Compliant Children Research Articles

Bias in reported neurodevelopmental outcomes among extremely low birth weight survivors.

The purpose of this study was to investigate possible bias in the evaluation of neurodevelopment and somatic growth at 18 to 22 months' postmenstrual age among extremely low birth weight (ELBW) survivors (401-1000 g at birth). Data from a cohort of 1483 ELBW infant survivors who were born January 1993 through December 1994 and cared for at centers in the Neonatal Research Network of the National Institute of Child Health and Human Development were examined retrospectively. Children who were compliant with an 18- to 22-month follow-up visit, who visited but were not measured, or who made no visit were compared regarding 4 outcomes: 1) Bayley Scales of Infant Development, 2nd edition, Mental Developmental Index (MDI) <70 and 2) Psychomotor Developmental Index (PDI) <70, 3) presence or absence of cerebral palsy, and 4) weight <10th percentile for age. Logistic regression models were used to predict likelihood of these outcomes for children with no follow-up evaluation, and predicted probability distributions were compared across the groups. Compared with children who were lost to follow-up, those who were compliant with follow-up were more likely to have been 1 of a multiple birth, to have received postnatal glucocorticoids, and to have had chronic lung disease. These factors were significantly associated with MDI and PDI <70 in the compliant group. Chronic lung disease was associated with increased risk of cerebral palsy (CP). MDI and PDI scores <70 were found in 37% and 29% of children who were evaluated at follow-up, respectively. Prediction models revealed that 34% and 26% of infants in the no-visit group would have had MDI and PDI scores <70. Compliant children tended to have greater incidence of MDI <70 compared with those predicted in the no-visit group but not PDI <70. CP was identified in 17% of the compliant group and predicted for 18% of the no-visit group. Predicted probabilities of having CP were marginally higher among the no-visit infants compared with those who were compliant with follow-up. There were no statistically significant somatic growth differences among the compliant, visit but not measured, and no-visit groups. ELBW infant survivors who weighed 401 to 1000 g at birth and who are compliant with follow-up evaluations may have worse Bayley Scales of Infant Development, 2nd edition, MDI scores than infants with no visit. Thus, follow-up studies based on infants who are compliant with follow-up care may lead to an overestimation of adverse outcomes in ELBW survivors.

Successful Occlusion Therapy for Amblyopia in 11- to 15-Year-Old Children

To investigate the effectiveness of full-time occlusion therapy in treating amblyopia in 11- to 15-year-old children and to determine its lasting results. Fifty-five compliant children 11 to 15 years old who had amblyopia were treated with full-time (during all waking hours) occlusion of their good eye until no further improvement in the visual acuity of their amblyopic eye was observed on 3 consecutive monthly follow-up examinations. After this, part-time (4 hours per day) occlusion therapy was used randomly in 24 of 55 patients for 3 to 6 months for maintenance of the final visual acuity. Snellen visual acuity and its logMAR equivalent were recorded before treatment, at the cessation of full-time occlusion therapy, and on the most recent examination. All 55 of the patients had improved visual acuity after treatment. The mean improvement was 0.46 logMAR unit (4.6 Snellen lines). Thirty-two of the patients had a mean follow-up of 17.6 months after the cessation of full-time and maintenance occlusion therapy. Twenty-nine (91%) of the 32 patients maintained improved visual acuity, whereas 3 (9%) exhibited a regression in visual acuity. Maintenance occlusion therapy did not have a significant stabilizing effect on the improved visual acuity. Compliant, full-time occlusion effectively improves acuity in children 11 to 15 years old who have amblyopia due to strabismus, anisometropia, or both. Most older patients have lasting improvement with or without maintenance patching.

The outcome of childhood obesity management depends highly upon patient compliance.

Over the last 20 years, obesity in childhood and adolescence has become a major public health concern due to dramatically increasing prevalence rates. We evaluated the outcome of 294 children (135 girls, 159 boys) aged 6-16 years (median 10.9 years) enrolled in a single centre outpatient obesity intervention programme consisting of periodical visits to the outpatient unit with regular medical and dietetic counselling aiming at a modification of dietary and activity patterns of patients and parents. The average number of visits to the outpatient unit was 3.6 (SD 2.7) with a mean visit interval of 62.1 days. A mean drop-out rate of 27.5% between each scheduled appointment occurred. In a stepwise regression model, neither reduction of the standard deviation score of patients' body mass index (BMI-SDS) nor dietary counselling contributed to the total number of visits. The only significant contributor was the patients' initial BMI-SDS explaining 4.6% of the variance of attended visits adjusted for age and sex. Segregation of the patients into an "obesity" (initial BMI-SDS >/=90th percentile, at least three visits attended, n=59) and an "excessive obesity" (initial BMI-SDS >/=99th percentile, at least four visits attended, n=75) subgroup showed a mean reduction of BMI-SDS in the "obesity" group at visit three of 0.14 (SD 0.21, P<0.0001), and in the "excessive obese" group at visit four of 0.17 (SD 0.22, P<0.001). In a stepwise regression model, the mean interval between visits and regular dietary counselling explained 11.7% of the variance of BMI-SDS reduction at visit three in both subgroups. there is an urgent need for efficient strategies to improve adherence of outpatients to obesity treatment since, in terms of reduction in body mass index standard deviation score, a beneficial outcome can be achieved for compliant obese children and adolescents.

Good Children Presenting with Conversion Disorder

Current conceptualizations of conversion disorder in childhood draw from a range of theoretical perspectives. A large subset of children afflicted with conversion disorder has recurrently been described as ‘good’, ‘helpful’, ‘compliant’, ‘high- achieving’ and ‘conscientious’. Family characteristics noted in this group include high family expectations, inarticulate family relationships and hostility towards psychological explanations with an over-emphasis on medical aetiology. Physicians experience parental displeasure and anxiety in the form of demands for investigations and treatment, and feel pressure to comply with parental requests. Like physicians, good children with conversion disorder also feel compelled to satisfy their parents. As children, they are even less able to openly disagree with parental views or expectations, and manage their fear of parental rejection, hostility, anger or displeasure through compulsive compliance. This article discusses the contributions of attachment theory to our understanding of relationship patterns in families of extremely good compliant children and expands Taylor’s concept of ‘intolerable predicaments’. The development of the ‘compulsive compliant’ attachment strategy is discussed, and its application to the theory and treatment of children with conversion disorder is examined. Case vignettes are presented.

Parenting Practices and Aggressive Behavior in Chinese Children

Objective. We examined relations between parental warmth, guidance, and power assertion and child aggressive behavior in Chinese children. Design. A sample of children (N = 68), at 4 years of age, and their parents in P. R. China, participated in the study. Observational data concerning parenting and child compliance were obtained from home visits. Aggressive behavior was assessed in the context of peer interactions in the laboratory. Results. Maternal warmth and guidance were negatively associated with aggression. Parental power assertion was positively associated with aggression. The relations between parenting practices and aggressive behavior might be moderated by the child's characteristics: Whereas maternal warmth was negatively related to aggression mainly for compliant children, paternal positive parenting was negatively related to aggression for noncompliant and defiant children. Finally, maternal power assertion and paternal power assertion interacted with each other in predicting child aggression. Conclusions. The study provided valuable information about functional "meanings" of major parenting dimensions in Chinese culture.

The prevalence of uveitis in juvenile rheumatoid arthritis

Background: Because asymptomatic uveitis has been an important cause of visual loss in children with juvenile rheumatoid arthritis, periodic ophthalmologic screenings of such patients have been recommended. Recently, some authors have found a decreased prevalence of uveitis in children with juvenile rheumatoid arthritis. Methods: We studied a total of 76 patients (63 girls and 13 boys, aged 1 to 16 years), referred to 3 pediatric ophthalmology practices between March 1976 and October 1999. Follow-up examinations were performed at intervals of 3 to 6 months according to current guidelines, during the following 6 months to 23 years (mean, 55 months). Results: Uveitis developed in 10 children (13%). Of these 10 children, 2 were symptomatic (blurred vision, discomfort) and 7 were diagnosed with uveitis at the initial visit. Only 1 patient had asymptomatic uveitis after initial negative findings on screening examination. Final visual acuity for all the compliant children in the uveitis group was better than 20/30. Discussion: The prevalence of uveitis in our study is similar to rates found by other recent authors. This decrease may reflect a tendency for systemic medications to prevent the development of ocular inflammation. We believe that screening guidelines should be reevaluated, especially for asymptomatic children with negative findings on initial examinations. (J AAPOS 2001;5:2-4)

Successful amblyopia therapy initiated after age 7 years: compliance cures.

To report successful therapy for anisometropic and strabismic amblyopia initiated after age 7 years. A consecutive series of 36 compliant children older than 7 years (range, 7.0 to 10.3 years; mean, 8.2 years) at initiation of amblyopia therapy for anisometropic (19 patients; mean age, 8.3 years), strabismic (9 patients; mean age, 8.0 years), or anisometropic and strabismic (8 patients; mean age, 8.0 years) amblyopia was studied. Initial (worst) visual acuities were between 20/50 and 20/400 (log geometric mean, -0.83 [antilog, 20/134] for all patients; -0.88 [antilog, 20/151] for anisometropic patients; -0.70 [antilog, 20/100] for strabismic patients; and -0.88 [antilog, 20/151] for anisometropic and strabismic patients). Initial (worst) binocularity was absent or reduced in all cases. Therapy consisted of (1) full-time standard occlusion (21 patients; mean age, 8.0 years), (2) total penalization (7 patients; mean age, 7.8 years), or (3) full-time occlusive contact lenses (8 patients; mean age, 8.8 years). Final (best) visual acuities were between 20/20 and 20/30 for all 36 patients. Final (best) binocularity was maintained or improved for 22 (61%) of 36 patients, including 16 anisometropic patients (84%), 2 strabismic patients (22%), and 4 anisometropic and strabismic patients (50%). Given compliance, therapy for anisometropic and strabismic amblyopia can be successful even if initiated after age 7 years. Arch Ophthalmol. 2000;118:1535-1541

Future options for aerosol delivery to children.

There is an increasing awareness of the importance of reliable aerosol delivery, with emphasis on the dose delivered to the lungs, optimal clinical control, cost-effectiveness, and safety in children. Dose prescription should relate to the expected lung dose rather than the factory-dispensed dose, as at present. The device determines the lung dose. Clearly, therefore, the device should be considered an integral part of the prescription. Drug approval processes should clearly specify the device, and discourage the use of other devices. This would rationalize the choice of devices. Important new insights into factors essential for drug delivery to the airways have been acquired in recent years. Nasal inhalation increases systemic bioavailability, reduces lung dose, and adds to its variability; hence, face masks to prevent nasal breathing have been developed. Similarly, dead space in the inspiratory line causes a proportional reduction in lung dose; hence, attention should be paid to reducing such dead space. Plastics in spacers cause a rapid loss of drug due to electrostatic attraction of the aerosol. The residence time of the aerosol, i.e., the time available for inhalation, is increased in nonelectrostatic spacers, allowing less compliant children enough time to obtain a full dose. Eliminating the electrostatic charge can change the lung dose by several times; hence, nonelectrostatic materials should be used in future spacer devices. Compliance is the biggest problem in drug delivery to children. The inhaler design process should be reversed, adapting technology to the child. Interactive microchip technology should provide intelligent devices that react to correct handling and breathing maneuvers. An intelligent nebulizer has been developed that adapts nebulization to the child's breathing pattern, nebulizing only during inhalation and avoiding loss of aerosol during exhalation. An automatic device (AirPac) has been developed that transforms a dry-powder inhaler, Turbuhaler, into a spacer. In addition to the general advantages of spacer treatment, this device offers the advantage of a drug aerosol delivered without use of propellants or additives. The mechanical actuation ensures highly repeatable drug delivery. Finally, a nonelectrostatic, tower-shaped spacer provides a stable aerosol, which remains airborne for a prolonged period. The spacer is equipped with a face mask that prevents nasal breathing. Such features should improve our ability to treat young children with inhaled drug aerosols.

New, improved Helicobacter pylori eradication therapy in children.

New, improved Helicobacter pylori eradication therapy in children.

Recombinant human erythropoietin for treatment of anemia of chronic disease in children with Crohn's disease

We evaluated the efficacy and safety of and compliance with rH-EPO (150 U/kg three times a week subcutaneously for up to 12 weeks) for treatment of anemia in childhood Crohn's disease ( n = 4). The mean hemoglobin level before rH-EPO therapy was 109 gm/L (10.9 gm/dl) (range, 103 to 115 gm/L). The mean hemoglobin level in the three compliant children increased to 138 gm/L (13.8 gm/dl) after treatment. Response time for the correction of anemia ranged from 6 to 12 weeks (mean, 9.5 weeks). Resolution of symptoms of lethargy, poor appetite, and irritability occurred with correction of the anemia. The only adverse effect observed was transient local pain at the injection site.(J Pediatr 1998;132:155-9).

Maintaining theophylline compliance/adherence in severely asthmatic children: the role of psychologic functioning of the child and family.

Noncompliance with asthma therapy by asthmatic children and their families is a common cause of treatment failure. Psychologic factors have been reported to influence adherence patterns. To evaluate the relationship of psychologic function of severely asthmatic children and families with theophylline compliance during a 1-year follow-up period after inpatient asthma rehabilitation. Thirty-seven severely asthmatic children with a median age of 9 years (range, 2 to 17 years) were treated in an inpatient rehabilitation program (median, 15 days). Established clinical rating scales of psychologic adjustment were used for children (Child Global Assessment Scale) and families (Family Global Assessment Scale) at the time of admission. Patients were defined as noncompliant if 30% or more of theophylline levels obtained during the 1-year follow-up period were less than 5 mg/L (mumol/L). Compliant children had higher scores on the Child Global Assessment Scale than noncompliant children (64 versus 48, P = .09). Families of compliant children had significantly higher scores on the Family Global Assessment Scale than did families with noncompliant children (63 versus 54, P < .05). There was no statistical relationship between compliance status and parent-reported behavior problems, demographic factors (age, race, sex, and number of parents at home), health insurance, specialty referral at admission, measures of medical morbidity (days hospitalized, number of emergency care visits, and number of corticosteroid bursts), or length of rehabilitation stay. Both compliant and noncompliant children had comparable reductions in morbidity (hospital and emergency care, number of corticosteroid bursts required). Psychologic functioning of the child and family may be related to theophylline compliance.

Anisometropic and strabismic amblyopia in the age group 2 years and above: a prospective study of the results of treatment.

Forty-four children aged 2-9 years with strabismic and anisometropic amblyopia were prospectively followed up during amblyopia treatment. The efficacy of optimised treatment in terms of number of cured children, time to achieve cure, and rate of initial improvement of visual acuity was evaluated in relation to age at start of treatment, type and initial degree of amblyopia, and adherence to treatment regimen. Compliance with treatment was the most critical factor predicting a successful outcome. Among the compliant children 35 out of 36 were cured (visual acuity difference between amblyopic and non-amblyopic eyes not more than one line) within five months regardless of age, treatment regimen, and type or initial degree of amblyopia as compared with none in the group with low compliance. Most of these compliant children were cured within three months, with shorter treatment times on average for the younger children. The initial improvement of visual acuity was also faster at 2 years than at 4 years of age. Anisometropes with moderate amblyopia at the start of treatment were over-represented in the group with low compliance. We conclude that early diagnosis of strabismus in combination with general population screening at the age of 4 to detect amblyopia caused by anisometropia or microstrabismus seems to be efficacious for the cure of most cases. The major factor in treatment failure was found to be inadequate adherence to the treatment regimen.

Compliance and problem-solving competence in girls and boys.

The problem-solving abilities of 4- and 5-year old children (N = 208) were assessed to test the hypothesis that high levels of compliance are negatively related to problem solving. Problem-solving competence was examined with a task-specific measure and a standardized measure of general problem-solving performance. Low compliant children performed better on both measures. The role of compliance in the cognitive development of girls and boys is discussed.

Rewarding elementary schoolchildren for their use of safety belts.

This study reports on the application of reward procedures to elementary schoolchildren to increase their use of seat belts en route to two schools. Following strict rules for assessing buckle-up compliance, all passengers in a car had to be safely secured in order for the schoolchildren to receive rewards. Compliant children received paper slips as they arrived at schools, which were redeemable for stickers, bumper stickers, and coloring books. The slips were also used in weekly drawings for pizza dinners. The mean compliance rate for School 1 was 4.3% during baseline, 66.2% for the reward phase across 4 weeks, 60% for return to baseline, 17.2% for Follow-Up 1, and 8.5% for Follow-Up 2. For School 2, the mean percentage was 5.3% at baseline, 69.8% for the reward phase, 68.5% for return to baseline, 40.1% for Follow-Up 1, and 20% for Follow-Up 2. These results indicate that rewarding the schoolchildren increased their own seat-belt use as well as that of their adult drivers and other passengers. Decreases in usage were observed after the rewards were removed.

The Importance of Non Verbal Behavior in Giving Instructions to Children

The need to train parents of non compliant children to give clear instructions has been well documented in the literature (e.g., Robetts, McMahon, Forehand, & Humphreys, 1978). The focus to date, however, has been on the content of what is said, and not the non verbal aspects of instruction giving. In the current study, eight clinic and eight non clinic mother child pairs were observed. The non verbal elements of (i) distance from child, (ii) body arientation of mother, (iii) eye contact between mother and child, (iv) tone of voice, and (v) mother's orientation towards objects involved in the instruction were all related to the rate of child compliance.

Complementary Marital Roles of Male Heroin Addicts: Evolution and Intervention Tactics

Using Haley's concept of complementary and symmetrical relationships, we intensively studied the role relationships of 28 male heroin addicts and their spouses. These couples had no symmetrical role relationships, but had an alternating sequence of two complementary role relationships. These complementary roles sequentially alternated from a compliant child with a nurturing mother, when the wife would deny her husband's drug abuse; to a rebellious son with a policing mother, when a financial or legal crisis would force her to confront his addiction. After this crisis, the couple entered treatment in the unstable complementary roles of contrite child and policing mother. During treatment, the wife was educated and supported to confront early signs of drug abuse, thus avoiding its denial, and the couple was encouraged to develop symmetrical roles by beginning to share minor responsibilities.

Clinical features of anorexia nervosa: A study of a consecutive series of 102 female patients

The clinical features, treatment, course and outcome of a consecutive series of 102 anorexia nervosa patients are reported in detail. Data were gathered from systematic retrospective analysis of case records and follow-up assessments conducted after a mean lapse from presentation of 5.9 yr. The patients, all diagnosed according to strict criteria, were found to have a relatively long history of illness and half had failed to respond to previous psychiatric treatment. Over 80% of patients had an onset of illness within 7 yr of menarche, and on the whole the group was premorbidly obese. Over 70% came from professional and managerial class families, and 80% were described as compliant children. They had done well academically but were socially inept before onset of illness. A disturbed premorbid relationship between patient and parents was found in over half of the cases, and this was often related to a disturbed parental relationship. However, no specific anorectic family transactional pattern was found. Weight disorders were common amongst family members. Half of the patients were admitted for intensive inpatient treatment, 30% had outpatient psychotherapy, while 10% had no subsequent treatment following initial consultation. At follow-up nearly 80% had normal or near normal body weight and relatively normal menstruation had recurred in 70%. Nevertheless two-thirds of the patients still showed a highly variable dietary pattern and over 40% still worried intensely about their weight and shape. Other psychiatric symptoms, in particular depression and social phobia, were common but overshadowed by the persistent weight phobia. In general, those who had recovered in terms of weight and menses also had better psychiatric status and psychosocial as well as psychosexual adjustment. The overall length of illness was 4.6 yr in those who had recovered. Two patients had died. Aspects of clinical features, family characteristics and identity of the syndrome are discussed.

Skills for Child Management and Family Support

This study evaluated the effects of a training program designed to teach one couple skills for better managing its child's behavior and for increasing occurrence of positive, reciprocal family interactions. Specifically, parents were taught to: (1) improve instructions to the child; (2) differentially attend to their child's behavior; and (3) improve support of one another by increasing interspouse consistency when responding to the child. A multiple baseline design across parent behaviors was employed. Training was conducted and data were collected in the home via direct observation of the family's behavior. Results suggest that compliant child behavior increased substantially when the parents were trained to differentially attend to their child. Introduction of spouse support and family interaction training yielded immediate increases in family interactions, interspouse consistency, and the occurence of positive statements among family members.