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Treatment of Pediatric Multiple Sclerosis.

An increasing number of children and adolescents with multiple sclerosis (MS) are being identified and treated with disease-modifying therapies. Yet, there currently is little experience to guide clinicians. As more rapid diagnosis is made possible with magnetic resonance imaging, the number of pediatric MS patients requiring treatment will increase with time. This review draws on information from adult and pediatric neurology sources and summarizes current available data. Additional research is clearly needed. Nonetheless, there are several treatment principles: 1) establishing the diagnosis by differentiating MS from acute disseminated encephalomyelitis or recurrent acute disseminated encephalomyelitis; 2) emphasizing that there are parallels between adult and pediatric MS regarding the clinical presentation, disease course, and ability to tolerate therapy (the more extensive experience in adult MS can be applied to most pediatric cases); 3) explaining the importance of starting treatment early in the disease course and that these therapies seem well-tolerated in children; 4) providing reassurance that the family is not alone; as approximately 5% of the MS population has symptom onset before age 18 years (experience with pediatric MS is growing and centers with pediatric MS programs exist in other countries and are developing within the United States); and 5) reviewing symptom management and addressing issues such as academic performance that are unique to the pediatric MS subpopulation.

Journal Article↗

Teaching ethics: more than an honor code.

An honor code is certainly a good place to start teaching engineering students about ethics, but teaching students to live honorably requires far more effort than memorizing a code of ethics statement or applying it just to academic performance. In the School of Engineering at Grand Valley State University, we have followed the model provided by the United States Military Academy at West Point. For our students this involves an introduction to the Honor Code as part of a larger Honor Concept at the very beginning of their studies and then making it an integral part of their preparation as engineers. The challenge is significant because the culture at large does not support living with an Honor Concept. This paper will begin with a discussion of the cultural context in which we must teach, because that context has changed significantly in the years since many faculty members were students themselves. The rest of the paper will detail the approach that we have taken to teach ethics as an engineer's way of life.

Codes of Ethics↗

Management of a hyperactive-conduct disordered child through correspondence training: a preliminary study.

This study examined the clinical effects of correspondence training procedures in the management of a hyperactive-conduct disordered boy. During the reinforcement of promise-do correspondence procedure, a toy (reinforcer) was given contingent upon the presence of a promise to inhibit target behaviors (e.g., inattention, overactivity, aggression) and the actual inhibition of such behaviors. This intervention was programmed in a multiple baseline design across settings. Consistently lower levels of hyperactivity and conduct disorders were noted during treatment, relative to baseline. A demonstration of the indirect effects of the procedures upon the child's academic performance was also seen.

Attention↗

Multi-dimensional child behavior therapy in the treatment of medically-related anxiety: a practical illustration.

This paper provides a practical illustration of a four-component model for conducting child behavior therapy. It describes the treatment of a 7-year-old boy, whose fears and anxieties regarding impending surgery were interfering with his sleep, concentration, and academic performance. Such childhood difficulties are encountered in primary care medical settings and it is likely that mental health practitioners will be increasingly called upon to treat them. The model provides a framework for selecting, organizing, and implementing strategies based on behavioral principles, with the goal of: (a) reducing the probability of the behavior by ecological change; (b) manipulating the immediate consequences of the problem behavior; (c) facilitating acquisition of new, more adaptive behaviors; and (d) long-term prevention by remedying fundamental deficits. The strategies used for each goal and the success of the overall intervention are described.

Anxiety Disorders↗

School absence rates as outcome measures in studies of children with chronic illness.

Health care providers are caring for growing numbers of children with chronic illnesses and research on the effects of various interventions with these children are being increasingly published. Data from a variety of sources indicate that children with chronic illness miss more school than their healthy peers. The relative ease with which school attendance data can be obtained and analyzed and the implications of excessive school absence for children's academic performance, social adjustment, and ultimate capacity to function in society suggest that school absence rates deserve to be more broadly emphasized in research on chronic illness in childhood. Although school absence rates have not been widely used as outcome measures in such studies they do reflect a wide variety of aspects of children's health status and have been shown to be responsive to interventions with children with various physical and mental health problems. Since these rates reflect both health and non-health related factors it is important that investigators recognize the nonspecific nature of this measure and account for non-health related influences either by sampling or analytic techniques.

Absenteeism↗

Language skills of delinquent and nondelinquent adolescent males.

A comparison of language skills between adolescent juvenile delinquent males and matched nondelinquent peers was made using an informal language sample analysis (a modified Clinical Discourse Analysis) and the TOAL-2 measure. Twenty-four institutionalized delinquents and 24 nondelinquents ranging in age from 14.4 to 17.9 years were subjects. Their respective mean full scale intelligence quotients were 99.75 and 101.25 and they had no known verified handicapping conditions. Two one-way ANOVAs showed that there were significant differences for language skills on the dependent measures between the two groups. Differences between the groups also were observed from descriptive statistics for academic performance. Implications for assessment and treatment of "at-risk" populations are addressed.

Achievement↗

The cognitive outcome of full-term small for gestational age infants at late adolescence.

OBJECTIVE: To assess the cognitive and academic performance of adolescents who were born small for gestational age (SGA) at term. METHODS: A 17-year historical prospective study was done by matching neonatal data of 1758 infants to the results of the medical and intelligence assessment performed at age 17 years at the army draft board medical examination in Israel. The results of children born SGA (weight at term birth below the third percentile) were compared to those of children who were born appropriate for gestational age (AGA). RESULTS: After adjustment by a multiple linear regression analysis, the mean (+/- standard error of the mean) intelligence test scores were 103.1 +/- 2.9 versus 105.8 +/- 1.5 (P = 0.3) for the males and 100.3 +/- 2.5 versus 104.7 +/- 1.6 (P < .03) for the females. Males born SGA at term were found to have lower educational achievements (having less than 12 years of schooling or attending a vocational school) compared with the AGA group. The odds ratio for this finding after adjustment by a logistic regression analysis was 2.40 (95% confidence interval 1.07-5.39; P < .03). Intranatal events were not found to have an effect on the measured neurodevelopmental outcome. CONCLUSION: Infants born SGA at term have an increased risk for lower cognitive performance and schooling achievements than those born AGA; this result seems to be unrelated to their intranatal course.

Adolescent↗

Schistosoma haematobium: effect of non-schistosomicidal drugs (tetracycline and sulphadimidine) on schoolchildren.

Pupils attending four secondary boarding schools in Mwanza Municipality, Tanzania, were examined parasitologically for Schistosoma haematobium. Prevalence of infection was highest in the age group 17 to 18 years in both sexes whereas the intensity was highest in the age group 15 to 16 years in girls and 17 to 18 in boys. Absence on grounds of sickness among the pupils studied was not related to the infection and the over-all academic performance was not clearly related to S. haematobium infection in either. Two drugs (tetracycline-HCL and sulphadimidine) commonly used for treatment of many bacterial infections in Tanzania were used. Administration of these drugs to schistosomiasis patients showed that both significantly lowered egg excretion and the degree depended on the dosage. Neither drugs affected the hatching of miracidia. It is speculated that the administration of both drugs might contribute to a higher accumulation of the eggs in the tissues. This effect could lead to more pathogenic effects as well as introducing an element of error in the studies on drug trials and chemotherapy. Treatment using metrifonate (Bilarcil) resulted in cure rates of 76% for girls and 93% for boys.

Adolescent↗

The menstrual cycle from a bio-behavioral approach: a comparison of oral contraceptive and non-contraceptive users.

The purpose of the present study was to clarify the effects of the menstrual cycle on: (1) accuracy and simple reaction time in a problem-solving situation; (2) academic performance; (3) identify corresponding cyclic changes in a set of psychophysiological measures during rest/test conditions; and (4) to compare oral contraceptive with non-oral contraceptive users. Eight volunteer females, 4 normally cyclic and 4 oral contraceptive users, reported once weekly throughout two menstrual cycles during which changes in blood pressure, heart rate, skin temperature, finger pulse amplitude, and verbal reaction time were monitored. Differences in verbal reaction time were found between oral contraceptive users and non-users over phases of the cycle, the users being significantly slower during menstrual and premenstrual phases. It was also observed that all subjects reacted slower in the menstrual and ovulatory phases during cycle one, although no differences were found during cycle two. Skin temperature changes between groups occurred during the postovulatory phase of cycle two, the control group having shown a much greater increase than oral contraceptive users. These results indicated a suppressive influence of oral contraceptives which appeared to affect cognitive rather than motor responses, and that these effects were residual when no pills were taken menstrually and premenstrually. Also indicated was the finding that although a 28-day cycle of menstrual events exists, periodicity of these events may be reflected in a much larger cycle non-currently defined.

Achievement↗

The effect of varying alveolar carbon dioxide levels on free recall.

A recent study suggested that students who have increased minute ventilation receive poorer grades. The present study was interested in determining the role alveolar carbon dioxide (CO2) levels play with cognitive abilities. A free recall task was used to examine list learning under two conditions of alveolar CO2 level: normal and decreased. The results suggested that decreased alveolar CO2 level affect the participant's ability to rehearse and recall information. It was concluded that conditions that reduce alveolar CO2 levels, such as hyperventilation resulting from stress, nervousness, or inappropriate breathing habits, can lead to poorer learning. If these conditions produce a habitual breathing pattern, the academic performance of the individual may suffer.

Adult↗

Some quantitative hemispheric EEG measures reflecting the affective profile of students differing in university academic success.

Quantitative measurements of the integrated epoch based EEG amplitudes obtained from two groups of university students differing in academic success during an eyes close, relaxed state revealed significantly higher right/left amplitude variance ratios and more right hemispheric non-Gaussian cumulated amplitude distributions among unsuccessful students. These data, which resemble patterns often found in depression, are consistent with, and appear to reflect specific affective differences that emerge using a concurrently administered, conventional psychometric inventory (Beck Depression Inventory) as well as a subjective self-assessment questionnaire. The results of this study may be useful in further elaborating the nature in which right hemispheric brain processes serve to mediate affective behavior, as well as influence academic performance.

Achievement↗

P300 from normals and adult children of alcoholics.

The P300 event-related brain potential (ERP) was obtained from 24 pairs of undergraduate male subjects. One member of each pair reported having a father who was alcoholic (FH+), the other reported no alcoholic family member (FH-). Pairs were matched on height, weight, academic performance, and personal drinking history. Three auditory task situations were employed which manipulated stimulus discrimination difficulty. All tasks employed 20% target and 80% standard tones randomly presented with the subjects required to move their index finger whenever a target tone was detected. No differences in P300 amplitude or latency were obtained between the groups. FH+ subjects tended to demonstrate decreased amplitudes with increased amounts of reported alcohol consumption but only for the most difficult task. The results of the present study suggest that the relationship between the P300 and the heritability for alcoholism is not yet clear and may be modulated by differences in task requirements, subject populations, and personal drinking history.

Adolescent↗

The co-morbidity of violence-related behaviors with health-risk behaviors in a population of high school students.

PURPOSE: To describe the frequency of violence-related behaviors and their association with other health behaviors among high school students. METHODS: The Youth Risk Behavior Survey was administered to all ninth and eleventh graders (n = 2075) of a school district in Texas. It provided information regarding violence-related behaviors and other health behaviors. Students were classified into four mutually exclusive, violence-related categories according to whether they were involved in a physical fight and/or carried a weapon. RESULTS: Overall, 20% of the students were involved in a physical fight but had not carried a weapon, 10% carried a weapon but had not been involved in a physical fight, and 17% had been involved in a physical fight and had carried a weapon. Prevalence of weapon-carrying and fighting were higher among males than females, and among ninth graders than eleventh graders. Among males, 48% had carried a weapon the month prior to the survey. Students who both fought and carried a weapon were 19 times more likely to drink alcohol six or more days than students who did not fight nor carried a weapon. Logistic regression analyses showed that drinking alcohol, number of sexual partners, and being in ninth grade were predictors of fighting. These three variables plus having a low self-perception of academic performance and suicidal thoughts were predictors of fighting and carrying a weapon. CONCLUSIONS: The data indicate that violence-related behaviors are frequent among high school students and that they are positively associated with certain health behaviors. Interventions designed to reduce violence should also address coexisting health-risk behaviors and target high-risk groups.

Adolescent↗

Effect of extended release stimulant-based medications on neuropsychological functioning among adolescents with Attention-Deficit/Hyperactivity Disorder.

Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with diminished neuropsychological functioning. This randomized, double-blind, placebo controlled, study is the first comparison of two extended release stimulant-based medications (Adderall XR and Concerta) and placebo on ADHD neuropsychological functioning. Adolescents diagnosed with ADHD (n=35, 19 males) completed three separate assessments (5, 8, 11 p.m.) on three different days and medications (Concerta, Adderall XR and Placebo). The assessments consisted of two different neuropsychological tests, the Delayed Matching-to-Sample and the Go/No-go (GNG), which measure visual memory, attention span, and response inhibition. Results indicated a significant effect of medication on signs of impulsivity and memory. Simple contrasts showed significant improvement in neuropsychological functioning (as measured by commission errors, reaction time, and recall accuracy) when participants were taking Concerta as opposed to placebo. These results suggest that Concerta impacts not only symptomatic behaviors but also cognitive functioning, which has implications for both academic performance and daily functioning.

Adolescent↗

Heterogeneity in phenotypes based on smoking status in the Great Lakes Smoker Sibling Registry.

We investigated whether 52 same-sex sibling pairs discordant for ever-smoking differed on psychiatric cofactors, alcohol and caffeine use, and responses to initial exposure to smoking. Ever-smokers scored significantly higher on measures of novelty seeking, depression, and childhood ADHD, and on alcohol dependence, alcohol intake, and caffeine intake. They reported significantly more pleasurable experiences, dizziness, "buzz," and relaxation upon initial exposure to smoking and significantly fewer displeasurable sensations, nausea, and cough than did nicotine-exposed, never-smoking siblings. Ever-smokers had significantly fewer years of education than their never-smoking siblings, suggesting that the concentration of smokers in lower socioeconomic strata may be partly due to downward mobility among smokers, possibly because of the observed elevation in psychiatric cofactors, which may interfere with academic performance. These findings are consistent with differences previously identified in unrelated ever- and never-smokers. Because same-sex siblings typically share a large set of common environments during childhood, our findings could be due either to genetic differences among siblings and/or (excepting educational level and responses to early exposure) to differences in adult environments.

Adult↗

Protective and compensatory factors mitigating the influence of deviant friends on delinquent behaviours during early adolescence.

This study examined factors that could moderate or compensate the link between exposure to deviant friends and delinquent behaviours in a sample of 265 early adolescents. The putative moderating or compensatory factors referred to the behavioural domain (i.e. novelty seeking, harm avoidance), the biological domain (i.e. physical maturation), the sociofamily domain (i.e. sociofamily adversity, parental practices), the school domain (i.e. academic performance), and the social domain (i.e. peer acceptance). A series of regression analyses showed that novelty seeking and puberty status moderated the link between friends' self-reported delinquency and participants' self-reported delinquency. In addition, all the factors except peer acceptance also had main effects that, cumulatively, reduced the association between friends' delinquency and self-rated delinquency through compensatory main effects. These results are discussed in light of the differential roles of moderating and of compensatory factors.

Adolescent↗

Visual training: current status in ophthalmology.

PURPOSE: To inform ophthalmologists of the current status of visual training. DESIGN: Personal perspective. METHOD: A perspective and analysis of current practices that include a review of the literature and personal experiences of the author. RESULTS: Visual training of some sort has been used for centuries. In the first half of the twentieth century, in cooperation with ophthalmologists, orthoptists introduced a wide variety of training techniques that were designed primarily to improve binocular function. In the second half of the twentieth century, visual training activities were taken up by optometrists and paramedical personnel to treat conditions that ranged from uncomfortable vision to poor reading or academic performance. Other visual training has been aimed at the elimination of a wide variety of systemic symptoms and for the specific improvement of sight and even for the improvement of athletic performance. At present, ophthalmologists and orthoptists use visual training to a very limited degree. Most visual training is now done by optometrists and others who say it works. Based on an assessment of claims and a study of published data, the consensus of ophthalmologists regarding visual training is that, except for near point of convergence exercises, visual training lacks documented evidence of effectiveness. CONCLUSION: Although visual training has been used for several centuries, it plays a minor and actually decreasing role in eye therapy used by the ophthalmologist. At the beginning of the twenty-first century, most visual training is carried out by non-ophthalmologists and is neither practiced nor endorsed in its broadest sense by ophthalmology.

Amblyopia↗

Early middle ear effusion and school achievement at age seven years.

OBJECTIVE: This study tested the hypothesis that children with early persistent middle ear effusion (MEE) are at risk for later deficits in academic performance. METHODS: We recruited 698 newborns and monitored them for MEE every 2 to 4 weeks at home until age 3 years. At age 7 years, it was possible to obtain school data for 226 children. Tests included the Iowa Tests of Basic Skills or the Stanford Achievement tests, the Woodcock Reading Mastery Tests, and the Woodcock-Johnson Tests of Achievement. RESULTS: There was no significant relationship between early MEE and measures of school achievement as shown by correlations or multiple regression. Differences between extreme MEE groups were not significant. School achievement was strongly associated with ethnicity, home environment, and socioeconomic status. CONCLUSIONS: Early persistent MEE does not appear to affect achievement in school at age 7 years.

Child↗