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Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications.

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental disorder in childhood, and primary care clinicians provide a major component of the care for children with ADHD. However, because of limited available evidence, the American Academy of Pediatrics guidelines did not include adolescents and young adults. Contrary to previous beliefs, it has become clear that, in most cases, ADHD does not resolve once children enter puberty. This article reviews the current evidence about the diagnosis and treatment of adolescents and young adults with ADHD and describes how the information informs practice. It describes some of the unique characteristics observed among adolescents, as well as how the core symptoms change with maturity. The diagnostic process is discussed, as well as approaches to the care of adolescents to improve adherences. Both psychosocial and pharmacologic interventions are reviewed, and there is a discussion of these patients' transition into young adulthood. The article also indicates that research is needed to identify the unique adolescent characteristics of ADHD and effective psychosocial and pharmacologic treatments.

Adolescent↗

Children with cleft lip/palate and mental retardation: a subpopulation of cleft-craniofacial team patients.

This study compares a subpopulation of persons with cleft lip/palate who have mental retardation (n = 56) to those with normal learning (n = 420), at a large university-based cleft-craniofacial center. Many of the patients identified as having mental retardation in this sample have the diagnosis of isolated cleft palate (46.8%). Nearly half (46.3%) of the patients with mental retardation were found to have multiple anomalies, syndromes or associated medical findings. Common findings included cardiopulmonary defects, seizures, and deviations in head size. In this clinic population, mental retardation was found more commonly among African-American patients with clefts, than among Caucasian patients with clefts. Higher rates of facial disfiguration and impaired speech were found in patients with clefts and mental retardation. This research demonstrates that among a population of persons with cleft lip and/or cleft palate, there is a subpopulation of children who also have mental retardation. Craniofacial-cleft teams will need to develop strategies to address the special needs of this group of patients.

Abnormalities, Multiple↗

Compensation.

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Australia↗

Post-acute rehabilitation outcome: relationship to case-management techniques and strategy.

Successful outcome for the traumatically brain-injured (TBI) patient is dependent on both a productive clinical therapy program and an effective case-management strategy by the carrier. This retrospective study focuses on identifying those case-management techniques which contributed to improvement in the disability, living, and occupational status of patients in a post-acute rehabilitation program. Statistical analysis indicated a positive relationship between two case-management factors and improved patient outcome. Additional analysis demonstrated predictive qualities of specific admission data for patient program cost. A review of these case-management techniques and their impact on discharge disability, living, and occupational status will be discussed.

Adult↗

Mental health assessment of young children in a managed care environment.

Managed behavioral health care is widely perceived as a threat to traditional practice in mental health at the expense of quality care. Although such assertions by mental health providers may prove to be justified in certain circumstances, they should not serve to obscure the quite reasonable public health motives behind managed care and the favorable effect managed care organizations may ultimately have on clinical decision-making and practice. By compelling practitioners to more clearly articulate the basis for their clinical judgments and by increasingly requiring evidence to support such judgments, they discourage the application of ill-considered, sometimes inappropriate, and occasionally iatrogenic evaluation and treatment interventions. In the future, there is significant danger that developmental assessment and treatment procedures for young children will be inappropriately constrained and diminished. This is especially true if those who work with young children fail to use the tools available to them to make the case for the best of current practice, whether a clearly stated clinical rationale, a formal appeal, the advocacy of our health professions, or applied clinical services research. The practices of our health plans need to be understood by providers in the context of managed care values. Primitive systems should not be confused with corrupt systems. Although undoubtedly the latter exist, they do not necessarily predominate. Within a managed care context and with due respect to managed care assumptions, it is possible to bring utilization management and contemporary practices in developmental assessment into closer alignment, ultimately to the benefit of children who need them.

Child, Preschool↗