Children's Psychological Outcomes Research Articles

Neuropsychological follow-up in neonatal screening: issues, methods and findings.

There are several ongoing studies of psychological outcome in children identified through neonatal screening with phenylketonuria, congenital hypothyroidism or congenital adrenal hyperplasia. These studies document the reduction in mental retardation, learning difficulties and behaviour problems associated with neonatal screening. They also describe other behavioural changes resulting from these disorders. Some behavioural changes are transient or preventable with early diagnosis and treatment, whereas some appear to be irreversible, reflecting permanent brain effects of abnormalities associated with the disease. Despite the variety of disorders studied, there are commonalities in approach and issues, including a developmental neuropsychological perspective resulting in behavioural assessments specific to the disorder and its likely manifestations, a recognition that behaviour may change across time in association with brain development and an understanding of the neural mechanisms underlying the behavioural changes. Assessments go beyond IQ, and include specific intellectual abilities, social behaviour, temperament, behaviour problems and identity. Behavioural changes are related to specific characteristics of the disease and its treatment, including the timing of exposure to abnormal hormones and/or neurotransmitters, the severity of the disease, and the age at initiation and adequacy of treatment. These studies provide information about the ways in which hormones and neurotransmitters affect the development and ongoing function of the brain, and an understanding of the ways in which neonatal screening results in improved psychological outcome. They also provide models for psychological follow-up of other disorders detected through neonatal screening.

Quality of Life in Survivors of a Primary Bone Tumour:A Systematic Review

Purpose. We conducted a systematic search of published literature, to assess (i) quality of life (QoL) for survivors of a bone tumour compared with the normal population; (ii) QoL implications following amputation, successful or failed limb salvage; (iii) adaptation of young children to amputation compared with older children or adolescents. Methods. Electronic databases were searched including Medline, PsycLIT and Cinahl covering the years 1982– 1998. Results. We identified 11 studies. Regardless of treatment, physical functioning was poor compared with population norms or healthy siblings.There was less consistent evidence regarding emotional functioning. Seven studies compared functioning in amputees and limb salvage patients.Two reported advantages in physical function for the limb salvage group, one for the amputees and the rest no differences. Evidence about social functioning or marriage is inconclusive, but there are suggestions that amputees report more job discrimination. Discussion. The literature is inconclusive, largely because of methodological problems. These include small and non-representative samples, and lack of sensitive and appropriate measures. Specific gaps in the literature include very little work concerned with psychological outcomes for children, or for those experiencing failed limb salvage. More attention needs to be given to gender differences in emotional response to traumatic surgery.The implications of the results for helping families balance the merits of different treatments are discussed.

Long‐term psychological outcome of children after surgery for transposition of the great arteries

To assess the psychological consequences of a single congenital heart defect, we tested intellectual function, self‐perception,‘'body image”, child psychiatric symptoms and the family climate in 21 boys and 10 girls, at a mean age of 13.2y, on average 11.5 y after surgery for transposition of the great arteries. Where applicable, test norms were used for comparison. WISC‐R IQ tended to be slightly lower than that of the general population. Self‐perception, as reflected on the“I think I am”test, was normal.“Body image”as measured by the“Draw‐a‐man”test was poor in the boys, but did not show a relationship with any other test tapping mental health. Six children (19%) had clinically significant child psychiatric symptoms, which is slightly more than expected, and were overrepresented in patients with poorer cardiac function. Five of these represented“internalizing”disorders. The patients’families scored higher than expected on the family climate“chaos”subscale, which has been demonstrated to be associated with the development of psychiatric symptoms. Overall, however, the children and their families were regarded as socially and psychologically well‐functioning.

Psychological Outcome in Children Treated for Brain Tumor

The cognitive and psychosocial functions of 16 children with brain tumor, treated with whole-brain or local radiotherapy, were studied. Fifteen nonirradiated children with acute lymphatic leukemia (ALL) served as a comparison group. Mean Wechsler Intelligence Scale for Children-Revised Full Scale IQscore and mean Visual-Motor Integration Test (Beery VMI) standard score were significantly decreased in the brain tumor group. The Achenbach checklists were filled in by mothers (Child Behavior Checklist, CBCL) and teachers (Teacher's Report Form). Overall adjustment was rated lower in the children with brain tumor. Although most of the children in the ALL group were well adapted, one third of them had low CBCL Social Competence scores relative to nonclinical norms. On a visual analog scale a significantly decreased tempo was assessed by mothers and teachers in the children with brain tumor and low speed and hypoactivity seemed to limit the majority of these children in school and daily life activities.

Oppositional Behavior in Children

Early intervention for children's oppositional behaviors is likely to be more effective than later treatment. The term oppositional includes a variety of noncompliant and aggressive behaviors that can be assessed with clinical interviews, rating scales, direct observation, and self-report measures. Treatment of children's oppositional behaviors is best approached from a parent training perspective. Parent training approaches have produced significant improvements in children's behavior, although far more research has been devoted to discipline than to identifying the more salient features of time-in. Recent advances in assessment and treatment are notable, but continued efforts are needed to determine the optimal treatments that produce the best social and psychological outcomes for children and adolescents.

Family Size: Implicit Policies and Assumed Psychological Outcomes

The recommended increase in the number of zero‐ and one‐child families proposed as one means of reducing average family size in the United States does not satisfactorily confront such issues as cultural proscriptions concerning the only child, nor offer evidence that the types of families that would result are those in which positive psychological characteristics are most likely to emerge. The literature surveyed suggests that a negative stereotype concerning the only child does persist, but that the psychological characteristics assumed for the only child have not been reliably demonstrated. Neither is there irrefutable evidence concerning psychological characteristics associated with other family sizes and ordinal positions. Family size recommendations should reflect a greater understanding of the opposition to the only child and should be paralleled by intensive research activity directed at developing a more comprehensive body of knowledge concerning the psychological outcomes for children, adults, and the society which might be anticipated.