Children Behavioral Functioning Research Articles

Congenital hypothyroidism in Wales (1982-1993): demographic features, clinical presentation and effects on early neurodevelopment.

Neonatal screening for congenital hypothyroidism (CH) was introduced in Wales in 1982. The aim of the study was to evaluate the demographic features and characteristics of infants identified during the first 12 years of screening and their neurodevelopmental progress in the first 2 years of life. Prospective collection of biochemical and clinical data (including results of Griffiths Mental Development Scales) obtained from questionnaires sent to paediatricians responsible for the ongoing clinical care of children with CH. In Wales, between 1982 and 1993, 136 infants with primary congenital hypothyroidism (CH) were identified by the neonatal screening programme. Of all new-borns, 99.8% were screened and the prevalence of CH was 1 in 3279 (1 in 2473 girls and 1 in 4770 boys). The prevalence of CH was increased in North Wales. CH was associated with increased birth weight (48.5% of infants weighed greater than 3.5 kg) and an increased prevalence of non-thyroidal congenital abnormalities (8%) and congenital heart disease (3%). Isotope scanning demonstrated an increased prevalence of normal or enlarged thyroid glands and fewer ectopic glands compared to those reported in other studies. The mean developmental quotients (DQs) for individual subsets of intellectual and behavioural functioning in children with CH aged 1 and 2 years were all above 100 (range: 103.5-111.9). In subjects with absent thyroids, these DQs were correlated with the serum concentrations of free thyroxine before treatment. The demographic features of infants with congenital hypothyroidism born in Wales are similar to those reported from other European studies although there are marked regional variations in prevalence within Wales for which there is no apparent explanation. The median age of starting therapy was 17 days and compares favourably with other screening programmes. The overall mental development of Welsh children aged 1 and 2 years with congenital hypothyroidism identified by neonatal screening is satisfactory.

The effect of seizure type and medication on cognitive and behavioral functioning in children with idiopathic epilepsy.

Antiepileptic drugs have been reported to have a variety of adverse effects on behavior and performance in children with epilepsy. Previous studies investigating these side effects, however, have not controlled for the baseline status of the child (e.g. underlying neurological condition, seizure type, socioeconomic status, family variables), making it difficult to determine whether changes in function are attributable to the use of medication. We investigated the cognitive and behavioral profiles of 43 children, aged from 4 to 16 years, with new onset, idiopathic seizures. Twenty-six of these children participated in a 6-month follow-up study, and 12 in a 12-month follow-up study, investigating the effects of antiepileptic medications on psychological functioning. The children were of average intelligence (mean IQ 108) and had not previously been treated with antiepileptic medication. Children were classified as having either generalized convulsive, generalized non-convulsive (absence), simple partial, or complex partial seizures. Prior to the initiation of treatment, children with partial seizures were found to perform better than children with generalized seizures on measures of cognitive functioning. Children with convulsive seizures obtained significantly higher cognitive scores than those with non-convulsive seizures. Children with generalized non-convulsive seizures had lower cognitive scores than subjects with other types of seizure. No differences were found between groups at baseline prior to the initiation of antiepileptic medications. Analysis of subjects' performance after 6 and 12 months of antiepileptic therapy showed no significant deterioration attributable to medication. The differences in cognitive performance of the four seizure groups at baseline were not apparent at the time of follow-up. These results indicate that intrinsic and environmental variables may play a more significant role in predisposing certain children to cognitive and learning problems than do antiepileptic medications.

Neuropsychological Features and Differential Diagnosis of Sleep Apnea Syndrome in Children

Recognizing the signs and effects of pediatric apnea is essential for accurate diagnosis and treatment of children with psychological difficulties. Sleep apnea can have serious deleterious effects on children's cognitive, behavioral, and physiological functioning. Diurnal effects include inattention, decreased academic performance, oppositionality, and restlessness, stemming from frequent nocturnal arousals, excessive daytime sleepiness, and hypoxia. Clinically, the effects of pediatric apnea appear similar to characteristics of other childhood disorders, most notably attention deficit hyperactivity disorder. Efforts to screen for sleep apnea should be regularly employed, especially for children who present with the symptoms discussed. Additional study of pediatric apnea is needed to heighten clinicians' awareness and improve diagnostic accuracy.

Association of Maternal Psychological Functioning to Pathology in Child Sexual Abuse Victims

The purpose of this study was to assess the psychological impact of disclosure of sexual abuse on child victims and their mothers and evaluate whether there was an association between maternal distress and report of child behavioral and psychological problems. Data on child psychological and behavioral problems and maternal psychological functioning were collected at the time of disclosure of sexual abuse and 9 months later for 49 subjects. The study showed the heterogeneity and severity of problems among victims and their mothers at baseline. These problems persisted almost a year later. Maternal distress was strongly correlated with the mothers' assessments of child functioning and was less strongly associated with the children's own assessments of their status. Because the mothers in this study reported high levels of persistent distress for themselves and their children, comprehensive intervention with the family may be an eficient route to child recovery afer disclosure of sexual abuse.

A family retreat as a comprehensive intervention for children with arthritis and their families.

Family resources and coping skills are important to adaptation to pediatric chronic illness. Psychological and educational interventions have been found to enhance the coping skills of children with juvenile rheumatic disease (JRD) and their families. We examined the efficacy of a 3-day family retreat as a multidisciplinary, comprehensive treatment. Children with JRD and their caregivers completed questionnaires assessing the children's behavioral and emotional functioning, pain, strain on caregivers' work and leisure activities, and caregivers' psychological distress before and 6 months after the family retreat. Principal caregivers were both parents for 16 children, mothers only for 10 children, and an aunt for 1 child. Improvements were found in children's emotional functioning, strain on caregivers' work, and strain on caregivers' leisure activities. Reductions in reported pain were not consistently revealed. Family retreats are an efficacious, multidisciplinary approach to helping families of children with JRD cope with the disease and its manifestations. Importantly, retreats offer a comprehensive intervention package that might not be available to families on an individual basis.

The Adelaide preschool language unit: Results of follow‐up

To determine educational, social and behavioural functioning of children who had been involved in a preschool language intervention programme between 1982 and 1990. Fifty children who attended the Unit were available for follow-up. The children were divided into three groups: (i) language disorder; (ii) speech disorder; and (iii) mixed speech and language disorder. A psychologist administered educational, cognitive and social behavioural tests. Speech, language and articulation were assessed by a speech pathologist. Cognitively, the 'mixed' speech and language group obtained lower scores than the speech and language disorder children; results on educational tests were also generally lower. All three groups were significantly underachieving in areas of language, reading, spelling and arithmetic relative to their performance IQ. No socialization problems were found. Severe speech and language disorders in young children, even after periods of intensive intervention, have a significant effect on later educational achievement even when children appear to be 'coping' in their educational settings.

Risk factors for behavioral dysfunction: The relative impact of maltreatment, SES, physical health problems, cognitive ability, and quality of parent-child interaction

An analysis to identify risks for behavioral dysfunction is described in which maltreatment is viewed as one of multiple factors putting behavioral outcome at risk. Based on a study of physically abused and neglected, and nonabused, non-neglected children ( n = 206) assessed at two points in time—preschool age and school age—variables representative of several domains (parenting, family environment, and child characteristics) were identified as significantly affecting children's behavioral functioning. Based on teachers' ratings, the children were assigned to one of three groups: high, medium, and low functioning. Discriminant analysis was used to determine which factors discriminated among the three groups. Results indicated that behavioral functioning is most strongly differentiated by the sociocultural and family climate in which the child is raised with physical and emotional maltreatment being significant but less powerful influences.

Assessment of developmental toxicity: neuropsychological batteries.

Assessment of change in behavioral functioning in children as a function of neurotoxicity is not a trivial undertaking. Psychological tests, widely (though erroneously) considered to be the "gold standard" for measurement of behavior in humans, are not adequate for the task; they tap the structure of cognition, not the behavioral repertoire, and cannot (alone) address developmental change. Comprehensive neurobehavioral assessment must be undertaken within a multidisciplinary assessment strategy incorporating knowledge of brain and brain development, cognitive processes and their development, brain-behavior relationships, and detailed knowledge of neurotoxicants, their action and the exposure thereto. Initial assessment batteries must be adequately broad ranging and must incorporate strategies and data for evaluating the impact of predictable nonbrain variables; they must also be cost efficient to respond to the realities of funding and the exigencies of field testing. Measures of neuropsychological outcome are optimally characterized as they relate to behavioral domains specified in terms of the competencies of infants and children of different ages; relevant information is derived from demographic, socioeconomic, medical, developmental, and educational sources, as well as from detailed observational data and performance on psychological tests. Two levels of assessment are proposed.

Impact of Maternal Drug Use and Life Experiences on Preadolescent Children Born to Teenage Mothers

The influence of maternal drug use and unconventional behavior on children's behavioral problems, cognitive functioning, and self-esteem is examined for children aged 8 and older born to adolescent mothers. Analyses are based on 581 unique mother-child dyads from the 1986 National Longitudinal Survey of the Work Experience of Youth (NLSY). Causal models indicate that maternal attitudes and experiences as an adolescent or young adult (having been raised in a non-intact home, self-esteem, and delinquency) and current family structure have different consequences for the home environments provided for girls and boys. These same maternal characteristics also directly influence children 's externalizing and internalizing problem behaviors, and feelings of self-worth. The effect of maternal drug use on children is indirect and operates through increasing the risk of marital disruption. A substantial body of evidence indicates that children of teenage mothers lag behind other children on cognitive and emotional development (Chase-Lansdale, Brooks-Gunn, & Paikoff, 1992; Hofferth, 1987). Being a teenage mother elevates the risk of unfavorable life circumstances, which contribute to the likelihood of negative outcomes in the child (Christ et al., 1990; Hofferth, 1987; McLanahan & Booth, 1989). The risk and protective factors that contribute to differences in development among the children of adolescent mothers need to be identified (Luster & Dubow, 1990). Maternal nonconventional attitudes and behaviors--in particular, drug use--have received little attention. These experiences may influence the child directly. ,r indirectly through other factors, such as quality of parenting. The reduced parenting skills of adolescent parents may partially explain the disadvantaged outcomes of their children (Chase-Lansdale et al., 1992; Christ et al., 1990). This article assesses the influence of maternal attitudes and experiences as a teenager and young adult, with emphasis on drug use, family structure, and parenting behaviors on preadolescent development. We examine the predictors of child outcomes in the arenas of cognitive, behavioral, and psychological adjustment. The analyses are based on the National Longitudinal Survey of the Work Experience of Youth (NLSY). DRUG USE AND SOCIAL PARTICIPATION Drug use in adolescence and young adulthood is associated with lower conformity to adult social roles, especially family roles. Illicit drug use increases the risk of early sex (Rosenbaum & Kandel, 1990), premarital pregnancy (Mensch & Kandel, 1992; Yamaguchi & Kandel, 1987), and cohabitation (Bachman, O'Malley, & Johnston, 1984; Newcomb, 1986; Yamaguchi & Kandel, 1985a), while marijuana use delays marriage and marital childbearing (Donovan & Jessor, 1985; Yamaguchi & Kandel, 1985b). Drug use not only affects the timing of role participation but also the stability and quality of role participation. For example, marijuana use during marriage increases the risk of divorce (Yamaguchi & Kandel, 1985b). Little is known, however, about how drug use in the general population affects parenting and the development of the drug user's children. As we discuss below, differences in the ways drug users and nonusers relate to their children have been reported in an earlier study (Kandel, 1990). The impact of drug use may be particularly important among teenage mothers who are less well-prepared than older mothers for the demands of childrearing. The influence of drug use on social roles may be related to a general unconventional lifestyle that differentiates users from nonusers (Elliott, 1993). Several cross-sectional and longitudinal studies have documented that adolescents and young adults who use marijuana, cocaine, and other illicit drugs are less religious, more depressed, more delinquent and antisocial, and have lower self-esteem than nonusers (Brook, Brook, Gordon, Whiteman, & Cohen, 1990; Donovan & Jessor, 1985; Kandel, 1984; Kaplan, 1980; Newcomb & Bentler, 1986). …

The application of structural equation modeling to maternal ratings of twins' behavioral and emotional problems.

The application of structural equation modeling to twin data is used to assess the impact of genetic and environmental factors on children's behavioral and emotional functioning. The models are applied to the maternal ratings of behavior of a subsample of 515 monozygotic and 749 dizygotic juvenile twin pairs, ages 8 through 16, obtained through mailed questionnaires as part of the Medical College of Virginia Adolescent Behavioral Development Twin Project. The importance of genetic, shared, and specific environmental factors for explaining variation is reported for both externalizing and internalizing behaviors, as well as significant differences in the causes of variation in externalizing behaviors among young boys and girls. The usefulness of applying structural equation models to data on monozygotic and dizygotic twins and the potential implications for addressing clinically relevant questions regarding the causes of psychopathology are discussed.

Major Life Events and Changes in the Behavioural Functioning of Children

The relationship between major life events and changes, across a 2-yr period, in the level of parent-reported behavioural/emotional problems in 1397 children from a general population sample was investigated using a highly modified version of the Coddington Life Events Record and the Achenbach Child Behavior Checklist. The life event questionnaire used in the present study proved to have a satisfactory reliability. The number of life events increased significantly with increasing age of the child, and a higher incidence of such events was found for families with lower socio-economic status. A significant relationship was found between the total score of negative life events across the 2-yr period and changes in the level of behavioural/emotional problems of the children.

Behavioural Treatment of Childhood Recurrent Abdominal Pain: Relationships Between Pain, Children's Psychological Characteristics and Family Functioning

This study examined the impact and side effects of a cognitive behavioural program for the treatment of recurrent abdominal pain (R.A.P.) on children's behavioural adjustment and family functioning. It assessed the extent to which changes in children's pain symptoms covaried with family processes thought to be etiologically significant in cases of R.A.P. Results showed that pain symptoms of both experimental and control children improved significantly six months after initial assessment. Treatment achieved its objectives more quickly with a higher proportion of completely pain-free children. None of the measures of child adjustment or family conflict, expressiveness, independence or achievement orientation were associated with changes in pain intensity ratings or parent observational measures of pain behaviour. There was no evidence that treatment was associated with any negative side effects.

Intellectual and academic outcome following closed head injury in children and adolescents: Research strategies and empirical findings

The literature on intellectual and academic outcome after closed head injury in children and adolescents is reviewed. The research strategies and variables used to evaluate recovery are considered in terms of empirical findings and methodological issues. It is argued that assessment of outcome must take place within the context of an understanding of the child's premorbid behavioral and cognitive functioning. In addition, more fine‐grained tests of cognition other than global IQ measures should be utilized to tap subtle information processing, problem solving, and scholastic achievement deficits resulting from traumatic brain injury.

Professionals' negative expectations of boys from father‐headed single‐parent families: Implications for the training of child‐care professionals

The study explored the possibility that individuals' assessment of children's personality and behavioural functioning may reflect stereotypic perceptions involving more negative expectations of boys from father‐headed as opposed to mother‐headed single‐parent families. These hypotheses were based upon the assumptions of the pre‐emincnce of the maternal role in the parent‐child relation. The objective was to determine whether stereotypic perceptions, if any, prevail equally or differentially among laypersons and trained professionals such as teachers and social workers. Consistent with the hypotheses, the findings showed that both laypersons and professionals had more negative expectations of boys from father‐ as opposed to mother‐custody homes. Comparison of laypersons with the professional group of teachers and social workers combined showed no significant differences between the perceptions of these two groups of respondents. The teachers, however, had significantly fewer stereotypic negative perceptions of boys from father‐headed families than laypersons and social workers. The implications of the findings are discussed for the welfare of the children and their single parents, and the training of professionals.

"Difficult" Children as Elicitors and Targets of Adult Communication Patterns: An Attributional-Behavioral Transactional Analysis

A transactional model of adult-child interaction was proposed and tested. In determining the effects that caregivers and children have on each other, it was maintained that adult attributions act as important moderators in the interaction process. Specifically, it was predicted that adult beliefs about the causes of caregiving outcomes act as selective filters or sensitizers to child behavior--determining the nature and amount of adult reaction to different child behaviors. It was further predicted that adult attributions act in a self-fulfilling fashion, that is, the communication patterns that follow from caregiver beliefs act to elicit child behavior patterns that maintain those beliefs. In a synthetic family strategy, elementary-school-aged boys were paired with unrelated mothers (N = 96) for videotaped interactions. Children were either trained or preselected on two orthogonal dimensions: responsiveness and assertiveness. Mothers were premeasured on their self-perceived power as caregivers (S+) and the social power they attributed to children (C+). Videotapes were analyzed separately for adult facial expression and posture, voice intonation, and verbal communication. Each of these behavioral dimensions was measured on the dimensions of affect, assertion, and "maternal quality" (e.g., baby-talk). We expected low self-perceived power to sensitize the adult to variations in child responsiveness and high child-attributed power to sensitize the adult to variations in child assertiveness. Two transactional sequences were obtained (the same patterns were obtained for acted and dispositional enactments of child behavior): 1. Low S+ mothers (in comparison with high S+ mothers) were selectively reactive to child unresponsiveness. These adults reacted to unresponsive children with a communication pattern characterized by a "maternal" quality, negative affect, and positive affect that was unassertively inflected. Unresponsive children, in turn, reacted to low S+ mothers with continued unresponsiveness. 2. High C+ mothers (in contrast to low C+ mothers) were selectively reactive to child unassertiveness. These adults reacted to shy children with a "maternal," strong, and affectively positive communication style. Unassertive children, in turn, reacted to high C+ mothers with increased assertiveness. High S+ and low C+ mothers demonstrated no significant alterations in their behavior as a function of child behavior. This nonreactivity had positive consequences for child unresponsiveness (reduced) and negative consequences for child unassertiveness (maintained).(ABSTRACT TRUNCATED AT 400 WORDS)

Human exposure to lead from motor vehicle emissions

A strictly quantitative assessment of the contribution made by car exhaust gas lead to the body lead burdens of young children will probably never be attained. However, there is now available a substantial scientific literature relating airborne lead to lead in humans; especially in young children who ingest deposited and impacted aerosol lead on both food and non‐food items. The distributions of lead burdens reported for new‐born and pre‐school children have been set against levels of lead absorption recently associated with pregnancy problems in women and impaired cognitive/ behavioural functioning in children. When viewed from the perspective provided by geochemically derived natural levels of lead in air, water, food and the blood of Man, the findings described should not be surprising.

RAISED LEAD LEVELS AND IMPAIRED COGN ITIVE/BEHAVIOURAL FUNCTIONING: A REVIEW OF THE EVIDENCE

SUMMARYResearch findings on the effects of raised lead levels on children's cognitive and behavioural functioning are reviewed. The results are considered separately with respect to clinic‐type studies of children with high lead levels, studies of mentally retarded or behaviourally deviant children, chelation studies, smelter studies, and general population studies of dental lead. It is concluded that, although the findings are somewhat contradictory, the evidence suggests that persistently raised blood lead levels in the range above 40/μg/100ml may cause slight cognitive impairment (a reduction of one to five points on average) and less certainly may increase the risk of behavioural difficulties. There are pointers that there may also be psychological risks with lead levels below 40μg/100ml, but the evidence on this point is inconclusive so far. Parallels are drawn with studies of other brain traumata and some suggestions are made with respect to both practical implications and the needs for further research.

Pneumato-ophthalmitis. A case of E. coli panophthalmitis.

Alloimmunity remains a barrier to long-term graft survival that necessitates lifelong immunosuppressive therapy after renal transplant. Medication nonadherence has been increasingly recognized as a major impediment to achieving effective immunosuppression. Electronic medication monitoring further reveals that nonadherence manifests early after transplant, although the effect is delayed. The etiology of nonadherence is multifactorial, with the strongest risk factors including past nonadherence and being an adolescent or young adult. Other risk factors with smaller but consistently important effects include minority race/ethnicity, poor social supports, and poor perceived health. In children, risk factors related to parental and child psychologic and behavioral functioning and parental distress and burden are also important. Qualitative systematic reviews highlight the need to tailor interventions to each transplant recipient’s unique needs, motivations, and barriers rather than offer a one size fits all approach. To date, relatively few interventions have been studied, and most studies conducted were underpowered to allow definitive conclusions. If the kidney transplant community’s goal of “one transplant for life” is to become a reality, then solutions for medication nonadherence must be found and implemented.