma were similar to children not experiencing recurrent seizures. The association between seizures and behavioral problems was supported using behavioral ratings from teachers.

Adolescent↗

PubMed2003

Neuropsychiatric aspects of epilepsy in children.

Children with epilepsy are at increased risk of behavioral and emotional problems compared with both children from the general population and children with other chronic illnesses not involving the central nervous system. Risk factors are multiple and include additional neurological impairment, intractable seizures, and family dysfunction. The case of Peter is used to illustrate the neuropsychiatric aspects of epilepsy and to discuss possible interventions for the child with epilepsy and psychiatric problems.

Child↗

PubMed2003

Behavior and mental health problems in children with epilepsy and low IQ.

The purpose of this cross-sectional descriptive study was to describe the particular types of behavioral problems, self-concept, and symptoms of depression experienced by children with both low IQ and epilepsy. Three groups of children (83 males, 81 females; mean age 11 years 10 months, SD 1 year 10 months; age range 9 to 14 years) with epilepsy were compared: (Group 1) Low IQ (<85), n=48, 25 males, 23 females; (Group 2) Middle IQ (85 to 100), n=58, 24 males, 34 females; and (Group 3) High IQ (>100), n=58, 34 males, 24 females. The Child Behavior Checklist, Piers-Harris Self-Concept Scale, and Children's Depression Inventory were used to measure behavior, self-concept, and depression respectively. Results indicated that children in the Low IQ group had the most behavioral and mental health problems. Additionally, there were IQ group-by-sex interactions, with females in the Low IQ group being at the highest risk for poor self-concept. Findings suggest that children with both epilepsy and low IQ should be carefully assessed for mental health problems in the clinical setting.

Adolescent↗

PubMed2003

ADHD and epilepsy in childhood.

Attention-deficit-hyperactivity disorder (ADHD) has been associated with childhood epilepsy; prevalence figures have ranged from 8 to 77%, depending on the sample studied and the criteria used for diagnosis. In the general population the prevalence of ADHD is approximately 5%, with the majority of affected children having ADHD combined type. As part of a larger study of behavioral problems in children with epilepsy, we assessed 175 children (90 males, 85 females; age range 9 to 14 years, mean age was 11 years 10 months, SD 1 year 8 months) for evidence of ADHD. The children had at least a 6-month history of epilepsy. The primary caregiver completed both the Child Behavior Checklist (CBCL) and the Child Symptom Inventory-4 (CSI) or Adolescent Symptom Inventory-4 (ASI). On the CBCL, the mean attention problem T score was 64.6 (SD 10.5) for adolescents and 67.9 (SD 11.6) for children. On the CSI or ASI, 20 of 175 children met DSM-IV criteria for ADHD combined type; 42 of 175 had ADHD predominantly inattentive type; and 4 of 175 met criteria for ADHD predominantly hyperactive-impulsive type. There were significant correlations between the CBCL attention score and inattention (r = 0.68) and hyperactivity-impulsivity (r = 0.59). Sex, seizure type, and focus of seizure discharge were not predictors of symptoms of ADHD. Children with epilepsy are at risk for symptoms of ADHD. They differ from other samples of children with ADHD by the higher proportion of children with ADHD predominantly inattentive type and by an equal male: female ratio.

Adolescent↗

PubMed2002

Progressive behavioral changes in children with epilepsy.

Children with epilepsy are known to have high rates of mental health problems. The role of seizures in the development of these problems is not known primarily because of difficulties in separating the effects of seizures from the three other potential causal factors: (a) poor child and family response to the condition, (b) side effects of antiepileptic medication, and (c) neurological dysfunction that causes both the seizures and the behavioral problems. Although cross-sectional studies focusing on children with chronic epilepsy show associations between behavior problems and each of these causal factors, it is not possible to isolate the effects of any one causal factor using this design. A stronger approach is to conduct prospective studies of children with new-onset seizures. Recent research on children with new-onset seizures suggests that side effects of antiepileptic medication and poor child and family response do not play major roles in the development of behavior problems. Results from a prospective study in children with new-onset seizures show an association between seizures and behavior problems. Separating effects of seizures from effects of neurological dysfunction on behavior problems, however, will be difficult even in prospective studies of children with new-onset seizures. Transient cognitive impairment (TCI) from interictal epileptiform discharges is proposed as an alternative explanation for behavior problems.

Adolescent↗

PubMed2002

Recurrent seizures and behavior problems in children with first recognized seizures: a prospective study.

PURPOSE: Children with epilepsy have high rates of behavior problems. The purpose was to describe prospectively the association of seizures and behavior problems in children with new-onset seizures. METHODS: Subjects were 224 children with new-onset seizures (aged 4-14 years) and 159 siblings (4-18 years). Caregiver's ratings of the behavior were collected 4 times: at baseline, and at 6, 12, and 24 months. During the 2-year period, 163 (73%) children had at least one additional seizure, and 61 (27%) had none. Data were analyzed by using repeated measures analysis of variance both with and without covariates [site, age, gender, race, caregiver education (years), and seizure medications]. RESULTS: On average, children had higher CBCL Total and Internalizing Behavior Problems scores across all times when experiencing recurrent seizures than when not experiencing recurrent seizures (Total Problems, p = 0.041, controlling for demographics and seizure medications). Siblings had significantly lower Total and Internalizing Problems scores than both children experiencing (Total Problems adjusting for covariates, p = 0.0001) and not experiencing recurrent seizures (p = 0.0004). Externalizing Problems scores were not significantly different among children with recurring seizures, children without recurring seizures, and siblings. CONCLUSIONS: Recurrent seizures significantly predicted behavior problems very early in the course of a seizure condition, even when key child, demographic, and seizure variables were controlled. Explanations for these findings include the possibilities that both seizures and behavior problems are caused by an underlying neurological disorder, that seizures per se disrupt behavior, or that children have negative psychological responses to seizure activity.

Adolescent↗

PubMed2002

Teacher assessment of behaviour in children with new-onset seizures.

RATIONALE: Recent data suggest that children with new-onset seizures may be at increased risk for behaviour problems. Teachers are an excellent source of data about such problems. They do not have the potential bias that a parent worried about a new onset of seizures might have and, furthermore, they are accustomed to comparing performance of children and work in an environment in which the behavioural problems associated with epilepsy may be quite evident. We obtained teachers' reports of behaviour problems in children in the 2 months prior to their first recognized seizure. We also obtained similar data on children with new-onset, moderate severity asthma. In addition to comparing behavioural scores between children with seizures and children with asthma, we compared teachers' assessments of behaviour in children with no prior seizures to those of children with previously unrecognized seizures. METHODS: We evaluated 192 children with new-onset seizures, including 129 children with no prior episodes and 63 children with recognized prior seizure-like episodes. The comparison group consisted of 78 children with new-onset, moderate severity asthma. Behaviour was assessed by the teacher's report form (TRF) of the child behaviour checklist (CBCL) or the caregiver-teacher report form for ages 2-5 (C-TRF). Mean scores were compared by two-sample t -tests and analysis of variance (ANOVA). RESULTS: The children with new-onset seizures had more thought problems than children with asthma. In comparison to children with no prior seizures, the children with prior unrecognized seizures had higher scores in total behaviour problems, internalizing problems, somatic complaints, anxious/depressed, thought problems, and attention problems. CONCLUSIONS: In this sample, children with prior unrecognized seizures were already at increased risk of teacher-rated behaviour problems before starting medication and before any possible stigma effects related to seizures. This sequence suggests underlying neurological problems causing both behavioural problems and seizures.

Adolescent↗