Withdrawal In Children Research Articles

The Role of Maternal Behavior in the Relation between Shyness and Social Reticence in Early Childhood and Social Withdrawal in Middle Childhood

AbstractThe moderating effect of maternal behavior in the relations between social reticence and shyness in preschool and subsequent social withdrawal was investigated. Eighty children (47 females) were judged for degree of social reticence during play with unfamiliar peers at the age of four and mothers completed the Colorado child temperament inventory (CCTI). At the age of seven, the children were coded for degree of social withdrawal during peer play and mothers and children were observed during structured and unstructured activities. Two significant interaction effects indicated that maternal report of shyness was a positive predictor of age‐seven social withdrawal when mothers lacked positivity; whereas observed social reticence was associated with higher degrees of social withdrawal when mothers were highly negative. Maternal positivity and negativity differentially influenced the development of social withdrawal in childhood, such that maternal negativity is associated with poor social functioning in children who have an established history of social withdrawal; whereas maternal positivity is associated with better social outcome for preschoolers who are viewed as temperamentally shy.

Randomized Controlled Trial of Traditional Chinese Medicine (Acupuncture and Tuina) in Cerebral Palsy: Part 1—Any Increase in Seizure in Integrated Acupuncture and Rehabilitation Group Versus Rehabilitation Group?

The objective of this study was to observe for any change in baseline seizure frequency with acupuncture in children with cerebral palsy. A randomized controlled study was conducted: Group I consisted of integrated acupuncture, tuina, and rehabilitation (physiotherapy, occupational therapy, and hydrotherapy) for 12 weeks; and Group II consisted of rehabilitation (physiotherapy, occupational therapy, and hydrotherapy) for 12 weeks. After a washout period of 4 weeks, Group II then received acupuncture and tuina for 12 weeks. Each subject received 5 daily acupuncture sessions per week for 12 weeks (total = 60 sessions). All children were assessed for any change in seizure frequency during treatment. One hundred and sixteen (116) children were recruited and randomized into Group I (N = 58) and Group II (N = 58). Thirty-three (33) children withdrew (9 from Group I and 24 from Group II). Of the remaining 83 children, Group I consisted of 49 and Group II of 34 children. For baseline, 5 children (6%; 5/83) had seizures. During phase 1 (12 weeks) of integrative treatment and subsequent 4-week follow-up, 3 children in Group I had seizures. Among those 3 children with seizures, 1 child with prior history of recurrent febrile seizure had 3 more recurrent febrile seizures during acupuncture treatment and 2 children without any prior history of seizures had new-onset seizures (1 with 3 recurrent febrile seizures and 1 with afebrile seizure). For Group I, 2 children with epilepsy had no increase in seizure frequency during acupuncture treatment. For Group II during the phase 2 acupuncture period, none had increase in seizure frequency. In both groups, 4 of 5 children (80%; 2 in Group I and 2 in Group II) with seizures had no increase in seizure frequency during acupuncture treatment and follow-up. The risk of increasing seizure is not increased with acupuncture treatment for cerebral palsy.

Children's Relationships with Mothers and Teachers: Linkages to Problem Behavior in Their First Preschool Years

A majority of developmental psychologists have recognized that early adult-child relationship plays an important role in children's social development. Previous research on developmental psychopathology indicated that the mother-child relationship and teacher-child relationship both separately served as protective as well as risk factors in children's externalizing and internalizing problems. However, less attention has been given to how the mother-child and teacher-child relationships combine to influence children's emotional and behavioral adjustment. The aim of the present study was to investigate the separate as well as joint contributions of mother-child relationship and teacher-child relationship to children's internalizing and externalizing problems. Furthermore, since the present study focuses on preschool beginners, it also represents a specific program to identify the possible risk and protective factors that affect children's social adjustment during the transition from home to preschool. Based on a sample of 102 preschoolers aged 2 to 3 years and their mothers and teachers, the present study examined mother-child and teacher-child relationships in relation to these children's internalizing and externalizing problems in their first preschool years. Hierarchical regression analysis was applied to detect the separate effects of mother-child and teacher-child relationships on children's behavior problems as well as the moderation effect of teacher-child relationship on the relation of mother-child relationship to behavior problems. The results indicated that after controlling the effects of children's Time 1 behavior problems, the mother-child relationship was not a significant predictor of their Time 2 behavior problems, while teacher-child conflict could negatively predict children's Time 2 withdrawal and delinquency problems. The teacher-child relationship and child gender served to moderate the association between mother-child relationship and children's externalizing and internalizing problems, in that a positive association between mother-child conflict and children's aggression was found only in girls (simple slope = 0.83, t= 2.00, p 0.05) but not in boys. A high-quality teacher-child relationship predicted negative associations between mother-child closeness and children's withdrawal (simple slope = -0.48, t= 2.01, p0.05), anxiety (simple slope = -0.96, t= 2.68, p 0.01), aggression (simple slope = -1.03, t= 2.35, p 0.05), and delinquency (simple slope = -0.46, t= 2.37, p 0.05) problems, while a low-quality teacher-child relationship predicted no significant associations between mother-child closeness and children's withdrawal, aggression, and delinquency problems and a positive association between mother-child closeness and children's anxiety problem (simple slope = 1.06, t= 3.12, p 0.01). These findings highlight the importance of examining the continuity of adult-child relationship at home and at preschool in order to best understand children's emotional and behavioral adjustment and of expanding the existing research on parent-child relationship by underlying the importance of teacher's influence in the socialization process.

Conversations with Barney: A Conversation Analysis of Interactions with a Child with Autism

This study arose from an intervention programme aimed to develop the communication and social interaction skills of Barney, a six-year-old child diagnosed with Pervasive Developmental Disorder (Autistic Spectrum). The approach we take is a social constructionist one that challenges the assumption of a Western psychiatric approach emphasising the impairment and deficits associated with autism. Conversation analysis is employed as a method of elucidating the collaborative mechanisms employed by Barney and his co-participants in making sense of one another. The aim of this study was to closely examine the communicative behaviour and interactive styles of Barney and his co-participants, their implications for communicative success ( co-ordinated interaction) or breakdown ( discordant interaction), and the implications for ways in which the child is positioned within the discourse in relation to his co-participants. Our constructions of the data suggested the following: A playful, activity-based interactive style constituted by non-verbal turns, affection, and short, simple utterances enhanced co-ordinated interaction. Discordant interaction seemed to result from a tendency of the co-participants to dominate the interaction (e.g., frequent and repetitive questioning) which directed and constrained interaction and resulted in the child's withdrawal. Other implications are highlighted. This research informs intervention efforts and encourages co-participants to reflect on ways in which interaction is co-constructed between themselves and the child with autism.

Peer status and behaviors of maltreated children and their classmates in the early years of school

Objective The aims of the present study were to investigate (1) whether young children with a known history of maltreatment by caregivers have more problematic peer relationships and classroom behaviors than other children, and (2) if children's behaviors with peers mediated associations between maltreatment and children's problem peer relations. Method Participants included 400 young children (ages 4–8, M age = 6.6), and 24 teachers in 22 schools. Six percent of children had a known history of maltreatment. Multiple methods (ratings and nominations) and reporters (children and teachers) were utilized to obtain information on peer relationships. Teachers reported children's physical/verbal aggression, and withdrawn and prosocial behaviors. Results Young children were able to nominate and rate whom they liked versus disliked in their classes, and their reports were modestly correlated with teacher reports. Regardless of the reporter, maltreated children were significantly more disliked, physically/verbally aggressive, withdrawn, and less prosocial, compared with their classmates. Among all children, physical/verbal aggression, withdrawal, and prosocial behavior were associated independently with some aspect of peer status. Maltreatment had indirect associations with peer likeability and peer rejection via maltreated children's relatively higher levels of physical/verbal aggression and, in some cases, withdrawal and relatively lower prosocial behavior. Maltreatment had an indirect association with teacher-reported peer acceptance via children's withdrawal. Conclusions Findings indirectly associate early family experiences with problems in peer relationships, especially lower peer likeability and more rejection, via children's behaviors with peers. The finding that linkages exist even in the very earliest years of school highlights the need for very early home- or school-based efforts focused on improving behavior and relationships of maltreated children and others children with similar profiles.

Novel spacer device does not improve adherence in childhood asthma

The Funhaler (FH) is a novel spacer device (holding chamber) that has been designed to improve adherence and aerosol delivery in young asthmatic children using a metered dose inhaler. A pilot study reported a 38% increase in parent-reported adherence over 2 weeks compared with the child's normal spacer. The aim of this study was to investigate whether the FH would be associated with superior adherence in the medium term (3 months) using an objective assessment. Forty-seven children aged 18 months to 7 years were randomised to a FH or control small volume spacer. Participants were reviewed monthly for 3 months. Adherence was measured using an electronic monitoring device (Smartinhaler). Disease control was based on symptom scores and exacerbation rates. Twenty-six children were randomised to the FH and 21 to the control spacer. Three children withdrew (FH = 2). Median adherence each month for the 3 months was 74%, 54%, and 46% for the FH and 70%, 73%, and 54% for the control spacer. The difference in adherence was not statistically significant (P = 0.47, 0.37, and 0.23, respectively). There was also no significant difference in exacerbation rates or symptom scores. Seven of the FHs broke during the study. The FH was preferred by 21/24 parents randomised to the FH compared with their child's normal spacer. Despite the FH being popular with children and parents its use was not associated with improved adherence or disease control.

Maternal and child health problems: The inter-generational consequences of early maternal aggression and withdrawal

The purpose of this study was to determine the impact of childhood aggression and social withdrawal on adult health, and to examine the transfer of health-risk to offspring. Previous studies have linked aggression to poor health habits, whereas social withdrawal has been linked to increased symptom reporting. Little research has attempted to examine the effects of parents’ childhood behaviour problems on health in the next generation. Seventy-four parents from disadvantaged neighbourhoods in Montreal (roughly half of whom were identified in childhood as being highly aggressive and/or withdrawn) and their offspring aged 9–11-years old participated in this prospective, longitudinal study. Health histories of mothers and target children were taken during structured home interviews. Regression analyses tested the relationship between parents’ behaviour problems in childhood and subsequent health outcomes in both generations. Mothers who were high on both aggression and withdrawal in childhood showed the earliest signs of health problems. Maternal childhood aggression predicted lower self-rated health and some current health problems, whereas maternal childhood withdrawal predicted more somatizing symptoms such as frequent headaches. Offspring of socially withdrawn mothers or fathers were more likely to be prescribed medication for respiratory problems and Ritalin, despite no matching maternal reports of higher incidence of behavior or respiratory problems. In summary, there were distinct health patterns for families of individuals who are highly aggressive and socially withdrawn in childhood, with implications for transfer of poor health habits to the next generation.

Intergenerational predictors of diurnal cortisol secretion in early childhood

AbstractThe present study examined potential intergenerational links that may contribute to atypical patterns of diurnal cortisol secretion in early childhood. Salivary cortisol samples were collected across 1 waking day in 36 pre‐school children whose mothers are participants in an ongoing longitudinal project. Hierarchical Linear Modeling (HLM) identified statistically significant predictors of individual differences in daily cortisol trajectories. Children displayed relatively low post‐awakening values and flatter cortisol trajectories across the day as a function of unsupportive maternal behaviour, second‐hand smoke and maternal histories of social withdrawal in childhood. These results suggest that individual differences in young children's pattern of diurnal cortisol are associated with a variety of current and historical maternal characteristics and behaviours. The identification of intergenerational predictors of children's diurnal neuroendocrine functioning may provide new insights into the transfer of health and developmental risk from parent to child. Copyright © 2007 John Wiley & Sons, Ltd.

Seizure Recurrence and Risk Factors after Antiepilepsy Drug Withdrawal in Children with Brain Tumors

To study seizure outcome after antiepilepsy drug (AED) withdrawal in brain tumor patients and to analyze risk factors for seizure recurrence. Brain tumor patients with seizures and at least one attempt at AED discontinuation were identified from the hospital database and neurology clinic records. After defining study variables, patient charts were abstracted for clinical and demographic data. Statistical analyses used log-rank tests and multivariable Cox proportional hazards models. Sixty-two patients discontinued AEDs at a median time of 5.6 years from the first seizure (range, 1.2-19.6 years). Median time since AED withdrawal was 2.3 years (range, 0.4-15.1 years). Seizures recurred in 17 (27%) patients within a median time of 0.8 years (range, 0.06-7.7 years). Median seizure-free period before AED withdrawal was 1.3 years (range, 0.1-11 years). More than one tumor resection and whole-brain radiation treatment (WBRT) were associated with seizure recurrence, whereas posterior fossa tumor location was correlated with reduced seizure recurrence risk. At seizure recurrence, control was easily reestablished in 10 patients with AED reinstitution and after dose adjustment in five; two patients with poor drug compliance continue to have seizures. In 48 patients who had an EEG before AED withdrawal, spikes or slow waves did not correlate with seizure recurrence. AED withdrawal can be successfully achieved in majority of carefully selected patients. WBRT and multiple tumor resections seem to be associated with an increased hazard for seizure recurrence.

Antiepileptic Drug Withdrawal in Childhood: Does the Duration of Tapering Off Matter for Seizure Recurrence?

There is no consensus on how long the duration of antiepileptic drug withdrawal after seizure control should be. The objective of the present study was to verify if the duration of tapering off matters for seizure recurrence in children with controlled epilepsy. In this prospective study, patients were randomized to taper the antiepileptic drug during a period of 1 or 6 months. Fifty-seven patients met the inclusion criteria; 24 were girls, and ages ranged from 2 to 16 years (mean 9.45 years). There was no difference between the two groups according to age, gender, type of epileptic syndrome, electroencephalogram abnormality, and antiepileptic drug (P > .05). In the 1-month group, seizure recurred in 10 patients, as opposed to 12 patients in the 6-month group. The analysis of seizure recurrence in each group showed no difference (P > .05). We conclude that the duration of antiepileptic drug tapering off does not influence the risk of seizure recurrence in childhood.

Grown‐up coeliac children: the effects of only a few years on a gluten‐free diet in childhood

To evaluate clinical and psychological status of adults with childhood diagnosis of coeliac disease who were re-exposed to gluten after only a few years and now on a gluten-containing diet, compared with adults with recent diagnosis of coeliac disease, and adults who remained on gluten-free diet after childhood diagnosis. A total of 195 adults with a biopsy suggestive of coeliac disease in childhood, who either had adhered to a gluten-free diet for at least 1 year after diagnosis and now are either on gluten-free diet (n = 110) or on gluten-containing diet (n = 85), and adults with newly diagnosed coeliac disease (n = 165) underwent a medical check-up. Body mass index and main laboratory indices were statistically different among groups (lowest in never on gluten-free diet, highest in gluten-free diet). The lowest average levels of bone mineral density were found among never on gluten-free diet patients. Prevalence of autoimmune disorders was increased in never on gluten-free diet when compared with the transient gluten-free diet and gluten-free diet groups. Histology revealed villous subatrophy in all patients of never on gluten-free diet group, in 39 of 110 patients of gluten-free diet and in 84 of 85 of transient gluten-free diet groups. Herpetiform dermatitis was found in three patients of gluten-free diet, three of transient gluten-free diet and three of never on gluten-free diet. Dental enamel defects were found in 15 patients of transient gluten-free diet, 43 of never on gluten-free diet and in zero of the gluten-free diet group. Pregnancy outcome was not significantly different between the two groups, but neonatal weight was lower and breast feeding was shorter in the never on gluten-free diet group. Sexual habits, alcohol intake and cigarette smoking were significantly different in the never on gluten-free diet group when compared with the other two groups. Gluten withdrawal in childhood partly protects coeliac adults from clinical and behavioural effects of gluten sensitivity.

A Behaviour‐Based Peer‐Nomination Measure of Social Withdrawal in Children

Research on social withdrawal has been impeded by problems in the definition of the construct and in its measurement. The purpose of this study was to develop a behaviourally‐based peer‐nomination measure useful in measuring two types of withdrawal: Inhibited/Wary and Self‐Conscious/Anxious. In Study 1, we report the development of the measure. We examined whether this two‐factor structure would be supported by data obtained from multiple informants. Data were collected from children in grades 3, 5, and 7, and their peers and teachers. Intercorrelations of peer‐, teacher‐, and self‐reports of the Behaviour‐Based Peer‐Nomination Measures of social withdrawal supported the validity of the Inhibited/Wary dimension; teacher‐peer agreement also provided support for the validity of the Self‐Conscious/Anxious dimension. In Study2, the Behaviour‐Based Peer‐Nomination Measure of Social Withdrawal was cross‐validated against observed play behaviour with 120 boys and girls. Results revealed some concordances between observational and peer‐nomination data.

Carbamazepine Withdrawal in Children With Previous Symptomatic Partial Epilepsy: Effects on Neuropsychologic Function

Neurocognitive performance was evaluated in seven children with symptomatic partial epilepsy prior to, and at least 12 months after, discontinuation of carbamazepine. The patients treated with carbamazepine monotherapy were seizure-free for at least 2 years and without electroencephalographic anomalies for at least 1 year. Results indicated that carbamazepine at therapeutic levels does not affect intellectual, memory, or attentional functions, or more complex frontal functions. Nevertheless, after therapy withdrawal scores on frontal function tests used in this study improved significantly. This suggests that these functions could have been better without carbamazepine therapy. The fact that carbamazepine decreases neuron membrane excitability and could reduce the information circuity, particularly in the frontal areas, is offered as a possible explanation. Further studies on larger samples using the same design are required to validate these results.

AED Withdrawal in Children with Cerebral Palsy

The safety of antiepileptic drug (AED) withdrawal in 65 children with cerebral palsy (CP) who had been seizure-free for at least 2 years was investigated in the Neurology Department, Texas Scottish Rite Hospital for Children, Dallas.

The Child Behavior Scale: A teacher-report measure of young children's aggressive, withdrawn, and prosocial behaviors.

The Child Behavior Scale: A teacher-report measure of young children's aggressive, withdrawn, and prosocial behaviors.

ERIC/EECE Report: Shyness, Inhibition and Withdrawal in Children

ERIC/EECE Report: Shyness, Inhibition and Withdrawal in Children

Beyond the boundaries: A patient, a therapist and an allegation of sexual abuse

Abstract This paper explores the difficult clinical situation when a child makes a false allegation of sexual abuse against a therapist. The experience of an allegation being acted upon, involving the child's withdrawal from therapy and full child protection procedures, is contrasted with three cases where it was not found necessary to follow that protocol. Aspects of the child's pathology and history are shown to blur the distinction between acting-out and remembering, to lead to concrete rather than symbolic thinking, and comment is made on early primitive mechanisms and anxieties overlaid by experiences of neglect and abuse. Factors in the child are paralleled in the response of the network, with consequent increased vulnerability of the therapist. Difficulties of containment and issues in continuing therapy are explored.

Pilgrim's progress: the effect of salmeterol in older children with chronic severe asthma

Twenty-four children aged 12–17 years entered a randomized, double-blind placebo-controlled study investigating the use of salmeterol in chronic severe asthma. In addition to their usual medication, the children were given either placebo or 100 μg salmeterol b.d. by dry powder inhalation. Treatment was continued throughout one term at a residential school for asthma. Symptom scores, peak expiratory flow rates, spirometry and quality-of-life scores were compared between the two treatment groups. One child withdrew during the run-in period. Twelve pupils received placebo and 11 pupils received salmeterol. There were consistent improvements in favour of salmeterol, reaching statistical significance for morning and evening peak flow rates and spirometry when measured on four occasions during the study period. There were no medication-related adverse events recorded and no pulse rate changes. Salmeterol (100 μg b.d.) is well tolerated and efficacious in older children with chronic severe asthma.

Annotation: sociometry and peer relationships.

Annotation: sociometry and peer relationships.

Peer Rejection in Childhood.

Introduction 1. Recent advances in the study of peer rejection S. R. Asher Part I. Behavioural Characteristics of Peer Rejected Children: 2. Peer group behavior and social status J. D. Coie, K. A. Dodge and J. Kupersmidt 3. Children's entry behavior M. Putallaz and A. Wasserman 4. Preschooler's behavioral orientations and patterns of peer contact: predictive of peer status? G. R. Ladd, J. M. Price and C. H. Hart Part II. Parent-Child Relations and Peer Rejection: 5. Social withdrawal in childhood: developmental pathways to peer rejection K. H. Rubin, L. J. Lemare and S. Lollis 6. Parent-child interaction M. Putallaz and A. H. Heflin Part III. Social-Cognitive Process: 7. Issues in social cognition and sociometric status K. A. Dodge and E. Feldman 8. Reputational bias: view from the peer group S. Hymel, E. Wagner and L. J. Butler Part IV. Consequences of Peer Rejection: 9. Peer rejection and loneliness in childhood S. R. Asher, J. T. Parkhurst, S. Hymell and G. A. Williams 10. The role of poor peer relationships in the development of disorder J. Kupersmidt, J. D. Coie and K. A. Dodge Part V. Issues in Intervention Research: 11. Adapting intervention to the problems of aggressive and disruptive rejected children J. D. Coie and G. K. Koeppl 12. Toward the development of successful social skill training for preschool children J. Mize and G. W. Ladd Conclusion: 13. Toward a theory of peer rejection J. D. Coie.