Problems In School-aged Children Research Articles

Behavioral Problems in School-Aged Children of Mothers with HIV/AIDS

This study examined the relationships between selected risk and resistance factors and maternal reports of child behavior problems on the Child Behavior Checklist (CBCL) in families affected by maternal HIV/AIDS. Data were obtained from 193 mothers with late-stage HIV/AIDS who were included in a sample consecutively recruited from the New York City Division of AIDS Services Income Support to participate in Project Care, a randomized trial of a permanency planning intervention. Each mother reported on one HIV negative index child 5–12 years of age. Child behavior problems were related significantly to the mother’s psychological distress and marginally to her having illness-related activity restrictions, but not to other measures of maternal physical health, stigma or disclosure of her HIV to the child. Two child dispositional factors, productivity and independence, and two family factors, adaptability and a good parent–child relationship, were related to better child functioning, but family cohesion was a risk factor for poorer adjustment in this sample. These are likely to be key target variables useful to policy makers in planning programs to assist these children in coping successfully with their mother’s illness.

The management of recurrent abdominal pain

Recurrent abdominal pain is a common problem in school-aged children, and although many patients do not have an underlying identifiable pathology, it is important that those children with such conditions are diagnosed and treated promptly. This article sets out some of the common conditions presenting as recurrent abdominal pain in modern hospital-based practise, emphasizing features in the history and examination which point towards organic disease. Functional abdominal pain and irritable bowel syndrome are described. A scheme for appropriate use of investigations is suggested.

Attachment Disorganization

Attachment Disorganization

Sleep and behavior problems in school-aged children.

The primary purposes of the present study were to survey the prevalence of sleep problems in school-aged children and to examine these associations with parental perception of sleep problems, medical history, and childhood psychopathology. Sleep and medical history questionnaires and the Child Behavior Checklist were administered to the parents of 472 children between ages 4 and 12 years receiving routine pediatric care from urban, rural, and suburban pediatric practices. Although sleep problems were reported for 10.8% of the sample during the past 6 months, less than one half of the parents who identified sleep problems reported that they had discussed sleep with their child's pediatrician. The best predictor of current sleep problems was a history of sleep problems before age 2 years. Sleep problems such as snoring, tiredness during the day, and taking excessive time to fall asleep were very common, occurring at least 1 night per week in over 20% of the total sample. Factor analysis of the sleep problems questionnaire resulted in 5 sleep problem factors that accounted for 58.7% of the variance. Specific sleep problem factors include: parasomnias, enuresis/gags, tiredness, noisy sleep, and insomnia. Sleep problem factor scores were differentially associated with medical history variables and measures of childhood psychopathology. Children rated highly on parasomnias were more likely to have frequent falls and to display pica. Parasomnias and noisy sleep were inversely associated with socioeconomic status (SES). Children from lower SES families were rated higher on these factors than children from higher SES families. Enuresis/gags was the only sleep problem factor associated with age. Younger children scored higher on this factor. Duration of naps was highly correlated with age and with bed times during the week and weekends. As expected, younger children were more likely to nap for longer periods and to have earlier bed times. In addition, higher tiredness factor scores were associated with napping and with later bed times during the week and weekend. Boys were much more likely than were girls to have higher scores on enuresis/gags, and higher enuresis/gags scores were associated with an increased prevalence of trauma and falls. Bed times were not associated with any other sleep problem factor score. Children rated highly on tiredness were more likely to have a history of hospitalizations. Tiredness factor scores were strongly associated with the sleep practice of sharing a bed but not with sharing a room. Sharing a room was not associated with any sleep problem factor score. High scores on noisy sleep were associated with allergies, falls frequently, and with sharing a bed. Children with high scores on the insomnias were also more likely to display an increased prevalence of allergies. Parental perception of global sleep problems was surprisingly common in school-aged children receiving routine pediatric care. Parental reports of their children's sleep problems may be a red flag for specific sleep problems and psychiatric, social, or medical problems. Sleep problems should be queried about during pediatric visits for school-aged children.

The Children's Sleep Habits Questionnaire (CSHQ): Psychometric Properties of A Survey Instrument for School-Aged Children

To present psychometric data on a comprehensive, parent-report sleep screening instrument designed for school-aged children, the Children's Sleep Habits Questionnaire (CSHQ). The CSHQ yields both a total score and eight subscale scores, reflecting key sleep domains that encompass the major medical and behavioral sleep disorders in this age group. Cross-sectional survey. Three elementary schools in New England, a pediatric sleep disorders clinic in a children's teaching hospital. Parents of 469 school-aged children, aged 4 through 10 years (community sample), and parents of 154 patients diagnosed with sleep disorders in a pediatric sleep clinic completed the CSHQ. N/A. The CSHQ showed adequate internal consistency for both the community sample (p=0.68) and the clinical sample (p=0.78); alpha coefficients for the various subscales of the CSHQ ranged from 0.36 (Parasomnias) to 0.70 (Bedtime Resistance) for the community sample, and from 0.56 (Parasomnias) to 0.93 (Sleep-Disordered Breathing) for the sleep clinic group. Test-retest reliability was acceptable (range 0.62 to 0.79). CSHQ individual items, as well as the subscale and total scores were able to consistently differentiate the community group from the sleep-disordered group, demonstrating validity. A cut-off total CSHQ score of 41 generated by analysis of the Receiver Operator Characteristic Curve (ROC) correctly yielded a sensitivity of 0.80 and specificity of 0.72. The CSHQ appears to be a useful sleep screening instrument to identify both behaviorally based and medically-based sleep problems in school-aged children.

Refractive error study in children: results from Shunyi District, China

PURPOSE: To assess the prevalence of refractive errors and vision impairment in school-age children in Shunyi District, northeast of Beijing, the Peoples Republic of China. METHODS: Random selection of village-based clusters was used to identify a sample of children 5 to 15 years of age. Resident registration books were used to enumerate eligible children in the selected villages and identify their current school. Ophthalmic examinations were conducted in 132 schools on children from 29 clusters during May 1988 to July 1998, including visual acuity measurements, cycloplegic retinoscopy, cycloplegic autorefraction, ocular motility evaluation, and examination of the external eye, anterior segment, media, and fundus. Independent replicate measurements of all children with reduced vision and a sample of those with normal vision were done for quality assurance monitoring in three schools. RESULTS: A total of 6,134 children from 4,338 households were enumerated, and 5,884 children (95.9%) were examined. The prevalence of uncorrected, presenting, and best visual acuity 0.5 (20/40) or worse in at least one eye was 12.8%, 10.9%, and 1.8%, respectively; 0.4% had best visual acuity 0.5 or worse in both eyes. Refractive error was the cause in 89.5% of the 1,236 eyes with reduced vision, amblyopia in 5%, other causes in 1.5%, with unexplained causes in the remaining 4%. Myopia −0.5 diopter or less in either eye was essentially absent in 5-year-old children, but increased to 36.7% in males and 55.0% in females by age 15. Over this same age range, hyperopia 2 diopters or greater decreased from 8.8% in males and 19.6% in females to less than 2% in both. Females had a significantly higher risk of both myopia and hyperopia. CONCLUSIONS: Reduced vision because of myopia is an important public health problem in school-age children in Shunyi District. More than 9% of children could benefit from prescription glasses. Further studies are needed to determine whether the upward trend in the prevalence of myopia continues far beyond age 15 and whether the development of myopia is changing for more recent birth cohorts.

Developing strategies to control schistosomiasis morbidity in nonenrolled school-age children: experience from Egypt.

Schistosomiasis is a major health problem in school-age children in much of the tropical world. They harbour the most intense infections for both Schistosoma mansoni and S. haematobium. In Egypt, the Ministry of Health and Population (MOHP) has implemented a successful school-based treatment programme in which children are screened and those found to be infected treated with praziquantel. High nonenrolment rates in some rural areas have a negative impact on the coverage of this programme and on its ability to reduce transmission in the community. The main aim of our study was to introduce and test a simple intervention to extend treatment to nonenrolled children using the routine MOHP schistosomiasis treatment programme. Twenty villages or ezbas in Tamia district, Fayoum governorate, with 8 schools and 1901 nonenrolled children were targeted. 88.5% of nonenrolled children attended schools to avail themselves of treatment. Coverage rates were significantly higher for girls (P < 0.001). These results are important for countries where schistosomiasis is endemic. They suggest that offering interventions in schools may not only improve the health of school attendees but also be an affordable way of extending services to out-of-school children.

Sociodemographic and condition-related characteristics associated with conduct problems in school-aged children with chronic health conditions.

To examine whether sociodemographic and condition-related characteristics are associated with conduct problems in children with chronic health conditions. Cross-sectional survey. Mothers of children 5 to 8 years old with diverse chronic health conditions who received care at 2 large urban medical centers. Mothers responded to a face-to-face structured interview that included the Eyberg Child Behavior Inventory, the Psychiatric Symptom Index, and questions about sociodemographic and health condition-related characteristics. Of the 356 children assessed, 138 (38.8%) had conduct problems as defined by criteria of the Eyberg Child Behavior Inventory. In logistic regression analyses, conduct problems were associated with younger child age, mother having a husband or partner unrelated to her child, poorer perceived prognosis, child having a learning disability, and maternal self-report of high emotional distress on the Psychiatric Symptom Index. Conduct problems were not related to child sex, maternal ethnicity or education, family receiving welfare, or a wide range of condition-related factors, including age at diagnosis, visibility to others, need to watch for sudden changes, presence of mobility or sensory-communication problems, using medication or equipment, annual hospitalizations, or physician visits. Conduct problems in children with chronic health conditions appear to be associated more closely with their sociodemographic and family characteristics than with condition-related risk factors. Additional research remains to be done on the ways that maternal adjustment, diagnosis-specific condition characteristics, and other risk factors influence children's behavior.

Head lice in pupils of a primary school in Australia and implications for control.

Anecdotal reports suggest that head lice infestations are a common problem in school-aged children in Australia; however, only a few data are available. The present study aimed to determine the prevalence of infestation with head lice in children in an urban Australian school. All 735 pupils from grades preschool to five of a government run primary school were invited to participate in the cross-sectional survey. Overall, 212 boys (46.5%) and 244 girls from 29 classes were examined. The main outcome measures were: (1) the detection of lice or eggs by visual examination of the child's head, and classification into 'not infested' and 'infested;' infested cases were further classified into 'active infestation' (lice or viable eggs found) or 'inactive infestation' (only unhatched eggs found); (2) for each child, a parent or guardian was asked to complete a standardized questionnaire. Of the 456 children examined, 33.7% (95% confidence interval = 95%-CI = [26.9%, 40.4%]) had evidence of infestation with head lice, 21.0% (95%-CI = [15.2%, 26.8%]) with active infestation. The prevalence of infestation (active plus inactive) varied greatly between classes, ranging from zero to 72.2% (p < 0.001). Head lice were more prevalent in girls than boys (p < 0.001). Analysis of questionnaires showed that 47.7% (95%-CI = [43.0%, 52.4%]) of the children had been infested with head lice in the previous 6 months. For children with active pediculosis capitis on examination, 14.0% (95%-CI = [7.9%, 22.4%]) of parents or guardians had not noticed the infestation. In an urban primary school in Australia, head lice infestation was present at a hyperendemic level. Clustering by class indicated the classroom as a main source of infestation. Control strategies implemented in schools and including the education of teachers and parents need to be evaluated.

A school-based schistosomiasis and intestinal helminthiasis control programme in Nigeria: acceptability to community members.

In a population with high prevalences in schoolchildren of infection with hookworm (32.4%), Ascaris (22.9%) and Trichuris (2.5%), visible haematuria (17.9%), micro-haematuria (17%) and proteinuria (47.3%), the knowledge about transmission of schistosomiasis and acceptability of a school-based control programme were assessed. The community perceived schistosomiasis (80.6%) and intestinal helminthiasis (66.5%) as important health problems in school-age children and most people would prefer placement of the control programme in school because it would eliminate transportation cost to the health facility. They welcomed the idea of using teachers for detection of infection and drug administration. The health staff, on the other hand, were willing to work with teachers, but emphasized that teachers should be limited to organizational and supervisory roles while they do tests and administer the drug. This view was also shared by the officials in the state ministries of health and education.

Psychological disturbance in atopic eczema: the extent of the problem in school-aged children.

Although psychological factors are widely considered to be important in atopic eczema, there have been few controlled studies to assess the extent of disturbance in affected children and the problems experienced by their parents. This study was designed to find out the degree of psychological difficulty experienced by children with atopic eczema, whether their mothers show higher levels of mental distress than a comparison group, and whether the families of children with atopic eczema have less social support than the comparison group. We investigated 30 school-aged children with atopic eczema for psychological problems using the Rutter parent scale and compared them with 30 children with relatively minor skin lesions such as viral warts. Mental distress in mothers was assessed using the General Health Questionnaire. The Family Support Scale was used to get a measure of the social support experienced by the families. We found twice the rate of psychological disturbance in children in the eczema group compared with the control group. This difference was statistically significant for children with moderately severe eczema and severe eczema, but not for children with very mild eczema. Levels of mental distress were no greater in mothers of children with eczema than in parents of the control group and there was no difference in the degree of social support experienced by their families. These findings indicate that school-aged children with moderate and severe atopic eczema are at high risk of developing psychological difficulties, which may have implications for their academic and social development.

PARENTAL UNEMPLOYMENT AND CHILDREN'S HEALTH. † 667

The impact of parental unemployment on children's physical and mental health was assessed in a random sample of 893 two-parent families with at least one child ≤ 19 living at home. Face-to-face structured interviews were conducted with both parents and the oldest child living at home using standardized measures. Random digit dialling was used to select 209 families currently experiencing unemployment (CU), 229 who have experienced unemployment previously during the past four years (PU) and 455 in which there has been steady employment during the past four years (SE). Unemployment was defined as one or both parents having experienced at least four weeks of continuous unemployment. The physical and mental health of children from the three types of families (CU, PU, and SE) were compared. Of the three groups, children from CU families were rated by their mothers as having the poorest overall health using a four-point scale ([horizontal bar over]x=2.85), followed by children from PU families ([horizontal bar over]x=2.79), and then children from SE families ([horizontal bar over]x=2.31) (p=.04). Children from CU families were also reported by their mothers to have had the most days during the past two weeks where they were too sick to engage in their usual activities ([horizontal bar over]x=0.88 days), followed by children from PU families ([horizontal bar over]x=0.65) and then children from SE families([horizontal bar over]x=0.46) (p=.01). There were also significant differences in levels of behavior problems in school aged children (≥6 years old), as assessed using the parent version of the Child Behavior Checklist. Children from PU families were reported to have the highest levels of both internalizing and externalizing behavior problems ([horizontal bar over]x=53.85 and [horizontal bar over]x=53.27, respectively), followed by children from CU families ([horizontal bar over]x=52.55 and [horizontal bar over]x=52.19, respectively) and finally children from SE families ([horizontal bar over]x=51.13 and [horizontal bar over]x=50.26, respectively) (p=.05 and p=.04, respectively). These results provide evidence that parental unemployment may be a risk factor for children's physical and mental health problems that should be considered by primary care providers.

Prospective assessment of Lyme disease in a school-aged population in Connecticut.

To determine the incidence and cumulative frequency of Lyme disease in a school-aged population in an area in which Lyme disease is endemic, serum specimens were obtained before and after the 1990-1992 tick seasons from 410 middle and high school students in southeastern Connecticut. Sera were tested for serologic evidence of infection with Borrelia burgdorferi, and students were questioned about physician-confirmed episodes of clinical Lyme disease. At enrollment, 29 (7%) students had a history of Lyme disease, and of these, 12 (41%) were seropositive for B. burgdorferi infection. Seronegative students (397) were followed prospectively over a total of 796 person years. At enrollment, 381 students (93%) had no history of Lyme disease, and of these, 1 (0.3%) was seropositive. During this period, 8 students developed clinical Lyme disease and 3 had asymptomatic infections with B. burgdorferi. The incidences of clinical Lyme disease and asymptomatic B. burgdorferi infection were 10.1 and 3.8 cases/1000 person-years, respectively. Lyme disease is an important health problem in school-aged children living in southeastern Connecticut.

Pre- and Postnatal Lead Exposure and Behavior Problems in School-Aged Children

The association between early lead exposure and later problem behaviors was evaluated prospectively in a cohort of 8-year-old children born during a 12-month period at one hospital. Lead levels in umbilical cord blood ( X = 6.8 μg/dl, SD = 3.1) and the dentin of a shed deciduous tooth ( X = 3.4 μg/g, SD = 2.4) provided measures of prenatal and postnatal exposure, respectively. Ratings on the Teacher Report Form of the Child Behavior Profile provided information about children′s problem behaviors. Cord blood lead level was not associated with the overall prevalence or nature of problem behaviors. In both crude and adjusted analyses, tooth lead level was significantly associated with total problem behavior scores (approximately 2 points in T score per log unit increase in teeth lead). Significant tooth lead-associated increases in both internalizing and externalizing scores were also observed (approximately 1.5 points in T score per log unit increase). Weaker associations were noted between tooth lead level and the prevalence of "extreme" problem behavior scores. The extent to which these associations reflect residual confounding is uncertain. These data suggest, however, that social and emotional dysfunctions are correlates and may be expressions of increased lead exposure.

Grammatical problems in school-age children with specific language impairment

Two claims as to the characterization of specific language impairment (SLI) are tested in the free conversation of groups of language impaired 7–10-year-olds (LI), and 3-, 5- and 7-year-old normally developing (LN) children. The first claim is that SLI is essentially an impairment of morpho-syntax affecting ‘feature-related’ elements, and the second is that it will not be characterized by errors in verbs' argument structures. Both claims are refuted: no qualitative difference was found between groups on feature-related error production. Both groups displayed argument structure errors, but there is evidence that SLI subjects produce a greater frequency and range of these. Some methodological problems are discussed relating to the identification of feature-related errors and the norms which this identification assumes.

Child maltreatment, stressful life events, and behavior problems in school-aged children in residential treatment.

This study examined the prevalence of child maltreatment, stressful life events, and behavior problems in school-aged children in residential treatment. The sample included 44 children, ages 5-13 years; 61% were male and 39% female. Results indicated that the entire sample had experienced one or more types of maltreatment, with physical abuse being more prevalent. Seventy-four percent of subjects scored in the clinical range on the Child Behavior Checklist (Achenbach & Edelbrock, 1983). Proportionally more physically abused children scored in the clinical range when compared to nonphysically abused children. The number of stressful life events experienced after admission to the treatment facility was found to be related to increased behavior problems.

Conversational problems in school-age children with specific language impairment

Conversational problems in school-age children with specific language impairment

Children of Divorce

Does divorce typically produce clinically significant problems in children? This paper reports the results of a study of a non-clinical sample of children of divorce using criteria to assess clinically significant levels of problems in school age children. Data gathered 0-4 months after divorce filing (at least 12 months after separation in North Carolina) from 86 families with 112 children aged 7-12 were compared to data from normal reference groups. Results showed that divorced and normal school age children were comparable in anxiety, self-esteem, school adjustment and behavior, and family environment. Only parent-reported home behavior problems differed from that for normal comparison groups. Children with clinically significant levels of behavior problems were less likely to have regular visitation and were more likely to have parents in conflict about child rearing. A small group of children with multiple problems appears to be at risk. The results suggest children may adapt to divorce much better t...

Severity of and vulnerability to health problems in school-age children.

Severity and vulnerability as important constructs in the Health Belief Model were examined in school-age children. Cognitive development theory and sex-role socialization theory provided the bases for predicting age and gender differences. Nine hundred forty-six children in first, fourth, and sixth grade from seven schools in five states participated in the study. Severity and vulnerability in six categories of health problems were described. Analysis of variance revealed significant age and gender differences. Girls perceived that health problems were both more severe and that they were more vulnerable to them than boys. Age was significant on the vulnerability dimensions, although age patterns varied by health problems. Clinical and educational implications are discussed.

Physical and Behavioral Aspects of Middle Ear Disease in School Children

Middle ear disease is today's primary aural health problem in school-age children. Until recently, pediatric health researchers were aware only of the medical consequences that middle ear disease had no children. Except in a few cases of chronic otitis media, the effects of middle ear disease were considered transitory. However, current research on middle ear disease suggests permanent changes in hearing sensitivity, reduced development of the auditory neural network and developmental delays in speech, language and cognitive skills dependent on hearing. This article presents a review of recent studies on the physical and behavioral aspects of middle ear disease and its sequelae in school children.