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PubMed1999

Factors affecting the reliability of clinical judgments about the function of children's school-refusal behavior.

Conducted two studies to examine the interrater reliability, test-retest stability, and the effect of various clinician variables, such as years of clinical experience, theoretical orientation, and prior experience with children, on clinical judgments about the reinforcement functions of children's school-refusal behavior. Results indicated that the judgments by individual clinicians were of questionable reliability. Judgments aggregated across 3 clinicians yielded acceptable interrater and test-retest reliability in Study 1, but a greater number of clinicians were necessary to achieve acceptable reliability in Study 2. Years of clinical experience and training were the only clinician variables related to the reliability of judgments about reinforcement functions. Several recommendations for the clinical assessment of the function of children's school-refusal behavior are discussed.

Adolescent↗
PubMed1985

Suicidal adolescents: factors in evaluation.

Suicide attempts among adolescents are occurring more frequently and their evaluation is a difficult task. The factors related to suicide attempts in eighty-two adolescents, ages 12 to 18 were examined. They had been admitted to the adolescent unit of a large, urban general hospital for evaluation of self-destructive behavior. A systematic review of the patients' charts was performed to gather information about family structure, functioning in school, suicidal risk, degree of depression, and stressful life events. Although most were moderately depressed, a significant proportion denied having tried to harm themselves. While some repressed their anger, the majority expressed anger openly, tended to feel sad and to carry out premeditated as well as more serious suicide attempts. Most had experienced family disruption, and nearly half were functioning poorly in school. Suicide risk correlated only with current stress, while depression correlated with life-long as well as current stress. Results suggest that identification of the suicide attempt and the contributory factors, especially the degree of overt anger and depression, are crucial in deciding appropriate interventions, providing adequate treatment, and avoiding recurrence.

Adolescent↗
PubMed1993

High, usual and impaired functioning in community-dwelling older men and women: findings from the MacArthur Foundation Research Network on Successful Aging.

The objective of this study is to determine the range of complex physical and cognitive abilities of older men and women functioning at high, medium and impaired ranges and to determine the psychosocial and physiological conditions that discriminate those in the high functioning group from those functioning at middle or impaired ranges. The subjects for this study were drawn from men and women aged 70-79 from 3 Established Populations for the Epidemiologic Study of the Elderly (EPESE) programs in East Boston MA, New Haven CT, and Durham County NC screened on the basis of criteria of physical and cognitive function. In 1988, 4030 men and women were screened as part of their annual EPESE interview. 1192 men and women met criteria for "high functioning". Age and sex-matched subjects were selected to represent the medium (n = 80) and low (n = 82) functioning groups. Physical and cognitive functioning was assessed from performance-based examinations and self-reported abilities. Physical function measures focused on balance, gait, and upper body strength. Cognitive exams assessed memory, language, abstraction, and praxis. Significant differences for every performance-based examination of physical and cognitive function were observed across functioning groups. Low functioning subjects were almost 3 times as likely to have an income of < or = $5000 compared to the high functioning group. They were less likely to have completed high school. High functioning subjects smoked cigarettes less and exercised more than others. They had higher levels of DHEA-S and peak expiratory flow rate. High functioning elders were more likely to engage in volunteer activities and score higher on scales of self-efficacy, mastery and report fewer psychiatric symptoms.

Activities of Daily Living↗
PubMedDate not supplied

Return to school as an outcome measure after a burn injury.

Outcome measures have become an important tool to assist with monitoring the efficacy of burn care. One such measurement for children is the time required for them to return to school, as well as their behavior and academic performance in school after a burn injury. The purpose of this study was to relate demographic data with return-to-school time and school performance. Through medical record review and interviews with patients, parents, and school teachers, information was obtained regarding the patient's burn injury, as well as home and school status before and after the burn injury. School information before the burn injury was obtained after patient admission. Schools were contacted 6 months after hospital discharge for data after the burn injury. Thirty-four patients aged 6 to 16 years had their outcomes evaluated from September 1993 to June 1995. Average total body surface area burned was 25.9%; the mean area of full-thickness burn was 17.5%. Length of stay averaged 30.8 days. Sixty-five percent of patients were discharged with splints, and all were discharged with a pressure program. Children returned to school an average of 7.4 days after discharge, and the average number of missed school days was 22. Thirty-four percent of the children had a school reentry visit, and either a phone call, written material, or both were provided in lieu of a visit to the other schools. For this population, burn injury did not appear to impact outcome negatively as it related to a child's return or function in school. These children returned to school rather rapidly after discharge and functioned as well or better after injury. Little loss of grade was noted, and only those children with problems in school before the burn injury had problems after the burn injury. Contact with the child's school before reentry might have assisted with the smooth transition.

Adolescent↗
PubMed1998

Neurobehaviour of school age children born to diabetic mothers.

AIM: To study the neurobehavioural effects that diabetes during pregnancy might have on children by school age. METHODS: The neurobehavioural function of 57 school age children born to 48, well controlled diabetic mothers was compared with 57 control children matched for age, birth order, and parental socioeconomic status, using several cognitive, behavioural, sensory and motor neurological tests. RESULTS: The IQ scores of the index group children were similar to those of control children (117.7 +/- 13.4 vs 118.5 +/- 10.1). There were no differences between the groups in various sensory motor functions. However, the index group children performed less well than the controls on indices of fine and gross motor functions, as observed on the Bruininks-Oseretzky test of motor proficiency. The scores of children born to diabetic mothers were higher than controls on the Touwen and Prechtl neurological examination. They also performed worse in the Pollack tapper test which is designed to detect minor neurological deficits, inattention, and hyperactivity. The index children had higher scores on the Conners abbreviated parent-teacher questionnaire which measures hyperactivity and inattention. There was a negative correlation between the performance of the index group children on various neurodevelopmental and behavioural tests and the severity of hyperglycaemia, as assessed by blood glycosylated haemoglobin and acetonuria. CONCLUSIONS: Diabetes during pregnancy adversely affects some fine neurological functions in children at school age, but not their cognitive scores. These effects are not correlated with the degree of glycaemic control.

Child↗
PubMed1998

A family based model of Hispanic adolescent substance use.

While adolescent substance use has been the focus of extensive research over the last few decades, Hispanic adolescent substance use has received only limited attention. Studies exploring predictors of Hispanic adolescent substance use have failed to adequately explore the contribution of the family on substance use. The present study examined the relative influence of family, school and peer influences, perceived student substance use, family substance use, and acculturation on a sample of Mexican-American early adolescents using structural equations modeling. The findings varied for males and females. Family functioning and family use directly influenced substance use for males. Family functioning influenced school and peer variables, however, these were unrelated to use. For females, family use and student use directly influenced substance use. Family functioning influenced family use and school and peer attachments. School and peer attachment predicted perceived student use. These findings suggest that family functioning has a primary role in Hispanic adolescent substance use.

Adolescent↗
PubMed1999

Short-term effect of ozone on the pulmonary function of children in primary school.

The objective of this study was to evaluate the short-term effect of ambient air pollution on the pulmonary function of schoolchildren. We sampled 941 children in primary school in three communities in Taiwan (Sanchun, Taihsi, and Linyuan). The nearby stations of the Taiwan air quality monitoring network provided the hourly ambient concentrations of sulfur dioxide, carbon monoxide, ozone, particulate matter < or = to 10 microm in aerodynamic diameter, and nitrogen dioxide. Spirometry was performed once for each sampled child. We also obtained the status of indoor air pollution and chronic respiratory disease history by using a structured questionnaire. Multivariate linear model analysis was used to evaluate pulmonary function effects of each pollutant in addition to determinants of indoor air pollution and meteorologic conditions. We found a significantly negative association of peak O(3) concentration on the day before spirometry with individual forced vital capacity and forced expiratory volume in 1 sec. The decrease in children's lung function can occur at peak hourly O(3) concentrations < 80 ppb. The slope of lung function decrease for Taiwanese children is approximately 1 mL/ppb for peak hourly O(3) exposure.

Adolescent↗
PubMed2002

Clinical relevance of electroconvulsive therapy (ECT) in adolescents with severe mood disorder: evidence from a follow-up study.

Given the limited knowledge on the long-term outcome of adolescents who receive electroconvulsive therapy (ECT), the study aimed to follow-up adolescents treated with ECT for severe mood disorder. Eleven subjects treated during adolescence with bilateral ECT for psychotic depression (n = 6) or mania (n = 5), and ten psychiatric controls matched for sex, age, school level, and clinical diagnosis, completed at least 1 year after treatment a clinical and social evaluation. Mean duration between time of index episode and time of follow-up evaluation was 5.2 years (range 2-9 years). At follow-up: (1) all patients except two in the control group received a diagnosis of bipolar disorder. (2) Fifteen patients had had more than one episode of mood disorder. (3) The two groups did not differ in social functioning nor school achievement. (4) Impact on school achievement was related to the severity of the mood disorder rather than ECT treatment. The results suggest that adolescents given ECT for bipolar disorder, depressed or manic, do not differ in subsequent school and social functioning from carefully matched controls.

Achievement↗
PubMedDate not supplied

Motor and sensory impairments in children with intractable epilepsy.

During a 3-year period (1988-1991), 72 children with severe intractable epilepsy were studied. A standardized protocol for assessment of motor and sensory function was designed for school age children. Function was quantified on a 4-point scale on 47 items, including gross motor function, balance, coordination, strength, range of motion (ROM), velocity, fine motor function, sensation, perception, and neurologic tests. Classification of handicaps according to World Health Organization (WHO) definitions was performed. Videotape documentation completed the assessment. Evaluation of treatment services showed that provision of rehabilitation services had been insufficient and provided only for children with additional major movement disorders, mainly cerebral palsy (CP) cases. To minimize the handicap in children with severe epilepsy, it is essential to clarify the total sensorimotor impairment pattern, including balance, coordination, and perceptual capacity. Impairments in these functions are, as shown in this study, frequent and exist independent of major disabilities such as mental retardation or cerebral palsy. When several neuroimpairments were identified, a multiplicative rather than an additive effect on the total handicap was evident.

Adolescent↗
PubMedDate not supplied

Psychosocial and neuropsychological function in children with epilepsy.

This paper reviews the psychosocial and neuropsychological effects of epilepsy on children and families across environments in which children function, specifically home and school. Epilepsy is a chronic disorder, affecting one percent of the population, that alters neurocognitive functioning effecting learning, memory and family adaptation. A review of epilepsy and its impact on quality of life, family and school function and psychiatric comorbidity are discussed.

Cognition Disorders↗
PubMed1995

Social competence in the school setting: prospective cross-domain associations among inner-city teens.

In this 6-month prospective study of 138 ninth-grade inner-city students, associations among different aspects of school-based social competence were examined. In addition, links between initial emotional adjustment and subsequent social competence at school were explored. Aspects of social competence examined included academic achievement, peer reputation, and teacher-related classroom behaviors. Emotional adjustment was measured based on self-reported internalizing and externalizing symptoms. Consonant with views positing continuity and coherence of development, high temporal consistency was found within each social competence domain. In addition, superior adjustment in one domain was sometimes associated with subsequent improvements in other spheres as well. Exceptions found to this pattern were that (a) both as an antecedent and as a consequent variable, peer-rated sociability was negatively linked with other indices of school-based functioning, and (b) among girls, high anxiety was related to improved performance at school over the year. Ecological influences in adolescent adjustment are discussed, and implications of the findings for future research are explored.

Adolescent↗
PubMed1989

Cognitive-behavioral therapy and relationship therapy in the treatment of children referred for antisocial behavior.

The present study evaluated alternative treatments for children (N = 112, ages 7-13) referred for severe antisocial behavior. Children were randomly assigned to one of three treatments: problem-solving skills training (PSST), problem-solving skills training with in vivo practice (PSST-P), which included therapeutically planned activities to extend training to settings outside of treatment, or client-centered relationship therapy (RT). PSST and PSST-P children showed significantly greater reductions in antisocial behavior and overall behavior problems, and greater increases in prosocial behavior than RT children. These effects were evident on measures obtained immediately after treatment and at a 1-year follow-up, and on measures of child performance at home and at school. PSST-P children showed greater changes than PSST children on measures of functioning at school at posttreatment, but these differences were no longer evident at follow-up. Children in both PSST conditions showed significant reductions in deviant behavior and improvements in prosocial behavior from pretreatment to follow-up, whereas RT children tended to remain at their pretreatment level of functioning. Notwithstanding the significant improvements, comparisons with nonclinic (normative) samples revealed that the majority of youth remained outside of the normal range of deviant behavior. Possible directions for improving treatment for antisocial youth are highlighted.

Adolescent↗
PubMed1979

Occupational therapy roles and functions in the education of the school-based handicapped student.

This article presents current roles and functions of the school-based occupational therapist that were identified through data analyses of surveys conducted during 1978. The major roles emerging from data are evaluation/screening, program planning, implementing intervention programs, supervision, and consultation. Functions of occupational therapy educational management for each of the roles are specified. The findings will be used in the development of competency-based educational programs to prepare the occupational therapist with the specialized competencies needed in the provision of services within school systems.

Persons with Disabilities↗
PubMed1999

The identification of agreed criteria for referral following the dental inspection of children in the school setting.

AIM: To clarify the function of the school based dental inspection. OBJECTIVE: For representatives of the Community Dental Service, General Dental Service and Hospital Dental Service to identify an agreed set of criteria for the referral of children following school dental inspection. DESIGN: Qualitative research methodology used to establish a consensus for the inclusion of referral criteria following dental screening. SETTING: Ellesmere Port, Cheshire, England. MATERIALS: A Delphi technique was used to establish a consensus amongst the study participants on the inclusion of nine possible criteria for referral following dental screening. All participants scored each criterion in the range 1-9, with a score of 1 indicating that referral of individuals with the condition should definitely not take place, and a score of 9 indicating referral should definitely take place. Referral criteria were accepted only if they achieved a group median score of 7 or more, with an interquartile range of three scale points, with the lower value being no less than 7. RESULTS: Four of the nine possible criteria met the agreed group standard for inclusion: 'Sepsis', 'Caries in the secondary dentition', 'Overjet > 10 mm', and 'Registered & caries in the permanent dentition'. CONCLUSION: It is possible to agree clear criteria for the referral of children following the school dental inspection.

Child↗
PubMed1983

Integrating school of community efforts to promote health: strategies, policies, and methods.

The purposeful integration of school and community efforts indeed may be the critical element in a formula to promote the health of school-aged children and youth. Obviously there are numerous strategies, policies, and methods to functionally integrate school and community activities. As concluded by the Director of the U.S. Office of Maternal and Child Health in a paper on "New Policies in School Health": What is required, then, are not new policies in school health, but, a reaffirmation and implementation of policies that have been with us for many years.

Adolescent↗