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PubMed1995

The significance of self-reported anxious symptoms in first grade children: prediction to anxious symptoms and adaptive functioning in fifth grade.

In an earlier study of an epidemiologically defined sample of first grade children, primarily between the ages of 5 and 6, self-reported anxious symptoms proved relatively stable and were significantly related to adaptive functioning. In the present study we follow that cohort of first graders longitudinally and assess the prognostic value of self-reports of anxious symptoms in first grade with respect to anxious symptoms and adaptive functioning in the late elementary school years or at about age 10. First grade anxious symptoms were found to have significant prognostic value in terms of levels of anxious symptoms and adaptive functioning in fifth grade.

Adaptation, Psychological↗
PubMed1995

The natural history of respiratory symptoms in preschool children.

We studied the natural history of preschool respiratory symptoms in a population-based sample of children followed during the early school years. Current symptoms, ventilatory function, bronchial responsiveness to methacholine (BR), atopic status, and peak expiratory flow variability (PEFV) were assessed. Among those initially asymptomatic (210 subjects), 83.3% remained symptom-free, 6.7% started to wheeze, and 10% developed recurrent cough. Nearly half (46.9%) of the initial wheezing group (145 subjects) became symptom-free, 37.9% continued to wheeze, and 15.2% reported recurrent cough. Over half (56.0%) of the cough group (127 subjects) became symptom-free, 7.2% developed wheeze, and 36.8% reported continuing cough. Preschool wheezers showed the greatest BR (geometric mean 1.91 mg/ml) and the highest atopic prevalence (AP) (43.6%) when compared with the preschool asymptomatic group (BR: 3.39 mg/ml; AP: 23.8%) and the cough group (BR: 2.62 mg/ml; AP: 26.7%) (p = 0.0001 and p = 0.006 respectively). Children whose wheeze had persisted from the preschool period exhibited the poorest ventilatory function, the highest BR, a high AP, and high PEFV. The study shows that fewer than half of preschool wheezy children continued to wheeze in the early school years but those with persistent wheeze display many of the clinical characteristics consistent with a diagnosis of asthma.

Age Factors↗
PubMed2006

Economic burden and absenteeism from influenza-like illness in healthy households with children (5-17 years) in the US.

BACKGROUND: School children (5-17 years) function as vectors in influenza epidemics. The objective of this study was to quantify the burden of influenza-like illness (ILI) on US healthy households with school-aged children. METHODS: The Medical Expenditure Panel Survey database of 1996-2002 was queried to compare annual total medical expenses and absenteeism incurred by otherwise healthy households with school-aged children that reported experiencing ILI to similar households that did not experience ILI. RESULTS: We identified 12,850 healthy households with at least one school-aged child. Households reporting one or more ILI episodes incurred $281.47 higher total annual medical expenses than those without an ILI. Employed members in households with ILI lost an average of 1.12 more workdays from their illness compared to those in the households without ILI. Furthermore, households with ILI in which all members were employed and medically insured lost an additional 0.89 workdays due to caring for other ill household members. School children in households with ILI missed 1.91 more school days annually and 4.87 more school days if the household had three or more students. The total annual additional cost to a household experiencing ILI, including medical expenses and productivity losses was $538.75 for fully employed and insured households and $424.83 if one or more members were unemployed or uninsured. CONCLUSIONS: ILI increase economic burden among households with school-aged children and lead to more school and workdays lost. Initiatives to vaccinate school-aged children should be explored.

Absenteeism↗
PubMed1999

Parental employment, school climate, and children's academic and social development.

Longitudinal data were used to examine the effects of parental employment status and school climate on children's academic and social development. Hierarchical regression, analyses of covariance, and latent growth modeling were used to assess various aspects of change as a function of work status and school climate with family income and education as control variables. Parental employment was associated with positive changes in social and academic progress even after controlling for prior developmental level, climate, and family income although effects were small and complex. School climate had minimal effect on the outcome variables. Income and education were related to various school outcomes.

Adult↗
PubMed2006

Teens' perceptions about attention deficit/hyperactivity disorder and medications.

This qualitative study describes teens' perceptions about attention deficit/hyperactivity disorder (AD/HD) and medications. The four modes of adaptation of the Roy Adaptation Model were the framework for this study. Data were collected through semistructured interviews with 15 high school teens aged 14-17 with parent-reported AD/HD. An inductive analysis identified four themes: (1) physiologic (medication)--"Medications are a hassle, but they work"; (2) role function--"I do better in school when I take the meds"; (3) interdependence-"With meds things are better with my family, and friends don't know I am any different"; and (4) self-concept/group identity--"I'm just an everyday teenager, pretty much." The composite main theme was, "Meds help me." School nurses can use this information to guide interventions for families and teens with AD/HD and in working with health care providers, teachers, staff, and communities in a multidisciplinary effort toward an adaptive educational experience for teens.

Activities of Daily Living↗
PubMed2002

Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic.

OBJECTIVE: The substantial discrepancy in the male-to-female ratio between clinic-referred (10 to 1) and community (3 to 1) samples of children with attention deficit hyperactivity disorder (ADHD) suggests that gender differences may be operant in the phenotypic expression of ADHD. In this study the authors systematically examined the impact of gender on the clinical features of ADHD in a group of children referred to a clinic. METHOD: The study included 140 boys and 140 girls with ADHD and 120 boys and 122 girls without ADHD as comparison subjects. All subjects were systematically assessed with structured diagnostic interviews and neuropsychological batteries for subtypes of ADHD as well as emotional, school, intellectual, interpersonal, and family functioning. RESULTS: Girls with ADHD were more likely than boys to have the predominantly inattentive type of ADHD, less likely to have a learning disability, and less likely to manifest problems in school or in their spare time. In addition, girls with ADHD were at less risk for comorbid major depression, conduct disorder, and oppositional defiant disorder than boys with ADHD. A statistically significant gender-by-ADHD interaction was identified for comorbid substance use disorders as well. CONCLUSIONS: The lower likelihood for girls to manifest psychiatric, cognitive, and functional impairment than boys could result in gender-based referral bias unfavorable to girls with ADHD.

Adolescent↗
PubMed2002

Measuring functional outcomes after prematurity: developmental impact of very low birth weight and extremely low birth weight status on childhood disability.

Our purpose was to describe functional outcomes in essential activities in preschool, school-age, and adolescent children who were born very (<32 weeks gestation) and extremely (<28 weeks gestation) prematurely. Very low birth weight (VLBW; 1000-1499 g), or extremely low birth weight (ELBW;<1000 g) populations are the focus of our analysis. We describe models of disablement and enablement for specifying the complexity of childhood outcomes using a framework of pathophysiology, impairment, functional limitation and functional strengths, disability in social roles and social participation, societal limitations and environmental facilitators. Representative early childhood, preschool, school-age, and adolescent studies were examined in terms of describing children's functional strengths and challenges after VLBW and ELBW survival. In early childhood, disability was assessed by diagnosing neurosensory impairments and delays on developmental testing. Instruments for measuring functional status in essential activities of self-care, mobility, communication and learning are described. Rates of neurosensory disability in the first three years among recent ELBW survivors ranged from 9-26% for cerebral palsy, 1-15% for blindness, 0-9% for deafness, and 6-42% for evolving cognitive disability (MDI <70). Rates of preschool functional limitation were 5-27% motor, 5-30% self-care, and 5-22% communicative. Rates of school-age functional educational disabilities exceeded 50%. Rates of adolescent activity limitation were 13-32% and vocational limitations were 27-71%. By examining the functional strengths and challenges of children with major neurodevelopmental impairments after very or extremely preterm birth, we can examine causal pathways that lessen the risk of severe functional disability. Among children with mild to moderate disability, we can enhance functional outcomes, optimize community participation, and provide quality family supports. In order to assess the changing outcomes of this vulnerable population of survivors, combinations of clinical and survey based methodologies are required.

Achievement↗
PubMed2004

Evaluation of selected auditory tests in school-age children suspected of auditory processing disorders.

OBJECTIVE: To compare the auditory function of normal-hearing children attending mainstream schools who were referred for an auditory evaluation because of listening/hearing problems (suspected auditory processing disorders [susAPD]) with that of normal-hearing control children. DESIGN: Sixty-five children with a normal standard audiometric evaluation, ages 6-14 yr (32 of whom were referred for susAPD, with the rest age-matched control children), completed a battery of four auditory tests: a dichotic test of competing sentences; a simple discrimination of short tone pairs differing in fundamental frequency at varying interstimulus intervals (TDT); a discrimination task using consonant cluster minimal pairs of real words (CCMP), and an adaptive threshold task for detecting a brief tone presented either simultaneously with a masker (simultaneous masking) or immediately preceding it (backward masking). Regression analyses, including age as a covariate, were performed to determine the extent to which the performance of the two groups differed on each task. Age-corrected z-scores were calculated to evaluate the effectiveness of the complete battery in discriminating the groups. RESULTS: The performance of the susAPD group was significantly poorer than the control group on all but the masking tasks, which failed to differentiate the two groups. The CCMP discriminated the groups most effectively, as it yielded the lowest number of control children with abnormal scores, and performance in both groups was independent of age. By contrast, the proportion of control children who performed poorly on the competing sentences test was unacceptably high. Together, the CCMP (verbal) and TDT (nonverbal) tasks detected impaired listening skills in 56% of the children who were referred to the clinic, compared with 6% of the control children. Performance on the two tasks was not correlated. CONCLUSIONS: Two of the four tests evaluated, the CCMP and TDT, proved effective in differentiating the two groups of children of this study. The application of both tests increased the proportion of susAPD children who performed poorly compared with the application of each test alone, while reducing the proportion of control subjects who performed poorly. The findings highlight the importance of carrying out a complete auditory evaluation in children referred for medical attention, even if their standard audiometric evaluation is unremarkable.

Adolescent↗
PubMed2002

Education rights and the special needs child.

A child with a disability has a federally protected right to special education and related services when he or she needs them to benefit from education. The term "disability" is not limited to physical disability but rather includes mental disability, including mental retardation, serious emotional disturbance, autism, traumatic brain injury, specific learning disabilities, and other health impairments. A parent may request that a child be evaluated by the school district for special education and related services. The law sets forth specific guidelines for the evaluation, assessment, and eligibility determination. Unique to each child, the IEP is the written plan that documents the child's special education and related services. The initial IEP is developed at a meeting among parents, various school personnel, and others whom the parents may wish to invite. Parents are an integral part of the team and are involved in all decisions by the team. The IEP must be reviewed annually, with attention given to whether educational objectives have been met. For a child with mental health issues, the IEP likely contains "related services," such as counseling, and measurable goals to improve behaviors in the school setting. When a child's condition is such that he or she cannot benefit from education in the regular school setting, other placements are considered. The school district maintains the ultimate responsibility of the cost of all such education placements, including residential care. A child with behaviors that result in frequent suspensions should have a functional analysis assessment by the school psychologist. The results of the assessment can be used to create a behavioral intervention plan. (If the school refuses to perform an assessment or develop a plan, the usual remedy of a due process hearing is available to the parents.) This plan should address problem behaviors and include strategies for redirecting the child's behavior. Even if a special education child is "expelled" from school, the district maintains the responsibility of providing FAPE. For this reason, districts--even in their own interests--should be proactive in dealing with these children, which often has not been the case. The Supreme Court has said that a child with services under IDEA (a child with an IEP) must receive some benefit from his or her education [31]. The issue of "how much benefit is enough benefit" is still troubling to parents and schools alike. The court also has ruled that related services, even costly ones such as a one-to-one nursing aide, must be provided if a qualifying child needs such services to access education [29]. Children with disabilities were long excluded from the public education system in this country. Obvious exclusion rarely occurs in the current education system, although exclusion through isolation does. Children with disabilities, especially mental disabilities, need and deserve the same educational benefit offered to children without those differences.

Adolescent↗
PubMed1995

Adverse outcomes of bacterial meningitis in school-age survivors.

OBJECTIVE: To determine the outcomes of bacterial meningitis in school-age survivors. DESIGN: Prospective cohort study. SETTING: Teaching pediatric hospital. CHILDREN: During 1983 through 1986, 158 meningitis survivors, ages 3 months to 14 years, treated at a single center were enrolled. Between 1991 and 1993, 130 children, 82% of the original cohort, were evaluated at a mean age of 8.4 years and a mean of 6.7 years after their meningitis. OUTCOME MEASURES: Blinded neurologic, neuropsychologic, audiologic, behavior, and socio-demographic assessments were compared with those from grade- and sex-matched control children. Multivariate analyses adjusted for age at testing and socio-demographic variables. RESULTS: There was a systematic increase in risk of abnormality or poorer functioning for children with meningitis, compared with control children, across all categories tested, which was significant for fine motor function, Intelligence quotient (IQ) scores, and tests of school behavior, neuropsychologic function, and auditory figure-ground differentiation. Eleven children who had experienced meningitis (8.5%) had major deficits (IQ < 70, seizures, hydrocephalus, spasticity, blindness, or severe to profound hearing loss); a further 24 (18.5%) cases and 14 (10.8%) control children had minor deficits (IQ 70 to 80, inability to read, mild to moderate hearing loss, abnormalities in speech discrimination, or school behavior problems). Overall, children who had meningitis were at greater risk (26.9%) for disability. Children with acute neurologic complications had more adverse outcomes than those with uncomplicated meningitis and control children (39% vs 18% vs 11%, respectively). CONCLUSIONS: One in four school-age meningitis survivors has either serious and disabling sequelae or a functionally important behavior disorder, neuropsychologic or auditory dysfunction adversely affecting academic performance. As a group, survivors function less well than their classroom peers, and risk is greatest for, but not confined to, those who had acute neurologic complications. All survivors require careful follow-up, at least until school age.

Adolescent↗
PubMed2005

Implementing family-centered interventions within the public middle school: linking service delivery to change in student problem behavior.

The Adolescent Transitions Program is a family-centered intervention strategy designed to reduce problem behavior and prevent drug use within a public school environment. A parent consultant within a Family Resource Center (FRC) provided universal, selected, and indicated interventions that enhanced and supported positive parenting practices known to serve as protective factors. Implementation of the 3-year FRC model involved 584 students and their families in 4 middle schools. Analyses focused on the dynamics and effects of parent consultant activities and services. Differences in school "adoption" of the FRC services were found to be a function of both passage of time and school environment. Despite significant variation in implementation across schools, FRC services significantly reduced the growth in problem behavior over the course of the middle-school years. The implications of these findings for dissemination of empirically supported, school-based, family-centered interventions are discussed.

Adolescent↗
PubMedDate not supplied

Determinants of adjustment for children of divorcing parents.

Family physicians frequently see children and parents when they are adjusting to marital separation. This study examined how well child adjustment at school could be determined from an assessment of interspousal relations, maternal functioning, and child perception variables. Teachers evaluated adaptive functioning, social withdrawal, and aggressive behavior at school for a carefully selected sample of 22 boys and 24 girls (ages 7-12) whose parents had been separated for two to 18 months. Regression analyses indicated that boys' overall school adjustment was associated with better maternal parenting skills, lower child fear of abandonment, less blaming of father for the separation, and positive parental verbal attributions toward the other parent. Girls with better overall school adjustment reported less blaming of their mothers and a higher rate of positive attributions by mother about father. These findings suggest concepts family physicians can use in working with families to minimize the effect of divorce on children.

Aggression↗
PubMed2006

The primary care physician's approach to functional abdominal pain in childhood.

BACKGROUND: Recurrent abdominal pain in children was defined initially by Apley and updated recently by Rome II criteria. The intent of the Rome II criteria is to provide greater insight into functional disorders of the gastrointestinal tract. Because markers for these disorders are lacking, diagnostic evaluations may vary. In this investigation, the individual approach of the primary care physician to the child with functional abdominal pain (as defined by Rome II criteria) is explored both in a hypothetical and clinical setting. STUDY: A clinical vignette and survey involving the evaluation of a school-aged child with prototypical functional abdominal pain was distributed to area primary care physicians (n=201 completed). The actual physician approach for functional abdominal pain was determined through chart review of children referred to gastroenterology clinic (n=103). RESULTS: Physicians favored limited organ-specific testing, with urinalysis, preferred most. Physicians with extreme anticipation of a positive yield requested more testing than their nonanticipatory counterparts (5.7+/-2.2 vs. 2.0+/-2.0, P<0.001). Ultrasound was the only diagnostic test requested with greater frequency in actual subjects than hypothetical (31% vs. 18%, P<0.005). CONCLUSIONS: In accordance with published guidelines, physicians requested minimal testing for functional abdominal pain. Increased ultrasound requests in the clinic setting may be more reflective of the need for reassurance rather than seeking an organic etiology.

Abdominal Pain↗
PubMed2001

[Medical and educational support to children with neuromuscular disorders in schools: an analysis based on a questionnaire to teachers].

To clarify the medical and educational support necessary for ordinary school life of children with neuromuscular disorders, a questionnaire was sent to their homeroom teachers. The 13 outpatients consisted of 7 with Duchenne muscular dystrophy, 5 other muscular dystrophies, and 1 with another myopathy. Their teachers desired the environment and system, such as elevators and personnel to support their movements, should be improved. Regarding the school curriculum, special advice of medical staff was considered to be necessary to provide physical education and to promote their well-retained activities. The teachers regarded it valuable to teach them together with healthy children, for the children with or without neuromuscular disorders, teachers, and people in the community. In the future, it is expected that national sanatariums and schools for the handicapped will function as special facilities that are open to the community for general counselling and provide various informations. Pediatric neurologists should play a role as managers caring for the patients, their families, teachers, schools, and communities.

Adolescent↗
PubMed2006

[Health education, prevention and/or health promotion].

Multilevel school interventions on its social environment have demonstrated their efficacy for the prevention of health risk behaviours. Emotional well-being, sense of security, trust and belonging to a community, participation to the functioning and rules of the school, positive and interactive communication, constitute efficient protective factors against substance use in particular. Health education in a traditional way as well as focused specific preventives actions fail to achieve their objectives when not included as part of an active school policy promoting a good climate in social relationships. Health professionals and teaching staff must work together with the pupils in linking their responsibilities towards the everyday life and events of their school.

Adolescent↗
PubMedDate not supplied

A further look at the prognostic power of young children's reports of depressed mood and feelings.

A primary objective of the present study was to determine the validity of first graders' self-reports of depressed mood and feelings. To that end, the prognostic power of first grade self-reports of depressed mood and feelings was examined with respect to later psychopathology and adaptive functioning in a population of urban school children (N = 946). First grade self-reports of depressed mood predicted later child academic functioning, the need for and use of mental health services, suicidal ideation, and a diagnosis of major depressive disorder by age 14. The prognostic power of these early self-reports suggests that children as young as 5 or 6 years of age are capable of providing valid reports of depressed mood and feelings.

Child↗
PubMed1986

Seasonal affective disorder in children and adolescents.

The authors studied seven children with symptoms of seasonal affective disorder. During the winter months the children regularly experienced irritability, fatigue, school difficulties, sadness, and sleep changes as well as other symptoms of seasonal affective disorder found in adults. An open trial of bright environmental light reversed many of these symptoms and improved mood and psychosocial functioning in the winter months. School counselors and therapists should consider seasonal affective disorder in the differential diagnosis of children with school difficulties that are most prominent in the fall-winter semester.

Adolescent↗
PubMedDate not supplied

Attitudes of faculty members of schools of public health toward public service.

Public service has long been considered one of a traditional triad of academic functions--teaching, research, and service. Yet even in schools of public health, where service is purported to be an integral component of the institution's mission, faculty generally do not accord as high a value to service performance or approach it with the same degree of commitment as they do research and teaching. A study was conducted to examine faculty perceptions and attitudes toward the service function and its relationship to teaching and research within schools of public health. The data were taken from a mailed questionnaire survey of 20-30 faculty members in each of 20 schools of public health in the United States. The response rate was 71 percent, or 387 returned questionnaires. Respondents generally felt that the greatest value of service lies in its potential for enhancing the image and prestige of the school, and in the fulfillment of the community obligation of the institution. The possibility that service might bring about improvements in faculty research and teaching, or improvements in health services and public health, was rated significantly lower. Thus, respondents did not view service as useful for its contribution to their own careers or to public health practice as much as they regarded it as a beneficial contribution to the reputation of the institution. This view undermines the traditionally held notion that public service either benefits a particular constituency outside the school or enhances the professional development of faculty members themselves.

Attitude↗