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PubMed1995

Relationship between the family APGAR and behavioral problems in children.

OBJECTIVES: To assess the use of the Family APGAR instrument as a supplement to usual clinical methods for the detection of psychosocial problems in children and to evaluate the relationship between the Family APGAR and physician diagnosis and elevated Child Behavior Checklist (CBCL) scores. DESIGN: Cross-sectional. SETTING: Ambulatory care center of a community-based, university-affiliated family medicine training program. SUBJECTS: One hundred fifty-two parents of children aged 3 to 16 years. MAIN OUTCOME MEASURES: Family functioning was considered poor if Family APGAR scores were 5 or less. For the CBCL, sum total T scores greater than the 90th percentile for nonreferred children were considered clinically significant. Physicians used a checklist to indicate the presence of psychosocial problems or family dysfunction. RESULTS: Agreement between the Family APGAR scores and the physician's detection of child psychosocial problems was weak (kappa = 0.23). There was no relationship between the Family APGAR scores and physician perception of family dysfunction (kappa = -0.05). Although agreement between the Family APGAR and CBCL classifications was weak (kappa = 0.20), families with low Family APGAR scores were more than twice as likely to have children with clinically significant CBCL scores than those with higher scores (risk ratio = 2.08; 95% confidence interval = 1.02 to 4.24). CONCLUSIONS: The relationships among the Family APGAR and CBCL scores and physician detection of child psychosocial problems were weak. Child psychosocial problems were more than twice as likely to be present when the Family APGAR score was low. These findings suggest that family functioning is related to child psychosocial problems, but that the Family APGAR may not improve screening for child psychosocial problems.

Adolescent↗

PubMed2004

Clinical determinants of health-related quality of life in patients with irritable bowel syndrome.

BACKGROUND: Current guidelines recommend routine assessment of health-related quality of life (HRQOL) in patients with irritable bowel syndrome (IBS). However, physicians rarely have the time to measure HRQOL with the appropriate methodological rigor, and data suggest that HRQOL in patients with IBS is often estimated using inaccurate clinical gestalt. The identification of predictive factors could allow physicians to better assess HRQOL without using misleading clinical clues. We, therefore, sought to identify determinants of HRQOL in patients with IBS. METHODS: We examined 770 patients, 18 years or older, with IBS at a university-based referral center. Subjects completed a symptom questionnaire, the Symptoms Checklist-90 items psychometric checklist, and the 36-Item Short-Form Health Survey. The main outcome was HRQOL as measured by the mental and physical component scores of the 36-Item Short-Form Health Survey. We first developed a list of hypothesis-driven HRQOL predictors, and then performed multivariate regression analysis to measure the independent association of each predictor with HRQOL. RESULTS: Seven factors (r(2) = 0.39) independently predicted physical HRQOL: (1) more than 5 physician visits per year, (2) tiring easily, (3) low in energy, (4) severe symptoms, (5) predominantly painful symptoms, (6) the feeling that there is "something seriously wrong with body," and (7) symptom flares for longer than 24 hours. Eight factors (r(2) = 0.36) independently predicted mental HRQOL: (1) feeling tense, (2) feeling nervous, (3) feeling hopeless, (4) difficulty sleeping, (5) tiring easily, (6) low sexual interest, (7) IBS symptom interference with sexual function, and (8) low energy. CONCLUSIONS: Health-related quality of life in patients with IBS is primarily related to extraintestinal symptoms rather than traditionally elicited gastrointestinal symptoms. These findings suggest that rather than focusing on physiological epiphenomena (stool characteristics and subtype of IBS) and potentially misleading clinical factors (age and disease duration), physicians might be better served to gauge global symptom severity, address anxiety, and eliminate factors contributing to chronic stress in patients with IBS.

Activities of Daily Living↗

PubMed2005

Child behavior and quality of life in pediatric obstructive sleep apnea.

OBJECTIVE: To assess behavior and quality of life in children with obstructive sleep apnea (OSA) undergoing tonsillectomy and adenoidectomy compared with control children. DESIGN: Prospective controlled study. SETTING: Hospital-based pediatric otolaryngology practice. PARTICIPANTS: Forty-two children (25 boys and 17 girls; mean [SD] age, 5.8 [2.5] years) with OSA confirmed by positive findings on polysomnography undergoing tonsillectomy and adenoidectomy and 41 control children (29 boys and 12 girls; mean [SD] age, 7.3 [3.8] years) with no history of snoring undergoing unrelated elective surgery. INTERVENTIONS: Parents completed the standardized Child Behavior Checklist and a validated pediatric OSA quality-of-life survey before and 3 months after surgery. MAIN OUTCOME MEASURES: Child Behavior Checklist T scores and score classifications and quality-of-life survey mean scores. RESULTS: Change in mean total problem T score was significantly greater in the OSA group (from 51.6 at baseline to 48.3 at follow-up) than in controls (from 45.5 at baseline to 46.7 at follow-up) (P = .03). The improvement in total T score classification (normal vs borderline or abnormal) was significant for children with OSA compared with control children (P = .009). Children with OSA had significant improvements in the quality-of-life survey mean total score and all individual domain scores compared with controls (P<.001). CONCLUSIONS: Behavioral and emotional difficulties are found in children with documented OSA compared with control children, and they improve after treatment. Large improvements in disease-specific quality of life are also found. Scores on a standardized measure of behavior assessment demonstrated significant correlation with scores on a validated quality-of-life instrument.

Adenoidectomy↗

PubMed2001

Exposure to violence: psychological and academic correlates in child witnesses.

BACKGROUND: Inner-city children are frequently exposed to violence; however, there are few data regarding the psychological and academic correlates of such exposure in young children at school entry. OBJECTIVES: To document exposure to violence in inner-city children aged 7 years; assess their feelings of distress; and evaluate the relationships of exposure to violence with school performance, behavior, and self-esteem. SETTING: A study center in an inner-city hospital. PARTICIPANTS: One hundred nineteen inner-city children evaluated at age 7 years; 119 caregivers (biological and foster). DESIGN: As part of a longitudinal study, children were administered the following by a masked examiner: Things I Have Seen and Heard (TISH) to assess exposure to violence; Levonn, a cartoon-based interview for assessing children's distress symptoms; and the Culture-Free Self-Esteem Inventory, Second Edition. School performance was assessed by school reports and child behavior by the Child Behavior Checklist (CBCL), the Parent Report Form, and the Teacher Report Form. Caregivers for children were administered the parent report version of the Checklist of Children's Distress Symptoms (CCDS-PRV) as well as the CBCL Parent Report Form. MAIN OUTCOME MEASURES: Exposure to violence (TISH); feelings of distress (Levonn); school performance; behavior (CBCL Parent Report Form and CBCL Teacher Report Form); and self-esteem (Culture-Free Self-Esteem Inventory). RESULTS: We found that these children were frequently exposed to violence. For example, 75% had heard gun shots, 60% had seen drug deals, 18% had seen a dead body outside, and 10% had seen a shooting or stabbing in the home (TISH). Many showed signs of depression and anxiety; eg, 61% worried some or a lot of the time that they might get killed or die and 19% sometimes wished they were dead (Levonn). Higher exposure to violence (TISH Total Violence score) was correlated with higher Levonn composite scores for depression and anxiety and with lower self-esteem (P< or =.04), and was also associated with lower grade point average and more days of school absence (P< or =.02). Caregiver assessment of child anxiety correlated poorly with child report of anxiety (P =.58). CONCLUSIONS: Young inner-city children have a high exposure to violence by age 7 years; many show signs of distress that frequently are not recognized by caregivers. Further, higher exposure to violence in children correlates with poorer performance in school, symptoms of anxiety and depression, and lower self-esteem.

Anxiety Disorders↗

PubMed2001

Witnessing violence among inner-city children of substance-abusing and non-substance-abusing women.

OBJECTIVES: To determine if children of substance-abusing mothers witness more violence than children of non-substance-abusing (control) mothers, and to determine if children who witness violence have more behavioral problems and higher stress scores than children who do not witness violence. DESIGN: Cross-sectional research design comparing exposure to violence among children of substance-abusing mothers and control mothers of low socioeconomic status. SETTING: An inner-city pediatric clinic. PARTICIPANTS: Forty substance-abusing mothers and their children, and 40 non-substance-abusing mothers and their children, examined when the children were 6 years old. MAIN OUTCOME MEASURES: Maternal report of children's exposure to violence was assessed using the Exposure to Violence Interview and the Conflict Tactics Scale. Maternal report of children's behavior was assessed using the Child Behavior Checklist and the Children's Response to Stress Inventory. RESULTS: Children of substance-abusing mothers did not witness more violence than the control children (P>.05). However, 6-year-old inner-city children in the present study witnessed a high rate of violence: 43% had seen someone beaten up, 13% had seen someone threatened with a knife, and 7% had seen someone stabbed or shot. Children witnessing violence had significantly higher aggressive, delinquent, anxious/depressed, withdrawn, attention, and social problems (P<.05) on the Child Behavior Checklist, and higher stress scores (P =.05) on the Children's Response to Stress Inventory. CONCLUSIONS: More than half of the 6-year-old inner-city children in the present study witnessed some form of violence. Witnessing violence was associated with more behavioral problems and higher stress scores as assessed through maternal report. Subsequent research should examine the long-term effects of this exposure to violence among young children.

Adult↗

PubMed2001

Identification and management of psychosocial problems by preventive child health care.

OBJECTIVES: To assess the degree to which physicians and nurses working in preventive child health care (child health professionals [CHPs]) identify and manage psychosocial problems in children, and to determine its association with parent-reported behavioral and emotional problems, sociodemographic factors, and general and mental health history of children. DESIGN: The CHPs examined the child and interviewed parents and child during their routine health assessments. The parents completed the Child Behavior Checklist. SETTING: Nineteen child health care services across the Netherlands, serving nearly all school-aged children routinely. SUBJECTS: Of 4970 children aged 5 through 15 years, eligible for a routine health assessment, 4480 (90.1%) participated. MAIN OUTCOME MEASURES: Identification and management of psychosocial problems by CHPs. RESULTS: In 25% of all children, CHPs identified 1 or more psychosocial problems. One in 5 identified children were referred for further diagnosis and treatment. Identification of psychosocial problems and subsequent referral were 6 times more likely in children with serious parent-reported problem behavior according to the Child Behavior Checklist total problem score (8% of total sample). However, CHPs identified no psychosocial problems in 43% of these children and therefore undertook no action. Other child factors associated with CHPs' identification and referral were past treatment for psychosocial problems, life events, and academic problems. After adjustment for these, sociodemographic characteristics did not predict referral. CONCLUSIONS: The CHPs identify psychosocial problems in school-aged children frequently and undertake actions for most of them. Screening for psychosocial problems may be a promising option to reduce these problems, but accurate identification should be enhanced.

Adolescent↗

PubMed2001

Effectiveness of a home intervention for perceived child behavioral problems and parenting stress in children with in utero drug exposure.

OBJECTIVE: To determine if a home-based nurse intervention (INT), focusing on parenting education/skills and caregiver emotional support, reduces child behavioral problems and parenting stress in caregivers of in utero drug-exposed children. DESIGN: Randomized clinical trial of a home-based INT. SETTINGS: Two urban hospital newborn nurseries; homes of infants (the term infant is used interchangeably in this study with the term child to denote those from birth to the age of 36 months); and a research clinic in Baltimore, Md. PARTICIPANTS: In utero drug-exposed children and their caregivers (N = 100) were examined when the child was between the ages of 2 and 3 years. Two groups were studied: standard care (SC) (n = 51) and INT (n = 49). INTERVENTION: A home nurse INT consisting of 16 home visits from birth to the age of 18 months to provide caregivers with emotional support and parenting education and to provide health monitoring for the infant. MAIN OUTCOME MEASURES: Scores on the Child Behavior Checklist and the Parenting Stress Index. RESULTS: Significantly more drug-exposed children in the SC group earned t scores indicative of significant emotional or behavioral problems than did children in the INT group on the Child Behavior Checklist Total (16 [31%] vs 7 [14%]; P =.04), Externalizing (19 [37%] vs 8 [16%]; P =.02), and Internalizing (14 [27%] vs. 6 [12%]; P =.05) scales and on the anxiety-depression subscale (16 [31%] vs. 5 [10%]; P =.009). There was a trend (P =.06) in more caregivers of children in the SC group reporting higher parenting distress than caregivers of children in the INT group. CONCLUSIONS: In utero drug-exposed children receiving a home-based nurse INT had significantly fewer behavioral problems than did in utero drug-exposed children receiving SC (P =.04). Furthermore, those caregivers receiving the home-based INT reported a trend toward lower total parenting distress compared with caregivers of children who received SC with no home visits.

Affective Symptoms↗

PubMed2002

Child sex differences in primary care clinicians' mental health care of children and adolescents.

BACKGROUND: Sex differences in the medical and mental health care of adults are well established. OBJECTIVE: To study the effect of child patient's sex on whether primary care clinicians (PCCs), including pediatricians, family physicians, and nurse practitioners, found or treated mental health problems in primary care settings. DESIGN: The data were collected by clinicians and parents from 21 065 individual child visits (50.3% girls) in 204 primary care practices. METHODS: Each PCC enrolled a consecutive sample of approximately 55 children and adolescents aged 4 to 15 years. Parents filled out questionnaires, including the Pediatric Symptom Checklist, before seeing the clinician. Clinicians completed a survey after the visit about the psychosocial problems and recommended treatments, but they did not see the results of the Pediatric Symptom Checklist or any other data collected from the parents. RESULTS: Boys were more likely to be seen for a mental health-related visit and by a clinician who identified them as "my patient." Boys with parent-reported symptom profiles that were similar to those of girls were more likely to be identified as having attention-deficit/hyperactivity problems or behavior or conduct problems and less likely to be identified as having internalizing problems. Adjusting for parent-reported symptoms, PCCs were more likely to prescribe medications for boys. Child sex differences in referrals to mental health specialists and the provision of counseling to families were not statistically significant. CONCLUSION: There are substantial sex differences in the mental health care of children in the primary care system.

Adolescent↗

PubMed2004

Parental report of outdoor playtime as a measure of physical activity in preschool-aged children.

BACKGROUND: Keeping young children physically active is an important strategy to promote their health and well-being. To our knowledge, survey measures of physical activity in preschool-aged children are unavailable. Time spent playing outdoors is a potential surrogate measure of physical activity in preschoolers, but parental-report measures of outdoor playtime have not been evaluated. OBJECTIVE: To compare a direct measure of physical activity in preschool-aged children with 2 parental-report measures of children's outdoor playtime. MAIN OUTCOME MEASURES: Three days of recording with a 3-dimensional accelerometer were used to directly measure physical activity in 250 preschool-aged children. We calculated each child's average vector magnitude per minute while awake. Parental report of outdoor playtime was measured in 2 ways: (1). the score from a checklist used to record outdoor playtime over 3 days and (2). a recall of the usual minutes of daily outdoor playtime during the prior month. We calculated Spearman rank correlation coefficients among these 3 measures. RESULTS: The mean age of the children was 44 months, 87.7% were white, and 12.3% were black. Parents reported that their children spent a mean (+/-SD) of 146 (+/-113) minutes playing outdoors each day. Physical activity as measured by the accelerometer was significantly correlated to the time spent playing outdoors, as measured by the checklist (r = 0.33, P <.001) and recall (r = 0.20, P =.003). CONCLUSION: Parental-report measures of outdoor playtime were significantly correlated to a direct measure of physical activity in preschool-aged children, and are worthy of future evaluation as a survey measure.

Child, Preschool↗

PubMed2006

Relationship between the decision to take a child to the clinic for abdominal pain and maternal psychological distress.

BACKGROUND: Among adults with functional gastrointestinal disorders, psychological distress influences who consults a physician, but little is known about predictors of consultation when the patient is a child. OBJECTIVE: To determine the relative contributions of psychological symptoms of the mother, psychological symptoms of the child, severity of child abdominal pain, and family stress to consultation. DESIGN: Observational study. SETTING: Health maintenance organization. PARTICIPANTS: Two hundred seventy-five mothers of 334 children who had abdominal pain in the past 2 weeks, as per child self-report. MAIN OUTCOME MEASURES: Mothers completed questionnaires about themselves (Symptom Checklist 90-Revised) and their children (school absences, medication use, and the Child Behavior Checklist). Children completed the Pain Beliefs Questionnaire to assess perceived pain severity. RESULTS: Thirty-nine children had been taken to the clinic for abdominal pain symptoms at least once in the past 3 months (consulters), whereas 295 were nonconsulters. Logistic regression analyses revealed that both the child's self-report of perceived pain severity (P<.001) and maternal psychological symptoms (P = .006) predicted consultation. Although children who visited physicians had significantly more psychological symptoms, this was not a significant predictor of consultation after adjusting for maternal psychological symptoms. Family stress did not predict consultation. CONCLUSION: The decision to take a child to the clinic for abdominal pain is best predicted by maternal psychological distress and the child's perceived pain severity.

Abdominal Pain↗

PubMed1994

Performance of screening tools for mental health problems in chronically ill children.

We examined the sensitivity, specificity, positive predictive value, and negative predictive value of three different screens for child and adolescent emotional and behavioral disorders among a large group of chronically medically ill children and adolescents. The performance of the Child Depression Inventory (CDI), Pediatric Symptom Checklist (PSC), and Child Behavior Checklist (CBCL) in detecting emotional or behavioral disorders was compared with the diagnoses obtained by an intensive structured psychiatric interview (Diagnostic Interview Schedule for Children, Version 2.1) of 112 children and adolescents with chronic medical conditions, and their parents, recruited from a tertiary-care medical center. The CDI, PSC, and CBCL all demonstrated low sensitivity, positive predictive value, and negative predictive value, but high specificity. We conclude that these three commonly used screening tests performed poorly as screens because of their low sensitivity among children and adolescents with chronic medical conditions. The CDI, PSC, and CBCL should not be relied on as screening instruments for psychopathologic conditions in children and adolescents with chronic medical conditions. Although the screening measures studied may confirm a clinician's concern, the negative findings of this study suggest their use may be misleading and undermine the pediatrician's clinical judgment.

Adolescent↗

PubMed1997

Insurance status and recognition of psychosocial problems. A report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Networks.

OBJECTIVE: To examine the effect of insurance status on clinician recognition of psychosocial problems for pediatric primary care visits. DESIGN: A cohort study of 10,250 visits by children 4 to 15 years old for nonemergent care. SETTING: Two large primary care research networks reported data from 172 primary care clinicians in office-based practice. PATIENTS: Ten thousand two hundred and fifty unique children presenting consecutively to participating physicians for nonemergent services with a parent or caregiver. MAIN OUTCOME MEASURE: Children were classified as positive for psychosocial problems if their score on the parent-reported Pediatric Symptom Checklist exceeded the standard cutoff of 28. Clinician recognition was obtained by report as a dichotomous variable. Insurance status was categorized by payor and plan structure. RESULTS: Clinicians did not recognize psychosocial problems for a substantial number of children with scores suggestive of marked psychosocial dysfunction on the Pediatric Symptom Checklist. Insurance type was not associated with rates of recognition. However, provider familiarity with patients, provider discipline, and patient demographics were associated with increased recognition of psychosocial problems. CONCLUSIONS: Differences in treatment among various insurance groups documented in prior studies are not likely to be related to varying recognition rates, but rather to availability and choices of treatment by insurers, families, and clinicians. Continuity of care was the strongest predictor of clinician recognition.

Cohort Studies↗

PubMed1977

Symptom change and prognosis in clinic psychotherapy.

Applicants for outpatient psychotherapy completed a symptom checklist that permitted evaluation of the duration, intensity, and patterning of presenting symptoms. Random assignment of patients acceptable for psychotherapy to immediate treatment or to the waiting list resulted in two comparable groups who repeated the symptom checklist after an average interval nine months. Patients in psychotherapy showed a greater reduction in average intensity of all symptoms than was observable in the waiting list group. In the waiting list group, improvements tended to be limited to those patients whose conditions were of comparatively brief duration. In the psychotherapy group, improvements of chronic patients were frequent; however, improvements tended to occur among those patients reporting some new symptoms rather than those giving no evidence of exacerbation. A predmoninance of "neurotic" over "behavioral" complaints also appeared to be predictive of a positive response to psychotherapy.

Acute Disease↗

PubMed1995

Failure of naltrexone hydrochloride to reduce self-injurious and autistic behavior in mentally retarded adults. Double-blind placebo-controlled studies.

BACKGROUND: It is hypothesized that self-injurious behavior (SIB) and symptoms of autism may be due to overactivity in some opioid systems in the brain. We examined the efficacy and safety of naltrexone hydrochloride, an opioid antagonist, in the treatment of SIB and autism in mentally retarded adults. METHOD: Thirty-three mentally retarded adults with autism and/or SIB participated in double-blind, placebo-controlled crossover studies. Active treatment was first a single 100-mg dose of naltrexone hydrochloride. Subsequently, 19 subjects were treated with 50 mg/d and 14 with 150 mg/d of naltrexone hydrochloride for 4 weeks. The outcome was assessed by means of direct observations (n = 11) and on the basis of scores on a list of target behaviors, the Aberrant Behavior Checklist, and the Clinical Global Impression Scale. RESULTS: Thirty-two subjects (seven with autism, 16 with autism and SIB, and nine with SIB) completed the trial. Naltrexone treatment failed to have therapeutic effects on SIB and autism. On the contrary, naltrexone increased the incidence of stereotypic behavior on the Aberrant Behavior Checklist, and the care staff evaluated the effect of the 50-mg/d treatment as being significantly worse than that of the placebo treatment as measured by the Clinical Global Impression Scale. CONCLUSION: Our findings suggest that naltrexone has no clinical value for a broad group of mentally retarded subjects with SIB and/or autism.

Adolescent↗

PubMed2002

A cohort study of behavioral problems and intelligence in children with high prenatal polychlorinated biphenyl exposure.

BACKGROUND: In 1978, about 2000 persons in Taiwan were poisoned when their cooking oil was contaminated during manufacture with heat-degraded polychlorinated biphenyls, which are toxic, very widespread pollutant chemicals. The chemicals cannot be metabolized or excreted, and 8 of the first 39 children born to affected women died. When examined in 1985, 117 surviving children were found to have ectodermal defects, developmental delay, and disordered behavior. We have continued to observe the children. METHODS: From 1992 through 1995, 118 children born between 1978 and 1985 (during or after their mothers' exposure) and 118 matched neighborhood control children had cognitive function measured yearly with the Wechsler Intelligence Scale for Children-Revised and behavioral problems measured with the Achenbach Child Behavior Checklist and the Rutter Child Behavior Scale A. RESULTS: The exposed children scored 3 points (P =.05) lower than control children for IQ; 3 points (P =.002) higher on the Child Behavior Checklist (an effect size similar to the sex difference); and 6 points (P<.001) higher on the Rutter scale (3 times the sex difference). Birth year x exposure interactions, testing whether children born long after the exposure were as affected as those born soon after, were small and not significant. Age x exposure interactions, testing whether the children improved relative to control children as they got older, were significant only for the Rutter scale. CONCLUSIONS: Prenatal exposure to these compounds produces long-lasting cognitive and behavioral damage, but there is some evidence of recovery.

Adolescent↗

PubMed2003

Prospective study of adult mental disturbance in offspring of women with psychosis.

BACKGROUND: The high-risk method is an important strategy for studying the antecedents and causes of schizophrenia and other psychoses. The Swedish High-Risk Project is a prospective longitudinal study of offspring of women with a history of schizophrenic, schizoaffective, affective, or unspecified functional psychoses and control women with no history of psychosis. The offspring and their environments were studied beginning before birth, and again during childhood. This article reports the mental outcome results from the first adult follow-up at age 22 years. METHODS: Of 178 offspring, 166 (93%) were followed up and blindly assessed using standardized methods, including a self-report scale for mental symptoms and the Structured Clinical Interview for DSM-III-R. RESULTS: Compared with controls (n = 91), the offspring of mothers with schizophrenia (n = 28) showed a significantly increased frequency of DSM-III-R Axis I and Axis II disorders, poor global functioning, high Symptom Checklist-90 scores, and a history of mental health care and psychopharmacologic medication use. Offspring of mothers with affective disorders (n = 22) showed high Symptom Checklist-90 scores, more frequent poor functioning, and receipt of mental health care, with a significant increase in Axis I depressive disorders and no increase in Axis II disorders. The extension of schizophrenia and affective risk groups to include additional maternal "spectrum cases" (10 and 15 individuals, respectively) generally yielded similar results. CONCLUSIONS: Maternal schizophrenia is associated with widespread increases in offspring mental disturbance in adolescence and young adulthood, differing from offspring disturbance associated with maternal affective disorder.

Adolescent↗

PubMed2005

Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity.

CONTEXT: Hyperactivity and inattention are common symptoms in children with autistic disorder and related pervasive developmental disorders, but studies of stimulants in these conditions have been inconclusive. OBJECTIVES: To determine the efficacy and safety of methylphenidate hydrochloride in children with pervasive developmental disorders and hyperactivity. DESIGN: Double-blind, placebo-controlled, crossover trial followed by open-label continuation. SETTING: Five academic outpatient clinics. PARTICIPANTS: Seventy-two drug-free children, aged 5 to 14 years, with pervasive developmental disorders accompanied by moderate to severe hyperactivity. INTERVENTIONS: Prior to randomization, subjects entered a 1-week test-dose phase in which each subject received placebo for 1 day followed by increasing doses of methylphenidate (low, medium, and high doses) that were each given for 2 days. The low, medium, and high doses of methylphenidate hydrochloride were based on weight, and they ranged from 7.5 mg/d to 50.0 mg/d in divided doses. Subjects who tolerated the test dose (n = 66) were assigned to receive placebo for 1 week and then 3 methylphenidate doses in random order during a double-blind, crossover phase. Children responding to methylphenidate then entered 8 weeks of open-label treatment at the individually determined best dose. MAIN OUTCOME MEASURES: The primary outcome measure was the teacher-rated hyperactivity subscale of the Aberrant Behavior Checklist. Response was defined as "much improved" or "very much improved" on the Clinical Global Impressions Improvement item coupled with considerable reductions in the parent-rated and/or teacher-rated Aberrant Behavior Checklist hyperactivity subscale score. RESULTS: Methylphenidate was superior to placebo on the primary outcome measure, with effect sizes ranging from 0.20 to 0.54 depending on dose and rater. Thirty-five (49%) of 72 enrolled subjects were classified as methylphenidate responders. Adverse effects led to the discontinuation of study medication in 13 (18%) of 72 subjects. CONCLUSIONS: Methylphenidate was often efficacious in treating hyperactivity associated with pervasive developmental disorders, but the magnitude of response was less than that seen in typically developing children with attention-deficit/hyperactivity disorder. Adverse effects were more frequent.

Adolescent↗

PubMed1998

Impact of torture on refugees displaced within the developing world: symptomatology among Bhutanese refugees in Nepal.

CONTEXT: Most of the world's refugees are displaced within the developing world. The impact of torture on such refugees is unknown. OBJECTIVE: To examine the impact of torture on Bhutanese refugees in Nepal. DESIGN: Case-control survey. Interviews were conducted by local physicians and included demographics, questions related to the torture experienced, a checklist of 40 medical complaints, and measures of posttraumatic stress disorder (PTSD), anxiety, and depression. SETTING: Bhutanese refugee community in the United Nations refugee camps in the Terai in eastern Nepal. PARTICIPANTS: A random sample of 526 tortured refugees and a control group of 526 nontortured refugees matched for age and sex. MAIN OUTCOME MEASURES: The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for PTSD and the Hopkins Symptom Checklist-25 (HSCL-25) for depression and anxiety. RESULTS: The 2 groups were similar on most demographic variables. The tortured refugees, as a group, suffered more on 15 of 17 DSM-III-RPTSD symptoms (P<.005) and had higher HSCL-25 anxiety and depression scores (P<.001) than nontortured refugees. Logistic regression analysis showed that history of torture predicted PTSD symptoms (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.7-8.0), depression symptoms (OR, 1.9; 95% CI, 1.4-2.6), and anxiety symptoms (OR, 1.5; 95% CI, 1.1-1.9). Torture survivors who were Buddhist were less likely to be depressed (OR, 0.5; 95% CI, 0.3-0.9) or anxious (OR, 0.7; 95% CI, 0.4-1.0). Those who were male were less likely to experience anxiety (OR, 0.66; 95% CI, 0.44-1.00). Tortured refugees also presented more musculoskeletal system- and respiratory system-related complaints (P<.001 for both). CONCLUSION: Torture plays a significant role in the development of PTSD, depression, and anxiety symptoms among refugees from Bhutan living in the developing world.

Adult↗