Measures In Children Research Articles

Pilot Study of the Effect of Methyl B12 Treatment on Behavioral and Biomarker Measures in Children with Autism

The study objectives were to determine whether methyl B12 treatment improves behavioral measures in children with autism and whether improvement is associated with increased plasma concentrations of glutathione (GSH) and an increased redox ratio of reduced glutathione to oxidized glutathione (GSH/GSSG), both of which have been previously identified to be low in children with autism. This was a 12-week, double-blind, placebo-controlled, cross-over clinical trial of injectable methyl B12. Following this 12-week study, subjects were given the option of entering a 6-month open-label trial of methyl B12. All procedures took place at the UC Davis M.I.N.D. Institute. Subjects were 3 to 8 years old with autism. All subjects received 6 weeks of placebo and 6 weeks of methyl B12 at a dose of 64.5 mcg/kg every three days administered subcutaneously into the buttocks. Blood for GSH analysis and behavioral assessments were obtained at baseline, week 6, and week 12. Thirty (30) subjects completed the 12-week, double-blind study and 22 subjects completed the 6-month extension study. No statistically significant mean differences in behavior tests or in glutathione status were identified between active and placebo groups. Nine (9) subjects (30%) demonstrated clinically significant improvement on the Clinical Global Impression Scale and at least two additional behavioral measures. More notably, these responders exhibited significantly increased plasma concentrations of GSH and GSH/GSSG. Comparison of the overall means between groups suggests that methyl B12 is ineffective in treating behavioral symptoms of autism. However, detailed data analysis suggests that methyl B12 may alleviate symptoms of autism in a subgroup of children, possibly by reducing oxidative stress. An increase in glutathione redox status (GSH/GSSG) may provide a biomarker for treatment response to methyl B12. Additional research is needed to delineate a subgroup of potential responders and ascertain a biomarker for response to methyl B12.

Reliability And Validity For Measures Of Children's Self-Efficacy For Walking To School

Despite well documented associations between physical activity and well-being, most children do not meet current physical activity recommendations. Active commuting (e.g., walking, cycling) has been identified as a key target behavior for increasing physical activity in children. Self efficacy (SE) is a mediator of health behaviours such as active commuting. PURPOSE: To assess the reliability and validity of children's SE for walking to school as measured by child (C-SE) and parent (P-SE) questionnaires. METHODS: Complete data were collected for 165 elementary school children (57.0% boys, 43.0% girls; age 8-9 yr) and one of their parents (n = 115). The C-SE and P-SE assessed children's self-perceptions of SE and parents' perceptions of their children's SE, for overcoming barriers associated with walking to school. Both instruments comprised 14 items with either a 3-point (C-SE) or 5-point (P-SE) Likert response. To assess test-retest reliability of the C-SE, a subgroup of children (n = 23) completed the C-SE on two occasions, 7 days apart. RESULTS: Internal consistency was C-SE a =.80; P-SE a =.96. Test-retest reliability was ICC =.86 (2-way ANOVA model, adjusted for a single administration), with a trivial (D = 0.05), nonsignificant (p >.05) mean difference between trials. Preliminary exploratory factor analyses indicated that a unidimensional model explained 32% and 66% of total item variance in C-SE and P-SE respectively. C-SE and P-SE correlated significantly (r =.31, p <.01). Children's SE was significantly and meaningfully higher for children who walked to school compared to non-walkers, as measured by C-SE (p <.01; D = 0.60) and by P-SE (p <.01; D = 1.06). CONCLUSION: Reliability (internal consistency and 7-day test-retest) and validity (structural, convergent, and construct-related evidence) were acceptable to high for both parent and child questionnaire measures of children's SE for walking to school. SE for walking to school may be better represented by a multidimensional model. These instruments are suitable for use in investigations of active commuting in elementary school children. Future research will evaluate test-retest reliability over a longer period (8 weeks).

The Children’s Psychosocial Rehabilitation Treatment Adherence Measure: Development and Initial Validation

This paper reports on two studies designed to develop and validate a treatment adherence measure for Children's Psychosocial Rehabilitation (CPSR)--a home- and community-based treatment for youth with serious emotional disturbance. In Study 1, we derived CPSR treatment adherence and differentiation criteria from a treatment manual and evaluated their content validity via structured feedback from practitioners. In study 2 we assessed the reliability and validity of the resultant CPSR Treatment Adherence Measure (CTAM) in a clinical sample of youth receiving CPSR (n = 11) or outpatient psychotherapy (n = 20). Results from Study 1 revealed strong agreement among practitioners regarding the validity of the proposed adherence criteria (ICC = .82). Results from Study 2 indicated the CTAM had good internal consistency (parent- and supervisor report α's = .86 & .91) and high inter-rater reliability (r = .87, P = .001) in this pilot sample. CTAM scores reliably distinguished between children receiving CPSR versus psychotherapy (z = -3.16, P = .002) and between CPSR interventionists with reputations for high- (n = 4) or low- (n = 7) adherence to the model (z = -2.47, P = .014). Findings indicate the CTAM is worthy of further development as a practice and research instrument.

Temperament Styles in Zimbabwean Early Adolescents: A Rasch Measurement Model Analysis

The structure of temperament styles was investigated using Rasch analysis methods with data from 397 (46% males) Zimbabwean early adolescents. The students completed the Student Styles Questionnaire (SSQ), a 69 item children's self-report measure of temperament styles that uses a forced choice item format. Each item was scored as a dichotomous Rasch scale variable. Principal component analysis of the standardized residuals yielded unidimensional latent temperament variables for extroversion-introversion (EI), practical-imaginative (PM), thinking-feeling (TF), and organized-flexible (OL) styles. Higher endorsements were found for extroversion (E) than introversion (I) styles, for practical (P) than imaginative (M) styles, for feeling (F) than thinking (T) styles, and for organized (O) than flexible (L) styles. TF style indicators seemingly were targeted more appropriately to the Zimbabwean adolescents than were EI, OL, and PM styles. Rasch modelling methods appear to have merit when constructing and using interval scale measures of temperament styles from forced choice data.

Development and Validation of a Disease-Specific Quality-of-Life Measure for Children with Achalasia

Achalasia is an uncommon oesophageal motility disorder occasionally affecting children. Children with achalasia can experience significant morbidity, and quality-of- life (QoL) has never been studied in this population. The aim was to develop a disease-specific quality-of-life (DS-QoL) measure for children with achalasia. Item response theory methods were used to develop the DS-QoL measure. The construct validity of this measure was assessed by comparing items and domains with the generic PedsQL questionnaire. Reliability was assessed using Cronbach's alpha coefficient for internal consistency. 17 children completed the final DS-QoL measure, which consisted of 20 items in three domains. The completion rate for items was 99%. "Floor and ceiling effects" ranged from 0-19%. Construct validity was good with significant correlation between 2 domains and 2 items on the PedsQL. Reliability was excellent, with Cronbach's alpha coefficient ranging from 0.78-0.93. This DS-QoL measure is appropriate for use in children with achalasia and has shown good results in this validation study. Further work in higher numbers is necessary to determine discriminant validity and test-retest reliability.

Do mothers and fathers hold similar views about their child's arthritis?

Evaluations of the well-being of children with juvenile idiopathic arthritis (JIA) typically rely on parents as proxy respondents. An assumption of several studies appears to be that mothers' and fathers' ratings are interchangeable, as reports do not always specify which parent completed the assessments nor, in repeated measures, whether they were completed by the same parent. The aim of this study was to examine the level of agreement between mothers' and fathers' ratings of their child's quality of life (QOL) and to identify possible predictors of disagreement. Mothers and fathers (n = 82) of children with JIA completed ratings of their child's symptoms, QOL, and measures of their mood and beliefs about their child's illness and treatment. The number of active and limited joints and the physician's global assessment were also recorded. Intraclass correlation coefficients between mothers' and fathers' ratings of physical and psychosocial QOL were high (0.824 and 0.755, respectively). However, calculation of difference scores revealed that 70.6% and 65.9%, respectively, were classified as discordant. Where parents differed, the direction of difference was not systematic. Discordance in parents' mood states and in their illness and treatment beliefs explained a small amount of the variance in discordance in QOL. It should not be assumed that proxy ratings of a child's well-being can be generalized from one parent to the other. Studies that take repeated assessments should ensure that the same parent completes assessments at all time points. Other factors that may explain discordance between parents' ratings need to be explored.

Development of a Patient-Reported Outcome Measure for Children With Streptococcal Pharyngitis

The objective of this study was to develop a patient-reported outcome measure (Strep-PRO) for assessing symptoms of group A Streptococcus (GAS) pharyngitis from the child's point of view and to present preliminary data on its internal reliability, construct validity, and responsiveness. We selected 8 symptoms for inclusion in the Strep-PRO. We used the Strep-PRO to assess improvement in children who were aged 5 to 15 years and had confirmed GAS pharyngitis. Children completed the scale at study visits and as a diary at home. To evaluate internal reliability, we examined correlations between the items on the scale. To evaluate construct validity, we examined the correlation at entry between Strep-PRO scores and scores on other, previously validated measures of pain and functional status. To evaluate responsiveness, we examined the change in score from enrollment to follow-up. The correlation between the Strep-PRO score and parental assessment of symptoms was also evaluated. A total of 131 children were enrolled; 113 returned completed diaries. The internal reliability of the scale was high. The magnitude of correlations between Strep-PRO scores and other measures of pain and functional status ranged from 0.39 to 0.63. The responsiveness of the Strep-PRO was very good. The overall level of agreement between child Strep-PRO scores and parental assessment of symptoms was 0.57. The scale seems to measure effectively both pain and overall functional status in children with GAS pharyngitis. These data support the use of Strep-PRO as a measure of outcome in future clinical trials.

Abdominal Obesity, Waist Circumference, Body Mass Index, and Echocardiographic Measures in Children and Adolescents

Waist circumference (WC) may predict cardiovascular risk better than body mass index (BMI) in adults. The relationships between WC and echocardiographic measurements known to predict adult cardiovascular risk have not yet been explored in children. This investigation sought to investigate whether WC predicts echocardiographic measures of cardiac structure and function and whether WC is a better predictor of these outcomes than BMI. If associations between WC and measures of diastolic function are found, are they due to increased left ventricular (LV) mass and whether WC and LV mass have synergistic or antagonistic effects on measures of diastolic function? A total of 49 clinically normal children aged 3-19 years, including 17 with abdominal obesity, underwent detailed echocardiographic assessment to explore the associations between WC and various indices of systolic and diastolic function. Correlations, t-tests, and linear regressions were used for statistical testing. Results. Compared to subjects without abdominal obesity, those with abdominal obesity had increased left atrial dimensions, posterior wall thickness, and left ventricular (LV) mass index(2.7) (P < .05 for each comparison). Those with abdominal obesity also had altered LV filling patterns at the septal, lateral, and inferior wall by Doppler tissue imaging. WC was the sole predictor of, and was negatively associated with, the ratios of early peak velocity/late peak velocity at the septum, inferior wall, and right ventricle, and these associations were independent of LV mass (P < .001 for each comparison). Both BMI and WC were independent predictors of left ventricular mass index(2.7) (P= .001 and P= .05, respectively). Otherwise normal children and adolescents with abdominal obesity had altered left ventricular diastolic function. These differences were often better predicted by WC than by BMI. Our findings suggest the importance of considering WC in future studies of the cardiovascular impact of childhood obesity.

Development and Initial Validation of an Obesity‐specific Quality‐of‐life Measure for Children: Sizing Me Up

The present study describes the development and initial validation of a new obesity-specific, self-report measure of health-related quality of life (HRQOL) for children aged 5-13 years. Participants included 141 obese children (mean age=9.2 years, 67% female, 55% black, mean zBMI=2.52) and their primary caregivers. Children completed Sizing Me Up (obesity-specific HRQOL) and the PedsQL (generic HRQOL). Item content for Sizing Me Up was based on the published child obesity and HRQOL literatures and expert opinion. Items use phrasing to orient children to respond to questions in context of his/her size (e.g., "were teased by other kids because of your size"). Caregivers completed Sizing Them Up, a parallel parent-proxy, obesity-specific HRQOL measure. Initial psychometric evaluation of Sizing Me Up was completed by conducting a factor analysis and determining internal consistency, test-retest reliability, and convergent and construct validity. Sizing Me Up is a 22-item measure with five scales (i.e., Emotional Functioning, Physical Functioning, Social Avoidance, Positive Social Attributes, and Teasing/Marginalization) that account for 57% of the variance and a total HRQOL score. Internal consistency coefficients range from 0.68 to 0.85. Test-retest reliabilities range from 0.53 to 0.78. Good convergent validity was demonstrated with the PedsQL (rs=0.35-0.65) and the parent-proxy Sizing Them Up (rs=0.22-0.44). Sizing Me Up represents the first obesity-specific HRQOL measure developed specifically for younger school-aged children (aged 5-13 years) with preliminary evidence of strong psychometric properties that likely has both clinical and research utility in a variety of settings.

Children’s Self‐Report of Pain Intensity: What We Know, Where We Are Headed

The present paper provides a short, practical introduction to children's self-report measures of pain intensity, followed by an overview of principles and issues. Details on individual self-report scales were previously reported in a landmark systematic review in 2006 and will not be repeated here. Broader measurement issues discussed here include interpretation of pain scores over time, across individuals and in relation to contextual factors; special considerations affecting children younger than six years of age; social communicative functions of pain reports; cognitive developmental factors in understanding pain scales and their anchors; screening for the ability to use self-report scales and training for children who do not have this skill; level of measurement (interval versus ordinal); estimating clinically significant change for groups and individuals; and measurement of aspects of pain other than intensity. Also highlighted are areas in which there has been progress and a lack of progress since the last time this topic was featured at the International Forum on Pediatric Pain in 1996. The present article closes with an outline of key areas for further research on children's self-report of pain and a brief summary of recommendations for clinicians.

Abstract 4396: Clinical Response to Recombinant Acid α-Glucosidase is Predicted by Cardiac Outcome Measures in Children with Pompe Disease

Background : Pompe disease is an autosomal-recessive glycogen storage disease due to deficiency of acid α-glucosidase (GAA). Clinical findings in infantile onset disease are due to glycogen accumulation leading to hypertrophic cardiomyopathy, skeletal myopathy, respiratory failure and death. Enzyme replacement therapy (ERT) with recombinant human GAA (rhGAA; Myozyme®) has been shown to prolong survival in infants. We assessed the hypothesis that myocardial response to rhGAA predicts clinical outcome in Pompe. Methods: Echos during one year of ERT were reviewed from patients enrolled in open label trials of rhGAA (n=38). A standardized echo protocol was used at specific time points (wks 0, 4, 8, 12, 26, 38, 52). A central reader made measurements off-line, blinded to study information. Variables including LV mass, volumes, and ejection fraction (EF) were determined. Clinical outcomes at study-end were analyzed in 2 groups: Group A, alive and free of assisted ventilation (AV) or Group B, died or requiring AV. Z-scores were calculated for all echo variables and median z-scores between outcome groups at wk 0 and wk 52 were compared using median scores tests. Non-linear random effects models were used to examine changes over time. Results: Mean age at first infusion = 10.9±9.8 months (range 1.2 – 43.1). At study onset, 7/38 received AV. At study end, mean time to last infusion = 115±44 weeks with 16/38 in Group A and 22/38 in Group B. For Group A vs. Group B, median z-scores at week 0 for LV mass = 6.11 vs. 7.41, mass to volume ratio (MVR) = 4.5 vs. 8.8, and EF = 0.8 for both groups; p≥ 0.12 for each measure. Median z-scores for the same outcome groups, respectively, at week 52 for LV mass = 0.57 vs. 3.41 (p=0.06), for MVR = 0.48 vs. 3.54 (p=0.001) and EF = −0.6 in both groups. In the subgroup not requiring AV at study onset (n=31), MVR is higher at all times in Group B (p≤ 0.03). Conclusion: rhGAA therapy can prolong life in young patients with Pompe, improving outcome compared to an untreated natural history cohort. Even with ERT, there is significant morbidity and mortality. Diminished myocardial response with persistence of significant LV hypertrophy predicts progression to poor clinical outcomes. These and other predictors are required to fully understand response to ERT in Pompe disease.

Abstract 5709: The Pediatric Cardiac Quality of Life Inventory: A New Reliable and Valid Disease-specific Quality of Life Measure for Children and Adolescents with Congenital and Acquired Heart Disease

The Pediatric Cardiac Quality of Life Inventory (PCQLI) is a self-administered disease-specific quality of life (QOL) tool with patient and parent-proxy reporting (Child form 8 –12 yrs; Adolescent form 13–18 yrs), designed to assess the QOL of pediatric patients with congenital and acquired heart disease (CHD, AHD). Our purpose was to evaluate the reliability and validity of the PCQLI Seven centers recruited CHD and AHD patients age 8 –18 yrs. Patient-parent pairs completed the PCQLI, a generic QOL tool (PedsQL), and non-QOL questionnaires [Self Perception Profile for Children/Adolescents (SPPC/A); Youth Self Report and Child Behavioral Checklist (Achenbach)]. Test-retest reliability was evaluated by administering the PCQLI at 2 time points, and was assessed by Spearman correlation coefficient. Validity was tested by assessing: differences in PCQLI score among heart disease subgroups; associations between PCQLI score and the number of cardiac surgeries, catheterizations, hospitalizations, and doctor visits; the correlation between patient and parent PCQLI scores; and correlations between PCQLI score and the scores generated by generic QOL and non-QOL tools. The study was completed by 1486 patient-parent pairs. Heart disease subgroups included: biventricular repair (45.4%); Fontan palliation (12.6%); unrepaired CHD (12.0%); heart transplant (4.4%); and AHD (25.6%). Correlations evaluating test-retest reliability were high (r=0.78 – 0.90). Lower PCQLI score was associated with Fontan palliation (p&lt;0.001), as well as a greater number of cardiac surgeries, catheterizations, hospitalizations, and doctor visits (all p&lt;0.001). Disattenuated correlations between patient and parent PCQLI scores were moderate (r = 0.51– 0.69). The PCQLI score and generic QOL score were highly associated (r = 0.62– 0.77). Lower PCQLI score was strongly associated with lower Global Self-Worth score on the SPPC/A (p&lt;0.001), and lower Total Competency score (p&lt;0.001), higher Syndrome Scale scores, and higher DSM Oriented Scale scores on the Achenbach (p&lt;0.001). The PCQLI is a new disease-specific pediatric cardiac QOL tool that produces reliable and valid scores in children and adolescents age 8 –18 yrs. This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania &amp; West Virginia).

Development of the Tempe Sorting Task

This study examined psychometric properties of the Tempe Sorting Task (TST), a new measure of executive function (EF) for children. To increase the meaningfulness of test score interpretations, an age-appropriate construct was employed to incorporate Denckla's description of EF. Multiple measures of EF, including the TST, were collected for children (N = 81). Interrater reliability estimates of the TST scores across trials were high. Split-half reliability estimates were slightly lower and varied across trials. Multiple significant correlations were observed between the TST, Expressive Attention task, and teacher Attention Deficit Hyperactivity Disorder (ADHD) rating scales. Furthermore, statistically significant differences in TST scores between children with elevated versus normal-range ADHD ratings (dTrial1 = 1:49, dTrial2 = 0:86) provided some evidence of the discriminatory power of the TST. Overall, results provided some evidence supporting the interpretation of TST measures as indicators of children's EF. Advantages of the TST over existing children's EF measures are considered.

Closing the Gap in Children's Quality Measures: A Collaborative Model

The need for measures of the quality of healthcare provided to children and adolescents is well documented. However, children have been underrepresented in national healthcare quality measurement and reporting efforts. The Pediatric Data Quality Systems (Pedi-QS) Collaborative is addressing this gap. Two consensus measure sets and an assessment of nursing-sensitive indicators in pediatric care have been produced through the collaborative. The framework and measure set development process are described. Lessons learned from applying the process are summarized, and future directions are suggested. Voluntary collaborative efforts are vital for advancing children's measures, and national support and funding are also needed.

Appetitive traits and child obesity: measurement, origins and implications for intervention

Childhood obesity has multiple causes, most of them capable of explaining only one part of the problem. The population-wide impact of sedentary lifestyles and availability of energy-dense food is undeniable, but substantial individual differences in body weight persist, suggesting that individuals respond differently to the 'obesogenic' environment. One plausible mechanism for this variation is the early expression of appetitive traits, including low responsiveness to internal satiety signals, high responsiveness to external food cues, high subjective reward experienced when eating liked foods and preferences for energy-dense foods. Case-control studies support the existence of abnormalities in these traits among obese children compared with normal-weight children, and correlations between psychometric measures of child appetite and child weight suggest that appetitive trait profiles may not only promote obesity but also protect against it. The origins of appetitive traits are as yet uncharted, but will include both genetic and environmental influences. Parental feeding style may affect the development of appetite but the exact nature of the relevant behaviours is unclear and many studies are cross-sectional or begin late in childhood, obscuring causal relationships. Future research should explore determinants and biological mechanisms by using prospective designs beginning early in life, measuring relevant biomarkers such as gut hormones and incorporating neuroimaging and genotyping technologies. Potential clinical applications include the identification of 'at risk' children early in life and interventions to modify appetitive traits or ameliorate their impact on intake and weight.

SPECIAL TREASURES

WITH METICULOUS care Debbie pasted a photograph of little Penny Blades skipping in the playground into the child's Special Measures Early Years report booklet. Beneath it she wrote:

3. Validation of a Diary Measure of Children's Physical Activities

This study compares levels of physical activity of 9–14-year-old children from a self-reported time diary with those measured using an accelerometer. Children (N=92) wore an accelerometer for one weekend day and completed a 24-hour time diary for that day. The time children spent in moderate to vigorous physical activity from time diaries was moderately highly correlated with the measured results. Self-reported and objective measures of in tensity were correlated, but the correlation varied substantially by activity and characteristics of the family. This study provides empirical evidence to support the validity of time-diary estimates when accelerometer data are not available.

Body Mass Index Measures in Children with Cerebral Palsy Related to Gross Motor Function Classification

To investigate the prevalence of overweight in a clinic-based population of children with cerebral palsy (CP) and its association with gross motor function status. Retrospective chart review. We calculated body mass index (BMI; kg/m2) from charted height and weight and recorded Gross Motor Function Classification Scale (GMFCS levels I-V) on the basis of clinical descriptions in clinic notes for 137 children (2-18 yrs old) with CP seen in a pediatric rehabilitation clinic at an academic medical center. BMI percentiles were reported according to sex-specific age group standards for growth set by the U.S. Centers for Disease Control and Prevention (CDC). Associations were modeled by Pearson's chi2 distribution. Out of the total CP subject group, 29.1% were considered overweight (>95th percentile) or at risk for overweight (85th to 95th percentile). Ambulatory children (GMFCS levels I and II) showed a trend (Pearson's chi2, P = 0.06) toward higher prevalence of overweight (22.7%) compared with nonambulatory children (levels IV and V, 9.6%). Underweight was more prevalent in nonambulatory children (P < 0.01). Logistic regression analysis did not identify any significant predictors for overweight. In our patient population, analysis of BMI suggests that children with CP have a high rate of overweight and are at risk of overweight, particularly among ambulatory children. More study is needed, using measures more accurate than BMI, to clarify risk.

Effect of Lisdexamfetamine Dimesylate on Parent-Rated Measures in Children Aged 6 to 12 Years With Attention-Deficit/Hyperactivity Disorder: A Secondary Analysis

Objective: To evaluate the efficacy of lisdexamfetamine dimesylate (LDX) in school-aged children with attention-deficit/hyperactivity disorder (ADHD), using the Conners' Parent Rating Scale, Revised Short Version (CPRS-R: S) and its subscales. Methods: This was a secondary post hoc analysis of data from a placebo-controlled, double-blind, parallel-group, forced doseescalation trial. Boys and girls aged 6 to 12 years with a primary diagnosis of ADHD were randomly assigned to LDX (30, 50, or 70 mg/d) or placebo. Improvement on the CPRS-R: S and its subscales (ADHD Index, hyperactivity, appositional, and cognition) at 10: 00 AM, 2: 00 PM, and 6: 00 PM was analyzed. Safety assessments included the identification of adverse events and were conducted throughout the study. Results: Of the 290 patients randomized, 285 were included in the intent-to-treat population. Parents noted significant improvements at all 3 assessment times on the CPRS-R: S total score and for the CPRS-R: S ADHD Index, hyperactivity, and cognition subscales, regardless of the subject baseline disease severity. For the CPRS-R: S appositional subscale, significant improvement was noted at 10: 00 AM and 2: 00 PM (P < 0.01), and overall, significant improvement occurred in subjects who were more severely ill at baseline. The tolerability of LDX was comparable to that of other stimulants. Conclusion: Once-daily treatment with LDX was associated with significant improvement in parent-rated assessments of AD HO-related behavior throughout the day at approximately 10: 00 AM, 2: 00 PM, and 6: 00 PM. Lisdexamfetamine dimesylate was effective and well tolerated in this study population of children aged 6 to 12 years with ADHD.

Predictors of fatness and physical fitness in nine-year-old Icelandic school children

In recent years, the prevalence of overweight and obese children has increased in Iceland, as in most Westernized countries. The main objectives of this study were to assess predictors of fitness and fatness of 9-year-old school children in Iceland. In total, 488 subjects (73.3% participation rate) from 18 randomly selected primary schools participated in this cross-sectional study. Height, weight, sum of four skinfolds and other anthropometric measures were performed on all children. Fitness was assessed via a maximal cycle ergometer test in 229 children and of those, 177 wore Actigraph accelerometers to measure physical activity over five consecutive days. Questionnaires regarding family background and lifestyle were completed by 361 mothers and 332 fathers. The main findings from our study showed fatness, area of living and sex, as well as background variables, such as fathers' smoking and income, and number of sport practices attended per week were important predictors of fitness (best-fit model: R-sq=0.48, p<0.0001). In addition, parental body mass index (BMI), mothers' smoking and physical activity and children's objective measure of physical activity were found to be important predictors of children's fatness (best-fit model: R-sq=0.23, p<0.0001). These results provide information about predictors of fitness and fatness of 9-year-old children and emphasize the inverse association between the two. Further, our results suggest that mothers have a stronger influence on children's weight than fathers but the opposite may be true for fitness.