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PubMed2004

Clinical validation of the paediatric pain profile.

The Paediatric Pain Profile (PPP) is a 20-item behaviour rating scale designed to assess pain in children with severe neurological disability. We assessed the validity and reliability of the scale in 140 children (76 females, mean age 9 years 11 months, SD 4 years 7 months; range 1 to 18 years), unable to communicate through speech or augmentative communication. Parents used the PPP to rate retrospectively their child's behaviour when 'at their best' and when in pain. To assess interrater reliability, two raters concurrently observed and individually rated each child's behaviour. To assess construct validity and responsiveness of the scale, behaviour of 41 children was rated before and for four hours after administration of an 'as required' analgesic. Behaviour of 30 children was rated before surgery and for five days after. Children had significantly higher scores when reported to have pain than 'at their best' and scores increased in line with global evaluations of pain. Internal consistency ranged from 0.75 to 0.89 (Cronbach's alpha) and interrater reliability from 0.74 to 0.89 (intraclass correlation). Sensitivity (1.00) and specificity (0.91) were optimized at a cut-off of 14/60. PPP score was significantly greater before administration of the analgesic than after (paired-sample t-tests, p<0.001). Though there was no significant difference in mean pre- and postoperative scores, highest PPP score occurred in the first 24 hours after surgery in 14 (47%) children. Results suggest that the PPP is reliable and valid and has potential for use both clinically and in intervention research.

Adolescent↗
PubMed1978

Dependency of different types in schoolchildren with epilepsy.

By means of the Self-Administered Dependency Questionnaire (SADQ), 4 types of dependency on mother were measured in 65 children with epilepsy attending ordinary school, sub-grouped according to sex, level of schooling, electrographic type of epilepsy, and drug treatment. The various dependency scores of each subgroup were compared with the appropriate norms available for the SADQ. Compared with normal boys, epileptic boys of primary school age (N = 16) were generally found to be more in need of close physical emotional contact with their mother and her physical proximity when away from home, although they were less ready to talk to her about their practical problems and ask for her help. The needs of epileptic boys of secondary-school age (N = 18) were expressed more in terms of their mother's help with practical matters at home. In contrast, no significant differences were apparent between epileptic and normal girls at either level of schooling. In comparisons between epileptic children who consistently produced only generalized seizure activity in their EEG (N = 31), a right temporal spike discharge (N = 16) or a similar discharge on the left (N = 18), both boys and girls with a left temporal spike discharge tended to show significantly higher need for close physical emotional contact with their mother than children in the other electrographic groups. No clear relationship was seen between dependency scores and type of anti-epileptic drug treatment.

Age Factors↗
PubMed1997

Maternal directive and facilitative interaction styles: associations with language and cognitive development of low risk and high risk toddlers.

The purpose of this study was to examine the relation of maternal interaction styles to the development of a sample of 56 toddlers (19 low risk, 37 high risk) seen at 12 and 24 months of age. At 12 months, videotapes of mother-child interaction were coded for directiveness, sensitivity, and elaborativeness. At 12 and 24 months, cognitive and language measures were collected. A directive maternal style was negatively correlated with sensitivity and elaborativeness, whereas sensitive and elaborative ratings were positively correlated, suggesting a facilitative style. Regression models significantly predicted receptive language and cognitive development at 24 months but not expressive language. Maternal directiveness at 12 months was negatively relative to later receptive language skills, whereas elaborativeness at 12 months was positively predictive of later cognitive development. Child status variables and maternal interactional styles contributed about equally to the prediction of later cognitive and language outcomes.

Child Language↗
PubMed1999

Engagement in child and adolescent treatment: the role of parental cognitions and attributions.

Parental engagement in the treatment process is influenced by parents' beliefs about the cause of their children's problems, perceptions about their ability to handle such problems, and expectations about the ability of therapy to help them. This paper examines the role of parental cognitions related to attributions and expectations in relation to engagement in child mental health treatment. Reviewed studies indicate that parental attributions and expectations influence three aspects of treatment: help seeking, engagement and retention, and outcome. This paper integrates findings from developmental and clinical research, highlights gaps in the literature, presents the beginnings of a model regarding the parental attributional process as it relates to engagement in treatment, recommends future research directions, and discusses clinical implications.

Adult↗
PubMed2003

Developing concise measures of childhood activity limitations.

OBJECTIVES: Although several national health surveys have implemented data collection efforts to identify and characterize disability among children, the large number of items these surveys have required to measure childhood disability prohibit their use in general population surveys. Using a conceptually based approach, we examine whether concise sets of survey items--feasible for use in general population surveys--can be used to measure functional limitations in activities among children. METHODS: We analyze three nationally representative population surveys that contain detailed questions on childhood activity limitations. We first examine the full set of survey items and then eliminate survey items, one by one, exploring different combinations and examining the results of each successive elimination. RESULTS: Across the three surveys, we consistently demonstrate that it is possible to reduce the number of survey items needed to measure childhood activity limitations and still produce comparable estimates. Concise sets of measures may contain as few as six items, making it possible to include in general population surveys. However, our concise sets of measures do not produce comparable estimates across surveys, which reflects differences in the types of questions and differences in the wording of questions found in the original survey instruments. CONCLUSIONS: On the basis of our findings, we reemphasize the importance of the wording of survey questions, the importance of validating survey questions, and finally, we recommend a concise set of items that can be used to measure childhood activity limitations in general population surveys.

Activities of Daily Living↗
PubMed2003

FcgammaR polymorphisms: Implications for function, disease susceptibility and immunotherapy.

Leukocyte Fcgamma receptors (FcgammaR) confer potent cellular effector functions to the specificity of IgG. FcgammaR-induced leukocyte functions, including antibody-dependent cellular cytotoxicity, phagocytosis, superoxide generation, degranulation, cytokine production and regulation of antibody production, are essential for host defense and immune regulation. The efficacy of IgG-induced FcgammaR function displays inter-individual heterogeneity due to genetic polymorphisms of three FcgammaR subclasses, FcgammaRIIa (CD32a), FcgammaRIIIa (CD16a), and FcgammaRIIIb (CD16b). FcgammaR polymorphisms have been associated with infectious and autoimmune disease, or with disease severity. FcgammaR polymorphisms may furthermore serve as markers for therapeutic efficacy and side-effects of treatment with monoclonal antibodies. In this review, FcgammaR function and the relevance of FcgammaR polymorphisms as prognostic markers for inflammatory disease and antibody-based immunotherapy are discussed.

Autoimmune Diseases↗
PubMed1996

Working memory, attention, and communication disturbances in schizophrenia.

The authors hypothesized that schizophrenic communication disturbances reflect specific cognitive deficits in the areas of working memory and attention. They examined the cognitive correlates of communication disturbances, as measured by linguistic reference performance, in schizophrenic (n = 48), bipolar (n = 24), and nonpsychiatric control (n = 23) individuals. Reference performance ratings in the schizophrenic patients were associated with scores on tests of working memory and attention and were not related to performance on concept formation or verbal fluency tests. In contrast, in the bipolar and nonpsychiatric individuals, reference performance was associated with concept formation and verbal fluency test scores but was not related to performance on tests of working memory. Implications with respect to the processes underlying schizophrenic communication disturbances are discussed.

Adult↗
PubMed2003

Clever hands: uncontrolled intelligence in facilitated communication.

Five studies examined how people who are answering questions on behalf of another person may use their own knowledge to answer correctly while attributing authorship of their answers to the other. Experiments 1 and 2 found that participants instructed to answer yes/no questions randomly were unable to do so. They were more often correct on easy than hard questions, and extended opportunity and incentive did not reduce this effect. Experiments 3-5 found similar correctness for participants who were asked to answer yes/no questions by sensing either the ostensible keyboard finger movements or unvoiced inclinations of another person who had been admonished not to answer, and who was infact a confederate and was not even given the questions. In this paradigm, the answers were often attributed to the other.

Adult↗
PubMed2004

Assessing and managing medically fragile children: tracheostomy and ventilatory support.

Over the past decade, there has been an increase in premature births. Children born prematurely often present with complex medical conditions; some require a tracheostomy. Although many children with tracheostomies require assistance to achieve effective communication, speech-language pathologists may have limited information with respect to the medical issues and communication needs of this population. The purpose of this article is twofold. First, a review of basic information on tracheostomy and ventilatory support in the pediatric population is provided. Second, information on the assessment of communication skills and intervention specific to voice for the child with a tracheostomy is detailed. Two case studies are presented. The case studies illustrate the diversity and medical complexity common to this population and provide practical information for the clinician working with a child with a tracheostomy.

Child↗
PubMed2006

Demographics of preschoolers who require AAC.

PURPOSE: The purpose of the investigation was to gather demographic information pertaining to preschoolers who require augmentative and alternative communication (AAC). METHOD: To obtain this information, a survey was developed and then distributed to preschool speech-language pathologists (SLPs) in Pennsylvania. RESULTS: Results indicated that approximately 12% of preschoolers receiving special education services required AAC. These children came from diverse ethnic and racial backgrounds, had a wide variety of disabilities, used a range of AAC systems, and required services from a wide range of educational professionals. IMPLICATIONS: The findings indicate the pressing need for all preschool SLPs to be prepared to provide services for children who require AAC.

Child, Preschool↗
PubMed2003

The influence of information and role-playing experiences on children's attitudes toward peers who use AAC.

A school-based intervention designed to increase the positive nature of children's attitudes toward peers who use AAC is described. Small groups of children were given only information about AAC or they were given information about AAC and the opportunity to role-play being nonspeaking. Results indicated a greater positive effect of the information plus role-play experience compared to the effects of being given information alone for older children and boys. Clinical implications and suggestions for future research are discussed.

Attitude↗