Parental Frustration Research Articles

A Complex quest: The development and research of underachievement interventions for gifted students

AbstractThe seeming lack of motivation of many academically gifted students is an area of frustration and concern for many parents, teachers, and psychologists. This article explores two studies in which researchers designed interventions to improve academic achievement. Both interventions were created using the Achievement‐Orientation Model. The first study matched the intervention to the student and found that the students' grades increased over the intervention period,t(45) = 2.56,p= .014,d= .38. Students using treatments linked to goal valuation and environmental perceptions showed the greatest academic grade growth; the self‐efficacy and self‐regulation groups showed little or no grade improvement. Building on the finding that goal valuation was important, the second study used a mixed‐methods design to pilot an intervention focused on goal valuation and student autonomy. The results of this study were mixed, as the intervention appeared to help two of the three students. Although these studies offer further insight into possibilities for promoting academic achievement among gifted students, further research examining how to best support and foster academic achievement in underachieving gifted students is needed. © 2012 Wiley Periodicals, Inc.

Preemie Parent Frustration: Dealing With Insensitive Comments

Preemie Parent Frustration: Dealing With Insensitive Comments

The Phenomenon of Sibling Teasing: Three Mothers' Perceptions of Their Children's Teasing Behaviors

Teasing is often regarded as a rite of passage, a normal and common activity of childhood. Yet teasing is a complex relational issue involving many elements, such as intent, verbal utterances, nonverbal behavior, meaning, interpretation, and emotional affect. Teasing within the sibling relationship can be a source of great parental frustration, as parents often lack a clear understanding of how to address the behavior. Mothers' perceptions of their children's teasing, their own self-history with teasing, and responses to observed teasing scenarios may directly affect the nature, form, and function of sibling teasing, at times acting as an unintended license to tease.

Culturally-Sensitive Information-Sharing in Pediatric Palliative Care

This study aimed to learn about experiences of Mexican American and Chinese American families who require pediatric palliative care. This article describes parents' perceptions of information-sharing by health care providers during their child's hospitalizations and at their child's death. The study used a retrospective design of grounded theory analysis. Participants included 36 parents (26 Mexican American and 10 Chinese American) from 28 families who experienced between 6 months and 5 years before study participation the death of a child who was aged </=20 years. Participants were recruited through 2 university hospitals in northern California. Parents' identified 3 types of information shared by health care providers: (1) information about the child's daily life in hospital; (2) information about the parents' daily life in hospital; and (3) information about treatment and end-of-life issues. Parents' narratives focused primarily on information shared by physicians; nurses, social workers, chaplains, interpreters, and other parents were also important sources of information. Four patterns of information-sharing emerged: (1) no information; (2) basic information; (3) basic information plus implications; and (4) basic information plus implications plus attention to parents' questions, concerns, and emotions. Positive and negative impacts of these patterns on parents are described. Language and cultural differences create barriers to information-sharing by health care providers to parents who are in need of pediatric palliative care. Less than optimal patterns of information-sharing contribute to frustration, anger, and sadness for parents long after their child's death.

L. Leventhal-Belfer: Why do I have to? A Book for Children Who Find Themselves Frustrated by Everyday Rules

Laurie Leventhal-Belfer’s WhydoIhaveto? is a thoughtfully structured guide for children who are frustrated with everyday rules and adults who are frustrated with those children. This short book is packed with a comprehensive set of questions, phrased from a child’s perspective, dealing primarily with social expectations. The questions are broken down into sections dealing with home, with friends, and with school. The author addresses these questions by first validating the child’s frustration, providing an answer, suggesting solutions, affirming the child, and inviting the child to add their ideas. Each question is accented with simple before and after illustrations related to following the rule. The words “autism” and “Asperger’s”, or indeed any other technical jargon, are left completely out of the book. However, the rigidity and limited flexibility of many children on the spectrum is likely to be effectively targeted using this book. The writing level is suited for grade schoolers and adolescents. The author’s use of a consistent structure throughout the book will be helpful to its target audience as children are able to predict what is coming next and brainstorm their own solutions. Sections like, “Why do I have to let other kids play a game the ‘wrong way’?”, “Why do I have to ask my teacher if it is OK to leave the room?”, and “Why do I have to rest when I’m not tired?” will be familiar to many children, parents, and professionals. The questions speak to the magnitude of the author’s clinical experience, as do the evidence-based and clinically tested suggestions she offers for the child. For example, suggestions for the child who doesn’t like asking the teacher for permission to leave the room include, “Ask the teacher the best ways to tell them when I need to leave the room, ask the teacher if I can use a card for those times when it’s very hard for me to talk, choose a ‘safe place’ with my teacher where I can go when I need some quiet time to cool down if I get upset” (61). Solutions incorporate choices, replacement behaviors, sensory techniques, informal functional analyses, self-talk, reward charts, timers, and other tools that are successful for children with autism and Asperger’s. The book falls short in the clarity of some of the answers provided to its readers. While they are generally clear, some devolve into you-have-to-follow-the-rules-because-you-have-to logic, which will add to the frustration of some children. At times, the writing switches perspectives rapidly in order to help the child better understand the feelings of others involved. For example, in response to “Why do I have to go to a friend’s house when I would rather stay home?”, the author writes, “It can be very hard to leave your house to go visit a friend when you are in the middle of doing something you enjoy at home. You might have been frustrated when you had a play date set up, but your friend couldn’t make it. It might help to remember the times that you had fun playing with other kids at their houses or at the park” (40). Unfortunately, this makes some of the answers unclear and may add to rigidity in children who have difficulty thinking from others’ points of view. However, most of the answers will satisfy the majority of children, and the setup of the book as well as the introduction makes it clear that the guide is meant to be adapted for each child’s success. This book will be an invaluable addition to the shelves for children who are challenged by the expectations of daily living. The insightful questions, thoughtful answers, and clinically tested suggestions will decrease frustration for children and parents alike.

The Pediatric Infectous Disease Journal® Newsletter

The Pediatric Infectous Disease Journal® Newsletter

Worldwide Prevalence of Head Lice

To the Editor: Pediculosis capitis has been well-known since antiquity (1). Human infestation can result in psychological frustration for parents and children (2); furthermore, preventive and therapeutic practices, such as head shaving and the “no-nit” policy of excluding infected children from school, can also induce social stress. We sought to synthesize the available evidence regarding the worldwide prevalence of lice infestation in the 21st century by conducting a literature search of PubMed and Scopus databases in which we searched for the term pediculosis. We also searched Google for the terms head lice/pediculosis capitis and individual country names and evaluated references of the articles and reports retrieved through this search. Eligible studies were archived from January 1, 2000, to January 18, 2008. We retrieved 55 studies (Technical Appendix). Most studies referred to schoolchildren, but some involved refugees, urban slums, child labor, jails, orphanages, and fishing communities. Most studies had been conducted in Asia; Turkey was overrepresented. Prevalence varied from 0.7% to 59% and was higher in girls and women. Of the 29 studies, 24 involved schoolchildren; the other studies involved refugee children, child laborers, the general population, street children, jail inmates, and children accompanying their mothers in prison. In Europe, prevalence varied from 0.48% to 22.4%. However, 1 study reported a much higher annual incidence (37.4%) in England (3). A study in the Ukraine showed increasing adult representation in the overall affected population (4). Six studies involved schoolchildren; the remaining studies involved refugees, homeless persons, and the general population. Data from Africa, with the exception of 1 study in South Africa, were derived from Egypt. Prevalence varied from 0% to 58.9% and was higher in females. The study in South Africa (5) challenges the generally accepted concept that head lice infestation refers to lower socioeconomic status; of 2 schools, 1 in a low socioeconomic status area, populated by black students only, and the other in a high socioeconomic status area, populated by students of various races, head lice infestation was found only in the second school, solely among white pupils. Of 6 studies in Egypt, 4 involved diverse populations: urban poor preschool children, orphanage children, and the general population. Most studies in the Americas were conducted in Brazil, although we also found data from the United States, Cuba, and Argentina. Prevalence varied from 3.6% to 61.4% and was higher in females. Of 7 studies, 4 involved populations other than schoolchildren to some extent: urban slum residents, fishing community residents, adolescents and adults sampled randomly from the general population, elderly nursing home residents, and persons living with repeatedly infested children. A recent study in Brazil (6) noted that prevalence rates determined by visual inspection are twice that of rates determined by hair analysis. Only 1 study has been performed in Oceania. This study in Australia reported prevalence of 13% and that girls were more likely to have active infection. Our review shows that pediculosis capitis is widespread throughout the world and does not discriminate on socioeconomic status grounds. The traditional perception of head lice as a parasitosis exclusively associated with schoolchildren of low socioeconomic status is challenged by some of the reports (Technical Appendix). Most studies underestimate overall prevalence by assessing it in a specific timeframe; to the contrary, head lice infestation is a dynamic process that can spread hypergeometrically in closed environments such as schools and in the community (7). The point-prevalence reported by Heukelbach et al (8) may represent a more accurate indicator. Although socioeconomic status seems to be an indicator of the magnitude of lice infestation, more specific determinants are the dynamic processes of hygienic status and overcrowding. A recent study in Turkey compared 2 neighboring villages with different socioeconomic status. The only factor that was statistically significantly related to pediculosis capitis was size of the household; >6 inhabitants was associated with increased prevalence (9). Another parameter that may indirectly influence overall prevalence and account for the leveling of the prevalence gradient between rich and poor is awareness of head lice and preventive and therapeutic practices. A study in Australia showed that although parents prefer to play a major role in prevention and treatment, they may lack insight into recent advances and dilemmas regarding these measures (10). Variations in reported prevalence were found even in data from the same country. These differences can result from surveys being conducted during different seasons, various examination techniques, reporting of active infestation or presence of nits, and potential introduction of effective pediculicides. Although head lice account for a substantial number of missed schooldays in children, among others, it is surprising that pediculosis capitis is not monitored and prevalence is not regularly reported. Although we cannot extinguish the parasite, effective monitoring and planning will enable us to limit the prevalence and distribution of this parasitosis.

Dat's Story: Things Have Got to Change

WHEN MY son was in elementary school, he gained a new friend, a youngster from Vietnam who had just arrived in this country. Dat and a younger brother came not with their parents, who remained in Vietnam, but in the care of their two teenage brothers. I remember reading the small card Dat carried that designated him--an 8- or 9-year-old--as the family member best able to answer questions in English. The thought of this little boy presenting that card as he confronted a strange and scary new world simply took my breath away. Dat was a good student. He and my son were ahead of their classmates in math and frequently were paired to work together on more challenging independent activities. Both flourished in math until the day came to enroll in eighth-grade algebra. My son Joe got in. Dat did not. Dat's older brothers were unquestioningly respectful of school authority and would not challenge the school's decision. Because I knew how advanced Dat was in mathematics, I phoned the school on his behalf. Now--some 20 years later--I remain appalled and angry at the response. The principal, an excellent administrator who had brought another school to Blue Ribbon School status and truly was a very caring man, said no. Dat's English skills were not sufficient to allow him to handle the language involved in algebra, and he didn't want him to fail. I pushed back, describing what I knew of Dat's prior performance. Just give him the opportunity to show what he can do, I pleaded. But the algebra class proceeded without one of the students who undoubtedly would have excelled in it. Then what I had feared, happened. Not having eighth-grade algebra moved Dat off the college track. He was put into what he later told my son were baby classes, and the future he might have had changed significantly. Joe and Dat grew farther apart, as they were no longer in the same classes, and over time, we lost track of this talented young immigrant. Why tell this story? The common perception of Asian immigrants is that they are bright, they work hard, and they succeed. So if this still happened to Dat, how often does something similar happen to Latino students and others for whom English is not the first language and for whom low expectations are too frequently the norm? During a January 2008 two-day symposium on English-language learners (ELLs), one attendee pleaded with the experts to understand the depth of frustration for immigrant parents who--after filling out the language survey paperwork--find their children assigned to low-level classes that too often limit their opportunities to excel and move into the mainstream, even when their intelligence and work ethic are strong. The symposium was sponsored by ETS and the National Council of La Raza and brought together scholars, multiple agencies and organizations, and practitioners. Experts presented statistics and the research and raised issues related to better accountability and performance. CHANGING DEMOGRAPHICS Eugene Garcia of Arizona State University presented data from the Centers for Disease Control. In 2005, 24% of U.S. babies born were Hispanic. He also noted that one out of every five children in the U.S. between birth and age 8 is Hispanic, that 79% of these children live in just nine states, and that in 25 other states, 10% or more of the children aged 8 and under are Hispanic. Rather surprisingly, Census Bureau data say that over half of ELL children in our schools were born in the U.S. These children make up 75% of the ELL students in grades K-5 and 57% of those in grades 6-12. Data from the National Clearinghouse for English Language Acquisition show that between 1995 and 2005, more than 10 states experienced greater than 200% growth in the number of ELL students. The highest growth was in Kentucky (417%), Indiana (400%), and South Carolina (372%). David Francis of the University of Houston presented data showing that by 2015, ELL students are expected to be 30% of our school-age population. …

Arch taping as a symptomatic treatment in patients with Sever's disease: A multiple case series

Background Sever's disease, is a musculoskeletal condition occurring in adolescence that symptomatically manifests as posterior heel pain during ambulation. Often participation in physical activity is severely limited resulting in frustration for children and parents alike. Conservative treatment options have included rest, abstinence from athletic activity, heel lifts, foot orthotic devices, ice, and calf-stretching exercise. The authors are proposing arch taping as an additional viable treatment option for controlling heel pain during athletic and other weight-bearing activities in patients with Sever's disease. Objective To assess the immediate impact of arch taping in controlling heel pain during ambulation in a group of subjects with Sever's disease and to discuss possible biomechanical explanations. Methods and measures Eleven subjects diagnosed with Sever's disease with a history of posterior heel pain were evaluated and treated by three different therapists in three different regions in the USA. Level of perceived pain during ambulation was reported before and immediately after arch tape application. The Wilcoxon Signed Ranks Test was utilized to assess pain reduction with significance set at p < 0.05 level and effect size was determined with Cliff's delta statistic. Outcomes Each subject reported an immediate reduction in heel pain during ambulation with arch taping. The median reduction in pain was 5 levels. Wilcoxon's statistic was significant with p = 0.001 and Cliff's delta revealed a value of 0.97 indicating a large pain reduction effect with arch taping. Conclusions The arch taping technique applied in this case series was effective in the immediate reduction of posterior heel pain during ambulation and allowed an early return to sports activities for those involved in athletics. This technique could be considered an additional treatment option for others with similar clinical presentations. Possible biomechanical explanations may relate to a windlass effect provided through the taping technique.

Compiling, costing and funding complex packages of home-based health care

Nurses play a central role in putting together complex packages of care to support children with complex healthcare needs and their families in the community. However, there is little evidence or guidance to support this area of practice. At present, the process of compiling a care package and obtaining funding takes too long, causing significant delays in discharge and great frustration for parents, children and professionals. This article presents a combination of best practice guidance and, where possible, evidence-based principles that can be adapted and applied to an individual case irrespective of the child's diagnosis. The aim is to assist nurses and other healthcare professionals in organising funding for packages of care, bringing about the desired outcomes of successful discharge and appropriate community support. To work effectively as keyworkers for these children and families nurses need knowledge and skills in relation to: multidisciplinary assessment frameworks and processes, identifying appropriate models of service provision, costing care packages and approaches to obtaining funding. A further article next month will address risk management and clinical governance issues in delivering complex home-based care.

On Ethics and Deafness: Research, Pedagogy and Politics

This paper considers ethical issues surrounding the education of students with significant hearing losses. Rather than focusing on history or current challenges, it looks ahead to the not-too-distant future to examine the likely collision of ethics, pedagogy and politics. To a large extent, ethical issues looming on the horizon can be tied back to older challenges, not in any causal sense, but in the sense of recognising that forces which drove disagreements and barriers to educational progress in the past are likely to continue or re-emerge in new forms in the future. In one sense, this prospective analysis reflects the frustration of many educators, parents and researchers. Rather than being pessimistic, however, it argues that if we are cognisant of our less than stellar progress in the past, we have the potential to make great strides in deaf education in the future. Only by being fully informed by objective evidence and setting aside philosophical and emotional considerations can we best serve deaf and hard-of-hearing students of tomorrow. Copyright © 2006 John Wiley & Sons, Ltd.

On ethics and deafness: research, pedagogy and politics

This paper considers ethical issues surrounding the education of students with significant hearing losses. Rather than focusing on history or current challenges, it looks ahead to the not-too-distant future to examine the likely collision of ethics, pedagogy and politics. To a large extent, ethical issues looming on the horizon can be tied back to older challenges, not in any causal sense, but in the sense of recognising that forces which drove disagreements and barriers to educational progress in the past are likely to continue or re-emerge in new forms in the future. In one sense, this prospective analysis reflects the frustration of many educators, parents and researchers. Rather than being pessimistic, however, it argues that if we are cognisant of our less than stellar progress in the past, we have the potential to make great strides in deaf education in the future. Only by being fully informed by objective evidence and setting aside philosophical and emotional considerations can we best serve deaf and hard-of-hearing students of tomorrow. Copyright © 2006 John Wiley & Sons, Ltd.

Identifying psychosocial problems among youth: factors associated with youth agreement on a positive parent‐completed PSC‐17

The choice of informant is a critical piece in the identification of psychosocial problems in youth. While many behavioural measures have been adapted to include information from multiple sources, in the case of parents and youth, poor agreement has been found. Our study purpose was to identify youth and parent factors associated with whether the youth agrees with a positive parent-completed screen of youth psychosocial problems. Parents of youth aged 10-15 years who were seen for a medical visit at eight clinics completed the 17-item Pediatric Symptom Checklist (PSC-17). Youth scoring positive on the screen and their parents/guardians were interviewed by telephone after the visit (n = 145). We conducted bivariate and multivariate analyses to identify parent characteristics and child factors associated with whether the youth agrees with the positive parent-completed screen. Fifty per cent of youth participants agreed with their parent on a positive parent-completed PSC-17 based on their completion of the Y-PSC-17 as a self-report measure. Youth who reported a positive Y-PSC-17 in agreement with their parent were twice as likely to meet diagnostic cut-offs on sub-scales of anxiety/depression and aggression on the Child Behaviour Checklist (P < 0.01 and P < 0.05 respectively), reported lower parent-child connectedness (P < 0.01) and their parents reported more anger/frustration (P < 0.05) than youth who disagreed with the positive parent-completed screen. Most of these associations remained significant when controlling for the other factors and demographic characteristics in multivariate analysis. Findings indicate that when the youth agrees with a positive parent-completed PSC-17, there is higher parent frustration, lower parent-child connectedness, and the youth is more likely to have a diagnosis of an emotional or behavioural disorder. Thus, when possible, the use of both parent and youth as informants provides necessary information in formulating a comprehensive treatment strategy to address the psychosocial needs of youth.

Use of complementary and alternative medicines by children and adolescents with inflammatory bowel disease

The use of complementary and alternative medicines (CAM) appears increasingly prevalent in children and adolescents. Individuals with chronic illness may have patterns of greater usage. This questionnaire-based study aimed to ascertain the frequency of use by a group of children with proven inflammatory bowel disease (IBD) and to consider the reasons for their use. A questionnaire was sent by mail to the parents of patients currently attending a paediatric IBD clinic. Parents were asked to describe their child's usage of alternative and probiotic therapies and to comment on a number of aspects of such therapies. Forty-six (77%) of 60 mailed questionnaires were returned. The mean age of the children was 10.9 (+/- 4.1) years and they were taking an average of 1.7 (+/- 0.8) prescribed medications. Thirty-three (72%) of the children were said by their parents to be having CAM, with four having five or more such therapies (average 2.4 +/- 1.3 agents per child). The most commonly used agents were probiotics (78%) and fish oils (56%). A minority (12%) of respondents reported that their child's CAM was very effective, although many (50%) noted partial benefits. The 13 children who had never used any CAM therapies ('non-users') did not differ from the 'users' in terms of gender, age, disease or duration of disease. As expected, non-users expressed greater concerns about use of CAM and described different attitudes towards such therapies. Complementary and alternative medicines, especially probiotic therapies, frequently are administered to children and adolescents with inflammatory bowel disease. Often this appears to be due to parental frustration with managing their child's chronic illness. Practitioners caring for children and adolescents with IBD need to be aware that their patients may be using alternative therapies and adopt an open attitude in this situation.

Parents’ Discipline of Young Children: Results From the National Survey of Early Childhood Health

To examine the use and predictors of different discipline practices by parents of very young children using data from the 2000 National Survey of Early Childhood Health (NSECH). NSECH is a nationally representative telephone survey of 2068 parents of young children between the ages of 4 and 35 months conducted by the National Center for Health Statistics. The survey includes questions about parents' use of 5 discipline practices: yelling, spanking, time out, toy removal, and explanations. chi2 analyses and logistic multivariate regression were used to examine associations between discipline practices and child, parent, and demographic factors. Among young children aged 19 to 35 months, frequent parental use of discipline strategies ranged from 26% (spanking) to 65% (taking away toy or treat), 67% (yelling), 70% (using time out), and 90% (providing explanations). In multivariate analyses, child age predicts reports of more frequent spanking and yelling, and child developmental risk is associated with increased reports of yelling. Parent frustration predicts frequent use of every discipline practice, including a greater inclination to use aversive practices. Lower parental emotional well-being is associated with reports of frequent yelling and spanking. Black ethnicity and maternal age predict more frequent spanking, and Spanish-speaking parents reported less frequent use of time out and taking away a toy. Child age and developmental risk and parents' ethnicity, emotions, and mental health are closely associated with discipline practices in the first 3 years of life. These factors are important for pediatricians to recognize in providing anticipatory guidance about discipline.

Familial Predictors of Treatment Outcome in Childhood Anxiety Disorders

To determine whether family factors are predictive of outcome in children with anxiety disorders who are receiving cognitive-behavioral treatment. Participants were 61 children aged 8 to 12 years (mean = 10.0, SD = 1.4) with Axis I anxiety disorders who had been referred to a large Toronto children's hospital. Parents and children completed measures assessing family functioning, parenting stress, parental frustration, and parental psychopathology before and after treatment. Outcome measures included clinician-rated functioning (Children's Global Assessment Scale) and self- and parent-rated anxiety (Revised Children's Manifest Anxiety Scale). Child ratings of family dysfunction and frustration predicted clinician-rated improvement (total R2 = 0.28, p < .001). Mother and father reports of family dysfunction, and maternal parenting stress, predicted mother-rated child improvement (total R2 = 0.18, p < .01). Father-rated somatization and child reports of family dysfunction and frustration predicted child-rated improvement (total R2 = 0.25, p < .001). Several family factors improved with treatment. Family dysfunction appears to be related to less favorable treatment outcome in children with anxiety disorders.

Pedagogy of Patriarchy: A Window on American 21st Century Gifted Education

The issue of grouping gifted students by ability has been a point of controversy for a long time. In the fall of 1957, the Soviet Union successfully launched Sputnik into space, igniting intense debate in this county about the quality of American education. Since then, nurturing the talents of our gifted and talented children has been one of the most enchanting, yet controversial, issues educators have faced. On the one hand, people have admired the gifts and the drive of individuals who achieve excellence and have given priority to programs for educating the brightest students, especially in math and science. On the other hand, people have stigmatized gifted education as giving to the haves (Colangelo & Davis, 1997, p. 3). This ambivalent attitude toward giftedness has caused frustration for both educators and parents of students. With close examination, we can see that the ambivalent attitude toward gifted education is the result of simplistic dichotomous thinking that the pursuit of excellence and equality are mutually exclusive and antagonistic. When we shift the framework of analysis on this issue from a zero-sum dichotomy to a more comprehensive philosophy that can include both gifted education and mainstream education simultaneously, the tension between the pursuit of excellence and equality can be alleviated. This tension can be described in terms of two different approaches to education: (equality-oriented) and (excellence-oriented) pedagogy. It is the purpose of this paper to promote patriarchal as more appropriate for, and beneficial to, the development of gifted education in the United States. Fromm (1951) defined a matriarchal society as a culture that is unconditionally equal. In the concept of matriarchy, a mother loves all her children equally and unconditionally since her love is based on the fact that they are her children. It does not matter if they exhibit any particular merit or achievement in a matriarchal order. The value system of the matriarchal society seems deeply imbedded in our educational practices, ignoring individual students' different learning needs and our society's unique cultural traits. Matriarchal pedagogy, a zeal for equality in education, has vehemently asserted the rights of less-able learners, students with psychological and physical disabilities, and students with different needs because of their culture, ethnicity, gender, language, and so forth. The contention of matriarchal pedagogy is incontestable because there really exist many students who have needed help, and the rights of these students ought to be fervently defended in human society. However, it should be acknowledged by the same token that gifted students also deserve treatment. Gifted and talented students' exceptional capabilities are not sufficiently challenged by the mainstream targeted traditional curriculum and instruction within matriarchal pedagogy. Within matriarchal pedagogy, for instance, all gifted and talented children and adolescents should be placed into heterogeneous classrooms in order to actualize unconditional equality, neglecting their special learning needs and their superior abilit y. As a result, some gifted and talented students may find schools intolerable, feigning illness or creating other excuses to avoid the trivialities of activities they mastered years ago. Some may eventually give up entirely and drop out of school as soon as they are legally able (Davis & Rimm, 1998). The detrimental impacts of this mismatch is described as a quiet crisis (U.S. Department of Education, 1993, p. 5) and nothing short of an American tragedy (Renzulli, 1991, p. 75). Gifted education is logically an entity of special education because the target population represents a group of students whose learning styles and thinking dimensions demand different experiences from those of the mainstream population. …

Implementation of an Educational Program for Children with Autism

In Kuwait, care of disabled children is undertaken by many government and nongovernment agencies and institutions. It is scattered, unplanned, and unintegrated. In the last decade, however, growing concern by private and voluntary sectors about the care of disabled children has been in evidence. A review of current facilities in Kuwait and other oil-rich countries suggests that autistic children are at a great disadvantage in terms of their basic rights and the adequacy of the services provided them. This is due to the low level of public awareness of the problem, a lack of legal mandates, and the transitional developmental stage of the society. Diagnostic and assessment facilities could be a great tool in indicating the magnitude of the syndrome and planning appropriate action; but, unfortunately, such facilities are inadequate. This necessitates the use of external experts for the short term to help create the needed indigenous capacity for diagnosis and assessment. An evaluation of existing educational facilities for autistic children in Kuwait gave rise to an impetus to establish a separate program for these children. A compelling factor was the frustration of parents who were unable to place their children in ordinary public schools and forced to enter them in unsuitable programs. Although one private school had been accepting autistic children since 1989, there was no truly separate, specialized program for them.

Detection of β-Thalassemia Carriers in Jordan

Hemoglobinopathies are a major health problem in many areas of the world. Two of the most prevalent hemoglobinopathies are sickle hemoglobin (Hb S) and βthalassemia. Thalassemia is a molecular abnormality with underproduction of one of the globin chains. 3 Heterozygous states for β-thalassemia genes, known as β-thalassemia minor, are usually not associated with clinically significant disease. β-thalassemia has a high prevalence in the Mediterranean area, and in the Middle and Far East. Thalassemia screening programs have demonstrated effectiveness as antecedents to more successful management of the disease, including early intervention and prevention of complications. However, the value of screening programs has not been without controversy, due to the social and psychological impact on the individual and the family, 1 such as parental frustration, the lack of adequate information on the disease among the local population, and a cultural system which makes a carrier feel inferior. Jordan is located in an area where β-thalassemia is prevalent, but no definite screening program has yet been developed. The aim of this study is to determine the real prevalence of thalassemia carriers in Jordan, using our own cutoff points, and to develop a better understanding of this disease. This should result in a more efficient utilization of health care resources and improved planning in the provision of health care services.

Constipation and encopresis in childhood.

1. Adel Abi-Hanna, MD 2. Alan M. Lake, MD* 1. 2. *Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. 1. Constipation is a symptom, not a diagnosis, that has multiple etiologies and multiple alternative treatments. 2. Encopresis or fecal soiling has many etiologies, not all of which are associated with fecal retention or responsive to laxatives. 3. Children who have Hirschsprung disease almost never have encopresis because the aganglionic segment maintains tonic contraction due to the absence of inhibitory neurons containing nitric acid and vasoactive intestinal polypeptide. 4. Functional retentive constipation is associated with loss of lower colonic muscle tone and will not resolve until complete repetitive evacuation of the lower colon allows muscle tone to be restored. 5. Successful treatment of constipation and encopresis requires a combination of patient and parent education, medical therapy, nutritional intervention, behavioral modification, and long-term monitoring of compliance. Constipation is a very common frustration for children, parents, and physicians. It is reported to account for nearly 5% of all outpatient visits to pediatric clinics and more than 25% of all referrals to pediatric gastroenterologists. Painful defecation and encopresis (involuntary passage of stool from the anus) usually are the first manifestations noted. Constipation generally is defined by the hard nature of the stool, the pain associated with its passage, or the failure to pass three stools per week. It would be preferable to define constipation as the failure to evacuate the lower colon completely with a bowel movement. This allows the parents and physician to realize that a child who has three small stools daily may not yet have evacuated the colon, while a child who has two large soft stools a week may not be constipated. The frequency of stools in most children decreases from a mean of four per day in the first week of life to 1.7 per day by the age of 2 years. Over this interval, stool volume increases more than tenfold while maintaining …