Treatment Approach For Children Research Articles

Vitiligo: Treatment Approach in Children

CME Educational Objectives 1. Describe the psychosocial impact of vitiligo in the pediatric population. 2. Identify current treatment options for pediatric vitiligo. 3. Explain the indications for referral of a child with vitiligo to a dermatologist.

Multisite Trial on Efficacy of Constraint-Induced Movement Therapy in Children with Hemiplegia

In the past decades, several treatment approaches have been used to improve upper limb function in hemiplegic cerebral palsy. Only recently has constraint-induced movement therapy emerged as a treatment approach for children with hemiplegic cerebral palsy with the aim of reversing the behavioral suppression of movement in the affected upper limb. To date, evidence on this treatment has been very poor and limited, because all currently available trials reveal methodological limitations and a need for additional research to support the application of this treatment technique. This article presents the methodological choices, design, and main characteristics of an ongoing controlled clinical trial on the effectiveness and safety of constraint-induced movement therapy combined with an intensive rehabilitation program and compared with two comparison groups: one treated with an intensive rehabilitation program and the other with standard treatment. Twenty-one rehabilitation sites are currently recruiting patients with hemiplegic cerebral palsy, aged between 2 and 8 yrs, who have never undergone constraint therapy. Primary outcome measures include two major domains: upper limb motor ability (Quality of Upper Extremity Skills Test) and hand function assessment evaluating both grip function and spontaneous use of the affected side (Besta scale). Secondary outcome measures concern overall function, behavior, compliance, and satisfaction with treatment program of both child and family. Patients' follow-up is of 12 mos after treatment. Research in children has always been neglected in comparison with adults, because of ethical reasons regarding the use of children for experimental purposes. The consequence has been the utilization of treatment and assessment tools and techniques that have not always been tested in pediatric patients or evidence is very scarce. Discussing and working on pediatric research methods represents an urgent need in rehabilitation research.

A behavioral perspective of childhood trauma and attachment issues: Toward alternative treatment approaches for children with a history of abuse.

A behavioral perspective of childhood trauma and attachment issues: Toward alternative treatment approaches for children with a history of abuse.

Management of intracranial aneurysm in children: clipped and coiled

ObjectivesThe objective was to describe the clinical features of intracranial aneurysm in children and evaluate the efficacy and safety of different treatment approaches for children with intracranial aneurysms.Materials and methodsClinical data of 13 child patients with intracranial aneurysms that were diagnosed and treated in our hospital in the past 16 years were reviewed. Long-term follow-up data were also collected and reported.ResultsDirect surgical treatment was performed on eight out of all 13 patients; among them, seven achieved good recovery and one died. The remaining five patients were treated with Guglielmi detachable coils (GDC). The aneurysm was successfully sealed off in one case and achieved good postoperative recovery. Residual aneurysm was detected in two cases; a second resection surgery was performed on one patient who died after the operation and on another with neck occlusion who recovered well. Two cases experienced aneurysm recanalization after interventional therapy; among them, one was treated with a second embolotherapy but had recanalization once again and was finally cured by aneurysm resection surgery.ConclusionAneurysmal surgery is proved to be a safe and effective treatment for children with intracranial aneurysm. Although requiring a long-term follow-up period to determine the clinical outcome, GDC is also shown to be safe for a child having acute bleeding. Once a residual aneurysm or recanalization occurs, microsurgery is recommended.

Specialist residential education for children with severe emotional and behavioural difficulties: pupil, parent, and staff perspectives

Specialist residential schools have been proposed as a coherent treatment approach for children with severe emotional and behavioural difficulties. This research aimed to explore the perspectives of a range of stakeholders regarding the benefits and disadvantages of attendance at a residential school for children with severe emotional and behavioural problems. Interviews were conducted with pupils (N = 5), parents/carers (N = 6), and staff (N = 12). There was considerable consistency in findings across all stakeholders. Parents/carers, staff, and pupils all perceived there to have been a range of important benefits including: a positive and substantial impact on the children's emotional and behavioural development, improved capacity to deal with difficult feelings, better self‐esteem, and improved relationships with others. Stakeholders also observed educational improvements, although some parents/carers expressed concerns about levels of academic achievement. Further research is needed to assess whether the perceived changes identified by the current study can be substantiated objectively, to identify the therapeutic processes at work, and to assess the cost‐effectiveness of residential treatment compared with other interventions.

An investigation of the factors affecting handwriting performance in children with hemiplegic cerebral palsy

Purpose. This study investigated the effects of sensory – perceptual – motor and cognitive functions on handwriting performance in primary-school children with left-hemiplegic cerebral palsy, compared with that of their healthy peers.Methods. The study included 26 children aged 8 – 12 years with left-hemiplegic cerebral palsy and 32 typically developing children of similar age with dominant right hand. The Minnesota Handwriting Assessment was used to evaluate handwriting ability. The Bruininks – Oseretsky Test of Motor Proficiency was used to assess motor performance. Cognitive function was assessed by the Loewenstein Occupational Therapy Cognitive Assessment. The Ayres Southern California Sensory Integration Tests were used to assess visual perception, kinaesthesia, and graphesthesia.Results. Statistically significant differences were found between the two groups in sensory-perceptual-motor and cognitive function and in handwriting ability (p < 0.05). There were also significant correlations between handwriting parameters and upper-extremity speed and dexterity, proprioception, bilateral coordination, visual and spatial perception and, visual-motor organisation in children with cerebral palsy (p < 0.05).Conclusions. The results showed that left-hemiplegic children with cerebral palsy whose right sides were dominant were significantly less competent at handwriting than their right-dominant, healthy peers. It was found that the impairment in proprioception seen in the non-hemiplegic side in children with cerebral palsy, and also the impairment in bilateral coordination, speed and dexterity of the upper extremities, visual and spatial perception, visual-motor organization, and tactile-sensory impairments negatively affected their handwriting skills. In the treatment approaches for children with hemiplegic cerebral palsy, comprehensive sensory – perceptual – motor assessments that involve both extremities must be performed in detail at the earliest possible stage, in order to minimize the existing problems with early-treatment policies. Developing the sensory – perceptual – motor and cognitive function of hemiplegic children would thus be possible, and they would be able to adapt to the same primary-school curriculum as their healthy peers.

Practitioner Review: Clinical applications of pediatric hypnosis

Over the past quarter century, hypnosis has been employed in a broad range of pediatric clinical settings; however, its efficacy and feasibility as a treatment approach for children and adolescents remain in question. Published studies on the role of clinical hypnosis in the management of specific pediatric medical and psychological conditions were identified and reviewed. Pediatric clinical hypnosis has been employed in diverse medical settings to treat primary conditions (e.g., enuresis), as well as to address factors related to management of the condition (e.g., skills training for asthma) or its treatment (e.g., burn dressing changes). Despite great breadth to the possible applications of pediatric hypnosis and many reported successes, much of the present research comprises case histories and small, uncontrolled group studies. To date, research in pediatrics views clinical hypnosis as a promising tool with the potential to help manage a variety of conditions. However, additional research, particularly utilizing randomized, controlled methodologies and adequate sample sizes, is required.

Factors affecting event free survival (EFS) after high dose chemotherapy with stem cell rescue (HDC/SCR) in children with brain tumors

9057 Background: HDC/SCR is a novel approach for treatment of children with brain tumors. Despite several studies suggesting results are better in children with primitive neural ectodermal tumors (PNET) or medulloblastoma (MB), it is controversial whether other factors can predict outcome. Methods: We retrospectively analyzed data from 53 patients who underwent HDC/SCR for brain tumors at Children Hospital Los Angeles between June 1992 and June 2005. Patients were aged 4 months to 15.8 years at diagnosis and 9 months to 18.1 years at transplant. In all cases the conditioning regimen included thiotepa and/or etoposide and/or carboplatin. The variables considered were age at diagnosis, histology, extent of disease, conditioning regimen, radiation therapy, stem cell type and timing of transplant. Results: Diagnoses included 33 PNET/MB, 8 high-grade gliomas, 5 ependymomas, 3 germinomas, 2 choroid plexus carcinomas and 2 rhabdoid tumors. Overall event free survival at 36 months was 53±9.1% in PNET/MB and 40±15.5% in tumors with other histology. Variables associated with better EFS in PNET/MB were no prior progression (p=0.00094), no spread into bone marrow (p=1.2 E-10) and age less than 3 years at diagnosis (p=0.046). There was a trend toward improved outcome if there was gross total resection of the tumor (p=0.11). Patients with PNET transplanted before progression had better EFS if they had localized disease at diagnosis (p=0.00024), and if gross total surgical resection was accomplished (p=0.11). Patients with PNET/MB transplanted after progression had better EFS if there was no spread of disease into blood or bone marrow (p=0.00023), if they were male (p=0.053), had localized disease at relapse (p=0.12) and if radiotherapy was given after transplant (p=0.053). In patients with tumors of other histology, the only variable associated with prolonged EFS was gross total resection (p=0.026). Conclusions: Children most likely to benefit from HDC/SCR for brain tumors are those less than 3 years old who are newly diagnosed with PNET that is locally confined, and those with a non-PNET diagnosis who have gross total resection of tumor. No significant financial relationships to disclose.

Outcomes after HLA-matched sibling transplantation or chemotherapy in children with B-precursor acute lymphoblastic leukemia in a second remission: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research

AbstractThe best treatment approach for children with B-precursor acute lymphoblastic leukemia (ALL) in second clinical remission (CR) after a marrow relapse is controversial. To address this question, we compared outcomes in 188 patients enrolled in chemotherapy trials and 186 HLA-matched sibling transplants, treated between 1991 and 1997. Groups were similar except that chemotherapy recipients were younger (median age, 5 versus 8 years) and less likely to have combined marrow and extramedullary relapse (19% versus 30%). To adjust for time-to-transplant bias, treatment outcomes were compared using left-truncated Cox regression models. The relative efficacy of chemotherapy and transplantation depended on time from diagnosis to first relapse and the transplant conditioning regimen used. For children with early first relapse (< 36 months), risk of a second relapse was significantly lower after total body irradiation (TBI)–containing transplant regimens (relative risk [RR], 0.49; 95% confidence interval [CI] 0.33-0.71, P < .001) than chemotherapy regimens. In contrast, for children with a late first relapse (≥ 36 months), risks of second relapse were similar after TBI-containing regimens and chemotherapy (RR, 0.92; 95% CI, 0.49-1.70, P = .78). These data support HLA-matched sibling donor transplantation using a TBI-containing regimen in second CR for children with ALL and early relapse.

Elimination Diets in Autism Spectrum Disorders

The use of complementary or alternative treatment approaches in children with autism spectrum disorders (ASDs) is increasing, and the most popular of such approaches are diets that eliminate either gluten or casein, or both. The popularity of these diets indicates a need for more rigorous research into their efficacy. Owing to significant methodological flaws, the currently available data are inadequate to guide treatment recommendations. The purpose of this review is to examine the available trials of gluten/casein diets in children with ASDs regarding the strength of their findings and also concerning points that may be useful in the design of future studies. Seven trials of these diets in ASD are critically reviewed; 6 of these were uncontrolled trials and 1 used a single-blind design. All reported efficacy in reducing some autism symptoms, and 2 groups of investigators also reported improvement in nonverbal cognition. Design flaws in all of the studies weaken the confidence that can be placed in their findings. Careful double-blind, placebo-controlled studies are needed to evaluate whether actual benefit undergirds the diets' popularity and to provide better guidance to clinicians and caregivers. The literature currently available suggests that diets eliminating both gluten and casein (rather than either alone) should be studied first and that outcome measures should include assessments of nonverbal cognition.

Internalized other Interviewing of Children Exposed to Violence

This paper outlines a treatment approach for children and families exposed to violence that aims at decreasing traumatic stress symptoms in children and increasing emotional regulation. Using an Internalized Other Interview within a narrative framework, the child and therapist engage in a reconstructive process to heal the narrative disruption brought about by violence and trauma. It involves a reprocessing of traumatic material and a reworking of damaged attachments between parent and child. The author draws on concepts derived from relational psychodynamic theory and narrative therapy.

Adoptive Transfer of Adenovirus Specific T-Cells in Children with Systemic Adenovirus Infection after Allogeneic Stem Cell Transplantation.

Allogeneic stem cell transplantation (SCT) has become an increasing treatment option for a variety of malignant and non-malignant disease. During immune reconstitution the host is at significant risk for viral infections. Human adenovirus (HAdV) infection is especially in children an important and serious complication. Virus-specific T-cells are essential for the clearance of HAdV, since antiviral chemotherapy has been insufficient to date. We present a new treatment option using virus-specific donor T-cells for adoptive transfer of immunity to patients with systemic HAdV-infection. We isolated in 6 patients with systemic HAdV-infection after SCT virus-specific T-cells of the donor, according to INF-γ secretion after short in vitro stimulation with viral antigen, resulting in a combination of CD4+ and CD8+ T-cells. Between 5-50x103/kg T-cells were infused for adoptive transfer. For follow-up, the infection and the in-vivo expansion of infused T-cells were evaluated. Isolated cells showed high specificity and markedly reduced but residual alloreactivity in-vitro. In three of four evaluable patients the infused T-cells underwent an in-vivo expansion and in these three patients the viral load decreased in peripheral blood after adoptive T-cell transfer. In-vivo expansion of specific T-cells was dose-independent. T-cell infusion was well tolerated. One patient experienced GvHD°II of the skin after T-cell transfer. In conclusion specific T-cell immunotherapy as a new treatment approach for children was performed in 6 cases of systemic HAdV-infection after allogeneic SCT. Induction of a specific T-cell response through adoptive transfer has been shown feasible and effective to protect from HAdV-related complications.

Creation of a commission for accreditation of programs and services using Applied Behavior Analysis for treatment purposes.

The field of Applied Behavior Analysis has evolved to the point of providing services in many organizations and educational settings in the United States. ABA is considered in a growing number of schools, provider organizations, and by states, as the most effective intervention approach for children with autism. Advances in the research have led to numerous applications of behavior analysis methodologies, and the creation of the Behavior Analyst Certification Board in 2000. Yet, despite certification setting a standard for competence in the practice of Applied Behavior Analysis, there are no established standards in the U.S. for organizations or agencies that provide ABA as a primary treatment approach. This paper presents a brief statement of the need and purpose of such standards for accreditation in the implementation of ABA services. Keywords: Applied Behavior Analysis, behavior analysis accreditation, treatment, autism services. ********** It seems to me that the time has come in the development and progression of the field of Applied Behavior Analysis to devise a broad-based set of standards of practice for the field. Other professions including the American Psychological Association, American Psychiatric Association, and The Academy of Child and Adolescent Psychiatry, have all developed practice guidelines and standards for providing treatment and services for its practitioner members. In addition, there are a number of models for service and treatment delivery which are approved for third party reimbursement by Managed Care Organizations and Insurance Companies. Oversight bodies in this country are used by such payers to ensure standards of service delivery are met, including the Joint Commission for Accreditation of Hospital Organizations (JCAHO), CMS (Formerly HCFA), and NCQA. With the exception of devising ethical standards, the Association for Behavior Analysis International has not devised a set of practice standards for its practitioner members. There appears in fact to be some opposition to moving towards supporting clinical practice of Applied Behavior Analysis amongst the leaders of the association due to concerns about legal liability, and to retain the image of the organization as primarily supporting interest in research and academics in the field. One significant advance in the field of Applied Behavior Analysis in the past five years that sets the stage for the need to devise practice standards, and for a form of accreditation, is the creation of the Behavior Analyst Certification Board (BACB)[TM] in 1998, by Gerald Shook. This board is now recognized in at least 8 states in the U.S., and in four other countries. The board established standards for certification of individual practitioners based upon the Florida Behavior Analyst Certification process devised by the Florida Department of Children and Families in the 1980s. The board offers two levels of certification, as many behavior analyst practitioners now are aware of, including Board Certified Associate Behavior Analyst requiring a minimum of a Bachelor's degree, and Board Certified Behavior Analyst, requiring a minimum of a Master's degree, from an accredited university program or independent course as approved by the BACB. The BACB has established a curriculum that must be minimally adhered to for candidates to be eligible for certification at each level, along with supervision requirements, and a set of ethical standards for practitioners it certifies. The BACB has not established standards of practice, but the state of Florida under the auspices of Florida DCF, have established standards of practice for applied behavior analysis, which is written in state law for recipients of service by the Developmental Disabilities division. Indeed, one could visit any of a number of different states or specific programs, facilities, schools, or other agencies that provide ABA services in the United States, and find various practice standards and quality measures. …

Finding Individual Meaning: Defining Cognitive-Constructivist Psychotherapy as a Treatment Approach for Children and Adolescents

Finding Individual Meaning: Defining Cognitive-Constructivist Psychotherapy as a Treatment Approach for Children and Adolescents

Treatment approaches for children with Tourette's syndrome.

Tourette's syndrome has been of neurologic and psychiatric interest since the original description of this condition by Gilles de la Tourette in 1885, and it has been associated with a wide variety of treatments over the years. With the advent of advances in neurochemistry and neuropharmacology, a neurobiologic approach has emerged with the application of many drugs from the fields of neurology and psychiatry. In addition, many of the comorbid conditions that coexist, such as attention deficit disorder and obsessive compulsive disorder (OCD), are amenable to both pharmacologic and behavioral approaches. Drug treatment has included dopamine receptor blockers for tics, dopamine agonists, dopamine depletors, and stimulants for attention deficit hyperactivity disorder (ADHD), noradrenergic drugs for tics and ADHD, serotonergic drugs for OCD, and chemical denervation for involuntary movements with the use of botulinum toxin and stereotactic surgery. It is the purpose of this review to outline the various approaches that are currently available as treatments, realizing that as new drugs are introduced in neurology and psychiatry, they too will find their way into treatment options.

Survival of intentionally retained permanent incisor roots following crown root fractures in children.

Retaining tooth roots, following crown loss, confers a number of benefits including the preservation of alveolar bone. Intentional root retention in adults has been widely investigated but little is known about this treatment approach in children. Therefore, the aim of the present study was to investigate the clinical outcomes associated with permanent anterior root retention in a young population. The study group comprised 53 children who had received treatment in the paediatric dentistry clinic, Charles Clifford Dental Hospital, Sheffield, UK, over the past 10 years, following a complicated crown root fracture of a permanent maxillary incisor at or below the gingival margin. Data relating to patient age at crown root fracture, gender, previous trauma history, tooth vitality, treatments performed and clinical outcomes were obtained retrospectively using patient records. The mean age of the subjects at initial crown root fracture was 12.1 years (range 8.3-15.8 years) and there were more than twice as many males (n = 37, 70%) as females (n = 16, 30%). In just over half of the cases seen (n = 29, 54%), the tooth involved was already nonvital at the time of crown root fracture. For the majority of these nonvital teeth (n = 27, 93%), primary treatment had comprised placement/replacement of a calcium hydroxide root dressing. The remaining two teeth did not require root treatment as a satisfactory gutta percha root filling was already present. A variety of treatments was undertaken for the 24 vital roots: in 15 (63%) cases the pulp was extirpated and calcium hydroxide placed; three (12%) cases were subject to a pulpotomy; five (21%) cases were left untreated with the hope that vitality would be maintained following gingival healing and in one case the radicular pulp was extirpated and immediately obturated with gutta percha. The mean time that the roots were kept under review was 2.6 years (+/- 1.57, range 0.6-6.8). During this period, only five roots (9%) had to be removed due to persistent periapical infection. There were no complications associated with the five cases where vital root submergence had been permitted but all three cases which had initially undergone a pulpotomy subsequently presented with pulpal necrosis necessitating pulpal extirpation and calcium hydroxide therapy. These findings indicate that efforts to retain permanent anterior roots in a young population are justified in view of the high clinical success rate of over 90% over a 2-year period.

Pediatric HIV/AIDS: Issues and Strategies for Intervention

Pediatric HIV/AIDS: Issues and Strategies for Intervention

Mothers and Children Together

Summary Treatment groups for both mothers and children together who have experienced mother assault is a unique therapeutic milieu which has been underutilized in the treatment field. This article presents a 10-week feminist-informed family systems group model as part of a treatment approach for children exposed to family violence and can be used with families of children from pre-school to adolescence. This model provides a context in which the experience of family violence can be debriefed, and issues related to trauma, safety, secrecy, and post-abuse family restructuring can be addressed by family members together. In addition, play and art therapy based interventions are presented and are tailored for the beginning, middle, and end of the group process.

An Intervention Approach for Children with Teacher-and Parent-Identified Attentional Difficulties

Using a multimodal and multi-informant method for diagnosis, we selected 33 children by teacher and parent nomination for attention and work completion problems that met DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD). Of the 33 children in this group, 21 participated in the initial intervention, and 12 were placed in an ADHD control group and received the intervention after pre- and posttesting. A similarly selected group of 21 children without difficulties in attention and work completion served as a control group. Each child was assessed on pre- and posttest measures of visual and auditory attention. After an 18-week intervention period that included attention and problem-solving training, all children in the intervention and control groups were retested on visual and auditory tasks. Children in both ADHD groups showed significantly poorer initial performance on the visual attention task. Whereas the ADHD intervention group showed commensurate performance to the nondisabled control group after training, the ADHD control group did not show significant improvement over the same period. Auditory attention was poorer compared to the control group for both ADHD groups initially and improved only for the ADHD intervention group. These findings are discussed as a possible intervention for children with difficulties in strategy selection in a classroom setting.

Structured Yet Functional

This article examines the structure-functionality relationship in traditional communication-based treatment approaches for children with autism. Contrary to popular opinion supporting either highly structured or highly functional treatment, viable middle ground is proposed. The article concludes with instructional tips specific to the implementation of structured yet functional treatment.