Behavioral Changes In Children Research Articles

Brief Report: Increasing Children's Safe Pedestrian Behaviors through Simple Skills Training

Hundreds of American children are killed and thousands more injured annually as pedestrians. Simple and effective interventions targeting behavioral changes in children are needed. The present study tested a simple, skill-based training method for increasing safe pedestrian behaviors. Eighty-five children ages 5-8 participated. Children behaved more safely following training, indicating very brief training can produce at least short-term improvements in pedestrian behaviors. Results are discussed with regard to the involvement of parents in the practical application of a simple training procedure and future directions for pedestrian interventions.

Snoezelen: A controlled multi-sensory stimulation therapy for children recovering from severe brain injury

Objective: To investigate the effects of Snoezelen therapy on physiological, cognitive and behavioural changes in children recovering from severe traumatic brain injury (TBI).Methods: An observational study was conducted to assess the physiological, cognitive and behavioural changes of children recovering from severe TBI while receiving Snoezelen therapy. Fifteen subjects completed the pre- and post-Snoezelen treatment measurements computed over 10 consecutive sessions. Physiological, cognitive and behavioural measures were administered. Data was collected prospectively on each session in the Snoezelen room and were analysed by calculating the difference between pre- and post-treatment measurements for each Snoezelen session.Results: Results revealed significant changes on physiological measures. Heart rates decreased for each subject in each treatment session and were found to be significant (p = 0.032). Muscle tone was decreased in all the affected extremities (right upper extremity p = 0.009, left upper extremity p = 0.020, right lower extremity p = 0.036 and left lower extremity p = 0.018). Agitation levels decreased over time and the overall cognitive outcome measures showed significant improvement when comparing the beginning of treatment with the end.Conclusion: This study revealed a beneficial use of Snoezelen therapy with children recovering from severe brain injury. However, there continues to be a critical need for evidenced-based research for this patient population and others in this multi-sensory environment.

Awareness During Anesthesia in Children

Source: Davidson AJ, Huang GH, Czarnecki C, et al. Awareness during anesthesia in children: a prospective cohort study. Anesth Analg. 2005;100:653–661.Investigators from The Royal Children’s Hospital in Melbourne, Australia carried out a prospective cohort study to assess the incidence and nature of awareness during anesthesia in children. This study was “nested” in a larger study of behavioral changes in children after hospitalization and anesthesia. Patients ages 5 to 12 years having general anesthesia for any procedure were eligible for the study. Study children were randomly enrolled from each day’s operating room schedule. The type of general anesthesia provided was not controlled. Following anesthesia, enrolled subjects were asked a set of screening questions at 3 different times; the first or second day, the third day, and finally the 30th day post-anesthesia. Behavior changes were assessed at 30 days post-anesthesia. One of the principal investigators interviewed all cases of possible awareness and generated a case report. The reports were reviewed by 4 pediatric anesthesiologists from outside locations and classified as “awareness,” “possible awareness,” or “not awareness.”Eight-hundred-sixty-four children were interviewed using questions such as “Did you have any dreams or feel or hear anything while you were having the operation?” There were 28 cases of suspected awareness based on the screening questionnaire. At least 1 of the 4 outside reviewers felt that 12 of these 28 reports represented “awareness.” Seven of the 12 cases had a unanimous consensus of “awareness” by all 4 reviewers, giving an incidence of awareness of at least 0.8% (95% CI, 0.3 to 1.7%). Five of these children reported pain, classified as “mild” in 4, and “moderate” in 1. No child reported being upset at the time of the interview. One of 5 of the “aware” children had a significant deterioration in behavior. This was not significantly different from the 15.8% incidence of behavior deterioration in the “non-aware” group. The authors were unable to demonstrate a statistically significant difference between the “aware” and “non-aware” groups in the use of sedative premedication, type or length of anesthesia, use of muscle relaxants, age, or incidence of critical events.Dr. Valley has disclosed no financial relationships relevant to this commentary.The authors demonstrated an incidence of awareness (0.8%) in a cohort of pediatric patients who were relatively healthy and undergoing elective surgery; that percent-age is considerably higher than that quoted for adults (0.1 to 0.2%).1 Only 1 of the “aware” subjects received muscle relaxants. As the authors discussed, higher anesthetic requirements (minimum alveolar anesthetic concentration [MAC]) and differences in the pharmacology of intravenous anesthetics may partially account for a higher incidence of awareness in children.2,3 An interesting clinical practice by the anesthesiologists at the study site may also explain some of the cases of awareness. After induction of anesthesia in an “Induction Room,” the patient was disconnected from the anesthesia circuit and transported a short distance to the operating room where the patient was then reconnected to an anesthesia circuit and inhalation anesthesia resumed or started. Six of the 7 “aware” subjects had an inhalation (versus intravenous) induction. Hence, it is possible that some “lightening” of anesthetic depth occurred during this time. The authors acknowledge that this could have been a factor in 5 of the 7 reported cases of awareness.This article comes on the heels of a “Sentinel Event Alert” sent out by JCAHO in October 2004,4 which alerted anesthesia providers to the problem of awareness during anesthesia and suggested how it could be prevented and managed. The Society for Pediatric Anesthesia, the AAP section on Anesthesiology and Pain Medicine, and the ASA Pediatric Anesthesia Committee took issue with some of the recommendations and sent a joint letter to JCAHO asking that the alert be withdrawn. The letter noted the paucity of data on the use of “awareness monitors” for pediatric patients, cited evidence that in some situations these devices can be misleading, and expressed concern about the recommendations on the use or avoidance of certain anesthetic agents and muscle relaxants.Awareness during anesthesia can and does occur in children. Clinicians and researchers are now charged with developing sound clinical guidelines to prevent, detect, and deal with cases of awareness in children.Knowledge of this problem may result in better awareness on the part of anesthesiologists both in transferring children receiving inhaled anesthesia from an “induction room” to an operating room, and in the OR.

Postoperative behavioral changes in children after tonsillectomy

The purpose of this randomized clinical trial, with children undergoing tonsillectomy, was to compare changes in the child’s postoperative behavior with “as needed” or around-the-clock analgesic dosing. Children were randomized to receive acetaminophen with codeine (12mg/5ml) for 3 days after surgery every 4 hours “as needed” (PRN Group: N=28) or every 4 hours around-the-clock (ATC Group: N=52). Parents were asked to compare each behavior listed in the home log with the child’s normal behavior before surgery, and record observed behavioral changes once a day, beginning on the day of surgery and for the first three days after surgery.

Occupational therapists' reported experiences using weighted vests with children with specific developmental disorders.

The purpose of this study was to identify specific practice patterns of a convenience sample of paediatric occupational therapists and the behavioural changes that they observe when they use weighted vests with children with developmental disorders. Although the practice of weighted vests is accepted clinically, there is little discussion of their use nor is there empirical evidence of their efficacy in the literature. A convenience sample of 51 occupational therapists from different geographic areas of the United States participated in a telephone survey about how they used weighted vests with specific children. This study was a follow-up to a mail survey about paediatric occupational therapists' opinions and general practice patterns with weighted vests. Although the interviewees observed some different behavioural changes in children with various developmental disorders when these children used weighted vests, their practice patterns in using the vests were similar across disabilities. The most common behavioural changes noted were increased attention and staying on task. Participants' opinions and practice patterns related to weighted vests are discussed. This study is not generalizable as it utilized a self-selected group of therapists. However, the findings from the qualitative data can provide direction for future quantitative studies by providing important data about practice patterns that may serve as independent variables examining the effectiveness of weighted vests.

An interim analysis of a cohort study on the preoperative anxiety and postoperative behavioural changes in children having repeat anaesthetics

Introduction Anxiety in the preoperative period and at induction of anaesthesia in children is associated with disturbances in postoperative behaviour 1-4). There is little work looking at the effects of repeat anaesthetic procedures on anxiety and subsequent postoperative behaviour disturbances. The aim of this study was to see if the effect of repeat anaesthetics was cumulative on postoperative behavioural problems and whether repeated anaesthetics provoke increasing anxiety. We investigated factors that may identify children who are susceptible to behavioural changes following repeat anaesthetics. We present an interim analysis of data on 8 patients as part of a long-term cohort study on 40 children with retinoblastoma who have required repeat anaesthetics for assessment and treatment of their condition. Method Approval for this study was granted by the East London and City Health Authority ethics committee. 40 patients are being recruited and being followed over a two year period. All children have retinoblastoma and are between the ages of 18 months to 4 years. The anaesthetic technique was not standardised but details of it were collected. Data collected were demographic details of child (age, sex, weight, ASA grade, siblings, stressful events in the last 3 months, recent immunisations, number of previous anaesthetics, problems with previous general anaesthetics, medical history of children, temperament of child using the EASI scoring system (4); demographic data of parents (age, parental education, family members affected, baseline measure of parental anxiety using State trait anxiety inventory (STAI). Anxiety on entry into the anaesthetic room and at induction was measured by the modified Yale preoperative anxiety scale (mYPAS), cooperation of the child at induction was measured by the Induction compliance checklist (ICC). Anxiety of the parent after induction was measured by the STAI score. Behaviour was measured at 1 day, 1 week, 1 month and 4 months after each procedure by means of the post hospital behaviour score (PHBQ) (5). A comparison with preoperative behaviour was made and data is presented of the percentage of children with new negative behavioural problems. A detailed analysis of the types of behaviour change was noted. anova for repeat measures with multiple dependent measures was used to analyse data on child anxiety and postoperative behavioural problems. Results Eight patients have had 3 separate anaesthetics over one and a half years. These have been at 4 monthly intervals. There was no significant increase in anxiety levels with repeat anaesthetics. The median mYPAS score at induction were 100 for all 3 anaesthetics. (P = 0.41). The type of behavioural change was variable and demonstrated no trend. No patient was identified as being prone to behavioural changes after every anaesthetic. Patients who displayed new negative behavioural problems would have them after any anaesthetic with no obvious cumulative effect with each repeat anaesthetic. Conclusions Our patients had maximum anxiety scores at induction, so the mYPAS scoring system is not sensitive enough to show that repeat anaesthetics provoke increasing anxiety. There is a very random pattern to behavioural disturbances after repeat anaesthetics with no evidence that negative behavioural changes are compounded with repeated anaesthetics. Collection of complete data from the remaining 32 patients may yield some trends regarding behavioural disturbances but our use of the mYPAS to measure anxiety in this very anxious population is unlikely to be helpful.

Progressive behavioral changes in children with epilepsy

Children with epilepsy are known to have high rates of mental health problems. The role of seizures in the development of these problems is not known primarily because of difficulties in separating the effects of seizures from the three other potential causal factors: (a) poor child and family response to the condition, (b) side effects of antiepileptic medication, and (c) neurological dysfunction that causes both the seizures and the behavioral problems. Although cross-sectional studies focusing on children with chronic epilepsy show associations between behavior problems and each of these causal factors, it is not possible to isolate the effects of any one causal factor using this design. A stronger approach is to conduct prospective studies of children with new-onset seizures. Recent research on children with new-onset seizures suggests that side effects of antiepileptic medication and poor child and family response do not play major roles in the development of behavior problems. Results from a prospective study in children with new-onset seizures show an association between seizures and behavior problems. Separating effects of seizures from effects of neurological dysfunction on behavior problems, however, will be difficult even in prospective studies of children with new-onset seizures. Transient cognitive impairment (TCI) from interictal epileptiform discharges is proposed as an alternative explanation for behavior problems.

Behavioural changes in children following day‐case surgery: a 4‐week follow‐up of 551 children

The purpose of this prospective multicentre survey was to evaluate the occurrence and the type of changes in children's behaviour during the first 4 weeks following the day of surgery, and to assess the significance of some patient-related factors on the incidence. Pre- and postoperative questionnaires were completed by the parents of 551 children aged 4 months to 13.4 years in five hospitals incorporating nine operative units in Northern Finland. The overall incidence of problematical behavioural changes was 47% and that of beneficial changes 17%. Problematical changes were most common in the 1.0 to 2.9 year olds and the incidence decreased significantly from 46% on the day of the operation to 9% 4 weeks later (p < 0.0001). Predictors by multiple logistic regression analysis were age, mild pain at home following surgery, severe pain and a previous bad experience of health care which had adversely affected the attitude of the child towards doctors or nurses. Hospital influenced playing was a significant factor 3 and 4 weeks after the operation. By the 4th week, beneficial and problematical changes were equally common (9%). Gender, previous operations and experience of repeated paracenteses (for treatment of middle ear infection) did not have a significant effect on the incidence. Pain on the day of the operation predicted the occurrence of behavioural problems up to the 4th week, 2-4 weeks longer than the duration of pain itself. The results emphasise the importance of effective prevention of postoperative pain as well as the importance of avoiding unpleasant experiences in all contacts children have with health care. Playing could perhaps be used to help children cope with a short hospital experience.

Otitis Media and the Social Behavior of Day-Care-Attending Children

Research has suggested that young children who experience chronic middle ear disease (otitis media) in early childhood may display some initial developmental delays in language development as well as later problems in school. This association between otitis media and developmental problems is hypothesized to be linked to the hearing loss that accompanies frequent or long bouts of otitis media. Recent interest has focused on whether otitis media may be linked to behavioral changes in children, making them less responsive to the environment even when well. This study examined the relation between early otitis media in day-care-attending children and their subsequent behavior in the day-care classroom when the children were well. Findings suggest that day-care-attending children with chronic otitis media in the first 3 years of life play more often alone and have fewer positive and fewer negative verbal interactions with peers than nonchronic children in day-care. There were no differences between chronic and nonchronic otitis media children in their nonverbal behavior. Results may also contribute to our understanding of the development of the socially withdrawn child.

Behavioural change in children associated with the consumption of synthetic food colouring: Katherine S. Rowe, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, and David R. Briggs, School of Nutrition and Public Health, Deakin University, Geelong, Victoria 3217, Australia

Behavioural change in children associated with the consumption of synthetic food colouring: Katherine S. Rowe, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, and David R. Briggs, School of Nutrition and Public Health, Deakin University, Geelong, Victoria 3217, Australia

Food Coloring and Behavior

The association between the ingestion of tartrazine synthetic food coloring and behavioral change in children referred for assessment of hyperactivity was investigated at the Royal Children’s Hospital, University of Melbourne, Australia.

Synthetic food coloring and behavior: A dose response effect in a double-blind, placebo-controlled, repeated-measures study

Objective: To establish whether there is an association between the ingestion of synthetic food colorings and behavioral change in children referred for assessment of "hyperactivity." Participants: From approximately 800 children referred to the Royal Children's Hospital (Melbourne) for assessment of suspected hyperactivity, 200 were included in a 6-week open trial of a diet free of synthetic food coloring. The parents of 150 children reported behavioral improvement with the diet, and deterioration on the introduction of foods noted to contain synthetic coloring. A 30-item behavioral rating inventory was devised from an examination of the clinical histories of 50 suspected reactors. Thirty-four other children (23 suspected reactors, 11 uncertain reactors) and 20 control subjects, aged 2 to 14 years, were studied. Design: A 21-day, double-blind, placebo-controlled, repeated-measures study used each child as his or her own control. Placebo, or one of six dose levels of tartrazine (1, 2, 5, 10, 20, 50 mg), was administered randomly each morning, and behavioral ratings were recorded by parents at the end of each 24 hours. Results: The study identified 24 children as clear reactors (19 of 23 "suspected reactors," 3 of 11 "uncertain reactors," and 2 of 20 "control subjects"). They were irritable and restless and had sleep disturbance. Significant reactions were observed at all six dose levels. A dose response effect was obtained. With a dose increase greater than 10 mg, the duration of effect was prolonged. Conclusion: Behavioral changes in irritability, restlessness, and sleep disturbance are associated with the ingestion of tartrazine in some children. A dose response effect was observed. (J PEDIATR 1994;125:691-8)

Effects of drug administration in pregnancy on children's school behaviour

Files with prescription data were used to assess possible behavioural changes in children, whose mothers used benzodiazepines or neuroleptic drugs during the second half of their pregnancy. Prescriptions, bearing the identification number of women resident in one district of Prague, filed in pharmacies during 1974 and the first three months of 1975 represent the first part of the data. During 1984, children born in the appropriate earlier period were searched and linked with the earlier prescription data. A group of 68 children with possible exposure to neuroleptics and a group of 15 children possibly exposed to diazepam during the second half of their intrauterine development were found. Two groups of 55 and 7 children, respectively, born of mothers without exposure to these drugs, were chosen as controls. The teachers of classes attended by these children were addressed by a letter and asked to evaluate their behaviour at school. This was done by means of a form containing analogue scales evaluating different features of behaviour. Each child was compared with its control. The statistical evaluation with Student's t-test, regression analysis and analysis of variance did not reveal any significant difference between both groups and their controls.

Theophylline causes no behavioural changes in children with asthma

Theophylline causes no behavioural changes in children with asthma

Sinusitus With A Behavioral Presentation

AbstractThe case of a 9‐year‐old girl with sinusitus who presented with behavioral changes is discussed. The author notes no similar findings in the literature and demonstrates the need to search carefully for organic causes for behavioral changes in children. The author also urges physicians to be aware of changes in behavior as possible presenting symptoms of sinusitus.

Peer Models and Children’s Behavioral Change

This article critically reviews the research literature on peer modeling among children as a function of model attributes. Peer modeling is hypothesized to depend in part on perceived similarity between model and observer. Similarity serves as an important source of information for gauging behavioral appropriateness, formulating outcome expectations, and assessing one’s self efficacy for learning or performing tasks. Research is reviewed on the effects of model age, model sex, model competence, number of models, and model background. Peer models can foster diverse types of behavioral change in children, but attribute similarity does not automatically enhance modeling. The conditions under which similarity promotes behavioral change are discussed. Future research needs to assess children’s self-perceptions, as well as maintenance and generalization of behavioral changes. It is suggested that classroom peers can help train social skills, enhance self-efficacy, and remedy skill deficiencies.

Measuring actual reduction of risk to child abuse: A new approach

Previous efforts to measure the effectiveness of child abuse prevention programs have relied on proximate measures presumed to be predictive of actual skills. This paper presents documentation that brings those assumptions into question, describes actual observation and measurement of behavioral change in children before and after prevention education, and correlates that behavioral response with more traditional measures of effectiveness. Unique to the evaluation was the staging of an actual situation in which each of the children had an opportunity to leave the school building with a stranger. Each simulation was videotaped and conducted in such a way that the children remained unaware of the fact that they had been tested. In addition, tests of language development, self-esteem and knowledge of prevention and safety concepts were administered before and after participating in the Children Need to Know Personal Safety Training Program [1]. Several findings have significant value for future examinations and programming. The effectiveness of a primary prevention program based on age-appropriate, experiential and interactive instruction was empirically documented. Traditional instrumentation which elicits written or verbal responses to cognitive questions about safety may be misleading in assessing children's vulnerability. Higher self-esteem before instruction and higher knowledge/attitude scores after instruction were found to be predictive of a reduction in vulnerability. While this is a significant series of findings, some children did not achieve the objectives of the prevention program. These results suggest further possibilities for evaluation and some direction for improving prevention education.

Cognitive and Behavioral Changes in Children Resulting from Parental Divorce and Consequent Environmental Changes

Operationalizing divorce as environmental change helps to understand the processes leading to the development of psychopathology in some children of divorce. Children living with their divorced mothers and children living with their married, natural parents completed change measures (Recent Life Changes Questionnaire, Environmental Change Questionnaire), a behavior checklist (Child Behavior Checklist) and a cognitive/perceptual characteristics measure (Semantic Differential). Significant F-ratios were obtained for the main effects of parent marital status and extent of environmental change and for the interactions of marital status with environmental change and marital status with age at divorce. Processes leading to child psychopathology were identified as types of changes, changes in parent-child relations and increased demands on the custodial parent. Conceptualizing divorce as environmental change has significant implications for the development of primary prevention programs for this population of ch...

Children As Therapeutic Change Agents: Reinforcement Intervention Paradigms

By far the majority of the literature dealing with therapeutic behavioral change in children casts adults in the role of change agent. For a variety of reasons, including economy, necessity, and scientific curiosity, adults who design therapeutic interventions have begun to look more closely at the role of the child's classmates and playfellows in bringing about desirable behavioral change. The empirical roots of the notion that children may serve as therapeutic change agents are found in investigations of children's effectiveness as reinforcement agents. Patterson and Anderson (1965) conducted a laboratory experiment to demonstrate elementary students' ability to shape a peer's preference in a simple marble game. In a similarly designed study, Hartup (1964) used nursery school children as reinforcement agents to condition a peer's motor response (marbledropping rate). A subsequent study by Tikten and Hartup (1965) was undertaken to expand on the results Hartup originally obtained. Once again, elementary age children demonstrated their prowess as programmed social reinforcers. Evidence that retarded children can serve as agents of reinforcement was presented by Terrel and Stevenson (1965). All of these studies were also concerned with the relationship between differential effectiveness of children and sociometric status. Hartup, Glazer, and Charlesworth (1967) have presented data

Persons, situations, and time: A genetic view of behavioral change in children.

Persons, situations, and time: A genetic view of behavioral change in children.