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PubMed2004

Barriers to the use of assistive technology for children with multiple disabilities.

Assistive technology has aided children with multiple disabilities to improve access and participation in their school and home environments. Effective educational outcomes from assistive technology use are dependent upon a coordinated assessment and implementation process. The literature on assistive technology with children was reviewed in order to identify current barriers to its effective integration within schools. These barriers were found to include lack of appropriate staff training and support, negative staff attitudes, inadequate assessment and planning processes, insufficient funding, difficulties procuring and managing equipment, and time constraints. A team model for assistive technology assessment and planning is proposed to optimize the educational goal achievement of children with multiple disabilities. Such a model can help target the allocation of occupational therapy resources in schools to best promote educational and broader functional outcomes from assistive technology use.

Child↗
PubMed1998

Relationship between hunger and psychosocial functioning in low-income American children.

OBJECTIVE: Using large-scale surveys from nine states, the Community Childhood Hunger Identification Project (CCHIP) estimates that 8% of American children under the age of 12 years experience hunger each year. CCHIP operationalizes child hunger as multiple experiences of parent-reported food insufficiency due to constrained resources. The current study examined the relationship between food insufficiency and school-age, low-income children's psychosocial functioning. The study also assessed the interinformant (parent versus child) reliability and time-to-time reliability of the CCHIP measure. METHOD: Two hundred four school-age children and their parents from four inner-city public schools were interviewed using parent, teacher, and clinician report measures of psychosocial functioning. Ninety-six children and their parents were reinterviewed 4 months later. RESULTS: Hungry and at-risk for hunger children were twice as likely as not-hungry children to be classified as having impaired functioning by parent and child report. Teachers reported higher levels of hyperactivity, absenteeism, and tardiness among hungry/at-risk children than not-hungry children. Parent and child reports of hunger were significantly related to each other, and time-to-time reliability of the CCHIP measure was acceptable. CONCLUSIONS: Results of this study suggest that intermittent experiences of food insufficiency and hunger as measured by CCHIP are associated with poor behavioral and academic functioning in low-income children. The current study also supports the validity and reliability of the CCHIP measure for assessing hunger in children.

Adolescent↗
PubMed1997

Hand function in subjects with spina bifida.

The aim of our study was to assess the influence of the Arnold-Chiari malformation, cervical cord dysraphism and hydrocephalus on hand function in subjects with meningomyelocele, but without many of the other confounding factors commonly found in this group e.g low IQ and cerebral palsy, which in themselves cause poor hand function. Three groups of subjects who attended main stream schools underwent a basic neurological examination of the upper limbs and a battery of hand function tests. Group 1 consisted of subjects with meningomyelocele and shunted hydrocephalus (n = 21), Group 2 subjects had isolated shunted hydrocephalus (n = 13) and Group 3 were normal controls (n = 18). The results show that subjects with meningomyelocele had weaker power in the small muscles of the hand as compared to the controls and those with isolated hydrocephalus (p = 0.01) and poorer fine motor control and co-ordination. The meningomyelocele group scored significantly poorer in all of the tests as compared to the control group using the dominant hand (overall, p = 0.0003), and all of the tests but one using the non-dominant hand (overall, p = 0.0005). Our study has demonstrated that children with meningomyelocele have poorer hand function than healthy controls, which is due to causes other than hydrocephalus, poor IQ or cerebral hemisphere pathology. Instead, cerebellar and cervical cord abnormalities appear to be exerting a significant deleterious influence on the function of the upper limbs.

Adolescent↗
PubMed2000

Lung function measured by the oscillometric method in prematurely born children with chronic lung disease.

Premature birth is related to a chronic respiratory morbidity, which may persist until school-age. In these children, the forced oscillation technique would be suitable for evaluation of lung function even at preschool age, since it requires only minimal patient cooperation. In order to investigate the oscillometric findings related to premature birth, using the oscillation technique and conventional lung function methods 49 school-aged children born prematurely with (n=15) or without (n=34) chronic lung disease (CLD), and 18 healthy children born at full term were studied. Children with CLD had higher respiratory resistance (Rrs,5) and lower reactance (Xrs,5) than prematurely born children without CLD or healthy controls. Both Rrs,5 (r=-0.55, p<0.0001) and Xrs,5 (r=0.76, p<0.0001) were significantly associated with forced expiratory volume in one second (FEV1), the agreement with spirometry being better in Xrs,5 than in Rrs,5 (p=0.02). Rrs,5 was significantly related to airway resistance (Raw) measured by body plethysmography (r=0.63, p<0.0001), but underestimated resistance at high values of Raw. There was no significant relationship between the pulmonary diffusing capacity and the oscillometric findings. Compared to conventional methods, the oscillometric method yields concordant information on the severity of lung function deficit in children born prematurely, with or without chronic lung disease. In these children, the oscillometric findings are probably due to peripheral or more widespread airway obstruction. As conventional methods are not usually suitable for preschool children, oscillometry may serve as an alternative for early evaluation of chronic lung disease among children with premature birth in clinical or research settings.

Analysis of Variance↗
PubMed1994

Perceived family functioning and adolescent suicidal behavior.

OBJECTIVE: Family problems increase the risk of adolescent suicidal behavior, but the specific dimensions of family functioning related to adolescent suicidal ideation and suicide attempts have not been identified clearly. This study examined the relationship between family functioning and adolescent suicidal ideation and suicide attempts. Participating adolescents included psychiatric inpatients who had attempted suicide (n = 35), high school students reporting suicidal ideation (n = 33), nonsuicidal psychiatric inpatients (n = 29), and nonsuicidal high school students (n = 37). METHOD: The Family Assessment Measure was used to assess adolescents' perceptions of family functioning on two levels: (1) the family system and (2) parent-adolescent dyadic relationships. RESULTS: The suicidal psychiatric inpatients and the suicidal high school students did not differ in their perceptions of family functioning and mother-adolescent relationships. However, both suicide groups reported more distress and family dysfunction than did the nonsuicidal high school students. Perceived family functioning and mother-adolescent relationships were significantly correlated with levels of depression, hopelessness, and self-esteem. CONCLUSIONS: Family functioning is important to consider when assessing and treating adolescents for suicidal behavior.

Adolescent↗
PubMed2006

The health-promoting school: what role for nursing?

AIM: To review the existing literature on health-promoting schools and put forward recommendations for continuing progress. BACKGROUND: The World Health Organisation's Ottawa Charter for Health Promotion in 1986 sought to create a framework for health promotion action that conveyed the notion of capacity building as it related to specific settings. It provided the catalyst from which the health-promoting school movement emerged, against the backdrop of health professionals adapting to the changing needs and demands of clients and the evolving social context of the communities in which they live. Since then, the international health-promoting school movement has been one of the most successful of the settings-based projects and has expanded considerably over recent years. METHOD: An extensive review of available health-promoting school-related literature provides the basis for critical discussion and recommendations. FINDINGS: Traditionally, the school nursing movement has provided the backbone of nursing-related health promotion activity in the school setting. The literature, however, is generally critical of its contribution over the years - especially as its role is mainly confined to a 'conventional' health education function and has little to do with health-promoting school projects. There are more and more calls now for the school nursing service to either re-evaluate its function and processes or be devolved back into a broader primary health care practitioner role. CONCLUSION: Nurses should view the health-promoting school movement as another opportunity to embrace evolving broad-based health promotion concepts truly, as a means to forge and own their own health agenda and also as a means to move beyond a traditional reliance on a limited health education role. Schools also need to adapt and expand their efforts to focus on health promotion activities, in collaboration with the ever-widening community networks of health and social agencies. This requires the commitment of all healthcare professional groups. Nurses who practice in all settings, and not just school nurses, should be aiming to initiate and promote radical health promotion reform as set out in the health-promoting school movement. RELEVANCE TO CLINICAL PRACTICE: If health professionals wish to be at the forefront of current health-promoting school strategies they must embrace the radical health promotion reforms that are emerging from the current literature and put forward in this article. Building such group capacity, through developing social interaction, cohesion, participation and political action can only benefit the community at large and further emphasize the health promotion role of nursing. The health-promoting school movement is truly an international concept and, as such, deserves a concerted nursing representation and resourcing well beyond its current commitment.

Attitude of Health Personnel↗
PubMed1999

ADHD boys in young adulthood: psychosocial adjustment.

OBJECTIVE: To prospectively examine psychosocial functioning in young adulthood in children with attention-deficit/hyperactivity disorder (ADHD). METHOD: This 10-year prospective study compared psychosocial functioning in 18 young adult men in whom ADHD had been diagnosed in childhood and 18 male controls who had never been psychiatrically ill. Subjects' average age was 21 years at follow-up. Interviews assessed subjects' educational, occupational, residential, and marital status; utilization of mental health services; and psychological status. RESULTS: Young adults with ADHD were significantly more likely than controls to be using mental health services, to report psychological problems, and to have fathered children. In addition, a trend indicated that young men with ADHD were more likely to have dropped out of high school but subsequently attained a graduate equivalency diploma. There was also a trend for young adults with ADHD to report a greater history of trouble with the law; however, the groups did not differ on current legal problems. CONCLUSIONS: Overall, these young adults with ADHD appear to have overcome educational and legal difficulties experienced during high school. However, continued problems in psychological functioning appear to persist into young adulthood.

Adult↗
PubMedDate not supplied

Clinical and demographic factors associated with high levels of depression symptoms.

Beck Depression Inventory (BDI) scores were analyzed from 427 consecutive, nonpregnant, adult family medicine patients to delimit demographic and clinical parameters which would predict high levels of depression symptoms. BDI scores at or above the chosen cutoff score of 17 were present in 51 patients (12%). Unemployment, less than high school education, high usage of inpatient and outpatient services, complaints of nervousness or of a functional nature, and chronic illness were shown by univariate and multiple regression analyses to be associated with BDI scores in the depressed range. Nearly half of patients with certain combinations of risk factors (eg, less than high school education and functional complaint) scored in the depressed range. The reason for the visit, as stated by the patient, only rarely provided a reason to suspect depression. Whether or not clinicians decide to use a depression screening test, the presence of these demographic and clinical factors should prompt a search for depression. Educational efforts to improve recognition of depression in primary care should focus on awareness of clinical and demographic factors rather than on stereotypic, but rare presentations of depression.

Adolescent↗
PubMed1978

A study of the hygienic aspects of the pedagogic process.

A knowledge of the laws governing changes in the functional state of the organism of pupils during lessons at school is one of the principal bases for solving the hygienic problems of organizing the teaching. The main concern is the dynamics of changes in the actual functional state of the CNS as a result of a whole complex of endogenous and exogenous factors as well as the school work of the pupil itself. Changes in the functional state of the optic and acoustic analysors deserve special attention in this respect because of their great exposure in pedagogical work. The existing interindividual differences in performance and in the work rate of pupils should be solved by an adequate pedagogical approach. Correct use of the principle of differentiated tuition can be a positive contribution to solving some of the topical problems of hygiene of the pedagogical process.

Acoustic Stimulation↗
PubMed2001

Effect of peer led programme for asthma education in adolescents: cluster randomised controlled trial.

OBJECTIVE: To determine the effect of a peer led programme for asthma education on quality of life and related morbidity in adolescents with asthma. DESIGN: Cluster randomised controlled trial. SETTING: Six high schools in rural Australia. PARTICIPANTS: 272 students with recent wheeze, recruited from a cohort of 1515 students from two school years (mean age 12.5 and 15.5 years); 251 (92.3%) completed the study. INTERVENTION: A structured education programme for peers comprising three steps (the "Triple A Program"). MAIN OUTCOME MEASURES: Quality of life, school absenteeism, asthma attacks, and lung function. RESULTS: When adjusted for year and sex, mean total quality of life scores showed significant improvement in the intervention than control group. Clinically important improvement in quality of life (>0.5 units) occurred in 25% of students with asthma in the intervention group compared with 12% in the control group (P=0.01). The number needed to treat was 8 (95% confidence interval 4.5 to 35.7). The effect of the intervention was greatest in students in year 10 and in females. Significant improvements occurred in the activities domain (41% v 28%) and in the emotions domain (39% v 19%) in males in the intervention group. School absenteeism significantly decreased in the intervention group only. Asthma attacks at school increased in the control group only. CONCLUSION: The triple A programme leads to a clinically relevant improvement in quality of life and related morbidity in students with asthma. Wider dissemination of this programme in schools could play an important part in reducing the burden of asthma in adolescents.

Absenteeism↗
PubMedDate not supplied

Work-based antipoverty programs for parents can enhance the school performance and social behavior of children.

We assess the impact of the New Hope Project, an antipoverty program tested in a random assignment experimental design, on family functioning and developmental outcomes for preschool- and school-aged children (N = 913). New Hope offered wage supplements sufficient to raise family income above the poverty threshold and subsidies for child care and health insurance to adults who worked full-time. New Hope had strong positive effects on boys' academic achievement, classroom behavior skills, positive social behavior, and problem behaviors, as reported by teachers, and on boys' own expectations for advanced education and occupational aspirations. There were not corresponding program effects for girls. The child outcomes may have resulted from a combination of the following: Children in New Hope families spent more time in formal child care programs and other structured activities away from home than did children in control families. New Hope parents were employed more, had more material resources, reported more social support, and expressed less stress and more optimism about achieving their goals than did parents in the control sample. The results suggest that an anti-poverty program that provides support for combining work and family responsibilities can have beneficial effects on the development of school-age children.

Achievement↗
PubMed2005

Attention deficit hyperactivity disorder--a review for family physicians.

Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral disorder characterized by persistent hyperactivity, impulsivity, and inattention that impairs educational achievement and/or social functioning. Its diagnosis is made by ascertaining whether the child's specific behaviors meet the diagnostic and statistical manual of mental disorders-IV-revised criteria. Its etiology is still unclear but recent studies suggest that genetics plays a major role in conferring susceptibility. Comorbidity with psychiatric disorders such as anxiety disorder, depression, oppositional defiant disorder and conduct disorder; and with specific learning disability is not uncommon. Although medication works well in most cases of ADHD, optimal treatment requires integrated medical and behavioral treatment. Methylphenidate (MPH) and atomoxetine are the two drugs being currently prescribed and their efficacy in decreasing the symptoms of ADHD is well documented. Pyschoeducational interventions in school can help increase the successful functioning of affected children and improve their academic performance. Almost half of affected children continue to show significant symptoms of the disorder into adolescence and young adulthood. The family physician can play an important role in detecting this condition early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child's academic and psychosocial progress on a long-term basis.

Atomoxetine Hydrochloride↗
PubMed1979

Neuropsychologic consequences of Reye syndrome.

Behavioral measurement of brain function was conducted in 40 children, one or more years after their recovery of Reye syndrome. Test measures included standard indices of intelligence, school achievement, visual-motor coordination and social maturity, plus the Halstead-Reitan Neuropsychological Batteries. There was a strong correlation between the degree of impaired neuropsychologic function and clinical grade at admission, the duration of impaired consciousness, and the number of exchange transfusions required. Patients with milder disease had normal brain function and fewer school problems. Language and perceptual-motor performance significantly improved with increasing years in recovery, suggesting that some of the disturbances of brain functioning are transient. The statistical analysis indicated that there are lasting, often subtle disturbances of higher cognitive function as a result of Reye syndrome. These deficits, not always apparent on clinical examination, are clearly correlated with the extent of neurologic involvement. This quantitative assessment of neuropsychologic function is a basis for determining the "quality of survival" in Reye syndrome, and such measurements should be included in the comparative evaluation of Reye syndrome treatment programs.

Achievement↗