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PubMed1998

Neurofeedback combined with training in metacognitive strategies: effectiveness in students with ADD.

A review of records was carried out to examine the results obtained when people with Attention Deficit Disorder (ADD) received 40 sessions of training that combined neurofeedback with the teaching of metacognitive strategies. While not a controlled scientific study, the results, including pre- and post-measures, are consistent with previously published research concerning the use of neurofeedback with children. A significant addition is that a description of procedures is included. The 111 subjects, 98 children (age 5 to 17) and 13 adults (ages 18 to 63), attended forty 50-min sessions, usually twice a week. Feedback was contingent on decreasing slow wave activity (usually 4-7 Hz, occasionally 9-11 Hz) and increasing fast wave activity (15-18 Hz for most subjects but initially 13-15 Hz for subjects with impulsivity and hyperactivity). Metacognitive strategies related to academic tasks were taught when the feedback indicated the client was focused. Some clients also received temperature and/or EDR biofeedback during some sessions. Initially, 30 percent of the children were taking stimulant medications (Ritalin), whereas 6 percent were on stimulant medications after 40 sessions. All charts were included where pre- and post-testing results were available for one or more of the following: the Test of Variables of Attention (TOVA, n = 76), Wechsler Intelligence Scales (WISC-R, WISC-III, or WAIS-R, n = 68), Wide Range Achievement Test (WRAT 3, n = 99), and the electroencephalogram assessment (QEEG) providing a ratio of theta (4-8 Hz) to beta (16-20 Hz) activity (n = 66). Significant improvements (p < .001) were found in ADD symptoms (inattention, impulsivity, and variability of response times on the TOVA), in both the ACID pattern and the full-scale scores of the Wechsler Intelligence Scales, and in academic performance on the WRAT 3. The average gain for the full scale IQ equivalent scores was 12 points. A decrease in the EEG ratio of theta/beta was also observed. These data are important because they provide an extension of results from earlier studies (Lubar, Swartwood, Swartwood, & O'Donnell, 1995; Linden, Habib, & Radojevic, 1996). They also demonstrate that systematic data collection in a private educational setting produces helpful information that can be used to monitor students' progress and improve programs. Because this clinical work is not a controlled scientific study, the efficacious treatment components cannot be determined. Nevertheless, the positive outcomes of decreased ADD symptoms plus improved academic and intellectual functioning suggest that the use of neurofeedback plus training in metacognitive strategies is a useful combined intervention for students with ADD. Further controlled research is warranted.

Adolescent↗
PubMed1993

Early reading performance: a comparison of teacher-based and test-based assessments.

An unresolved question in early screening is whether test-based or teacher-based assessments should form the basis of the classification of children at risk of educational failure. Available structured teacher rating scales are lacking in predictive validity, and teacher predictions of students likely to experience reading difficulties have yielded disappointing true positive rates, with teachers failing to identify the majority of severely disabled readers. For this study, three educational screening instruments were developed: (a) a single teacher rating, categorizing children into three levels of reading ability (advanced, average, poor); (b) a 15-item teacher questionnaire designed to measure students' cognitive and language ability, attentional and behavioral characteristics, and academic performance; and (c) a battery of language and reading tests that are predictive of, or correlate with, reading failure. The concurrent validity of each instrument was assessed in a sample of 312 Australian schoolchildren from kindergarten, Year 1, and Year 2. Students were assessed at the end of the 1989 school year after having completed 1, 2, or 3 years of schooling. The results suggest that the nature of the skills required for success in reading changes in the first 3 years of schooling. Both teachers and tests concur more closely as children progress through the elementary years and as the risk behavior (reading) becomes more accessible to direct measurement. Carefully focused teacher rating scales may be a cost-effective means of identifying children at risk of reading failure. Improved teacher rating scales should be developed and used to assist in the early screening process.

Child↗
PubMed1993

Psychosocial outcomes of children of unipolar depressed, bipolar, medically ill, and normal women: a longitudinal study.

The psychosocial functioning of children of unipolar depressed, bipolar, medically ill, and psychiatrically normal women was studied over a 2-year period. Ninety-six children aged 8-16 years were assessed at 6-month intervals on Child Behavior Checklist behavior problems, social competence, internalizing and externalizing behaviors, academic performance, and school behavior. The children of unipolar mothers showed significantly poorer functioning on all measures as compared with the other 3 groups of children, including bipolar offspring. A greater proportion of children in the unipolar group also had relatively chronic, clinically significant problems in psychosocial functioning. Children of bipolar women did not differ from children of psychiatrically normal women. Results are discussed in terms of the consequences of children's continuing exposure to maternal depression and attendant stressors, as well as the contribution of social and academic difficulties to a vicious cycle of maladjustment.

Adolescent↗
PubMed2003

Snoring in preschoolers: associations with sleepiness, ethnicity, and learning.

Sleep-disordered breathing (SDB) in children is associated with poor school performance, with minority children being at increased risk for both conditions. The latter have been attributable to low socio-economic status (SES). To further study these relationships, the contribution of SES to SDB and learning was examined in 1,010 validated questionnaires collected from parents of both white and African-American low-SES preschoolers. Twenty-two percent of disadvantaged preschoolers were reported to be at risk for SDB. These children were more likely to be African American, and had a higher incidence of daytime sleepiness, lower academic performance, and hyperactivity. Maternal education level did not account for these differences.

Black People↗
PubMed1996

Self-perceptions, motivation, and school functioning of low-income maltreated and comparison children.

Maltreated children are at risk for disturbances and delays in their socioemotional and scholastic functioning. This study examined the impact of child maltreatment and age on perceptions of competence, and the relations among perceived competence, motivation, and school functioning. The sample included 76 school children living in poverty, approximately two-thirds of whom had been victims of child maltreatment. Results indicated that both maltreated and nonmaltreated children exhibited maladaptive motivational orientations toward scholastic tasks and poor academic performance, supporting the idea that threats to scholastic functioning reside as much within the ecology of poverty as in that of maltreatment. Over and above the general effects of poverty, maltreatment was found to disrupt the psychological processes accounting for children's scholastic performance. Results revealed that younger maltreated children (6- and 7-year-olds) reported more inflated self-perceptions of competence and social acceptance than nonmaltreated children. In contrast, older maltreated children (8- through 11-year-olds) reported lower perceived social acceptance than nonmaltreated children. Among older nonmaltreated children, perceived competence was positively related to teacher's ratings of their effort, intrinsic motivation, and grades. For older maltreated children, these relations among self-perceptions and school functioning were in the opposite direction from those of nonmaltreated children, suggesting that the determinants of academic engagement are different for maltreated and nonmaltreated children.

Achievement↗
PubMed1991

A two-year experience with premedical postbaccalaureate students admitted to medical school.

To determine how well premedical postbaccalaureate students performed in and adjusted to medical school, the author examined the records for all 123 matriculants to the Brown University Program in Medicine in 1987-88 and 1988-89 and sent each student a questionnaire. More than one-third of the first-year students admitted to Brown were from premedical postbaccalaureate programs (that is, they had taken the traditional premedical course requirements after graduating from college). The postbaccalaureate students were older than the rest of their classmates, on average, and were more likely to have been non-science majors in college. Academic performances over the first two years were comparable in the two groups, and there was no significant difference between the groups in their self-reports of adequacy of preparation or involvement in extracurricular activities. The author concludes that, faced with a smaller applicant pool, medical schools may wish to consider premedical postbaccalaureate students as a valuable resource.

Adaptation, Psychological↗
PubMedDate not supplied

[The Zagreb Medical School from the "Croatian spring" to the first multi-party elections].

Schools of Medicine are institutions for an integrative approach to diseases and health, comprising at the same time scientific, teaching and treatment aspects of the nosological entities. These three functions are optimal only when academic freedom and sufficient financial support are satisfied. The authors analyze the last twenty years of academic performance of the University of Zagreb School of Medicine which were considerably influenced by the external political demands imposed by the so-called self-management phase of former communist regime. The constant restructuring of the internal organization, lower investments in science and quantitative expansion in all the activities of the School were the major characteristics of this period. International comparisons, especially in the light of recent development of molecular biology, demonstrate that this was rather growth than development of the oldest School of Medicine of Croatia. The authors emphasize the importance of academic freedom and strong international cooperation for the development and maintenance of quality of teaching schools.

Croatia↗
PubMed2004

Pune low birth weight study--cognitive abilities and educational performance at twelve years.

OBJECTIVE: To assess the intelligence, visuo-motor perception, motor competence and school performance of children with birth weight less than 2000 grams, at the age of 12 years. DESIGN: Prospective cohort study. SETTING: Infants discharged from a Neonatal Special Care Unit of a referral hospital with birth weight less than 2000 g between 1987-89 and followed up in the High Risk Clinic. METHODS: The children were assessed by the Weschler's Intelligence Scale, Bender Gestalt test for visuo-motor perception, Wide Range Achievement Test for specific learning disability, Draw-a-Person screening test for emotional problems and Movement Assessment Battery for motor competence. Academic achievement was also scrutinised. RESULTS: One hundred and eighty children weighing less than 2000 grams at birth and ninety control children were assessed. The mean IQ of the study group was normal (89.5 +/- 16.9), though significantly lower than that of controls (97.2 +/- 14.1; p<0.05). Pre term SGA children had the lowest mean IQ (85.4 +/- 17.7). In the 78 VLBW children, there were 12 (15.4%) mentally retarded children as compared to only 3 (3.3%) amongst controls (p<0.001). There were only 3 (3.8%) 'bright' children among the VLBW group, as compared to 20 (22.2%) in the control group (p<0.001). Visuo-motor perception and motor competence of the study group was poor, and they had writing and mathematics learning disability, especially the preterm SGA and VLBW group. Academic achievement was poor and the incidence of borderline intelligence was 24.4%, which has increased from 13.4% at 6 years. CONCLUSIONS: The intelligence and academic performance of the children weighing less than 2000 grams is significantly lower than that of controls, though within normal limits. They also have poor visuo-motor perception, motor incompetence, reading and mathematics learning disability. The preterm SGA and VLBW children had the poorest cognitive abilities.

Age Distribution↗
PubMed1998

School-age follow-up of prophylactic versus rescue surfactant trial: pulmonary, neurodevelopmental, and educational outcomes.

BACKGROUND: Exogenous surfactant replacement has improved survival and reduced pulmonary complications of prematurity. Improved early outcomes for infants of <30 weeks' gestation treated with a strategy of prophylactic versus rescue surfactant, if needed, were demonstrated in a multicenter, randomized trial conducted between 1985 and 1988. We reevaluated a subset of survivors from this trial to determine the pulmonary and neurodevelopmental outcomes at school age. METHODS: At 4.5 to 8 years of age, all survivors from one of the three centers were located, and 96% were evaluated. The original randomization included stratification by center and followed an intention-to-treat methodology in assessing the efficacy of prophylactic versus rescue treatment with surfactant. The follow-up test battery included a health-assessment questionnaire, spirometry, 88% saturation test, neurologic examination, and the McCarthy Scales of Children's Abilities (MSCA) and the Conners' Parent Rating Scale-48. Educational achievement was determined by school class placement and teachers' reports of achievement. RESULTS: Of the 192 children originally enrolled, 154 survived. Evaluations were performed on 148 of these infants. An abnormal pulmonary history was found in 45 (30%) of the children: 16 (22%) in the prophylactic group and 29 (39%) in the rescue group. Formal pulmonary function was evaluated in 81 children; 29 (78%) in the prophylactic group and 33 (75%) in the rescue group were considered abnormal. No significant differences were found between the two groups on either cognitive or motor subscales of the MSCA, the Conners' Parent Rating Scale-48, the neurologic examination, the education services received in school, or the teacher ratings of below-average academic performance. Intelligence scores measured on the MSCA were low-normal for both groups. Some level of educational assistance was being provided to 72 (49%) of the cohort studied, and both groups had below average educational performance and increased needs for educational assistance. CONCLUSIONS: Prophylactic surfactant administration to infants of <30 weeks' gestation was associated with fewer long-term clinical pulmonary complications than assignment to rescue administration. Formal pulmonary testing at school age did not reveal significant differences between treatment groups in those infants who could be tested. There also were no group differences found on neurologic, cognitive, behavioral, or educational assessments at school age.

Child↗
PubMed1988

An individual double-blind crossover trial for assessing methylphenidate response in children with attention deficit disorder.

To obtain more objective data on response to therapy and to overcome parents', teachers', psychologists', and physicians' concerns about potential overuse, I instituted individual double-blind crossover trials of methylphenidate for children with attention deficit disorder (ADD). Each child is given 0.3 mg/kg/dose twice daily for 2 weeks and placebo for 2 weeks in random order and in double-blind fashion. Parents and teachers record observations of behavior and academic performance. Analysis of 70 trials and follow-up clinical data demonstrated that (1) 51 children showed improvement in one of the 2-week periods and that period corresponded with methylphenidate therapy in 48 (69%); (2) 6 of the 22 who did not respond to methylphenidate experienced worsening of function while taking the drug; (3) history and physical findings were not helpful in predicting methylphenidate response; (4) there were no serious side effects during the trial; and (5) all but three of the responders took methylphenidate for at least 1 year with sustained improvement in behavioral function, academic function, or both. Individual double-blind crossover trials can be used in an office setting to identify objectively which children with ADD respond to treatment with methylphenidate. Because the trial demonstrates to parents, teachers, psychologists, and physicians that methylphenidate is or is not beneficial to a particular child, this clinical tool is associated with a high level of confidence that the drug is being appropriately prescribed.

Adolescent↗
PubMed2005

Rethinking procrastination: positive effects of "active" procrastination behavior on attitudes and performance.

Researchers and practitioners have long regarded procrastination as a self-handicapping and dysfunctional behavior. In the present study, the authors proposed that not all procrastination behaviors either are harmful or lead to negative consequences. Specifically, the authors differentiated two types of procrastinators: passive procrastinators versus active procrastinators. Passive procrastinators are procrastinators in the traditional sense. They are paralyzed by their indecision to act and fail to complete tasks on time. In contrast, active procrastinators are a "positive" type of procrastinator. They prefer to work under pressure, and they make deliberate decisions to procrastinate. The present results showed that although active procrastinators procrastinate to the same degree as passive procrastinators, they are more similar to nonprocrastinators than to passive procrastinators in terms of purposive use of time, control of time, self-efficacy belief, coping styles, and outcomes including academic performance. The present findings offer a more sophisticated understanding of procrastination behavior and indicate a need to reevaluate its implications for outcomes of individuals.

Achievement↗
PubMed1991

School adjustment of children of alcoholic fathers: comparison to normal controls.

The present study used objective indices of academic performance to test the hypothesis that children of alcoholic fathers (COA's) have poorer school adjustment than children of nonalcoholic parents (non-COA's). Subjects were 39 children of male alcoholics treated for alcoholism in a VA program and 33 control children whose nonalcoholic parents (matched on demographic indices) reported low marital conflict. The results showed that daughters of alcoholics, but not the sons, showed more variability than controls in their school attendance. There was suggestive evidence that they also missed more school days than controls, with a reversed pattern for the sons of alcoholics. Generally, however, the COA group was not compromised academically and did not show more conduct problems compared to controls. Within the COA group, long-term paternal drinking adjustment (years of problem drinking and total number of hospitalizations for drinking) appeared to be related to poorer GPA, while short-term adjustment (alcohol-related days in jail and number of days drinking in year previous to treatment) were more related to poorer attendance. The results are discussed in terms of the mechanism of the effect of paternal drinking on children's school adjustment and the difficulty in making generalizations about the consequences of being the child of an alcoholic.

Achievement↗
PubMed2002

An Internet-based approach to advising radiology residency applicants.

RATIONALE AND OBJECTIVES: The authors created a computerized database Web site enabling radiology residency applicants to utilize the experience of recent graduates from their school in maximizing the effectiveness of the residency advisory process. Objectives of this database Web site are (a) to provide general information regarding radiology as a specialty; (b) to allow students to gauge their chances of matching based on the experience of recent graduates from their school; (c) to provide advisors with a faster, more accurate assessment of a student's matching potential; and (d) to decrease the number of residency applications submitted through the Electronic Residency Application Service. MATERIALS AND METHODS: Thirty graduates from the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School (UMDNJ-RWJMS) from 1999 to 2001 who applied to radiology residency were successfully contacted by telephone or e-mail. Data were gathered regarding their academic performance and activities, residency application, and final match outcome and were entered into a spreadsheet for analysis. This information, along with student-to-student advice regarding the match, was also entered into an interactive Web site for use by UMDNJ-RWJMS medical students, radiology advisors, and deans. RESULTS: The Web site model was applied to radiology residency applicants from UMDNJ-RWJMS. This database Web site provided general radiology information and allowed students and advisors to gauge their chances of matching based on the experience of past applicants from their school. CONCLUSION: This database Web site can provide a realistic comparison of a student's academics with those of previous applicants. Yearly analysis of school-specific data can help advisors follow applicant trends and modify their own advice. The database Web site can be easily duplicated and, if applied to other schools and specialties, could potentially benefit students nationally.

Educational Measurement↗
PubMed2005

[Acute recurrent headaches: clinical and epidemiological characteristics].

OBJECTIVE: To analyze the epidemiological and clinical characteristics of migraine and tension-type headache in the pediatric age group with the aim of facilitating their differential diagnosis in clinical practice. PATIENTS AND METHODS: Information on epidemiological and clinical characteristics, physical examination and complementary examinations, if performed, was collected from the medical records of 225 children with acute recurrent headache. The criteria defined by the International Headache Society (IHS) were used in the diagnosis. RESULTS: A total of 98.2 % of the patients had primary headache: migraine (48.9 %), tension-type headache (48.4 %) and mixed (0.9 %). Thirty percent of those with migraine had migraine with aura. The mean age at onset was 8.6 6 2.9 years in migraine and 9.7 6 2.5 years in tension-type headache (p < 0.05), with no differences between sexes. Children with tension-type headache showed a greater prevalence (p < 0.05) of female sex, urban origin and excellent academic performance. Children with migraine had a greater prevalence (p < 0.05) of positive family history. Migraine headaches were unilateral (44.1 %) or bilateral (55.9 %), pulsating (77.1 %), aggravated by physical activity (68.8 %), caused lost days at school (65.3 %) and were usually accompanied by vomiting (71 %) and photophobia/sonophobia (67 %). Tension-type headaches were bilateral (81.8 %) and oppressive (85.3 %), were less frequently aggravated by physical activity (11.8 %) or interrupted activities (11.8 %) and were occasionally accompanied by vomiting (7.3 %) and photophobia/sonophobia (21.8 %). Electroencephalogram and brain computed tomography scan were performed in 21 % and 39.1 % of the patients, respectively, without changing their diagnosis. CONCLUSIONS: Migraine and tension-type headaches are a common cause of recurrent headache in the pediatric age group. Onset usually occurs in school-aged children. The IHS criteria for the differential diagnosis of headache in children are useful, although follow-up is the gold standard to validate diagnostic criteria.

Acute Disease↗
PubMed1985

Impact of undergraduate courses on medical student performance in basic sciences.

Many students planning to apply to medical school take undergraduate courses (for example, biochemistry, embryology, histology, and vertebrate anatomy) covering concepts that are taught within the medical school curriculum. Do these students perform better in similar courses in medical school than students without prior exposure? In the study reported here of 310 medical students, approximately 50 percent had taken biochemistry, 50 percent had taken a course dealing with vertebrate anatomy, 25 percent had taken embryology, and 25 percent had taken histology as undergraduates. In comparisons of the students with prior exposure to these courses and those without prior exposure, no statistical difference was noted in cumulative grade-point averages for the first year in medical school or in the students' scores in three of the four individual medical courses examined. In addition, there was no significant difference in the academic performances in the four courses between the students in the upper and the lower quartiles of the class. Implications regarding undergraduate preparation of medical school applicants are discussed.

Achievement↗
PubMed2002

Neurofibromatosis type 1 and the pediatric neurosurgeon: a 20-year institutional review.

Children with neurofibromatosis type 1 (NF1) undergo costly surveillance scanning for a variety of asymptomatic central nervous system lesions whose natural history is poorly understood. We performed a 20-year retrospective chart review of 25 patients with clinically proven NF1 who required surgery (group A) and contrasted this cohort with 150 NF1 patients who did not require surgery (group B). In group A, 52% of patients underwent multiple procedures for more than one lesion (p = 0.043). Group A patients were further distinguished from those in group B by exhibiting a greater number of optic gliomas (p = 0.015), nonoptic intracranial tumors (p = 0.006), cranial nerve (p = 0.000), paraspinal (p = 0.0062), craniofacial (p = 0.001) and visceral (p = 0.03) neurofibromas and moyamoya disease (p = 0.00), as well as a higher frequency of seizure disorder, sphenoid wing dysplasia and poor academic performance. Gadolinium enhancement occurred in 43% of optic gliomas, 50% of parenchymal gliomas, 100% of cranial nerve, 100% of plexus, 67% of paraspinal, 50% of craniofacial and 50% of visceral neurofibromas in group A, while only 1 group B tumor enhanced. In group A, radiological progression occurred after a median of 4 years from initial diagnosis for optic gliomas as well as cranial nerve, plexus and visceral neurofibromas, 2 years for paraspinal neurofibromas and brainstem gliomas and 2.7 years for craniofacial neurofibromas. Only 1 tumor progressed in group B. Therefore, a small subgroup of NF1 patients (12.5%) who require treatment are at risk of subsequently needing further surgical attention, whereas a larger group of NF1 patients (87.5%) carry an indolent form of the disease. We recommend imaging for asymptomatic, gadolinium-enhancing lesions every 2 years for optic pathway and parenchymal gliomas and cranial nerve and visceral neurofibromas, and every year for brainstem gliomas and paraspinal as well as craniofacial neurofibromas. Nonenhancing optic pathway lesions could be followed up radiographically much less often since they do not show progression.

Brain Neoplasms↗
PubMed1993

Success in baccalaureate nursing programs: a matter of accommodation?

This article explores student learning styles as an important variable in four-year baccalaureate nursing programs. Student learning styles were assessed by Kolb's Learning Style Inventory-1985 (LSI-1985), which identifies the accommodator, diverger, assimilator, and converger learning styles. The authors examined the relationship between learning style and academic performance as measured by grade-point ratio (GPR) and studied behaviors and attitudes as measured by Brown and Holtzman's (1964) Survey of Study Habits and Attitudes. Analysis indicated that this sample (N = 100) included mainly assimilators and divergers, making reflective observation the most common mode of learning. Compared to the accommodator/converger group, the assimilator/diverger group earned a significantly higher GPR, significantly better scores on the study habits variable of Work Methods (WM), and moderately better scores on the study attitude variable of Educational Acceptance (EA). Accommodators were identified as the most at-risk learning style group, and specific interventions were suggested to assist accommodators in adapting to the academic rigors of a nursing curriculum.

Achievement↗
PubMed2002

Relationship between blood lead concentrations and learning achievement among primary school children in Taiwan.

Over the past 20 years lead has been proven to exert an influence on the intelligence of children. Especially for children exposed to environmental lead, average blood lead was often lower than the officially recognized intoxication level. Because Kaohsiung is an industrial area in Taiwan and lead exposure is an important environmental issue, we attempted to ascertain the extent to which environmental lead influences the achievement of primary school children. We randomly selected 934 children from 32 primary schools in 11 districts of Kaohsiung City. Blood lead levels of the children were checked, and they were administered a questionnaire about their family information. Scores of several courses were used in this study on the relationship between a child's blood lead and his or her academic performance (Ranking with his or her classmates), including Chinese (reading and writing short Chinese articles), Mathematics, History and Society, and Natural Science. Multiple regression models were done with adjustments for the confounding effects of their parents' socioeconomic levels. The mean (SD) of 934 blood lead level was 5.50 (1.86) microg/dL. Spearman's coefficient showed that class rankings in Chinese, Mathematics, Natural Science, and History and Society were all strongly associated with blood lead levels (P<0.01). The multiple regression models revealed that blood lead level exerts a stronger influence on children's language ability (Chinese) than on their ability to calculate (Mathematics). Our results suggest that environmental lead exposure adversely affects a child's academic achievement, making a direct link between exposure to lead and academic attainment.

Child↗