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Parents' and physicians' perceptions of facial plastic surgery in children with Down's syndrome.

This study was designed to investigate both parents' and physicians' attitudes and perceptions concerning facial plastic surgery in persons with Down's syndrome. The results of this inquiry revealed that more physicians (63%) than parents (28%) feel that the children's facial features negatively affect their social development; most parents (85%) see their children well accepted by society whereas only 4% of physicians do so; approximately half of the physicians (51%) and parents (41%) thought that after hypothetical facial plastic surgery a child with Down's syndrome may accomplish more socially; the majority of the parents (92%) and physicians (76%) were concerned with the risk of the operation; and only 13% of parents but 44% of physicians indicated that facial plastic surgery should be done on children with Down's syndrome.

Adaptation, Psychological↗

Talking Wellness: a description of a community-academic partnered project to engage an African-American community around depression through the use of poetry, film, and photography.

The design, implementation, and preliminary evaluation of an enhanced community-engagement program that uses poetry, film, and photography at a film festival in south Los Angeles is described. This project is one of several Talking Wellness projects designed to develop social capital and enhance community engagement in projects designed to improve the community's capacity to communicate effectively about depression, to decrease the associated stigma, and to participate in the design and evaluation of research interventions. The high degree of collaboration in the development and evaluation of this community participatory research model is illustrated by describing the selection and design of the intervention and the development of the survey questionnaires used for data collection. The project is described from the perspective of community members involved in the process.

Adult↗

The empirical base for the implementation of social skills training with maltreated children.

Empirical research on the psychosocial sequelae of child maltreatment has identified numerous and severe social skills deficits in abused and neglected children that negatively affect their healthy adjustment. Social skills training programs have been successful in helping adults and nonmaltreated children improve their skills in interpersonal communication, problem solving, self-control, assertiveness, and stress management. Such training appears promising for intervention with maltreated children. Guidelines and rationales are presented for developing social skills training programs specifically focused on the developmental and situational needs of abused and neglected children.

Acculturation↗

Outcome in patients with profound biotinidase deficiency: relevance of newborn screening.

Profound biotinidase deficiency (PBD) is an autosomal recessively inherited disorder of biotin metabolism, which can be detected by newborn screening and treated with biotin supplementation. Children were investigated in whom PBD was detected by newborn screening and who were treated presymptomatically, or who were not screened but were diagnosed and treated after experiencing initial clinical symptoms (symptomatic children). In a follow-up of our study group, differences in development, social and behavioural adaptation, and signs of residual impairment were examined. Parents and physicians of children with PBD completed questionnaires which included the Child Behavior Checklist and Vineland Adaptive Behavior Scales. Information was obtained for 37 children (24 males, 13 females; median age at recruitment 6 years 8 months, range to 6 months-20 years; median length of follow-up 6 years 6 months, range 5 months to 18 years 3 months). All 11 symptomatic children had residual enzyme activity of <1%, or variants of the Michaelis-Menten constant which were not detected by newborn screening. Some symptomatic children showed residual impairments: hearing impairment (n=2), optic atrophy (n=2), both hearing impairment and optic atrophy (n=2). In addition, symptomatic children had a higher risk of delayed motor and speech development. No child with PBD detected by newborn screening (n=25) had auditory or visual loss; and milestones of speech development and motor skills were reached at an appropriate age. There was no significant difference in social adaptation or behavioural problems between symptomatic and asymptomatic children. Symptomatic children often have developmental delay and are at risk of irreversible damage to auditory, visual, or central nervous functions; whereas children with PBD (established presymptomatically following newborn screening) treated with biotin supplementation, do not experience these effects.

Adaptation, Psychological↗

Klaus Holzkamp and the rise and decline of German critical psychology.

The history of German Critical Psychology focuses on the works of its most significant representative, Klaus Holzkamp (1927-1995), and reconstructs the development of his ideas, critiques, and results. For historical-systematic reasons his work is divided into a precritical period (until 1968), a critical-emancipatory period (1968-1972), a critical-conceptual period (1973-1983), and a subject-scientific period (1984-1995). Social movements and internal problems of traditional psychology are identified as factors in the rise of his psychology, whereas the decline of Critical Psychology in the 1980s and 1990s is attributed to social development, limitations of a systematic-foundational framework, and the emergence of alternative critical approaches. Despite these problems the article shows that Holzkamp is an eminent theoretical psychologist who has made significant contributions to psychological knowledge.

Germany↗

The emergence of social phobia during clozapine treatment and its response to fluoxetine augmentation.

BACKGROUND: The underlying neurochemical basis of social phobia has yet to be fully explained, but there are suggestions of serotonergic and dopaminergic dysfunction. The atypical neuroleptic clozapine has been reported to induce anxiety symptoms, probably owing to its effect on serotonergic pathways. We report 12 cases of schizophrenic patients who developed social phobia during clozapine treatment. METHOD: Patients were assessed using the Structured Clinical Interview for DSM-III-R, Patient Version, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, the Liebowitz Social Phobia Scale, and the Brief Psychiatric Rating Scale. They were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. RESULTS: In 8 of the 12 cases, symptoms responded (> or = 35% reduction in Liebowitz Social Phobia Scale score) with an adjunctive regimen of fluoxetine. CONCLUSION: Data are discussed in light of neurochemical mechanisms and cognitive adaptations that could explain the onset of anxiety spectrum disorders (such as social phobia) in clozapine-treated schizophrenic subjects during remission of psychotic symptoms.

Adult↗

Oral health of children from rural excluded villages (Trancas and Calchaqui valleys. Tucumán, Argentina).

UNLABELLED: The general hypothesis of the study was to evaluate strategically important rural areas to confirm their characteristics of "excluded population" and identify the priorities to allocate human and financial resources of the international co-operation project. The aim of this study was to establish the degree of development of villages in the Trancas and Calchaqui valleys, and the oral health of children living in areas involved in an integral study on excluded villages in the northwest of Argentina. These villages are considered a priority in the UNIR Project; they are thus strategically important as a link with countries of the MERCOSUR. Data on living conditions were obtained through direct inquiries (Project UNIR, W. K. Kellogg Foundation/University of Tucumán) and from data supplied by the Ministry of Economy, by the Ministry of Culture and Education and by the SIEMPRO project of the Secretariat of Social Development of the Ministry of Health. The Human Development Index (HDI) was calculated as World Bank criteria (1995), The studies on dental conditions were carried out in all the children between 12 and 14 years old, that is a total of 58 in the Trancas Valley and 212 in the Calchaqui Valley. RESULTS: (1) The HDI was 0.731 for the province, 0.56 for the Trancas Valley and 0.51 for Calchaqui valley. (2) The results are above the values for the country in the first case, and below the average country values for the valleys. (3) The percentage of BNN families reached 92%. The results for oral health show: (4) the DMFT were 6.34 +/- 0.07 in the Trancas Valley and 7.47 +/- 0.276 in the Calchaquí valley. (5) Carious teeth (CT) were the most important component of this index. (6) The absence of a specific and preventive assistance. CONCLUSIONS: (a) Children between 12 and 14 living in the Valleys of Trancas and Calchaqui (Tucumán, Argentina) are affected by severe levels of caries, with values above the national and province means. (b) The human development index is below that of the corresponding national and province levels. (c) Inhabitants of these valleys can be identified as socially and biologically highly vulnerable. (d) The indicators of cariogenic risk reveal the importance of introducing oral preventive care components to the health plan for the area focused on the excluded population.

Adolescent↗

Demographic influences on the behavior of chimpanzees.

Recent research has revealed substantial diversity in the behavior of wild chimpanzees. Understanding the sources of this variation has become a central focus of investigation. While genetic, ecological, and cultural factors are often invoked to explain behavioral variation in chimpanzees, the demographic context is sometimes overlooked as a contributing factor. Observations of chimpanzees at Ngogo, Kibale National Park, Uganda, reveal that the size and structure of the unit group or community can both facilitate and constrain the manifestation of behavior. With approximately 150 individuals, the Ngogo community is much larger than others that have been studied in the wild. We have taken advantage of the unusual demographic structure of this community to document new and intriguing patterns of chimpanzee behavior with respect to hunting, territoriality, and male social relationships. Chimpanzees at Ngogo hunt often and with a considerable degree of success. In addition, male chimpanzees there frequently patrol the boundary of their territory and engage in repeated bouts of lethal intergroup aggression. By forming two distinct subgroups, male chimpanzees at Ngogo also develop social bonds above the level of dyadic pairs. While the sheer number of chimpanzees contributes to differences in hunting, patrolling, mating, and subgrouping at Ngogo, the demographic situation may also constrain behavioral interactions. At Ngogo, male chimpanzees who are closely related genetically through the maternal line do not appear to affiliate or cooperate with each other. Demographic constraints may be responsible for this finding. In this paper, I use these examples to illustrate how the demographic context affects the possible range of behavioral options open to individuals and ultimately contributes to the explanation of behavioral diversity in chimpanzees.

Animals↗

Independent and social play among profoundly mentally retarded adults: training, maintenance, generalization, and long-term follow-up.

Play skills were taught to eight profoundly mentally retarded adults in two interrelated experiments. In Experiment 1, a multiple baseline across subjects design was used to assess the efficacy of verbal and physical prompts on independent play. In Experiment 2, the same subjects and experimental procedures were used to develop social play. Verbal prompting and graduated physical guidance procedures were found to be effective in substantially increasing independent play in Experiment 1 and social play in Experiment 2. Positive changes were also observed in collateral behaviors. Inappropriate play decreased slightly and stereotypy decreased to very low levels. Social interaction increased substantially in Experiment 2 when social play was targeted but little change was observed in Experiment 1 when only independent play was targeted. Treatment gains were maintained for 26 weeks in Experiment 1 and 10 weeks in Experiment 2. In addition, the treatment gains were generalized across subjects and settings in Experiment 2. Finally, regular follow-up checks showed that independent and social play remained in the repertoire of the subjects for 12 months following the termination of programmed maintenance.

Adolescent↗

A demographic-economic explanation of political stability: Mauritius as a microcosm.

"This paper examines current models of economic and political development--social modernization theory, political and economic characteristics of stable regimes, and cross country analysis of political stability--and tests them on the Indian Ocean Island of Mauritius. The analysis continues with a causal explanation for political stability in Mauritius' recent history, derived from an examination of economic policies and demographic patterns. Political change in Mauritius over the past sixty years seems to be explained best by a model for political stability which integrates specific economic and demographic factors. The model, applicable to development in other third world nations, revises Malthus' conclusion that population and economic conditions move in an oscillatory relationship and replaces it with a more comprehensive theory, suggesting that political stability is a function of both economic development and a repeating cyclical relationship between economics and population."

Africa↗

Organizing Asian Pacific Islanders in an urban community to reduce HIV risk: a case study.

We present a case study of community organization efforts within the Asian Pacific Islander communities of San Diego County to reduce the risk of HIV transmission. We utilized a five-phase process to implement the strategies of locality development, social planning, and social action: community analysis, program design and initiation, program implementation, program maintenance and consolidation, and program reassessment. An evaluation of the process indicates that there were increases over time in the project's activities as well as in the levels of interagency connectedness. This is one of the few reported efforts to organize Asian Pacific Islander groups to address HIV transmission. Key elements that led to the successful organization of the original project into a tax-exempt nonprofit entity (the Asian Pacific Islander Community AIDS Project) were emphasis on community ownership, reliance on group consensus, use of "gatekeepers" to access communities, simultaneous multilevel programming, and service to the community as a "coordinating" entity.

Acquired Immunodeficiency Syndrome↗

The mother-infant relationship and infant development: the effect of pediatric intervention.

This study examined the impact of intervention provided in the context of pediatric health supervision visits on the mother-infant relationship during the first 6 months of life. 32 mother-infant dyads were randomly assigned at birth to either an intervention or attention control group, each of which received routine well-child care plus discussions regarding infant social development or accident prevention and nutrition, respectively. Blind assessment of infant and mother behavior frequencies, responsive behavior sequences, and affective relationship characteristics during a 21-min play observation revealed more sensitivity, cooperativeness, appropriateness of interaction, and appropriateness of play by the intervention group pairs, although differences in Bayley Mental Scales and the Uzgiris and Hunt subscales did not attain significance. Post hoc inspection of the behavioral correlates of the affective relationship characteristics provided support for molar assessment of mother-infant interaction as an adjunct to contemporary methods of behavioral microanalytic study.

Adult↗

Neurodevelopment after in utero amiodarone exposure.

It is not known whether amiodarone is neurotoxic to the fetus, as it is to adults. We evaluated neurodevelopment of a historical cohort (N = 10) of children exposed transplacentally to amiodarone. Scores on standardized tests of cognitive and language skills were compared (by Wilcoxon signed rank test) between eight toddlers and matched controls. It was not possible to obtain controls for older amiodarone-exposed children (aged 9.7 and 12.0 years), whose test results were compared descriptively with normative data. There was no difference in IQ scores between amiodarone-exposed toddlers and controls. All had favorable temperaments. However, amiodarone-exposed toddlers showed expressive language skills that were relatively poorer than verbal skills, when compared with controls (p = 0.046). One amiodarone-exposed toddler exhibited global developmental delay. The older amiodarone-exposed children had well-developed social competence, favorable global IQ scores, but problems with reading comprehension, written language, and arithmetic. This picture is reminiscent of the Nonverbal Learning Disability Syndrome. There may be neurotoxicity associated with transplacental exposure to amiodarone. Follow-up is warranted, although most mothers were happy with the development of their children.

Adult↗

The success of dietary protein restriction in alkaptonuria patients is age-dependent.

Alkaptonuria is characterized by an increased urinary excretion of homogentisic acid, pigmentation of cartilage and connective tissues, and ultimately the development of inflammatory arthropathy. Various diets low in protein have been designed to decrease homogentisic acid excretion and to prevent the ochronotic pigmentation and arthritic lesions. However, limited information is available on the long-term beneficial effects of these diets. We reviewed the medical records of 16 patients aged 3-27 years (4 > 18 years) to ascertain the age of diagnosis, growth, development, social behaviour, signs of complications and longitudinal dietary compliance. The diagnosis of alkaptonuria was made at an average age of 1.4 years (2 months-4 years); following the diagnosis all patients were prescribed a diet with a protein content of 1.5 g/kg per day. All patients showed normal growth and development, and no major complications of the disease. Behavioural problems associated with poor dietary compliance emerged as the main problem. Dietary compliance decreased progressively with age. The effect of dietary protein restriction in homogentisic acid excretion was studied by fixing the amounts of protein in the diet at 1 g/kg per day and 3.5-5 g/kg per day during 8 days. Twelve patients, aged 4-27 years, participated in the investigation. Protein restriction resulted in a significantly lower excretion of homogentisic acid in the urine of children younger than 12 years (p < 0.01), whereas this effect was less obvious for adolescent and adult patients. The results suggest that restriction of protein intake may have a beneficial effect on alkaptonuric children; but continuation of this regimen to older age seems questionable and not practical.

Adolescent↗

Intensity of CNS treatment for pediatric cancer: prediction of social outcomes in survivors.

PURPOSE: To evaluate the association of central nervous system (CNS) treatment intensity and the social functioning of children who have completed treatment for leukemia, lymphoma, and solid tumors outside the CNS. Furthermore, we expected that these associations would be moderated by child age at diagnosis and gender. METHOD: Peer, teacher, and self-report data were obtained for 82 cancer survivors (age 9-17 years) using classroom rating and nomination procedures that are widely used in research on social development. Information regarding cranial radiation therapy (CRT), intrathecal chemotherapy (ITC), and systemic methotrexate were obtained from medical records and used to create a composite index of CNS treatment intensity. RESULTS: Higher scores on the index of CNS treatment intensity were associated with poorer peer acceptance, fewer friendships, greater social sensitivity-isolation, and diminished leadership-popularity based on peer-report. These associations were stronger for boys and children who were younger (<10 years old) at diagnosis. In contrast, CNS treatment intensity was only predictive of teacher-perceptions of aggressive-disruptive behavior and it was unrelated to social self-perceptions. CONCLUSION: These results suggest that children who receive CRT and ITC are at risk for problematic peer relations, particularly if they are male or younger at diagnosis. Given the stability of poor peer relationships and documented linkages between peer problems and subsequent academic and psychiatric difficulties, clinical services should address these issues. Research is needed to identify mechanisms that account for these outcomes and provide direction for prevention and treatment efforts.

Adolescent↗

A review of child health in the 1958 birth cohort: National Child Development Study.

In the week 3-9 March 1958, 98% of all births in England, Scotland and Wales (approximately 17,000) were studied in the Perinatal Mortality Survey. The follow-up of surviving children, known as the National Child Development Study, comprises four major sweeps at ages 7, 11, 16 and 23. Medical examinations were conducted at each age, except at 23 when health was self-reported. Details of the child's family background and socio-economic circumstances were recorded, together with assessments of their social development and educational attainment. Seventy-six per cent of the target population were interviewed at age 23. The health of subjects in the 1958 cohort has been described in over 200 publications but there is no comprehensive account of findings from birth to age 23. This overview attempts to redress this. As new data are gathered from the study subjects at age 33, opportunities will exist to investigate associations between childhood factors and health in midlife. Data on their partners and children will be included, allowing studies of inter-generational and family health. Further indications of changing illness patterns will be possible from comparisons with data collected on earlier and later born cohorts.

Accidents↗

Autism: recognising the signs in young children.

Autism is an organic disorder affecting several areas of a child's development. Autism is present from birth, or very soon after, but the nature of the disorder can mean that diagnosis is delayed for months for years. Early intervention can improve long-term function and help the families. Babies with autism may display characteristic features of gaze, hearing, social development and play. Nurses working with babies and young children are in a prime position to recognise these characteristics and refer the family for specialised assessment. Learning disabilities may or may not be present in children with autism. Always listen to the parents. They often suspect something is wrong even though they may not be able to be precise.

Autistic Disorder↗

[Development conditions and development status of 10-year-old children in Basle].

Children from the "Basle Kindergarten Study" (born 1971-73) were re-examined during their 4th year of primary school, i.e. at the age of ten (1981-84) (Follow-up of a representative sample of 10% of all children in the first year of kindergarten). The aim of this study is to analyse differences in physical and psycho-social development of children living in different conditions, particularly between immigrant and Swiss children. First results are discussed.

Child↗