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Children with hypoplastic enamel defects of primary incisors are not at increased risk of learning-problem syndromes.

Developmental enamel defects of primary teeth have been associated in earlier reports with motor, hearing and psychological disturbances. The relationship between hypoplastic enamel defects and learning problems had not been evaluated previously. For a total of 149 girls and 196 boys we collected a primary tooth shortly after shedding and approximately 2 years later a teacher-completed questionnaire about function in school. Children with a hypoplastic enamel defect of one of their primary incisors were no more likely than their peers without an enamel defect to have any of 7 different learning problem syndromes. In the absence of reason to suspect selection bias, confounding, or misclassification of hypoplastic defects or school problems, we conclude that hypoplastic enamel defects are not associated with teacher-identified learning problems.

Child↗

Mental health and the timing of men's retirement.

BACKGROUND: Analysis of the Psychiatric Morbidity Survey of Great Britain showed that the prevalence of common mental disorders was lower amongst men at or above Britain's state pension age of 65, relative to younger men. Retirees below this age had consistently higher rates of mental disorders than working men. In contrast, the low prevalence of mental disorders amongst retirees aged 65 and older was similar to that of their working peers. The aim of this analysis was to investigate this pattern of results in a national sample of Australian men, and the mediating role of socio-demographic factors. METHOD: Data were from the Household, Income and Labour Dynamics (HILDA) in Australia survey (2003). The analyses included men aged 45-74 years who were active in the labour force (n = 1309), or retired (n = 635). Mental health was assessed using the mental health scale from the Short-Form 36 Health Questionnaire. RESULTS: Retirees were more likely to have mental health problems than their working peers, however this difference was progressively smaller across age groups. For retirees above, though not below, the age of 55 this difference was explained by poorer physical functioning. When age at retirement was considered it was found that early retirees who were now at or approaching the conventional retirement age did not display the substantially elevated rates of mental health problems seen in their younger counterparts. Further, men who had retired at age 60 or older did not display an initially elevated rate of mental health problems. CONCLUSIONS: The association between retirement and mental health varies across older adulthood. Retired British and Australian men below the conventional retirement age of 65 are more likely to have mental health problems relative to their working peers, and retirees above this age. However, poor mental health appears to be linked to being retired below this age rather than an enduring characteristic of those who retire early.

Age Factors↗

Is the discrepancy criterion for defining developmental disorders valid?

BACKGROUND: Most developmental disorders are defined by an achievement discrepancy in which achievement on one or more specific abilities is substantially less than a person's measured intelligence. We evaluated the validity of this discrepancy criterion by assessing parameters that determine variability across abilities and by assessing relationships between achievement discrepancies and behavioral disturbances. METHODS: Measures of intelligence, language, motor coordination, empathic ability, and attentional control were administered to a representative sample of 390 children aged 3 to 12 years. Parent ratings of child behavior were obtained. RESULTS: Results indicate that achievement discrepancies are a function of the correlation between ability measures, the shape of the ability distributions, and position on an index ability dimension. Discrepancies in achievement were not related to behavioral disturbance, but underachievement relative to age peers was invariably related to behavioral disturbance. CONCLUSIONS: We conclude that developmental disorders need to be redefined in ways that are consistent with how Mental Retardation is now defined, by (a) underachievements, (b) of defined magnitude, (c) using standardized measures, (d) with known relations to normal development, and (e) concurrent deficits on standardized measures of impaired function.

Age Factors↗

Socio-demographic profile of substance users seeking treatment.

This study was conducted to obtain a personality profile and a descriptive analysis of a typical substance user who is presently enrolled in a treatment center and is receiving professional help for his or her substance use at one of four participating treatment centers in a southwestern city in the United States. According to the findings, a typical substance abuser is a thirty-one year old male who is third born and has parents who are more frequently non-professional. Most respondents became involved with substance use because of peer influence and reported feeling bored/unhappy. First substance use experiences were more frequently with marijuana, although at the time of enrollment at the treatment center, alcohol, cocaine/crack, heroine, marijuana, and a combination of substances were typically used. When ranking the major problems they perceive having in their lives, respondents reported most frequently, substance use and being bored/unhappy in life. When assessing respondent's family type, a difference was found between the balanced and midrange families when considering their plans on having children. Of the substance using respondents, most were planning children in their lives and of this group, many were from extreme (low functioning) families.

Adult↗

Who uses consumer-run self-help organizations?

A multisite evaluation of community mental health services is used to answer two questions: (a) How do diagnosis, functioning, and self-assessments of consumer/survivor initiative (CSI) and assertive community treatment (ACT) participants compare?, and (b) What other supports/services are CSI and ACT participants using? The sample is from an Ontario evaluation of consumer/survivor peer initiatives in four communities (n=73). The reference group is new (n=48) and ongoing (n=134) clients of four ACT teams. Self-help organizations are serving a broader population of individuals who include a significant subgroup of persons with severe mental illness along with others with a mixed picture of higher functioning and greater instability. There is little overlap in the use of these modes of service delivery, which suggests that maintaining options within systems of care is critical to ensuring coverage and access for the broader population.

Adult↗

Contextual influence on the language production of children with speech/language impairment.

To investigate the possible contextual variability of language and interaction, data from 10 children with speech/language impairment and three different types of conversational partners (a parent, a peer and a clinician) were collected. The dialogues were analyzed with respect to the characteristics of the dialogues as whole, to the dominance and the productivity of the three types of conversational partners, and to the productivity, fluency and grammatical structure of the language production of the children with speech/language impairment. Productivity was measured as mean length of utterance (MLU) in words, number of utterances, number of different words and proportion of complete and intelligible utterances. Fluency was measured as the proportion of utterances containing a maze. Grammatical structure was analysed with respect to the use of grammatical morphemes, word order patterns, the occurrence of expansions and the complexity of verb forms. Significant differences, in particular between child-child and adult-child dialogues were found. The adult-child dialogues were asymmetrical, where the adults dominated through asking many questions and talking much. The peer dialogues were more dynamic and equal. In these dialogues the children with speech/language impairment took a more active role as a conversational partner. The children produced more utterances and different words with the adult partners, but variables related to fluency and grammatical structure did not vary as a function of the conversational partner. The results imply that children with speech/language impairment practise different aspects of their communicative ability with different types of conversational partners. In particular, it is important to provide them with opportunities to interact with peers, in order for them to develop their skills as independent conversational partners.

Articulation Disorders↗

The social-emotional development of "late-talking" toddlers.

OBJECTIVE: To examine the social-emotional problems and competencies of toddlers who evidenced lags in expressive language without concomitant receptive language delays. METHOD: Maternal report and observation of 14 "late-talking" toddlers was compared with that of 14 control toddlers. Participants were selected on the basis of maternal report of vocabulary production with the MacArthur Communicative Development Inventory Short Forms and by direct assessment with the Mullen Scales of Early Learning. Social-emotional functioning was assessed with the Infant-Toddler Social and Emotional Assessment, the Child Behavior Checklist 1.5-5, and the Vineland Adaptive Behavior Scales-Expanded Form. Toddler affect was observed using the Parent-Child Early Relational Assessment. The Parenting Stress Index Short Form was used to assess maternal stress. RESULTS: Late talkers were rated higher in depression/withdrawal and lower in social relatedness, pretend play/imitation, and compliance on the Infant-Toddler Social and Emotional Assessment and more withdrawn on the Child Behavior Checklist than controls. Observation indicated late talkers were more serious, more depressed/withdrawn, and less interested in play. Late talkers were reported to be lower in socialization on the Vineland. Mothers of late talkers endorsed higher parent-child dysfunction on the Parenting Stress Index. No differences were found for externalizing behaviors or peer relationships. CONCLUSIONS: Early lags in expressive language are associated with poor social-emotional adjustment. Intervention may ameliorate difficulty in linguistic and social-emotional functioning.

Affect↗

Functional magnetic resonance imaging in studies of neurocognitive effects of alcohol use on adolescents and young adults.

Alcohol use disorders (defined as alcohol abuse or dependence) are prevalent and serious problems among adolescents and young adults. Adolescence is a time of trying new experiences and activities that emphasize socializing with peers, and conforming to peer-group standards. These new activities may place young people at particular risk for initiating and continuing alcohol consumption. Exposing the brain to alcohol during adolescence may interrupt key processes of brain development, leading to cognitive impairment as well as to further escalation of alcohol use. Alcohol-induced adolescent learning impairments could affect academic and occupational achievements. Functional magnetic resonance imaging (fMRI) is a relatively new imaging technique that allows studying neurocognitive function. fMRI aims to determine the neurobiological correlate of behavior by identifying the brain regions that become active during the performance of specific tasks in vivo. The technique is non-invasive and relatively safe. This allows repeated studies to be carried out within a given subject. Several fMRI studies have been performed to evaluate neurocognitive function in adolescents and young adults with alcohol use disorders. Adolescents and young adults with alcohol use disorders had abnormalities in brain response to a working memory task. The results of the studies of cue reactivity and craving responses in young people suggest that the elevated physiological response and altered cognitive reactions to alcohol are involved in the pathogenesis of alcohol dependence in adolescents and young adults. Future fMRI studies may help ascertain the adverse affects of alcohol on brain function during early neurodevelopmental stages. fMRI may be uniquely powerful in the delineation of the underlying pathophysiology of alcohol use disorders in adolescents and young adults.

Adolescent↗

Acting nasty in the face of failure? Longitudinal observations of "hard-to-manage" children playing a rigged competitive game with a friend.

Peer problems are almost universal among children with disruptive behavior disorders, and have been linked to social information processing deficits that lead to heightened threat responses. This 2-year longitudinal study uses direct observations to examine the real-life significance of this finding. Forty "hard-to-manage" children and 40 typically developing control children were filmed at ages 5 and 7 playing a rigged competitive game in which they experienced a clear threat of losing. Group differences in negative behavior (hard-to-manage > controls) were stable over time and independent of verbal ability. Predictors of individual differences in negative behavior were also examined. Previous studies with this sample have shown that at 4 years of age, the hard-to-manage children displayed elevated frequencies of violent pretend play, coupled with poor performance on tests of executive function and theory of mind. In this study, 4-year-olds whose pretend play indicated a preoccupation with violence were more likely to respond negatively to the threat of losing a competitive game at age 5 and at age 7. Four-year-olds who performed poorly on tests of theory of mind and executive function showed higher rates of negative behavior at age 5 but not age 7. These findings highlight just a few of the multiple paths leading to peer problems among children with disruptive behavior problems.

Affect↗

Productive use of the English past tense in children with focal brain injury and specific language impairment.

In this study, 22 children with early left hemisphere (LHD) or right hemisphere (RHD) focal brain lesions (FL, n=14 LHD, n=8 RHD) were administered an English past tense elicitation test (M=6.5 years). Proportion correct and frequency of over-regularization and zero-marking errors were compared to age-matched samples of children with specific language impairment (SLI, n=27) and with typical language development (TD, n=27). Similar rates of correct production and error patterns were observed for the children with TD and FL; whereas, children with SLI produced more zero-marking errors than either their FL or TD peers. Performance was predicted by vocabulary level (PPVT-R) for children in all groups, and errors did not differ as a function of lesion side (LHD vs. RHD). Findings are discussed in terms of the nature of brain-language relations and how those relationships develop over the course of language learning.

Brain Injuries↗

From boys to men: predicting adult adaptation from middle childhood sociometric status.

This report examines the predictive validity of sociometric status at age 9-10 to young adult (age 23-24) antisocial behavior, work and school engagement, and arrests using Oregon Youth Study males (N = 206). A variety of analytic strategies included (a) multivariate analyses to examine the variation in adult adaptation as a function of sociometric classification at age 9-10, (b) regression analyses to evaluate the relative contribution of "liked most" and "liked least" peer nominations, and (c) structural equation modeling to predict the young adult outcome constructs from social preference at age 9-10. Contrary to expectation, when controlling for early antisocial behavior and academic skills, boys' social preference scores still predicted young adult outcomes. Longitudinal findings are discussed with respect to the salience of male peer rejection in middle childhood and the social developmental processes that may account for the predictive validity of peer rejection.

Adaptation, Psychological↗

Morquio syndrome: a rehabilitation perspective.

Morquio Syndrome (mucopolysaccharidosis type IV A) is a rare inherited connective tissue disorder characterized by skeletal dysplasia, restrictive pulmonary disease and normal intelligence. Tetraplegia secondary to subluxation of C1 over C2 because of odontoid dysplasia is a common occurrence in these patients but there are limited descriptions regarding their specific physiatric management. Two patients (aged 20 and 17 years) were admitted to a pediatric rehabilitation facility after cervical spine stabilization following recurrent tetraplegia (C4 ASIA C and C4 ASIA D). Following surgery, patients were ventilator dependent and aphonic. One patient was successfully weaned off the ventilator to nocturnal BiPAP, while the other was able to tolerate three hours of ventilator free time despite being ventilator dependent for ten years. At discharge, both patients showed significant improvement in mobility, self care skills and communication abilities. Functional independence was encouraged through use of various assistive devices for mobility, activities of daily living (ADL) and communication. Group counseling and peer support were extremely helpful in their adjustment to disability. Physiatric intervention is essential and requires understanding of the unique impairments encountered by tetraplegics with Morquio Syndrome.

Activities of Daily Living↗

Hospice social work: a search for identity.

This article describes social work's contribution to hospice philosophy and practice, calls attention to the lack of a distinct social work function on hospice teams, and examines various ways to resolve the problem of social work identity in hospice care. Insights from recent peer discussions of hospice social workers tend to support Kulys and Davis's (1986) earlier findings that psychosocial care is provided regularly by hospice team members other than social workers. Options for strengthening the hospice social work role are discussed, including the development of more specific therapeutic techniques and social work leadership in conducting applied research. The importance of maintaining a value-based, critical perspective is stressed.

Aged↗

Measuring aerosols generated inside armoured vehicles perforated by depleted uranium ammunition.

In response to questions raised after the Gulf War about the health significance of exposure to depleted uranium (DU), the US Department of Defense initiated a study designed to provide an improved scientific basis for assessment of possible health effects on soldiers in vehicles struck by these munitions. As part of this study, a series of DU penetrators were fired at an Abrams tank and a Bradley fighting vehicle, and the aerosols generated by vehicle perforation were collected and characterised. A robust sampling system was designed to collect aerosols in this difficult environment and monitor continuously the sampler flow rates. The aerosol samplers selected for these tests included filter cassettes, cascade impactors, a five-stage cyclone and a moving filter. Sampler redundancy was an integral part of the sampling system to offset losses from fragment damage. Wipe surveys and deposition trays collected removable deposited particulate matter. Interior aerosols were analysed for uranium concentration and particle size distribution as a function of time. They were also analysed for uranium oxide phases, particle morphology and dissolution in vitro. These data, currently under independent peer review, will provide input for future prospective and retrospective dose and health risk assessments of inhaled or ingested DU aerosols. This paper briefly discusses the target vehicles, firing trajectories, aerosol samplers and instrumentation control systems, and the types of analyses conducted on the samples.

Aerosols↗

Context-sensitive behavioral supports for young children with TBI: short-term effects and long-term outcome.

OBJECTIVE: To investigate the effects of a multicomponent cognitive-behavioral intervention on the challenging behavior of two young children with growing behavioral concerns after traumatic brain injury. DESIGN: Single-subject reversal designs were used to document the effects of the intervention on the specific dependent variables. In addition, qualitative data were collected to determine the children's long-term outcome and staff evaluations of the intervention. PARTICIPANTS: Both children were normally developing before injury at age 5 years. Both experienced increasing behavior problems as expectations in school escalated. MAIN OUTCOME MEASURES: Quantitative data included frequency and intensity of aggression and amount of work completed. Qualitative data included children's general engagement in school work and peer interaction and staff evaluations of the intervention. INTERVENTION: The intervention included components of positive behavior supports, cognitive supports, and an executive function routine. RESULTS: The targeted challenging behaviors were reduced to near zero with decreased intensity. Long-term outcome was positive. CONCLUSIONS: These results illustrate the potential for successfully treating behavior disorders in young children with traumatic brain injury using a support-oriented intervention that combines behavioral and cognitive components.

Brain Injuries↗

Assessing adolescent personality pathology.

BACKGROUND: Personality pathology constitutes a major form of psychopathology in adolescents. AIMS: To examine the reliability and validity of a Q-sort instrument for assessing adolescent personality pathology designed for clinically experienced informants. METHOD: A sample of 294 randomly selected psychiatrists and psychologists each provided data on a current patient, aged 14-18 years. Clinicians completed several measures, including the Shedler-Westen Assessment Procedure for Adolescents (SWAP-200-A). RESULTS: Factor analysis identified II dimensions of adolescent personality: psychopathology/malignant narcissism, dysphoria/inhibition, psychological health, histrionic sexualisation, schizotypy, sexual conflict, emotional dysregulation, anxious obsessionality, peer rejection, delinquent behaviour and attentional dysregulation. These correlated in predicted ways with a range of criterion variables, including measures of adaptive functioning, Axis II pathology, the Five Factor Model and the Child Behavior Checklist. CONCLUSIONS: The SWAP-200-A shows promise as an instrument for assessing personality pathology in adolescents. Trait dimensions such as delinquent behaviour and emotional dysregulation may prove useful additions to a classification of personality.

Adolescent↗

Epidemiology of juvenile violence.

It is difficult to review the epidemiology of juvenile violence because few studies focus specifically on this topic as opposed to childhood aggression or delinquency in general. More research is needed specifically on juvenile violence, which is generally measured using official records or self-reports. Self-report research shows that a substantial fraction of the male juvenile population commits violence, and that very few violent acts are followed by arrests or convictions. Racial differences in violence may be explainable by reference to racial differences in community contexts. There is a great deal of versatility in juvenile violence. Juveniles who commit one type of violent offense also tend to commit other types and nonviolent offenses. Violent offenders tend to be persistent or frequent offenders, and there is little difference between violent offenders and nonviolent but equally frequent offenders. Nevertheless, there is some degree of specialization in violence. More research is needed to investigate whether risk factors exist for violence that are not risk factors for serious nonviolent delinquency (e.g., biologic factors). Violent juveniles tend to have co-occurring problems such as victimization, substance abuse, and school failure. Often, they might be described as multiple-problem youth. There is considerable continuity from childhood aggression to juvenile violence. An early age of onset of violence predicts a large number of violent offenses. The major long-term risk factors for juvenile violence are individual (high impulsiveness and low intelligence, possibly linked to the executive functions of the brain), family (poor supervision, harsh discipline, child physical abuse, a violent parent, large family size, poverty, a broken family), peer delinquency, gang membership, urban residence, and living in a high-crime neighborhood (characterized by gangs, guns, and drugs in the United States). More research is needed on interactions among risk factors, and especially on interactions between biologic and psychosocial risk factors. Important short-term situational factors include motives of potential offenders (e.g., anger, a desire to hurt), alcohol consumption, and actions leading to violent events (e.g., the escalation of a trivial altercation). More specific research is needed on protective factors against youth violence, for example, by investigating why aggressive children do not become violent juveniles. More research is also needed on the development and validation of risk assessment instruments. To investigate developmental and risk factors for juvenile violence, longitudinal studies are needed. Such studies should include multiple cohorts, to draw conclusions about different age groups, and should include both boys and girls and the major racial and ethnic groups. They should measure a wide range of risk and especially protective factors. They should be based on large, high-risk samples, especially in inner-city areas, incorporating screening methods to maximize the yield of violent offenders while simultaneously making it possible to draw conclusions about the total population. They should include long-term follow-up studies to permit conclusions about developmental pathways. They should make a special effort to study careers of violence and to link developmental and situational data. It will not be easy to mount new longitudinal studies focusing specifically on juvenile violence, but such studies are needed to advance knowledge about the epidemiology of juvenile violence, including risk factors and developmental pathways.

Adolescent↗

Towards a systems definition of psychiatric practice.

Assessment of psychiatric practice has been difficult largely because of the apparent diversity of psychiatrists' theories, procedures, and goals. Searching for a unifying principle, we propose system identification failure (SIF), a defect in data-processing, as the unit of psychopathology underlying all psychiatric disorder (and other behavioral error). Definitive treatment must not only identify and correct the data-processing defect, but also eliminate the secondary symptoms. Emphasis is not on method of treatment but on goal or intent. Preparatory treatment includes supportive psychological and environmental measures and somatic therapies (regardless of type, duration, or intensity) which make definitive treatment possible. Palliative treatment must be frequently reviewed. Preventive treatment should prevent SIF-formation. We consider our proposal a distillate of the aims and implicit intent of experienced psychiatrists regardless of their training or theoretical orientation. The search for a functional definition of the practice of psychiatry was perhaps at one time an academic or lexicographic exercise, but, with the advent of peer review, it has become a pragmatic matter deserving of earnest attention. What is psychiatric practice? In a universe criss-crossed by psychiatrists "riding madly off in all directions." not only are the descendants of Anna O. and Dora analyzed in vivo and those of Little Hans at one remove, but also are distant figures and cultures subjected, often iv vitro, to critical scrutiny, while the "talking treatment" is applied to couples, families, groups, "networks" and communities. When one adds to this the diversity of biological therapies and institutional, environmental, and behavioral manipulations, the task of finding a common theme, much less procedure, becomes a worthy problem in hermeneutics, general semantics, or system analysis. Thus we must ask not only the operational question, "What do psychiatrists do?" BUt also, "What did you to to treat the specific psychopathology of this patient?" "Did it work?" AND, "Hos do you know?" Failure to deal with such questions as these will mark psychiatry's inability to cope with a reality that includes Professional Standards Review Organizations and an imminent National Health Insurance...

Cognition Disorders↗