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Biomedical subjects

David W Dunn

Publications and source records attributed to David W Dunn.

30 records · Page 2Linked to original sources

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

Hydrogen proton magnetic resonance spectroscopy in autism: preliminary evidence of elevated choline/creatine ratio.

Hydrogen proton magnetic resonance spectroscopy is only beginning to be studied in autistic individuals. We report an association between hydrogen proton magnetic resonance spectroscopy choline/creatine ratios and severity of autism as measured by the Children's Autistic Rating Scale (Pearson r = .657, P = .04) in 10 autistic children. Hydrogen proton magnetic resonance spectroscopy choline/creatine ratio measures the concentration of cytosolic choline including free choline used in the synthesis of acetylcholine. Elevation in this ratio has been interpreted as a result of membrane degradation such as caused by a tumor or, alternatively, as a result of choline synthesis associated with increased cellular proliferation. Recent neuropathologic evidence has implicated disruption of acetylcholine transmission in the brains of autistic adults. A case-controlled study of hydrogen proton magnetic resonance spectroscopy choline/creatine ratios is warranted.

Autistic Disorder↗

Media violence exposure and frontal lobe activation measured by functional magnetic resonance imaging in aggressive and nonaggressive adolescents.

OBJECTIVE: To understand better the relation between media violence exposure, brain functioning, and trait aggression, this study investigated the association between media violence exposure and brain activation as measured by functional magnetic resonance imaging (fMRI) in groups of normal adolescents and adolescents with disruptive behavior disorder (DBD) with aggressive features. METHODS: Seventy-one participants underwent neuropsychologic evaluation and assessment of exposure to violent media. Subjects also were evaluated with fMRI while performing a counting Stroop (CS) task. RESULTS: Frontal lobe activation was reduced in aggressive subjects compared with control subjects. In addition, differences in frontal lobe activation were associated with differences in media violence exposure. Specifically, activation during performance of the CS in control subjects with high media violence exposure resembled that seen in DBD subjects. CONCLUSIONS: Our findings suggest that media violence exposure may be associated with alterations in brain functioning whether or not trait aggression is present.

Adolescent↗

Identifying risk factors for maternal depression in families of adolescents with epilepsy.

ISSUES AND PURPOSE: To investigate factors associated with depressive symptoms in mothers of children with chronic seizure disorders. DESIGN AND METHODS: A cross-sectional correlational design was used with a sample of 115 mother-child dyads in families where the child had chronic epilepsy. RESULTS: A three-factor model consisting of family income, satisfaction with family relationships, and presence of child behavior problems explained 32% of the variance in maternal depressive symptoms. PRACTICE IMPLICATIONS: Childhood epilepsy has a negative effect on the mother's mood in many families. Child behavior problems were found to be the strongest predictor of maternal depressive symptoms. Assessing for behavior problems and maternal depression should become a routine part of the family nursing assessment.

Adult↗

Youth With Epilepsy: Development of a Model of Children's Attitudes Toward Their Condition.

A model of children's attitudes toward their epilepsy was tested in 173 children (9-14 years) with epilepsy and their parents. Predictor variables tested were child characteristics, family mastery, child worry, child self-efficacy for seizure management, child psychosocial care needs, and seizure variables. Data were analyzed using structural equation modeling, leading to a revised model in which less child worry, greater family mastery, and greater child seizure self-efficacy were directly related to more child positive attitudes. Discussion focuses on potential targets for psychosocial interventions aimed at improving attitudes toward epilepsy.

Journal Article↗