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Delayed female sexual maturation. How to approach differential diagnosis.

Delayed sexual development is present when an adolescent girl fails to experience, at an age that is beyond the average for her peers, those pubertal events that are indexes of gonadal function. Adolescent girls whose sexual development is delayed can be divided into three groups: (1) those who have not menstruated but have well-developed secondary sexual characteristics, indicating that they have a functioning hypothalamic-pituitary-ovarian mechanism, (2) those with poorly developed secondary sexual characteristics whose hypothalamus and pituitary are functional but who have ovarian failure, as indicated by high levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) (hypergonadotropic hypogonadism), and (3) those with poorly developed secondary sexual characteristics whose normal ovaries are not functioning because of a hypothalamic or pituitary disorder, as indicated by low or low normal serum FSH/LH levels (hypogonadotropic hypogonadism). There are, in addition, individuals with a female habitus and external female genitalia who were reared as females but have an XY karyotype and come to the physician with a complaint of delayed female sexual maturation.

Adolescent

Goal structure effects on social interaction: nondisabled and disabled elementary students.

This study compared social interaction behavior between nondisabled and disabled students, as a function of the way tasks were structured during a peer integration program. Of the eight pairs of students, four pairs were assigned to an individualistic goal-structured condition; the other four pairs, to a cooperative condition. For nondisabled students, the cooperative condition was associated with more social interaction during activity and free play sessions. For disabled students, the cooperative condition was associated with more social interaction during activity sessions, but not during free play sessions.

Adolescent

Aerobic and resistive exercise modify risk factors for coronary heart disease.

An awareness of the health-related benefits of regular physical activity, prudent diet, and cessation of cigarette smoking are some of the mechanisms by which risk factors for coronary heart disease (CHD) and the incidence of complications of atherosclerosis have declined in the American population. Exercise training is associated with improvements in lipid and glucose metabolism that are manifested by enhanced insulin sensitivity, improved glucose tolerance, increased high density lipoprotein cholesterol levels, reduced triglyceride and low density lipoprotein cholesterol levels, and reductions in blood pressure. In addition to reduced risk factors for atherosclerosis, physically conditioned individuals have better cardiovascular function at rest and during exercise than their inactive peers. Thus, exercising training reduces morbidity and mortality from atherosclerotic complications through both direct (cardiovascular) and indirect (risk factor modification) mechanisms. Many studies demonstrate a strong association between regular physical activity and reduced risk for CHD. This article provides a review of risk factors for CHD and the potential health benefits of aerobic and resistive exercise. The time seems apt for the institution of multifactorial cardiovascular risk prevention programs in which aerobic and resistive exercise are combined with prudent diet therapy and smoking cessation to reduce risk factors for CHD.

Coronary Disease

The maternal representation. A comparison of caregiver- and mother-reared toddlers.

Two groups of toddlers and their caregivers were observed at the Margaret S. Mahler Observational Research Nursery on different days. In one group (the caregiver group) the children of full-time employed mothers were cared for at home by paid caregivers. In the other group (the mother group) the children were cared for full-time by their actual mothers. These two groups are compared in terms of the children's expression of affect, interest in peers, identifications, separation protests, signals of communication, and symbolic functioning. Contributions from infant research are used to illustrate how recent conceptualizations about the construction of the maternal representation further understanding about the child's experience of multiple caregivers.

Adult

[The nurse's role in a child psychiatric unit of St. Sophia Children's Hospital, Athens, Greece].

The role of the nurse in a child psychiatric unit is defined by the systems: a. Nurse-child b. Nurse-child-family c. Nurses-children d. Nurses-disciplinary team (a). In these systems the nurse: assesses the child, identifies the problems, sets the goals, provides care, educates the child. (b). Reinforces the parents' role, intervenes to help the relationships in the family. (c). Facilitates the team interactions and also the healthy behaviour in the peer group team, provides secure relationships. The nurse also functions as a reinforcement which leads to maturity. (d). The nurse is an equal member in the therapeutic team, is the link for communication and the main source for information. He participates in the organization and management of the team. Many nurses are specialized in psychiatric and child psychiatric nursing. All nurses believe in the continuing education and they attend various seminars. Through the activities in the unit the nurses have an update information on the subject of their work. Supervisions with educational character have been established for the nursing team. The nurse works on the base of the "special nurse-child" relationship and has the full responsibility of the child. The special nurse fulfills the nursing history. Systematic observation and evaluation are performed by the special nurse: he identifies the problems, sets the goals, formulates a programme, writes down and evaluates the results which means that he works with the implementation of the nursing process.

Child

Child competence and psychiatric risk. III. Comparisons based on diagnosis of hospitalized parent.

The school competence of children whose parents were previously hospitalized for psychiatric disorder was studied. These children, at risk themselves for behavioral disorder, were compared to classmates as well as to each other based upon the diagnosis of the hospitalized parent. Four diagnostic groups were employed: narrowly defined schizophrenic, broadly defined schizophrenic, affective psychotic, and hospitalized nonpsychotic patients. Significant differences between the risk sample and classmates are reported along with differences among the diagnostic groups. Sons of nonpsychotic hospitalized patients were functioning most poorly and were in marked defiance of peer and adult norms. Parental and child IQ were found to have had little impact upon the data and were not considered major interactive variables. Issues concerning systems of diagnoses and the developmental implications of the findings are presented.

Achievement

Lateral specialization and social-verbal development in preschool children.

Forty-two 2 1/2- to 5 1/2-year-old children's social and verbal behaviors were observed during free play in a preschool. A test measuring lateral specialization of verbal function and a standardized psychometric test of verbal ability were also administered. Analysis of variance indicated that the right ear (left hemisphere) is predominant in processing verbal stimuli in children as young as 2 1/2. Multiple regression analyses revealed significant relations between the right ear accuracy score for dichotically presented verbal stimuli and both psychometrically measured verbal ability and a social-verbal factor score derived from play behavior. After the increase related to age was statistically partialled out from both verbal ability and social-verbal scores, verbal expression, length of verbal utterances, time spent in conversation, and peer social interactions increased and parallel play decreased as a function of right ear (left hemisphere) accuracy for verbal stimuli. The relationship between left ear (right hemisphere) accuracy scores for verbal stimuli and social-verbal behavior, however, was not linear. Very high and very low levels of left ear recall predicted an increase in the frequency of parallel play and low social-verbal behavior while moderate levels of left ear accuracy scores predicted the reverse.

Auditory Perception

Infants in play groups: time related changes in behavior toward mothers, peers, and toys.

Twenty-one 13-month-old infants, nine male and 12 female, were assigned to one of seven playgroups convening for 15 consecutive weekdays . Present at each 20-minute play session were three same-sexed peers with their mothers and an assortment of toys. There were systematic fluctuations in infants' attention to mother, peers, and toys. There findings suggest that a mother may serve different functions at different points in time: (a) as a secure base in initial sessions, (b) as a refueling stop when the infant grew tired, and (c) as an attractive alternative when the infant became bored with toys and peers. Within-day analyses revealed that activity level and toy exploration linearly decreased over time, while intentional contact with mother significantly increased. Social interaction with peers correlated negatively with interaction with mother over the course of the study. Sex differences over time were found to be significant: boys on day one were more interactive with both peers and toys but this level declined thereafter, while girls on day one spent more time in close proximity to mother and later, on subsequent days, increased their peer and toy play.

Child Development

Form and function in early communication: language and pointing gestures.

Pointing gestures of verbally advanced 2-year-olds were contrasted with those of less advanced peers, in order to examine the relationships of gesture to language during the acquisition of each. Hypotheses regarding the replacement of gestural functions by speech as verbal skills improve, regarding developmental correspondences between the two communicative domains, and regarding the independence of language acquisition from nonverbal developments were drawn from evolutionary, structuralist, and nativist viewpoints, respectively. Both formal and functional aspects of each communicative skill were measured, and were shown to be largely unrelated, particularly in the gestural domain. No evidence that language replaced gesture for communication in ontogeny was obtained. Correspondences between gesture and language occurred only between functional aspects of each, and the independence of developing language from gestural advances was suggested by the findings.

Child, Preschool

The social behavior of peer-identified aggressive, withdrawn, and aggressive/withdrawn children.

The behavioral patterns associated with peer ratings of aggression and withdrawal were explored. First, a discriminant function analysis (N = 74) using seven observational variables was found to significantly identify groups of Aggressive, Withdrawn, and Contrast fourth- and fifth-grade girls and boys. Aggressive/Withdrawn children were not distinguishable from Contrasts. In subsequent analyses comparing the behaviors of children in the four groups at two schools (total N = 117), children in the Aggressive and Withdrawn groups each showed distinctive patterns of social behavior, which were consistent across the two schools. The behavior of the Aggressive/Withdrawn children was not significantly different from that of Contrast children. However, results from one school suggested that Aggressive/Withdrawn children may receive a disproportionate amount of aggression from peers. Finally, the behavior patterns displayed by the deviant groups were similar for girls and boys, allowing for sex differences in base rates of playground behavior. These results confirm the observability of peer-identified patterns of aggression and withdrawal, and provide a detailed description of the behavior of such children in a free-play situation.

Aggression

Prediction of preschool social behavior from social-emotional development at one year.

In an attempt to directly investigate later consequences of the early mother-infant relationship, several measures of social-emotional and cognitive-motivational development at 12 months of age were correlated with two measures of preschool adjustment for 26 children. Results indicated that both of our measures of early social functioning were related to more optimal adjustment in a peer-setting at three-and-a-half years of age. Taken together, the results of the study provide empirical support for the widely held, but seldom tested, hypothesis that the quality of the early mother-infant tie has important consequences for the child's subsequent development in most areas.

Attention

Adolescent decision-making: the development of competence.

This article reviews evidence relating to the development of competence in decision-making during adolescence. The review focuses on cognitive aspects of decision-making and discusses nine indicators of competence: choice; comprehension; creativity; compromise; consequentiality; correctness; credibility; consistency; and commitment. The evidence suggests that by the age of 15 years many adolescents show a reliable level of competence in metacognitive understanding of decision-making, creative problem-solving, correctness of choice, and commitment to a course of action. Young adolescents (12-14 years) are less able to create options, identify a wide range of risks and benefits, foresee the consequences of alternatives, and gauge the credibility of information from sources with vested interests. No evidence is available relating to age differences in willingness to make choices, devise compromises, and show consistency of choices. Barriers to achieving competence in decision-making during adolescence include attitudinal constraints (e.g. beliefs about the proper age for making decisions), peer group pressures to conformity, breakdowns in family structure and functioning, and restricted legal rights to make important personal decisions (e.g. to donate blood or body tissue).

Adolescent

Dropping out of child psychotherapy: distinguishing early and late dropouts over the course of treatment.

The present study examined child, parent, and family factors that predict dropping out from therapy among children (ages 4-13) referred for the treatment of oppositional, aggressive, and antisocial behavior. It was proposed that factors predicting attrition would vary as a function of whether families dropped out early or late in treatment. Several factors related to family (e.g., socioeconomic disadvantage, adverse child-rearing practices), parent (e.g., stress, life events, history of antisocial behavior), and child functioning (e.g., severity and chronicity of antisocial behavior, lower IQ, peer relations) predicted premature termination from treatment. A different pattern was evident in the factors predicting early and late termination from therapy. The findings have implications for conceptualizing the process of engaging and retaining families in treatment and for preventing premature termination.

Adolescent

Factors affecting the school placement of children with spina bifida.

Integrating children with disabilities into mainstream schools has been an active policy in Britain since the 1981 Education Act. 26 children with spina bifida, 13 of whom were educated in mainstream schools, and 13 in special schools were assessed to clarify the relative importance of the following factors 1) IQ, 2) Mobility, 3) Hand function, 4) Bladder and bowel function, and 5) Behaviour. A marked difference was found between those attending mainstream and special schools. 11/13 of the former attained scores within the normal range as compared to only 2/13 of the latter. Neither mobility nor hand function alone were found to influence school placement and a marked correlation was found between the two. Whilst those educated in special schools had more marked problems, all children functioned poorly compared with the norms for able-bodied peers. Neither bladder nor bowel incontinence hindered attendance at mainstream school, but faecal soiling was considered the more serious problem. The frequency of behavioural problems showed a similar distribution amongst the two groups. Comments from parents highlighted their reservations about both special and mainstream schooling which indicates the policy for integration needs considerably more commitment from Government and Education Authorities in order to succeed.

Activities of Daily Living

That was a good meeting!

Good meetings are rare in many organizations. The purposes of meetings include sharing information, decision making, problem solving, education, planning, evaluation, and peer support. The structure of meetings flows from the basic function(s) of the group. Consideration is given to membership, degree of formality, limits of authority, and responsibility. Suggestions for successful meetings focus on establishing an agenda, sticking to the time schedule, appropriately using visual aids, and doing necessary post-meeting follow-up. Responsible and meaningful participation in the group process is an essential aspect of meeting effectiveness and efficiency. When all the elements are managed skillfully, the meeting can be GREAT.

Audiovisual Aids

A path analysis of an adolescent drinking behavior model derived from problem behavior theory.

The interrelationships between composite variables comprised of demographics, socialization, personality, perceived environment, conventional and problem behaviors, and their combined mediational influences on adolescent drinking behavior are examined. Students randomly sampled from four suburban, metropolitan-area high schools (N = 499) were administered the 250-question Survey of Underage Drinking Styles. All 12 composite variables, derived from the survey, were arranged in a causal model and submitted to a confirmatory path analysis. Data were analyzed by multiple regression procedures. According to the present model, a powerful pathway through to drinking may begin with family interaction problems, which may lead to a reduction in the adolescent's social coping skills. A reduction in the adolescent's coping skills may lead to a compensatory belief that alcohol improves mental and physical functions and an increased affiliation with and acceptance of the peer group's attitude and behavior toward consuming alcohol as a replacement coping skill. The adolescent's drinking may then increase as a result of the affiliative need to conform to peer group pressure.

Adolescent

The sexual differentiation of social play.

Sex differences in social play are quantitative and not qualitative, referring to frequency and not the form of the behaviors. Whereas increased perinatal exposure to exogenous testosterone masculinizes social play, experimental manipulations of androgen levels after this period (i.e. following critical periods for neuronal differentiation) apparently have no effect on the expression of social play. This effect appears to involve, at least in part, androgen receptor occupancy in the amygdala. In the rat, there is a prominent sex difference in nuclear-bound androgen receptors in the amygdala during the sensitive period for the masculinization of play-fighting. Moreover, testosterone implants directly into the amygdala during this period masculinize social play in females. Progesterone exposure reduces play-fighting in male rats, as does corticosterone. This latter effect may be mediated by corticosteroid receptors in the limibic brain. Perinatal androgen exposure may also be important in humans, since girls born with congenital adrenal hyperplasia diagnosed and treated at birth still show male-like patterns of play. Theories concerning the function of sex differences in social play emphasize either the social or motor learning functions. Juvenile male primate social rank correlates with number of peer social interactions, which predominantly take the form of play-fighting. Females on the other hand appear to spend less time play-fighting and spend more time waiting and competing for interactions with infants, i.e. play-mothering, whereby they acquire the motor skills necessary for handling infants. Such differences may reflect socio-biological and developmental cascades that are, in some way, initiated by perinatal hormonal events.

Animals