Towards Understanding the Effect of Serious Games on Attention, Adherence, and Behavior for Children with ADHD

Effects of a universal prevention program on externalizing behaviors: Exploring the generalizability of findings across school and home settings

BackgroundDepression is a severe psychological concern that negatively affects health in older adults. Serious games applied in various fields are considered appropriate interventions, especially in mental health care. However, there is a lack of evidence regarding the effects of serious games on depression in older adults.ObjectiveThis study aimed to investigate the characteristics and effectiveness of serious games for depression in older adults.MethodsA systematic review and meta-analysis of randomized controlled trials were conducted. In total, 5 electronic databases (PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library) were searched to identify relevant studies published until July 6, 2021. A total of 2 reviewers independently conducted study selection, data extraction, and quality appraisals. The risk of bias in the included studies was assessed using the JBI Critical Appraisal Checklist. For the meta-analysis, the effect size was calculated as the standardized mean difference (SMD) by using a random effects model.ResultsA total of 17 studies with 1280 older adults were included in the systematic review, and 15 studies were included in the meta-analysis. Serious game interventions were classified into 3 types: physical activity (PA), cognitive function, and both PA and cognitive function. The meta-analysis demonstrated that serious games reduced depression in older adults (SMD −0.54, 95% CI −0.79 to −0.29; P<.001). Serious games had a more significant effect size in community or home settings (SMD −0.61, 95% CI −0.95 to −0.26; P<.001) than in hospital settings (SMD −0.46, 95% CI −0.85 to −0.08; P=.02); however, the difference between groups was not significant. Among the types of games, games for PA (SMD −0.60, 95% CI −0.95 to −0.25; P<.001) and games for both (SMD −0.73, 95% CI −1.29 to −0.17; P=.01) had a significant effect on reducing depression in older adults. However, no significant correlations were observed between the duration or number of serious games and depression.ConclusionsSerious games were beneficial in reducing depression in older adults. Regardless of the study setting, serious games appeared to reduce depression. Particularly, serious games including PA had a significant impact on reducing depression. Furthermore, high-quality randomized controlled trials are needed to establish substantial evidence for the effectiveness of serious games on depression in older adults.Trial RegistrationPROSPERO CRD42021242573; https://tinyurl.com/26xf7ym5

Limited longitudinal research has been conducted on the impact of neglect on children's health and well-being. There is a need to consider the impact of specific subtypes of neglect on children's functioning. In addition, there is interest in examining the cumulative effect of experiencing >1 subtype of neglect. To examine the individual and cumulative relationships among physical, psychological, and environmental neglect and children's behavior and development at age 3, and the impact on changes in children's behavior and development between ages 3 and 5. One hundred thirty-six children and their primary caregivers participating in a prospective longitudinal study of children's development and maltreatment were assessed when the children were aged 3 and 5 years. The children were recruited from primary care clinics because of failure to thrive, risk for human immunodeficiency virus, or as a comparison group. Evaluations were conducted in laboratory and home settings using observations, maternal self-report, and standardized testing of the children. Scores on physical, psychological, and environmental neglect were combined into a Cumulative Neglect Index. Regression analyses were run to examine the association of specific subtypes of neglect and of cumulative neglect with children's functioning at age 3, controlling for group, sociodemographic risk, and maternal depression. The analyses were repeated examining the impact on child outcomes at age 5, controlling for the above 3 variables as well as the children's cognitive development and behavior at age 3. Of the subtypes of neglect at age 3, only psychological neglect was significantly associated with increased internalizing and externalizing behavior problems at age 3; the Cumulative Neglect Index was associated with internalizing problems. None of the neglect subtypes or cumulative neglect were predictive of changes in children's behavior and development between ages 3 and 5. Cognitive development of the entire sample was impaired at age 5, averaging 0.85 standard deviations below the norm, and their average externalizing behavior score was significantly problematic with an average of 0.60 standard deviations above the norm. In the context of poverty where many preschool children have poor cognitive development and increased behavior problems, psychological neglect is significantly related to reported behavior problems. Children who experienced multiple types of neglect had increased internalizing problems. Neglect did not explain changes in children's behavior or development between ages 3 and 5. There is a need for pediatricians to identify and address child neglect, particularly psychological neglect, as early as possible. Pediatricians should also screen for maternal depression.

Changes in sustained attention, attentional selectivity, and attentional capacity were examined in a sample of 113 participants between the ages of 12 and 75. To measure sustained attention, we employed the sustained-attention-to-response task (Robertson, Manly, Andrade, Baddeley, & Yiend, Neuropsychologia 35:747-58, 1997), a short continuous-performance test designed to capture fluctuations in sustained attention. To measure attentional selectivity and capacity, we employed a paradigm based on the theory of visual attention (Bundesen, Psychological Review 97:523-547, 1990), which enabled the estimation of parameters related to attentional selection, perceptual threshold, visual short-term memory capacity, and processing capacity. We found evidence of age-related decline in each of the measured variables, but the declines varied markedly in terms of magnitude and lifespan trajectory. Variables relating to attentional capacity showed declines of very large effect sizes, while variables relating to attentional selectivity and sustained attention showed declines of medium to large effect sizes, suggesting that attentional control is relatively preserved in older adults. The variables relating to sustained attention followed a U-shaped, curvilinear trend, and the variables relating to attentional selectivity and capacity showed linear decline from early adulthood, providing further support for the differentiation of attentional functions.

BackgroundMaternal feeding practices have been proposed to play an important role in early child weight gain and obesogenic eating behaviors. However, to date longitudinal investigations in young children exploring these relationships have been lacking. The aim of the present study was to explore prospective relationships between maternal feeding practices, child weight gain and obesogenic eating behaviors in 2-year-old children. The competing hypothesis that child eating behaviors predict changes in maternal feeding practices was also examined.MethodsA sample of 323 mother (mean age = 35 years, ± 0.37) and child dyads (mean age = 2.03 years, ± 0.37 at recruitment) were participants. Mothers completed a questionnaire assessing parental feeding practices and child eating behaviors at baseline and again one year later. Child BMI (predominantly objectively measured) was obtained at both time points.ResultsIncreases in child BMI z-scores over the follow-up period were predicted by maternal instrumental feeding practices. Furthermore, restriction, emotional feeding, encouragement to eat, weight-based restriction and fat restriction were associated prospectively with the development of obesogenic eating behaviors in children including emotional eating, tendency to overeat and food approach behaviors (such as enjoyment of food and good appetite). Maternal monitoring, however, predicted decreases in food approach eating behaviors. Partial support was also observed for child eating behaviors predicting maternal feeding practices.ConclusionsMaternal feeding practices play an important role in the development of weight gain and obesogenic eating behaviors in young children and are potential targets for effective prevention interventions aiming to decrease child obesity.

Prenatal and postnatal polybrominated diphenyl ether (PBDE) exposure and measures of inattention and impulsivity in children

You have accessThe ASHA LeaderFeature1 Jan 2012What’s the Story?What does the research say about how best to use social stories to help children with ASDs? Tiffany L. HutchinsPhD Tiffany L. Hutchins Google Scholar More articles by this author , PhD https://doi.org/10.1044/leader.FTR2.17012012.14 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In A universal feature of autism spectrum disorders (ASDs) is disruption in social cognition—the ability to interpret thoughts and feelings of oneself and others. This disruption is related to struggles with behavioral, communicative, and social functioning. A young boy with an ASD might, for example, physically push a peer instead of asking her to step aside. Telling the boy not to push may seem like the default course correction. But a more promising approach may be to target the core social-cognitive deficit through a story that bolsters the boy’s social understanding of the pushing event. Known in the literature as a “social story,” the approach has become one of the most popular ways to address the social-cognitive difficulties characteristic of ASDs (Hess, Morrier, Heflin, & Ivey, 2008; Reynhout & Carter, 2009). What’s less clear, though, is what exactly social stories are and how best to use them. These questions are complicated because guidelines for using social stories have been offered not only by their originator—educational consultant and former teacher Carol Gray (Gray & Garand, 1993)—but by other professionals working with children with ASDs over the last 25 years (Hutchins, in press). For Gray, a Social Story™ “describes a situation, skill, or concept” narrated according to 10 criteria. According to The New Social Stories™ Book, published in 2010, some of these key criteria include the use of: Background research and the collaboration of a team to answer who, what, when, where, why, and how. A patient, reassuring, and descriptive, rather than directive, approach. Language that is literally accurate and meaningful to the child. Careful consideration of formatting choices (e.g., length of story, font style/size, organization of text and illustrations). Specific sentence “types” that describe social information more than they direct audience behavior. A plan for editing, comprehension checks, and story review schedules. When it comes to research, however, most studies have examined social stories (lowercase) that don’t necessarily follow Gray’s 10 criteria or formal definition. Indeed, researchers and practitioners have not adhered to a uniform method of development and implementation, and a number of social-story “myths” have emerged (see sidebar). Despite this variability, the research in this area is substantive enough to provide some empirically supported recommendations for best practice. A Social Story in Action “Jacob needs visual supports to understand the who, what, where, when, how, and why of our culture and how he fits and belongs.” —Mother of a 17-year-old boy diagnosed with pervasive developmental disorder—not otherwise specified, an ASD So what, according to the existing research, goes into developing accurate, meaningful social stories? The following example provides an illustration. Jacob was enrolled in a general education classroom at his local high school and was receiving services from a speech-language pathologist, special educator, case manager, and paraeducator. He loved wind chimes and music and could play a variety of instruments in a truly gifted manner. Previous assessments indicated that Jacob had deficits in auditory comprehension, his verbal expression was limited to two- to five-word sentences, and his areas of strength were reading and writing. One important communication-enhancement goal involved his voice, which was often soft and whispered and trailed into silence. Following an examination that revealed normal structure and function of the larynx, Jacob began voice treatment with a university-based SLP. Jacob worked hard over the course of several weeks to lengthen his sentences and find what he called his “excellent voice,” which was louder and easier to understand. Unfortunately, he failed to generalize gains made in the clinic to other settings. Because we knew that Jacob could produce an “excellent voice,” we decided to develop a social story with some specific objectives. One was to enhance Jacob’s understanding of the social importance of using his “excellent voice.” Another was to recruit the participation of those with whom he had frequent and direct contact. We collaborated with Jacob, Jacob’s mother, and his SLP to learn about the “who, what, when, where, and why” that surrounded the production of his different voices. We used the Motivation Assessment Scale (MAS; Durand & Crimmins, 1992)—a tool designed to help service providers understand the purpose behind behaviors—and our previous observations of Jacob. We drafted a social story titled “Using my Excellent Voice [PDF]” and revised it with input from Jacob’s mother to ensure accuracy of content. We also incorporated vocabulary important for Jacob that reflected his great interest in music (e.g., a “basso profundo voice”). When asked about pictures, Jacob noted that he would like “BoardMaker pictures” in his story so we added Picture Communication Symbols. We incorporated particular font and formatting choices to highlight key messages (for instance, different fonts represent soft and loud voices). We also made specific choices about the length and complexity of sentences and illustrations on each page. We shared hard and electronic copies of the social story with Jacob, Jacob’s mother, and his special education team members. They agreed to read the social story with him across contexts, such as home and various school settings, to facilitate acquisition and generalization of skills. The electronic version of the social story was particularly important for Jacob, who often used an iPod touch; we expected use of this medium to enhance Jacob’s interest in and access to the story. Our team identified a topic—Jacob’s voice—that seemed critical to his success as a communicative partner. Through testing, discussion, and observation, we determined that the target represented an area in which Jacob had demonstrated some competency, which increased the likelihood that it was a developmentally appropriate target. We learned that Jacob was more likely to use his “excellent voice” when others spoke to him using short sentences and gave him more time to respond. Research Basis This example of the development and application of a social story is supported by research. But first, a caveat from descriptive reviews (Ali & Frederickson, 2006; Nichols, Hupp, Jewell, & Ziegler, 2006; Rust & Smith, 2006, 2011; Sansoti, Powell-Smith, & Kincaid, 2004) and quantitative literature reviews (Kokina & Kern, 2010; Reynhout & Carter, 2006, 2011; Test, Richter, Knight, & Spooner, 2010): Most authors agree that social stories are a promising intervention, but they universally acknowledge such methodological limitations as confounding treatment variables, lack of experimental controls, use of weak designs, and lack of research on efficacy, which demands rigorous experimental controls. The conclusions of others have been more positive. For instance, The National Standards Project (National Autism Center, 2010) identifies social story intervention as an established treatment for ASDs for children ages 6–14, based on sufficient quality, quantity, and consistency in the evidence base. Much of that evidence base points to effectiveness of the following practices, used in our work with Jacob: A team approach to gathering information. Although the research contains a few examples of appropriately rich data collection practices (Crozier & Tincani, 2005, 2007; Delano & Snell, 2006; Hutchins & Prelock, 2008; Lorimer, Simpson, Myles, & Ganz, 2002), experience suggests that these aspects are often underdeveloped or entirely overlooked in practice. To understand more fully the cause and purpose of problematic behaviors, social story authors are encouraged to—as done with Jacob—conduct observations and interview relevant others (e.g., parents, teachers, and other involved professionals). Performance of a functional behavioral analysis (FBA). This problem-solving process is designed to identify the purpose of a maladaptive behavior and strategies to address it. In our case, we used observation and the Motivation Assessment Scale to explore the purposes behind Jacob’s behavior. In support of this approach, a recent meta-analysis concluded that studies that used some form of FBA yielded higher effect sizes than those that did not (Kokina & Kern, 2010). Use of comprehension checks. Before formally launching our intervention with Jacob, we introduced the story to him and checked his comprehension of the text and images. Ensuring that key messages in a social story are understood as intended has received empirical support (Kokina & Kern, 2010; Reynhout & Carter, 2006). Use of repetition in teaching of the story. In Jacob’s case, he and all participants agreed to read the social story once or twice a week for several weeks to ensure constant exposure and reinforcement (Hutchins & Prelock, 2008; Norris & Datillo, 1999). The research base is murkier on other aspects of social stories. They’ve been used successfully to address an extraordinarily broad set of intervention targets (Hutchins, in press), including behavioral targets such as tantrums and aggression, communicative targets such as greeting and eye contact, and social interaction targets such as peer engagement and joint attention. In a recent meta-analysis, Kokina and Kern (2010) suggested that social stories targeting the reduction of problem behaviors may be more effective than those that teach appropriate social skills; however, researchers have rarely considered whether and which prerequisite skills or social understandings are needed to achieve social interaction goals (Kokina & Kern, 2010). In fact, from a theoretical perspective, any behavior that would benefit from enhanced social cognition may be an appropriate target of social stories when intervention is responsive to the individual’s developmental level. Social stories have been used successfully with children and adolescents with ASDs who vary widely in their cognitive and linguistic profiles. Gray (Gray & Garand, 1993) suggested early on that social stories were likely to be most effective for individuals with good language skills. Subsequently, Gray (1998) suggested that, with modification, social stories can be used successfully for individuals with ASDs with more severe challenges. However, investigations of the use of social stories in this population are comparatively rare and the evidence so far is mixed (Barry & Burlew, 2004; Quirmbach et al., 2009; Swaggart et al., 1995). A number of questions also persist about the best strategies for developing social stories. Gray (e.g., 1998, 2010) has asserted that sentences in a Social Story™ must be of a particular type and those types must adhere to a specific ratio. Readers familiar with the history of the social story literature will recognize various sentence types (e.g., perspective sentences, control sentences, directive sentences) that have undergone revision over the years. When researchers have systematically examined this issue, however, the usefulness of Gray’s sentence types and ratio has been seriously challenged (see Okada, Ohtake, & Yanagihara, 2008; Quirmbach et al., 2009; Reynhout & Carter, 2006, 2011). One point, however, is clear: What’s critical in the development of a social story is the gathering of accurate and individualized information. Ideally, this process involves collaboration among family members, caregivers, and professionals. The collaborative process we used in Jacob’s case helped us refine our thinking, coordinate workable plans, and develop shared responsibility for supporting his success. Indeed, the increasing popularity of social stories may be explained not only by the positive effects they may have on the audience, but also by their potential benefits to authors (Ali & Fredrickson, 2006). Three Myths About Social Stories Myth: The purpose of a Social Story™ is to change audience behavior. Fact: The purpose of a Social Story™ is to share meaningful and accurate information in a supportive, safe, and positive way. “The theory is that the improvement in behavior that is frequently credited to a Social Story is the result of improved understanding of events and expectations” (Gray, 2010, p. xxxi). Myth: Social Stories™ are quick and easy to develop. Fact: The planning, development, implementation, monitoring, and revision of Social Stories™ can be an incredibly time-intensive procedure. Ideally, it involves gathering accurate information and the participation of a team that has direct contact with the audience. Myth: Social Stories™ focus only on challenging situations. Fact: Gray (2010) has written with emphasis that “50% of all Social Stories must applaud what the audience is doing well. ...The rationale is simple. Given that Social Stories are helpful in teaching new concepts and skills, they may also be just as powerful in adding meaning and detail to praise” (p. xxxv). Sources Ali S., & Fredrickson N. (2006). Investigating the evidence base of Social Stories.Educational Psychology in Practice, 22(4), 355–377. CrossrefGoogle Scholar Barry L. M., & Burlew S. B. (2004). Using social stories to teach choice and play skills to children with autism.Focus on Autism and Other Developmental Disabilities, 19(1), 45–51. Google Scholar Crozier S., & Tincani M. J. (2005). Using a modified social story to decrease disruptive behavior of a child with autism.Focus on Autism and Other Developmental Disabilities, 20(3), 150–157. Google Scholar Crozier S., & Tincani M. J. (2007). Effects of social stories on prosocial behavior of preschool children with autism spectrum disorders.Journal of Autism and Developmental Disorders, 37, 1803–1814. Google Scholar Delano M., & Snell M. E. (2006). The effects of social stories on the social engagement of children with autism.Journal of Positive Behavior Interventions, 8(1), 29–42. Google Scholar Durand V. M., & Crimmins D. B. (1992). The Motivation Assessment Scale (MAS). Topeka, KS: Monaco and Associates. Google Scholar Gray C. (1998). Social stories and comic strip conversations with students with Asperger syndrome and high-functioning autism.In Schopler E. (Ed.), Asperger Syndrome or High Functioning Autism?(pp. 167–194). New York: Plenum Press. Google Scholar Gray C. (2010). The New Social Story™ Book. Arlington, TX: Future Horizons. Google Scholar Gray C., & Garand J. D. (1993). Social stories: Improving responses of students with autism with accurate social information.Focus on Autistic Behavior, 8(1), 1–10. CrossrefGoogle Scholar Hess K. L., Morrier M. J., Heflin L. J., & Ivey M. L. (2008). Autism treatment survey: Services received by children with autism spectrum disorders in public school classrooms.Journal of Autism and Developmental Disorders, 38, 961–971. CrossrefGoogle Scholar Hutchins T. L. (in press). Social Stories™.In Prelock P. A. & McCauley R. J. (Eds.). Treatment of autism spectrum disorders: Evidence-based intervention strategies for communication and social interaction.Baltimore: Brookes. Google Scholar Hutchins T. L., & Prelock P. A. (2008). Supporting theory of mind development: Considerations and recommendations for professionals providing services to individuals with autism spectrum disorder.Topics in Language Disorders, 28(4), 340–364. CrossrefGoogle Scholar Kokina A., & Kern L. (2010). Social Story™ interventions for students with autism spectrum disorders.Journal of Autism and Developmental Disabilities, 40, 812–826. CrossrefGoogle Scholar Lorimer P. A., Simpson R. L., Myles B. S., & Ganz J. B. (2002). The use of social stories as a preventative behavioral intervention in a home setting with a child with autism.Journal of Positive Behavioral Interventions, 4, 53–60. Google Scholar National Autism Center. (2010). National Standards Project. Retrieved from www.nationalautismcenter.org. Google Scholar Nichols S. L., Hupp S. D., Jewell J. D., & Zeigler C. S. (2006). Review of Social StoryTM interventions for children diagnosed with autism spectrum disorders.Journal of Evidence-Based Practices for Schools, 6(1), 90–120. Google Scholar Norris C., & Datillo J. (1999). Evaluating effects of a social story intervention on a young girl with autism.Focus on Autism and Other Developmental Disabilities, 14(3), 180–186. Google Scholar Okada S., Ohtake Y., & Yanagihara M. (2008). Effects of perspective sentences in Social Stories™ on improving the adaptive behaviors of students with autism and related disabilities.Education and Training in Developmental Disabilities, 43(1), 46–60. Google Scholar Quirmbach L. M., Lincoln A. J., Feinberg-Gizzo M. J., Ingersoll B. R., & Andrews S. M. (2009). Social stories: Mechanisms of effectiveness in increasing game play skills in children diagnosed with autism spectrum disorders using a pretest posttest repeated measures randomized control group design.Journal of Autism and Developmental Disorders, 39(2), 299–321. Google Scholar Reynhout G., & Carter M. (2006). Social stories for children with disabilities.Journal of Autism and Developmental Disorders, 36, 445–469. CrossrefGoogle Scholar Reynhout G., & Carter M. (2009). The use of Social stories by teachers and their perceived efficacy.Research on Autism Spectrum Disorders, 3, 232–251. CrossrefGoogle Scholar Reynhout G., & Carter M. (2011). Evaluation of the efficacy of Social Stories™ using three single subject metrics.Research in Autism Spectrum Disorders, 5, 885–900. CrossrefGoogle Scholar Rust J., & Smith A. (2006). How should the effectiveness of Social stories to modify the behavior of children on the autistic spectrum be tested?.Autism, 10(2), 125–138. Google Scholar Sansoti F. J., Powell-Smith K. A., & Kincaid D. (2004). A research synthesis of social story interventions for children diagnosed with autism spectrum disorders.Focus on Autism and Other Developmental Disabilities, 32(6), 535–543. Google Scholar Swaggart B. L., Gagnon E., Bock S. J., Earlies E. L., Quinn C., Myles B. S., & Simpson R. L. (1995). Using social stories to teach social ad behavioral skills to children with autism.Focus on Autistic Behavior, 10, 1–15. Google Scholar Test D. W., Richter S., Knight V., & Spooner F. (2011). A comprehensive review and meta-analysis of the Social StoriesTM literature.Focus on Autism and Other Developmental Disabilities, 26(4), 49–62. doi:10.1177/1088357609351573. Google Scholar Author Notes Tiffany L. Hutchins, PhD, is assistant professor of communications sciences and disorders at the University of Vermont. Her research interests include child language development, measures of Theory of Mind, and the efficacy of social stories to remediate deficits associated with autism. Contact her at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 17Issue 1January 2012 Get Permissions Add to your Mendeley library History Published in print: Jan 1, 2012 Metrics Downloaded 2,059 times Topicsasha-topicsleader_do_tagasha-article-typesCopyright & Permissions© 2012 American Speech-Language-Hearing AssociationLoading ...

Guided by a dyadic view of children's peer behavior, this study assessed actor and partner effects of attachment security and temperament on young children's behavior with an unfamiliar peer. At 33 months of age, child-mother attachment security was assessed via a modified Strange Situation procedure, and parents reported on child temperament (anger proneness and social fearfulness). At 39 months, same-sex children (N = 114, 58 girls) were randomly paired, and child dyads were observed during 3 laboratory visits occurring over 1 month. Actor-partner interdependence models, tested via multilevel modeling, revealed that actor security, partner anger proneness, and acquaintanceship (e.g., initial vs. later visits) combined to predict child behavior. Actor security predicted more responsiveness to the new peer partner at the initial visit, regardless of partner anger proneness. Actor security continued to predict responsiveness at the 2nd and 3rd visits when partner anger was low, but these associations were nonsignificant when partner anger was high. Actor security also predicted a less controlling assertiveness style at the initial visit when partner anger proneness was high, yet this association was nonsignificant by the final visit. The findings shed light on the dynamic nature of young children's peer behavior and indicate that attachment security is related to behavior in expected ways during initial interactions with a new peer, but may change as children become acquainted.

Background: Epistaxis, commonly known as nose bleeding, is a prevalent condition in pediatric patients, often managed either at home or in clinical settings. This study aimed to explore the differences in the management of pediatric epistaxis between home and clinical settings, focusing on gender distribution, clinical presentations, and treatment methods.Methods: A retrospective review was conducted, analyzing pediatric epistaxis cases managed both at home and in clinical settings. Data on gender distribution, clinical presentation, and treatment methods were collected and analyzed. Home remedies, first aid management, and clinical interventions like the use of nasal sprays and septoplasty were evaluated.Results: The study found significant differences in gender distribution between home (46.2% males) and clinical settings (61% males). Recurrent nasal bleeding was more common in home settings (75%), whereas more complex cases were predominant in clinical settings. Nasal sprays containing decongestants were widely used in clinical settings (62.1%), contrasting with a preference for first aid measures at home. Surgical interventions like septoplasty were occasionally employed in clinical scenarios.Conclusion: The study highlights distinct approaches to managing pediatric epistaxis in home versus clinical settings. It underscores the importance of tailored treatment strategies, considering the severity and frequency of epistaxis episodes. These findings suggest a need for comprehensive guidelines to assist caregivers and healthcare professionals in effective decision-making for pediatric epistaxis management. The study also emphasizes the necessity for ongoing research and education in this area.

The 'New Forest Parenting Package' (NFPP), an 8-week home-based intervention for parents of preschoolers with attention-deficit/hyperactivity disorder (ADHD), fosters constructive parenting to target ADHD-related dysfunctions in attention and impulse control. Although NFPP has improved parent and laboratory measures of ADHD in community samples of children with ADHD-like problems, its efficacy in a clinical sample, and relative to an active treatment comparator, is unknown. The aims are to evaluate the short- and long-term efficacy and generalization effects of NFPP compared to an established clinic-based parenting intervention for treating noncompliant behavior ['Helping the Noncompliant Child' (HNC)] in young children with ADHD. A randomized controlled trial with three parallel arms was the design for this study. A total of 164 3-4-year-olds, 73.8% male, meeting DSM-IV ADHD diagnostic criteria were randomized to NFPP (N=67), HNC (N=63), or wait-list control (WL, N=34). All participants were assessed at post-treatment. NFPP and HNC participants were assessed at follow-up in the next school year. Primary outcomes were ADHD ratings by teachers blind to and uninvolved in treatment, and by parents. Secondary ADHD outcomes included clinician assessments, and laboratory measures of on-task behavior and delay of gratification. Other outcomes included parent and teacher ratings of oppositional behavior, and parenting measures. (Trial name: Home-Based Parent Training in ADHD Preschoolers; Registry: ClinicalTrials.gov Identifier: NCT01320098; URL: http://www/clinicaltrials.gov/ct2/show/NCT01320098). In both treatment groups, children's ADHD and ODD behaviors, as well as aspects of parenting, were rated improved by parents at the end of treatment compared to controls. Most of these gains in the children's behavior and in some parenting practices were sustained at follow-up. However, these parent-reported improvements were not corroborated by teacher ratings or objective observations. NFPP was not significantly better, and on a few outcomes significantly less effective, than HNC. The results do not support the claim that NFPP addresses putative dysfunctions underlying ADHD, bringing about generalized change in ADHD, and its underpinning self-regulatory processes. The findings support documented difficulties in achieving generalization across nontargeted settings, and the importance of using blinded measures to provide meaningful assessments of treatment effects.

Serious games are computer or video games that contain elements that are specifically designed for the purpose of education or training. Serious games are increasingly being used within healthcare, but their introduction into and application in psychotherapeutic settings as an e-mental health treatment modality raises questions for both patients and therapists. Current research demonstrates the potential role and effectiveness of serious games within a psychotherapeutic context. However, a limited understanding of patients' and therapists' existing knowledge and experience of serious games, as well as of their readiness to utilize and apply them for the treatment of psychological conditions, requires further investigation. Acceptance, experience, and requirements for the utilization of serious games in therapeutic contexts were assessed through online surveys with German-speaking patients (n = 260) and psychotherapists (n = 234). Respondents' answers were analyzed by a combination of descriptive and inferential statistics by using SPSS. Current knowledge regarding serious games was very limited, with only 10.4% of patients and 11.5% of therapists reporting existing knowledge. However, a general openness toward the concept was observed: 88% of patients and 90% of therapists could envisage a therapeutic use. Patients (rs = 0.169, p = 0.006) who self-rated their level of computer and video game expertise as high were more likely to consider use within psychotherapy, compared with patients who self-rated their expertise as low. Therapists who currently play computer and video games perceive fewer disadvantages of serious game application in a psychotherapeutic context (p = 0.097). Consideration of serious game use was differentiated by the therapeutic approach (p = 0.003), specific mental disorders (highest rated relevant cases: anxiety disorders, affective disorders, disorders regarding impulse control, and adjustment disorders), and patient age (i.e., use with young adults was deemed the most appropriate by 91.8% of therapists). The application of serious games is conceivable for patients and therapists, especially as a complementary element to traditional face-to-face psychotherapy. Acceptance is strongly related to therapeutic context. Only a small number of therapists and patients agree on the possibility of using a serious game instead of face-to-face therapy.

Assessment of the functional capacity of the cardiovascular system is essential in sports medicine. For athletes, the maximal oxygen uptake [Formula: see text] provides valuable information about their aerobic power. In the clinical setting, the (VO(2max)) provides important diagnostic and prognostic information in several clinical populations, such as patients with coronary artery disease or heart failure. Likewise, VO(2max) assessment can be very important to evaluate fitness in asymptomatic adults. Although direct determination of [VO(2max) is the most accurate method, it requires a maximal level of exertion, which brings a higher risk of adverse events in individuals with an intermediate to high risk of cardiovascular problems. Estimation of VO(2max) during submaximal exercise testing can offer a precious alternative. Over the past decades, many protocols have been developed for this purpose. The present review gives an overview of these submaximal protocols and aims to facilitate appropriate test selection in sports, clinical, and home settings. Several factors must be considered when selecting a protocol: (i) The population being tested and its specific needs in terms of safety, supervision, and accuracy and repeatability of the VO(2max) estimation. (ii) The parameters upon which the prediction is based (e.g. heart rate, power output, rating of perceived exertion [RPE]), as well as the need for additional clinically relevant parameters (e.g. blood pressure, ECG). (iii) The appropriate test modality that should meet the above-mentioned requirements should also be in line with the functional mobility of the target population, and depends on the available equipment. In the sports setting, high repeatability is crucial to track training-induced seasonal changes. In the clinical setting, special attention must be paid to the test modality, because multiple physiological parameters often need to be measured during test execution. When estimating VO(2max), one has to be aware of the effects of medication on heart rate-based submaximal protocols. In the home setting, the submaximal protocols need to be accessible to users with a broad range of characteristics in terms of age, equipment, time available, and an absence of supervision. In this setting, the smart use of sensors such as accelerometers and heart rate monitors will result in protocol-free VO(2max) assessments. In conclusion, the need for a low-risk, low-cost, low-supervision, and objective evaluation of VO(2max) has brought about the development and the validation of a large number of submaximal exercise tests. It is of paramount importance to use these tests in the right context (sports, clinical, home), to consider the population in which they were developed, and to be aware of their limitations.

Background and Aims This study aims to compare the effectiveness of two computerized cognitive training applications, “Brain Train” and" CogniPlus”, in improving the response inhibition, selective attention, and visual-spatial processing speed of children with attention deficit/hyperactivity disorder (ADHD). Methods This is a quasi-experimental. Participants were 45 elementary school students diagnosed with ADHD who were selected by a convenience sampling method. The students were divided randomly into three groups: intervention group 1 (n=15, receiving training by Brain Train), intervention group 2 (n=15, receiving training by CogniPlus) and control (n=15). Each intervention group separately received training for two months, three session per week, each for 50-60-minutes. Performance of three groups were evaluated in response inhibition, selective attention, and visual-spatial processing in pre-test and post-test phases using Stroop test, the integrated visual and auditory continuous performance test (IVA+Plus), and visual-spatial processing subscale of the Stanford-Binet Intelligence Scales. Collected data were analyzed using the analysis of covariance. Results Results showed a significant difference between the two intervention groups in the study variables (P&lt;0.05), but there was no significant difference between two intervention groups in improving selective attention and response inhibition (P&gt;0.05). However, in visual-spatial processing, the group received training by Brain Train application showed a significant improvement more than the group received training by CogniPlus (P&lt; 0.05). Conclusion Computerized cognitive training applications can improve the cognitive skills of children with ADHD, where the Brain Train application is more effective than Cogniplus regarding the visual-spatial processing ability.

Relationships between negative emotionality and attentional control in effortful control

In humans, long-term marijuana use is associated with impaired impulse control and attentional capacity, though it has been difficult to distinguish pre-existing cognitive deficits from possible consequences of prolonged marijuana exposure. To evaluate the effects of long-term exposure to Δ9-Tetrahydrocannabinol (Δ9-THC), the primary psychoactive constituent in marijuana, on indices of impulse control and attentional capacity using the rat 5-Choice Serial Reaction Time Task (5-CSRTT). Ten 14-day cycles of Δ9-THC dosing and 5-CSRTT testing were employed, each comprised of 5-day Δ9-THC dosing (0.3 or 3 mg/kg b.i.d.) and 5-CSRTT testing during the 9 days of drug abstinence. Subsequent 5-CSRTT testing continued during 5 weeks of protracted abstinence. Dose-dependent increases in motor impulsivity (premature responses) and behavioral disinhibition (perseverative responses) emerged following 5 cycles of Δ9-THC exposure that persisted for the remaining dosing and testing cycles. Δ9-THC-related disruptions in motor impulsivity and behavioral inhibition were most pronounced during cognitively challenging 5-CSRTT sessions incorporating varying novel inter-trial intervals (ITIs), and these disruptions persisted for at least 5 weeks of Δ9-THC abstinence. Δ9-THC-related impairments in attentional capacity (response accuracy) were also evident during variable ITI challenge tests, though these attentional disruptions abated within 3 weeks of Δ9-THC abstinence. These observations demonstrate that long-term intermittent exposure to clinically meaningful Δ9-THC doses induces persistent impairments in impulse control and attentional function. If present in humans, these disruptions may impact academic and professional performance.