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Nine-year outcome of the Vermont intervention program for low birth weight infants.

Twenty-four low birth weight children who had received an experimental intervention (LBWE) during the neonatal period, 31 control children who had received no treatment (LBWC), and 36 normal birth weight children were compared. The intervention involved seven hospital sessions and four home sessions in which a nurse helped mothers adapt to their LBW babies. At age 9, LBWE children scored significantly higher than LBWC children on the Kaufman Mental Processing Composite, Sequential, Simultaneous, Achievement, Arithmetic, and Riddles scales, after statistical adjustments for socioeconomic status. The LBWE children had also advanced more rapidly in school than had LBWC children. Parent (Child Behavior Checklist) and teacher (Teacher's Report Form) ratings of school functioning were more favorable for LBWE than LBWC children, with especially strong effects on Teacher's Report Form scores for academic performance and the attention problems syndrome. At age 9, LBWE children were not significantly inferior to normal birth weight children on any measure. These results bear out a progressive divergence between the LBWE and LBWC children that first became statistically significant in cognitive scores at age 3. The findings suggest that the intervention prevented cognitive lags among LBW children and that this eventually had a favorable effect on academic achievement, behavior, and advancement in school. The progression from no significant differences between LBWE and LBWC children on early cognitive and achievement scores to significant and pervasive differences in later functioning argues for long-term follow-up periods to evaluate properly the power of behavioral interventions to compensate for biological risks.

Adaptation, Psychological↗

Yesterday a learner, today a teacher too: residents as teachers in 2000.

Resident physicians spend numerous hours every week teaching medical students and fellow residents, and only rarely are they taught how to teach. They can, however, be taught to teach more effectively. Teaching skills improvement initiatives for residents are taking a more prominent place in the educational literature. Limited evidence now suggests that better resident teachers mean better academic performance by learners. A small but important body of research supports selected interventions designed to improve residents' teaching skills, but not all studies have demonstrated significant educational benefits for learners. An increasing number of valid and reliable instruments are available to assess residents' clinical teaching, including objective structured teaching examinations and rating scales. In all specialties, rigorous research in evidence-based teacher training for residents will help prepare academic medical centers to meet the diverse and changing learning needs of today's physicians-in-training.

Clinical Competence↗

[Specific developmental language disorder: a theoretical approach to its diagnosis, aetiology and clinical symptoms].

AIM: This article presents an updated review about the definition, diagnostic criteria, classifications, etiology and the evolution of the specific language impairment (SLI). DEVELOPMENT: The specific language impairment is characterized by a developmental language delay and an impaired language, that persist over time and it is not explained by sensorial, motor and mental disabilities, neither by psycopathological disorders, socio-emotional deprivation, nor brain injury. The diagnosis is based on exclusional criteria. Some researchers propose different classifications considering the children performance in language comprehension and language production. Genetical linkage to the FOXP2 gen in the SPCH1 region of the chromosome 7 and to the chromosomes 13, 16 y 19 has been reported. The neuroimage studies have shown alterations in the volume and perfusion of some brain structures related to language. The manifestations of SLI may change during the development of the children and may disturb the self-esteem, the academic performance and the social abilities. CONCLUSIONS: The variability in the linguistic and cognitive performance, and the variety in the etiological findings in children with SLI, don't allow to settle the affected population as an homogeneous group. Different theoretical positions have emerged as a consequence of this condition.

Cognition↗

Acute and chronic effects of hypoglycemia on cognitive and psychomotor performance.

The acute and chronic effects of hypoglycemia on cognitive and psychomotor performance are reviewed. Studies involving pediatric and adult subjects, both with and without diabetes were evaluated. The preponderance of studies suggest that hypoglycemia can be an unintended yet frequent result of treatment of patients with IDDM. Significant cognitive and psychomotor deficits were reported even with mild episodes of hypoglycemia. Early age of diabetes onset and frequent episodes of hypoglycemia were found to be highly related to significant deficits in intellectual and academic performance. Patients evidencing performance deficits did not always report symptoms of hypoglycemia. Recovery of cognitive functioning lagged restoration of euglycemia but typically returned to baseline levels of performance. Recommendations for improved patient care are provided.

Cognition↗

[Evaluation of clinical competence in the postgraduate family medicine course, by means of the Structured Objective Clinical Test].

OBJECTIVE: To evaluate the clinical competence of first-year residents on the course specialising in family medicine, by applying a structured objective clinical test (SOCT) for simultaneous assessment of cognitive, affective and psychomotor areas. DESIGN: Observational and descriptive. SETTING: Family medicine clinics in the metropolitan area of Mexico City.Participants. 89 doctors on the specialist course in Family Medicine at the Autonomous University of Mexico (UNAM). MAIN MEASUREMENTS: After prior design of comparison lists, expert validation of content, and design of support material for the evaluation and pilot study, a SOCT with ten themes or sections, eight dynamic and two static, was administered. The cut-off point for competent performance was 60 out of 100, both in each section and in the overall average. The statistical analysis was univariate, using descriptive statistics. RESULTS: The overall average of scores in all sections was under 60. The highest average was 73, in the section for monitoring healthy children. In the five highest-scoring sections, the scattering was lower than in the other five. There were low scores in the family study section. CONCLUSIONS: Academic performance, as evaluated by a SOCT measuring clinical competence, was low. This kind of test enabled clinical competence to be assessed more objectively. Interval evaluation scales need to be tested so as to evaluate better the quality of the performance of clinical activities.

Clinical Competence↗

ODD and ADHD symptoms in Ukrainian children: external validators and comorbidity.

OBJECTIVE: To examine potential external validators for oppositional defiant disorder (ODD) and attention-deficient/hyperactive disorder (ADHD) symptoms in a Ukrainian community-based sample of 600 children age 10 to 12 years old and evaluate the nature of co-occurring ODD and ADHD symptoms using mother- and teacher-defined groups. METHOD: In 1997, parents, children, and teachers participated in extensive clinical assessments using standard Western measures. Four areas of functioning were assessed: child mental health, parent-child interactions, parental well-being, and school/cognitive performance. RESULTS: Mother-defined ODD versus ADHD symptom groups were differentiated by a history of overactivity and tantrums, behavior in school, and maternal anxiety and hostility. Teacher-defined groups were differentiated by conduct problems, internalizing symptoms, mother-child interactions, and paternal alcohol use. The effects of co-occurring ODD and ADHD symptoms were greater than would be expected based on their separate effects for conduct problems, internalizing symptoms, social problems, academic performance, parent-child relations, and marital discord. CONCLUSIONS: Children with ODD versus ADHD symptoms were not significantly different from each other for the majority of variables examined, and group differences were dependent on the rater used to define symptom groups.

Analysis of Variance↗

Joseph Lancaster and behavior modification in education.

In the early 1800s, Joseph Lancaster (1778-1838) developed an inexpensive method of education large numbers of the poor in England. Referred to as the "monitorial system," his method utilized students as monitors who performed many of the tasks normally undertaken by a teacher; it was used to teach classes that often exceeded a thousand students at one time. Student monitors were responsible for teaching and evaluating small groups of individuals in a somewhat regimented fashion. An incentive system was also used in a manner that closely resembles current applications of positive reinforcement in educational settings. Lancaster devised a token economy in which students earned tangible reinforcers for academic performance and deportment. Interestingly, the system spread quickly in the 1800s, and was implemented in many countries throughout the world. Its use declined as a result of both specific sources of dissatisfaction, such as the lack of individualization and dependence upon rote memorization, and general changes in the philosophy of education.

Behavior Therapy↗

Selecting radiology resident candidates.

Radiology resident candidate selection has become a burdensome, subjective, and somewhat arbitrary process. Because the luxury of many well-qualified candidates exists, there is an obligation to select them as honestly, equitably, and objectively as possible. Two years were spent in revising and modifying the resident selection process to make it more uniform and more efficacious. An application scoring form was devised to extract uniform pertinent information from the original application form. Candidates could then be ranked according to a numerical score derived from the form. This allowed easy selection of top candidates to be interviewed. A new interviewing scoring form was developed to include desirable characteristics of resident candidate performance. This form was also devised in such a way as to be easily scored and to allow selection of the top 20 to 25 candidates. These candidates were then ranked by participating faculty members while reviewing their application score forms and their interview forms. Positions for the residency training program were offered according to the ranking. The usefulness of both new forms was evaluated and confirmed by correlating form scores with faculty ranking of academic performance of current residents in the training program.

District of Columbia↗

Predictors of suicide ideation and depression in Hong Kong adolescents: perceptions of academic and family climates.

The unique dimensions of perceptions of school and family contributing to depression and suicide ideation in Hong Kong adolescents were examined in two studies. In Study 1, among 327 Hong Kong Chinese female students ages 13-18, 47% reported some suicide ideation. Suicide ideation was significantly associated with depression, test anxiety, academic self-concept, and adolescents' perceived parental dissatisfaction with academic performance. The correlation between test anxiety and depression was especially high (r = .51). Study 2 examined how three different aspects of perceived family relationship were associated with depression and suicide ideation. Among 371 Hong Kong Chinese adolescents ages 14-20, 52.6% reported suicide ideation. Low levels of family cohesion and support and high levels of parent-adolescent conflict were positively related to depression and suicide ideation in both genders. Across both studies, depression mediated associations between academic- and family-related variables and suicide ideation. Findings underscore the importance of both academic and family climate in understanding depression and suicide ideation among Chinese adolescents.

Adolescent↗

Parent-proxy EQ-5D ratings of children with attention-deficit hyperactivity disorder in the US and the UK.

BACKGROUND: The symptoms of attention-deficit hyperactivity disorder (ADHD) are associated with impairment in multiple domains of health-related quality of life (HR-QOL). HR-QOL of children with ADHD has been assessed by relatively long multidimensional questionnaires. A review of the literature found no studies using the brief, well established EuroQoL Five-Dimension Questionnaire (EQ-5D) to estimate the HR-QOL of children with ADHD. The objective of this study was to assess the HR-QOL of children with ADHD using parents' responses to the proxy version of the EQ-5D. METHODS: Participants were recruited in the midwestern US and in the vicinity of London, England. All parents completed three questionnaires: the EQ-5D proxy version; a measure of ADHD symptoms based on Diagnostic and Statistical Manual of Mental Disorders (4th Edition) [DSM-IV] criteria (the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV - Parent Version [ADHD-RS]); and either the Child Health Questionnaire - Parent Form 50 (CHQ-PF50) or the Child Health and Illness Profile - Child Edition (CHIP-CE), which are both generic multidimensional paediatric HR-QOL questionnaires. RESULTS: A total of 126 parents of children with ADHD participated in the study: 43 in the US and 83 in the UK. On the EQ-5D, participants indicated that 78.6% of their children experienced some problems or extreme problems performing usual activities, while 64.8% believed their child demonstrated some or extreme anxiety or depression. The mean EQ-5D index score was 0.75 and the mean visual analogue scale (VAS) score was 73.9. The EQ-5D index and VAS scores were found to be significantly correlated (p < 0.05) with several domains of the CHQ-PF50 (e.g. Mental Health, Self-Esteem, Family Activities, Psychosocial Summary Score) and the CHIP-CE (e.g. Satisfaction, Comfort, Academic Performance, Peer Relations). The EQ-5D scales were also significantly correlated with the ADHD-RS scales (p < 0.001). CONCLUSION: The proxy version of the EQ-5D, completed by parents, was able to detect impairment in children diagnosed with ADHD in the US and the UK. Furthermore, the EQ-5D index and VAS scores demonstrated construct validity among this sample through significant correlations with an ADHD symptom measure and previously validated multidimensional QOL instruments. These results suggest that parent-proxy EQ-5D ratings are feasible and valid for use as part of an overall health outcomes assessment in clinical studies of childhood ADHD.

Adult↗

The measurement and impact of childhood teasing in a sample of young adults.

This study examined the psychometric properties of the Teasing Questionnaire-Revised (TQ-R) and the relationships among recalled childhood teasing and current psychosocial distress in 414 undergraduate students. Participants were administered the TQ-R, Beck Depression Inventory-II, State-Trait Anxiety Inventory-Trait Version, Brief Fear of Negative Evaluation Scale, and UCLA Loneliness Scale. Confirmatory factor analysis supported a five-factor model assessing teasing related to performance, academic issues, social behavior, family background, and appearance. Internal consistency of the TQ-R and its factors was acceptable, and intercorrelations among subscales were moderate, suggesting that the factors measure related but conceptually distinct teasing experiences. Defining Pearson product-moment correlations with a magnitude of greater than.25 as conceptually meaningful, we found that the TQ-R Total score was meaningfully related to depressive symptoms, anxiety, fear of negative evaluation, and loneliness. Being teased in the Performance and Social domains as a child was moderately related to current psychopathology. Implications of these findings for clinical practice and future research are discussed.

Adult↗

Active learning of respiratory physiology improves performance on respiratory physiology examinations.

Active involvement in the learning process has been suggested to enhance creative thinking, judgement, interpretation, and problem-solving skills. Therefore, educators are encouraged to create an active-learning environment by incorporating active-learning strategies into the class. However, there is very little documentation of the effectiveness of active-learning strategies. Furthermore, faculty are often reluctant to incorporate new strategies without documentation of the effectiveness of these strategies. To address this concern, we compared the performance of two individual classes on an identical respiratory physiology examination. One class was taught respiratory physiology using active-learning strategies. The other class was taught respiratory physiology using the traditional lecture format. The results document that students who learned using active-learning strategies did significantly better (P < 0.05) on the respiratory physiology examination than students who learned by the traditional lecture format (61 +/- 2.2 vs. 86 +/- 1.0). Thus, by actively involving students in the learning process, academic performance is enhanced.

Education, Graduate↗

The development and psychometric investigation of the university student depression inventory.

BACKGROUND: Depression is prevalent among university students. It is debilitating and affects the academic performance of students. One of the most common reasons why students consult counselling centres is depression. Therefore it is important to assess the university students' depression by valid measures designed particularly for this purpose. METHOD: The present study developed the "University Student Depression Inventory" (USDI) to measure the depressive symptoms of university students. RESULT: Items based on a broad range of depression symptoms were subjected to factor analysis, resulting in a 30 item scale with three subscales: Lethargy; Cognitive/Emotional; and Academic Motivation. Psychometric investigation revealed satisfactory reliability and divergent and convergent validity. CONCLUSION: It is expected that multidimensional USDI would be a useful tool for university counselling services to assess the depression of the students.

Adolescent↗

The effects of methylphenidate on learning in children with ADDH: the stimulus equivalence paradigm.

Investigated the effect of methylphenidate (MPH) on the ability of children with Attention Deficit Disorder with Hyperactivity (ADDH) to learn both trained and untrained complex visual relationships and compared these findings to their school performance under identical dosage parameters. 26 children between the ages of 6 and 12 years with ADDH participated in a double-blind, placebo control, within-subjects design in which each child received four doses of MPH (5, 10, 15, 20 mg) and a placebo in a counterbalanced sequence. MPH enhanced children's learning of both taught and untaught visual relationships, and most changes were similar to, albeit less dramatic than, those obtained for the children's attention and academic performance in school. Results of group and single-subject analyses are presented and discussed with relevance to psychopharmacological research and understanding the complex relationship between learning and psychostimulants used in treating children with ADDH.

Attention↗

Intellectual problems shown by 11-year-old children whose mothers had postnatal depression.

The aim of the study was to examine long-term sequelae in the children of mothers who were depressed at 3 months postpartum. In a community sample from two general practices in South London. 149 women were given psychiatric interviews at 3 months postpartum and 132 of their children (89 %) were tested at 11 years of age. The children of women who were depressed at 3 months postpartum had significantly lower IQ scores. They also had attentional problems and difficulties in mathematical reasoning. and were more likely than other children to have special educational needs. Boys were more severely affected than girls, with the sex difference most pronounced on Performance IQ. The links between postnatal depression and the children's intellectual problems were not mediated by parental IQ and were not accounted for by measures of social disadvantage nor by the mother's later mental health problems. Breastfeeding did not remove the effect of the mother's illness on Full Scale IQ, but exerted its own influence on Verbal IQ and appeared to mediate the link with mathematical ability. The findings show that adverse experiences in infancy predict cognitive ability and academic performance a decade later.

Adult↗

Attention-deficit hyperactivity disorder: critical appraisal of extended treatment studies.

We undertook a systematic review of the literature on the long-term treatment of attention-deficit hyperactivity disorder (ADHD). We used systematic strategies to identify randomized treatment studies in which treatment was administered for 12 weeks or more. We included 14 studies involving 1379 subjects. Because of the limited number of high-quality studies and the heterogeneity of outcome measures, we did not perform meta-analysis. We rated 5 studies as adequate for methodological quality. Five studies followed children for more than 26 weeks. Pharmacologic interventions were studied more frequently than non-pharmacologic ones. Six studies permitted evaluation of the effects of combined drug and behavioural intervention. Twenty-five different outcomes were measured using 26 different tests. Stimulant medication appears to reduce ADHD (7 studies), dysfunctional social behaviour (6 studies), and internalizing symptoms (2 studies). Available studies provide little evidence for improved academic performance with stimulants (3 studies). Medications other than stimulants have not been studied extensively (3 studies). Only 1 study showed that combination therapy adds to the effects of medication. Rigorous treatment research among representative samples of ADHD individuals is needed.

Attention Deficit Disorder with Hyperactivity↗

Promoting principals' managerial involvement in instructional improvement.

Studies of school leadership suggest that visiting classrooms, emphasizing achievement and training, and supporting teachers are important indicators of the effectiveness of school principals. The utility of a behavior-analytic program to support the enhancement of these behaviors in 2 school principals and the impact of their involvement upon teachers' and students' performances in three classes were examined in two experiments, one at an elementary school and another at a secondary school. Treatment conditions consisted of helping the principal or teacher to schedule his or her time and to use goal setting, feedback, and praise. A withdrawal design (Experiment 1) and a multiple baseline across classrooms (Experiment 2) showed that the principal's and teacher's rates of praise, feedback, and goal setting increased during the intervention, and were associated with improvements in the academic performance of the students. In the future, school psychologists might analyze the impact of involving themselves in supporting the principal's involvement in improving students' and teachers' performances or in playing a similar leadership role themselves.

Journal Article↗

Otitis media in early childhood and cognitive, academic, and classroom performance of the school-aged child.

The relationship between the occurrence of otitis media during the first 3 years of life and cognitive, academic, and classroom performance during the third year of elementary school was evaluated in 44 socioeconomically disadvantaged children. The children attended a research day-care program where their otitis media experience and psychoeducational development were documented prospectively from birth. No significant relationship was found between otitis media in early childhood and performance on tests of verbal intelligence or academic achievement in the third year of school. The number of days of otitis media before 3 years of age was significantly correlated with teachers' ratings of children's attentional behavior in the classroom, however. Children with more early otitis media tended to be rated as less task oriented and less able to work independently than children with less otitis media. This was an exploratory study of a small number of children. Further study of the potential association is needed.

Child↗