Temperament in infants and young children.
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Attention Deficit Disorder with Hyperactivity↗
Biomedical subjects
F Oberklaid
Publications and source records attributed to F Oberklaid.
The development of Australian normative data for infant temperament.
Utilizing the revised Infant Temperament Questionnaire previously validated for use with Australian populations, a cohort of 2443 infants aged 4-8 months was studied. This sample was recruited in such a manner as to be representative of all infants of this age group in the State of Victoria. Temperament values obtained differed significantly from American norms on four of the nine temperament dimensions, providing further evidence for the importance of using culturally appropriate norms. There were associations between temperament and problem behaviours and some parent characteristics. The normative values for temperament presented are recommended for use in Australian settings.
Australia↗
Community outreach: an expanding role for hospitals.
Pressures for paediatric institutions to expand their traditional roles have come from changes in morbidity patterns, training requirements and community needs. Planning for new models of health care delivery has led to the development of the Community Outreach Program (COP), a hospital-based model which utilizes existing community resources to provide early intervention services, training in community paediatrics and integration of hospital and community-based health care. A process evaluation of the COP was performed after 18 months operation. Eighty-eight children were seen in a 7 week period, 20% with complex problems requiring further assessment and community consultation. Staff at the community agencies serviced considered the COP to be a major contributor to health care in their areas. Medical trainees developed new assessment techniques and management strategies for children with problems not previously encountered. It appears that the COP is a useful model for the delivery of health care, in particular to disadvantaged communities.
Australia↗
Comparison between children treated at home and those requiring hospital admission for rotavirus and other enteric pathogens associated with acute diarrhea in Melbourne, Australia.
The etiology of acute diarrhea in children less than 42 months of age attending one pediatric hospital in Melbourne, Australia, was studied during a 7-month period encompassing the winter of 1984. Pathogens identified in 157 children treated as outpatients with mild disease were compared with those in 232 children hospitalized with severe disease. The pathogens (and frequencies among outpatients and inpatients, respectively) detected were rotaviruses (32.5 and 50.9%), enteric adenoviruses (8.9 and 7.4%), Campylobacter jejuni (7.2 and 1.3%), and Salmonella sp. (4.0 and 1.7%). Electropherotypes of rotavirus strains from outpatients and inpatients were compared. Two strains predominated during the 7 months of this study and were observed with equal frequency from outpatients and inpatients. Rotaviruses of the same electropherotype caused a wide spectrum of disease, with symptoms ranging from mild to severe, life-threatening diarrhea. The similarity of etiological agents identified from children with mild and severe forms of acute diarrhea suggests that the etiology of community enteric illness can be reasonably inferred from the etiology of inpatient disease in children in the same geographic area. During the winter epidemic period, the severity of symptoms associated with rotavirus infection in young children is likely to be determined by the inherent susceptibility of the host rather than by genetic differences in the strains of infecting rotaviruses.
Acute Disease↗
Temperament of preterm versus full-term infants.
The temperament of a group of preterm infants (n = 126) was studied as part of a large, longitudinal study of infant temperament and behavior in a representative sample of Australian infants (n = 2443). Utilizing the Infant Temperament Questionnaire of Carey and McDevitt, previously revised and validated for an Australian population, ratings were made at 4 to 8 months corrected age, and data for the preterm group (less than 37 weeks gestation) were compared to those infants born at term (37 to 41 weeks). There were no significant differences between the two groups on any of the sociodemographic variables, on the mother's global rating of temperament, or on the reported incidence of colic, sleep problems, and excessive crying. There were also no differences between premature and full-term infants on any of the individual dimensions or clinical categories of temperament. We conclude that prematurity per se does not affect observed temperament at 4 to 8 months. However, we cannot extend these conclusions to high-risk infants who experience medical complications of prematurity, and who require intensive care for prolonged periods of time. These may represent an entirely different category of risk for subsequent difficult temperament and behavior problems.
Humans↗
The assessment of children with school problems: evaluation of a hospital-based multidisciplinary clinic.
A hospital based multidisciplinary clinic for the assessment of children with school problems was evaluated. Questionnaires were sent to parents and teachers of 44 children seen during the first year of operation of the clinic. The majority of parents found the assessment and report valuable in answering their questions about the child; felt the report was clear and helpful, and the recommendations appropriate and practical. Ninety per cent of recommendations made were implemented. These results indicate that such clinics would seem to be an appropriate way to address the needs of children with school problems, an important segment of the new paediatric morbidity.
Adolescent↗
The ritual school health examination: an idea whose time has passed?
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Adolescent↗
Temperament in infants born prematurely.
The temperament of infants born prematurely was studied to examine further the notion that prematurity may be a risk factor for an infant's subsequent social interaction. The Infant Temperament Questionnaire of Carey and McDevitt was revised and revalidated for an Australian population and sent to mothers of infants who had been born prematurely (36 weeks or less) and who were aged 4 to 8 months (corrected for prematurity). Two hundred and twenty-six questionnaires were distributed and 110 (49%) returned. There were no differences between respondents and nonrespondents with respect to gestational age, birth weight, method of delivery, Apgar scores, or perinatal complications. When compared to a control group (N = 240) of infants born at term and who came from families with similar demographic characteristics, infants born prematurely did not differ significantly on any of the nine temperament dimensions. Both groups had similar proportions of "easy," "difficult," and "slow to warm up" infants, and there were no significant differences in maternal global ratings of temperament between the two groups. Comparisons of infants of less than 33 weeks gestation gave results similar to those reported above. These data indicate that infants born prematurely have temperament profiles at 4 to 8 months similar to infants born at term.
Adult↗
Radiological services in a hospital emergency department--an evaluation of service delivery and radiograph interpretation.
Radiological services to the Department of Ambulatory Paediatrics were audited over 1 month. Of a total of 782 separate radiographs, more than two-thirds were performed outside hours when radiologists are normally in the hospital. For only 171 of the 782 radiographs (22%) were there immediate reports by a radiologist. To determine whether the absence of immediate radiologist reports affected clinical care, a process was introduced whereby radiologists reviewed interpretation of radiographs made by resident medical officers (RMO) when no report was available. Over a 5 month period 2888 patients had radiographs when there was no immediate radiologist's report. Comparisons were made between RMO interpretation and ultimate radiologist report in 1411 of these patients. In 232 cases (16.4%) there was a discrepancy between RMO interpretation and radiologist report; 70% of these were false positive (the RMO interpreting a normal film as abnormal) while 71 were false negative (the RMO interpreting an abnormal film as normal). This study demonstrates the utility of a relatively simple quality assurance measure in situations where clinical decisions have to be made in the absence of an immediate radiologist report.
Australia↗
Paediatric telephone consultation--a neglected area of health service delivery.
Telephone enquiries to a large paediatric institution were monitored over a 4 week period. Of the 1764 calls handled during this period (an average of 63 per day), over 75% sought advice regarding symptoms of illness in their children. The commonest were to do with vomiting and diarrhoea, fever, infectious disease, respiratory symptoms and feeding problems. It is suggested that it is no longer appropriate for such calls to be handled in an ad hoc manner as is the custom in most hospitals, but that specific telephone protocols be developed and evaluated to address this important area of paediatric consultation.
Ambulatory Care↗
Temperament in Australian infants.
A convenience sample of 240 infants aged 4-8 months was studied to evaluate the suitability of a revised version of Carey's Infant Temperament Questionnaire (ITQ) for an Australian population. Data analyses indicated all item/dimension correlations significant at P less than 0.01 or better, satisfactory internal consistency of the instrument as measured by alpha coefficients, and test retest reliability of 0.79. Infants rated as having a 'difficult' temperament were significantly more likely to be reported as having problem behaviours. Significant differences were found between Australian and American infants on three of the nine temperament dimensions - rhythmicity, activity and intensity. The results of this study indicate that this revised ITQ is suitable for use with Australian infants.
Australia↗
Children with school problems--an expanding role for the paediatrician.
Children with school problems comprise a significant part of the new paediatric morbidity. There is confusion in terminology and it is suggested that instead of attempting to make a diagnosis of doubtful validity and limited clinical utility, paediatricians focus instead on generating an accurate description of the strengths and weaknesses of these children. When placed in the context of a transactional model of aetiology and function, such an individual difference, nondiagnostic, nonlabelling approach facilitates the development of appropriate intervention strategies, as well as creating a suitable framework for interdisciplinary communication. It is suggested that such a broad based approach to the assessment and management of children with school problems allows the paediatrician to play an important role in enabling these children to fulfil their potential.
Child↗
'Hyperactivity' in childhood.
The management of a 'hyperactive' child entails a thorough individual assessment, close communication with the school, intensive work with the family and the development of an individualised management plan which takes account of the unique circumstances of the child and his or her environment.
Attention Deficit Disorder with Hyperactivity↗
The longitudinal study of findings in childhood. Analysis of an interdisciplinary process.
The Brookline Early Education Project provided periodic diagnostic assessments and individualized educational programs for approximately 300 children enrolled at birth in an attempt to reduce the prevalence of neglected health needs and school problems. A method, The Longitudinal Study of Findings, was developed to monitor and document diagnostic findings (determinations suggesting a possible service need). Each finding was rated for severity, treatability, and predictive value (potential impact on future function). At the 42-month-old check-point, 87% of children had at least one finding; there was a mean of 3.4 findings per child. Only 15% of findings had a high likelihood of treatability, and 12% were rated as highly predictive of later problems. Only 1.1% of findings were highly predictive and highly treatable. Whole certain categories of findings tended to prevail in isolation, others tended to coexist in the same child.
Child Health Services↗
Hyperactivity - the elusive syndrome.
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Child↗
An analysis of observed attention and activity patterns in preschool children.
An activity-attention scale was incorporated into the Pediatric Examination of Educational Readiness to determine whether performance of age-appropriate tasks would elicit or provoke attentional weakness or activity level modulation in a sample of prekindergarten children. Thirty-three (9.8%) of the 338 children met the criteria of weak attention and/or increased activity at one time during the assessment, and 18 (5.3%) met the criteria at two or more times. The "flagged" children were more likely to be boys and to have other developmental findings, lower McCarthy scores, and teacher concerns. Significant fluctuation of attention was noted commonly during the sessions. Furthermore, difficulty in interrater scoring of severity was demonstrated. This study underscores the variability and complexity of attention and activity findings, and confirms the need for direct observation as well as integration of information from all available sources.
Attention↗
Developmental output failure: a study of low productivity in school-aged children.
Children with low academic productivity in late elementary and junior high school present a vexing problem to parents and schools. A subgroup of these youngsters may have underlying subtle handicaps that result in reduced productivity and chronic underachievement. Such children may be clinically characterized as exhibiting "developmental output failure." Using parent and teacher questionnaires, educational achievement tests, and pediatric neurodevelopmental assessments, a group of 26 children was selected according to predetermined criteria from among the clinic population seen in The School Function Program at The Children's Hospital Medical Center. Common findings among the group included problems with expressive language, fine motor tasks, finger agnosia, attention, and retrieval memory. It is suggested that clinicians be aware of the possibility that a child in this age group with low academic work output may have underlying developmental dysfunctions, whose manifestations may not have been evident earlier in life.
Achievement↗
Evaluation of a multidimensional assessment procedure for preschool children.
The Pediatric Examination of Educational Readiness was administered to 386 preschool children to determine whether the predictive value of this instrument could be enhanced by the inclusion of systematic measures of processing efficiency, selective attention, behavioral adaptation, and neuromaturation. Findings on these dimensions, as well as the traditional developmental attainment measure, were consistent with McCarthy cognitive scores. Concerns regarding developmental attainment, processing efficiency, and selective attention were more common in children later found to have weak kindergarten mastery skills. Data analysis revealed minimal redundancy and specific additive effects in this multidimensional assessment. It is concluded that such instruments can contribute to a broader, more integrated diagnostic procedure for behavioral and developmental problems.
Attention↗