Treatment Of Preschool Children Research Articles

Integrated speech and phonological awareness intervention for pre-school children with Down syndrome

Integrated speech and phonological awareness intervention for pre-school children with Down syndrome

Efficacy of Applied Behavioral Intervention in Preschool Children with Autism for Improving Cognitive, Language, and Adaptive Behavior: A Systematic Review and Meta-analysis

To review the effectiveness of applied behavior intervention (ABI) programs for preschool children with autism spectrum disorder (ASD) in their cognitive, adaptive behavior, and language development. Systematic reviews, randomized or quasirandomized controlled trials (RCT) of ABI delivered to preschool children with ASD were reviewed. Quantitative data on cognitive, language, and behavior outcomes were extracted and pooled for meta-analysis (RevMan 4.2). Thirteen studies met the inclusion criteria. Six of these were randomized comparison trials with adequate methodologic quality (PEDro >or= 6). Meta-analysis of 4 studies concluded that, compared with standard care, ABI programs did not significantly improve the cognitive outcomes of children in the experimental group who scored a standardized mean difference (SMD) of 0.38 (95%CI -0.09 to 0.84; P = .1). There was no additional benefit over standard care for expressive language; SMD of 0.37 (95%CI -0.09 to 0.84; P = .11), for receptive language; SMD of 0.29 (95%CI -0.17 to 0.74; P = .22) or adaptive behavior; SMD of 0.30 (95%CI -0.16 to 0.77; P = .20). Currently there is inadequate evidence that ABI has better outcomes than standard care for children with autism. Appropriately powered clinical trials with broader outcomes are required.

Use of magnetophoresis of glutamic acid and magnesium sulfate in the rehabilitation of children with cerebral palsy

We report here our studies on the clinical efficacy of courses of magnetophoresis of glutamic acid and magnesium sulfate in the complex rehabilitation treatment of preschool children with spastic types of cerebral palsy. Clinical-neurophysiological investigations were performed in 40 children aged 1-7 years. Treatment was significantly more effective when use of running pulsed magnetic fields was combined with medicinal agents as compared with magnetotherapy using the same regime.

Dental behavioural management problems and dental caries prevalence in 3‐ to 6‐year‐old Swedish children born preterm

Today, most children born preterm survive without major impairments. But high frequencies of cognitive and behavioural difficulties arise. Studies on dental behavioural management problems (DBMP) in these children are lacking. In addition, studies on caries prevalence are few and inconclusive. This study aims to compare the frequency of behavioural problems and poor compliance with dental treatment in preschool children born preterm with those born full-term. The prevalence of caries was also studied. The study group included 187 children born between 23 and 32 weeks of gestation. The control group constituted full-term children matched by age, sex, immigrant background, and dental operator. DBMP, number of dental visits, missed appointments, and caries between ages 3 and 6 were noted. At age 3, but not at age 6, the prevalence of DBMP at clinical examinations was significantly higher in preterm children compared with the control group. Of the children who received dental treatments during preschool years, preterm children displayed significantly more DBMP. No significant difference in dental visits or in caries prevalence was found. Preterm children, however, missed significantly more dental appointments. Children born preterm display a higher prevalence of DBMP at dental examinations and treatments during preschool years.

Predictors and outcomes of speech and language therapists' treatment decisions

This study investigated predictors of decisions made by speech and language therapists (SLTs) to offer intervention for pre-school children and the children's outcomes relative to that decision. The study uses data from 347 children who were first assessed aged under 3 years 6 months by community speech and language therapists in the UK. Of these, 158 were offered therapy, 189 were either discharged or offered only monitoring appointments. After adjusting for the child's age and gender, six variables were significantly associated with the therapist's original decision: being a quiet baby, not using two word utterances or making comments on their play, being unintelligible to strangers and the child's score on auditory comprehension and expressive language scales of the Preschool Language Scales (PLS-3). These show a focus on communication variables rather than broader demographic and medical variables. At follow-up, aged 7 – 9 years, 56% of the children were available for re-assessment. Therapists' decisions at initial assessment show a sensitivity of .85 and a specificity of .61 relative to children's outcomes. Of the 191 children seen at follow-up, 21 were deemed to have ongoing difficulties.

Long-term Safety of Stimulant Medications Used to Treat Children with ADHD

<P>Attention deficit hyperactivity disorder (ADHD) is a common mental health condition that impacts children, adolescents, and adults. The practice parameters of both the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) acknowledge the chronic nature of this disorder and recommend treatments that address the need to manage it over time. Patient and parent education, individualized treatment plans, coordination of multiple health services, and working with the school system are some of the tools recommended as part of ADHD management. For decades, stimulant therapy has been the primary option for ADHD management.</P> <H4>ABOUT THE AUTHORS</H4> <P>Marc Lerner, MD, is Clinical Professor of Pediatrics, University of California, Irvine, CA. Tim Wigal, PhD, is Associate Clinical Professor of Pediatrics, UCI Child Development Center, Irvine, CA.</P> <P>Address correspondence to: Marc Lerner, MD, UCI Medical Center, Department of Pediatrics, 101 The City Drive ZC 4482, Orange, CA 92868; <a href="mailto:malerner@uci.edu">malerner@uci.edu</a>.</P> <P>Dr. Lerner has disclosed the following relevant financial relationships: McNeil Pediatrics, Novartis, and Shire: Consultant; Cephalon, Eli Lilly, McNeil Pediatrics, Novartis, and Shire: Research Support; and Eli Lilly, McNeil Pediatrics, Novartis/UCB, and Shire: Member of Speakers’ Bureaus. Dr. Wigal has disclosed the following relevant financial relationships: Celltech Pharmaceuticals Inc./UCB, Cephalon Inc, Eli Lilly and Company, McNeil Pharmaceutical, Novartis Pharmaceuticals Corporation, and Shire Development: Consultant; and McNeil and Shire: Member of Speakers’ Bureaus.</P> <H4>EDUCATIONAL OBJECTIVES</H4> <OL> <LI>Review the impact of new treatment options on the choice of long-term stimulant treatment regimens.</LI> <LI>In light of new Food and Drug Administration warnings, review the current evidence on cardiovascular effects of long-term attention-deficit/hyperactivity disorder (ADHD) treatments.</LI> <LI>Compare the safety of ADHD stimulant treatment in preschool children to the safety profiles found in school-aged children.</LI> </OL>

Long-term Safety of Stimulant Medications Used to Treat Children with ADHD

<h4>EXCERPT</h4> <p>Attention deficit hyperactivity disorder (ADHD) is a common mental health condition that impacts children, adolescents, and adults. The practice parameters of both the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) acknowledge the chronic nature of this disorder and recommend treatments that address the need to manage it over time. Patient and parent education, individualized treatment plans, coordination of multiple health services, and working with the school system are some of the tools recommended as part of ADHD management. For decades, stimulant therapy has been the primary option for ADHD management.</p> <h4>ABOUT THE AUTHORS</h4> <p>Marc Lerner, MD, is Clinical Professor of Pediatrics, University of California, Irvine, CA. Tim Wigal, PhD, is Associate Clinical Professor of Pediatrics, UCI Child Development Center, Irvine, CA.</p> <p>Address correspondence to: Marc Lerner, MD, UCI Medical Center, Department of Pediatrics, 101 The City Drive ZC 4482, Orange, CA 92868; <a href="mailto:malerner@uci.edu">malerner@uci.edu</a>.</p> <p>Dr. Lerner has disclosed the following relevant financial relationships: McNeil Pediatrics, Novartis, and Shire: Consultant; Cephalon, Eli Lilly, McNeil Pediatrics, Novartis, and Shire: Research Support; and Eli Lilly, McNeil Pediatrics, Novartis/UCB, and Shire: Member of Speakers’ Bureaus. Dr. Wigal has disclosed the following relevant financial relationships: Celltech Pharmaceuticals Inc./UCB, Cephalon Inc, Eli Lilly and Company, McNeil Pharmaceutical, Novartis Pharmaceuticals Corporation, and Shire Development: Consultant; and McNeil and Shire: Member of Speakers’ Bureaus.</p> <H4>EDUCATIONAL OBJECTIVES</H4><OL> <LI>Review the impact of new treatment options on the choice of long-term stimulant treatment regimens.</LI><LI>In light of new Food and Drug Administration warnings, review the current evidence on cardiovascular effects of long-term attention-deficit/hyperactivity disorder (ADHD) treatments.</LI><LI>Compare the safety of ADHD stimulant treatment in preschool children to the safety profiles found in school-aged children.</LI></OL>

Parents' and speech and language therapists' explanatory models of language development, language delay and intervention

Parental and speech and language therapist (SLT) explanatory models may affect engagement with speech and language therapy, but there has been dearth of research in this area. This study investigated parents' and SLTs' views about language development, delay and intervention in pre-school children with language delay. The aims were to describe, explore and explain the thoughts, understandings, perceptions, beliefs, knowledge and feelings held by: a group of parents from East Manchester, UK, whose pre-school children had been referred with suspected language delay; and SLTs working in the same area, in relation to language development, language delay and language intervention. A total of 24 unstructured interviews were carried out: 15 with parents whose children had been referred for speech and language therapy and nine with SLTs who worked with pre-school children. The interviews were transcribed verbatim and coded using Atlas/ti. The data were analysed, subjected to respondent validation, and grounded theories and principled descriptions developed to explain and describe parents' and SLTs' beliefs and views. Parent and SLT data are presented separately. There are commonalities and differences between the parents and the SLTs. Both groups believe that language development and delay are influenced by both external and internal factors. Parents give more weight to the role of gender, imitation and personality and value television and videos, whereas the SLTs value the 'right environment' and listening skills and consider that health/disability and socio-economic factors are important. Parents see themselves as experts on their child and have varied ideas about the role of SLTs, which do not always accord with SLTs' views. The parents and SLTs differ in their views of the roles of imitation and play in intervention. Parents typically try strategies before seeing an SLT. These data suggest that parents' ideas vary and that, although parents and SLTs may share some views, there are some important differences. These views have implications for the provision of appropriate services. Although this is a small sample from one group in the UK, the results indicate the need to investigate the views of other groups of parents.

Fine Motor Function and Oral-Motor Imitation Skills in Preschool-Age Children With Speech-Sound Disorders

Preschool-aged children with speech-sound disorders may be at risk for associated deficits in fine motor function. The objectives of this study were 2-fold: (1) to determine whether abnormalities in fine motor function could be detected in 2- to 5-year-old children with speech-sound disorders and (2) to determine whether there was a correlation between abnormal oral-motor imitation skills and abnormal fine motor function. Thirty-two children with speech-sound disorders (6 female, 26 male) were prospectively evaluated from July 2003 to July 2005, and the Peabody Developmental Motor Scales and the Kaufman Speech Praxis Test for Children were administered. The presence of abnormal oral-motor imitation skills as measured by the Kaufman Speech Praxis Test was associated with below-average fine motor performance. This finding has important implications for evaluation and treatment of preschool children with severe speech-sound disorders.

Treatment for Preschool Children With Interpersonal Sexual Behavior Problems: A Pilot Study

This pilot study evaluated a 12-week group treatment program for preschool children with interpersonal sexual behavior problems (SBP; N = 85; 53 completed at least 8 sessions). Many children presented with co-occurring trauma symptoms and disruptive behaviors. In intent-to-treat analysis, a significant linear reduction in SBP due to number of treatment sessions attended was found, an effect that was independent of linear reductions affiliated with elapsed time. Under the assumption that treatment can have an incremental impact, more than one third of the variance was accounted for by treatment effects, with female and older children most favorably impacted. Caregivers reported increase in knowledge, satisfaction, and usefulness of treatment. In addition to replication, future research is needed to examine (a) effects of environment change and time on SBP, (b) stability of treatment effects, and (c) best practices to integrate evidence-based treatments for comorbid conditions.

Validity and reliability of the Behavioural Observational Pain Scale for postoperative pain measurement in children 1???7 years of age*

Pain measurement is a necessity in pain treatment but can be difficult in young children. The aim of this study was to evaluate the validity and reliability of the Behavioural Observational Pain Scale (BOPS) as a postoperative pain measurement scale for children aged 1-7 yrs. The scale assesses three elements of pain behaviors: facial expression, verbalization, and body position. A prospective study. A day surgery care unit for children and a neurosurgical postoperative care unit. Seventy-six children aged 1-7 yrs (4.5 +/- 1.8) undergoing elective surgical procedures were observed. None. The study was divided into interrater reliability, concurrent validity, and construct validity. The interrater reliabilities of the observers were very good with a high agreement between the different nurses' BOPS scores. Each item of the BOPS scale ranged from kappa(w) 0.86 to 0.95. In the concurrent validity, BOPS and Children's Hospital of Eastern Ontario Pain Scale scores had a positive correlation indicating that both tools described similar behaviors (r(s) = .871, p < .001). In construct validity, the effect of analgesic was tested before analgesic administration and at 15, 30, and 60 mins after analgesic administration. The differences in BOPS score between the time intervals were significant (p < .01) before administration of analgesia and at 15, 30, and 60 mins. There was also statistical significance in the BOPS score (p < .01) between 15 and 60 mins after administration of analgesia. With BOPS, the caretaker can evaluate and document pain with high reliability and validity and thereby improve postoperative pain treatment in preschool children. The simple scoring system makes BOPS easy to incorporate in a postoperative unit.

Engaging Primary Health Care Providers in the Promotion of Healthy Weight among Young Children: Barriers and Enablers for Policy and Management

Recent national efforts to stem the alarming growth of childhood overweight and obesity in Australia have highlighted the importance of preventative strategies that focus beyond the child-on parents, families, primary health care providers (PHCPs) and child care services. But, while such efforts have to date focused on school-based interventions, once poor eating habits and sedentary lifestyles have set in, a growing body of research is indicating that PHCPs can play a more influential role in monitoring and modifying factors affecting prevention and early intervention in preschool children. This paper presents the findings of a systematic review to: (a) identify key barriers to the effective engagement of PHCPs with parents and child care staff in the promotion of healthy weight among children aged 2-6 years, (b) appraise "promising" interventions for strengthening the capacity of PHCPs to effectively deal with these barriers, and (c) synthesise policy options to encourage and engage PHCPs. The study draws on the lessons of promising interventions to highlight the urgent need to address organisational, attitudinal, knowledge, skills and training barriers, to facilitate the engagement of PHCPs in different settings-based environments (clinical, child care, home and community).

Treating Preschool Children Who Stutter: Description and Preliminary Evaluation of a Family-Focused Treatment Approach

The purpose of this article is to present a detailed description of a family-focused treatment for preschool children who stutter that addresses communication behaviors and attitudinal reactions that children and their parents may exhibit in reaction to stuttering, as well as a preliminary evaluation of the outcomes of that treatment. The study involved assessment of the children's speech fluency and a client satisfaction questionnaire that sought parents' opinions about which aspects of the treatment were beneficial. Participants were 17 children who stutter, ages 31 to 62 months, and their families. Responses to the questionnaire indicated that treatment helped families learn about stuttering and about strategies that facilitate children's fluency. Evaluation of the children's fluency revealed that all participants achieved improved fluency at the conclusion of treatment and at long-term follow-up. Findings suggest that this treatment approach may be useful for helping children achieve improved speech fluency, effective communication skills, and healthy communication attitudes.

Identification of preschool children with asthma from low-income families in Los Angeles, CA

Few studies have addressed asthma screening in the preschool age group. Early asthma recognition and intervention in preschool children may reduce costs related to unscheduled medical care and missed school and work. To facilitate an early recognition and referral process for asthma in a preschool education program in Los Angeles, CA. We administered a 7-question survey to parents and guardians of children aged 12 months to 6 years in the prekindergarten program of a large school district in Southern California. English and Spanish survey questions addressed health care use, school absenteeism, and asthma symptoms. Postsurvey reports to parents recommended clinical evaluation of children who had probable asthma. Of the 609 surveys returned from 8 centers (> or = 80% survey return rate), 12% were positive for probable asthma and only 5.4% of these cases had been previously diagnosed. Of the 12% found to have a high probability of asthma, 3 independent factors were associated with a lower likelihood of prior asthma diagnosis: Hispanic descent; Spanish speaking; and medicine use 2 or more times per week for symptoms such as cough, chest tightness, trouble breathing, or wheezing. Symptoms at play, during the day, and at night were noted in 35% to 44% of the preschoolers. Cough was the most frequently reported symptom (71.9%, n = 424). A school-based screening process in an early education program can help identify preschool children with a high probability of asthma and offer a basis for early recognition and intervention.

Increased periosteal circumference remains present 12 months after an exercise intervention in preschool children

We previously reported that calcium intake enhanced the leg bone response to physical activity of preschool children in a 12-month randomized trial of calcium supplementation and physical activity. To determine whether the intervention-induced changes in leg bone mineral content and size were maintained through the subsequent 12-month follow-up period, total body bone measurements by DXA and 20% distal tibia pQCT bone measurements were obtained at 24 months (12 months post-intervention). Children also were measured for height and weight, and accelerometer readings were obtained in a subset of children at 18 and 24 months (6 and 12 months post-intervention). Regression analyses were performed controlling for covariates and indicated that increases from 12 to 24 months were greater in the gross motor (GM) activity group (bone loading, large muscle exercises) vs. fine motor (FM) activity group (arts and crafts program) for arm bone area (BA) ( P < 0.01), total body ( P = 0.04) and arm ( P < 0.01) bone mineral content (BMC). There were no differences in BA or BMC changes from 12 to 24 months by calcium supplementation. Differences in tibia periosteal circumference by pQCT persisted at 24 months (GM 51.4 ± 0.4 mm vs. FM 50.2 ± 0.4 mm, P = 0.03) with a trend for greater endosteal circumferences in the children in the GM vs. FM groups at both 12 and 24 months (both, P = 0.08). There were no significant differences in cortical area or thickness by activity or supplement group at 24 months. Children in the GM group had greater accelerometer counts/day ( P = 0.04) and more time in vigorous activity ( P = 0.05) at 18 months compared to FM group. No differences in accelerometer readings were noted at 24 months. In conclusion, we found higher activity levels in children randomized to gross motor vs. fine motor activities 6 months after the intervention program ceased. Whether the greater periosteal circumference that was observed 12 months post-intervention was a persistent biological bone effect or due to persistently higher activity levels is not known.

Les antileucotriènes et asthme chez l'enfant d'âge préscolaire

Leukotrienes are potent inducers of bronchoconstriction and mediators of inflammation, and they increase vascular permeability and mucus production. These substances potentiate the influx of inflammatory cells in the airways of patients with asthma. Leukotriene synthesis inhibitors and receptor antagonists—antileukotrienes—are among the new class of antiasthmatic drugs. There are at present few published studies on the treatment of preschool children with antileukotrienes. While they seem to be effective in the management of chronic asthma and perhaps in the treatment of infants with virus-induced wheezing, it is still difficult to place them in the treatment of asthma in preschool children. Further evaluation and clinical experience should allow us to determine their place in the treatment of children with asthma.

Attention deficit hyperactivity disorder and preschool children.

This article presents a review of the literature on attention deficit hyperactivity disorder (ADHD) and preschool children. A review of the research revealed a predominant focus on pharmacological intervention, with considerably less research on other intervention approaches to ADHD in preschoolers. In particular, there was limited research related specifically to characteristics and best treatment of language-impaired preschool children with ADHD. The available literature did provide important information to further the understanding of the nature of ADHD in preschool-age children and to guide more effective assessment and intervention, both in a general sense and in the practice of speech-language pathology. The more general features of ADHD in preschool children (nature, diagnosis, intervention) are presented first, and then language service delivery implications are discussed. There is limited literature to guide language assessment and intervention for preschool children with ADHD; however, extrapolating from the literature on school-age children would suggest a focus on pragmatic skills, social skills, and emergent literacy.

The emotional impact of amblyopia treatment in preschool children: Randomized controlled trial

Purpose To investigate the emotional status of children undergoing active treatment for amblyopia. Design Postal survey, in the context of a prospective, multicenter, randomized controlled trial. Participants Parents of 177 children with a unilateral visual impairment referred from preschool vision screening. The children had been recruited to a randomized controlled trial of treatment for unilateral visual impairment and randomly assigned to receive either glasses with or without patches, glasses alone, or treatment deferred for 1 year. Methods A self-completion questionnaire, including a psychometric behavioral scale, was sent to the parents of all children recruited to the trial at age 4 years, to 66 whose deferred treatment began at age 5 years, and finally to 151 remaining in the trial at the end of follow-up. Main outcome measures Mean scores per treatment group on the Revised Rutter Parent Scale for Preschool Children. Comparison of parent responses to questions assessing the child's general well-being and difficulties associated with treatment. Results Completed questionnaires were returned for 144 of 177 (81%) children at a mean age (standard deviation) of 48 months (5.0), for 45 of 66 (68%) at a mean age of 61 months (5.8), and for 78 of 151 (52%) at a mean age of 67 months (5.0). Most parents reported having difficulty with patching their child regardless of age (77% at age 4 years and 73% at age 5 years), with fewer reporting difficulties with glasses alone (42% and 53%, respectively). Children were significantly more upset by patching than by glasses only (chi-square test, P = 0.03 for age 4 years and P = 0.01 for age 5 years), as were the parents of 4-year-olds (chi-square test, P = 0.01). Most parents thought their children were happy, cooperative, and good tempered, and behavioral scores did not differ between treatment groups. Conclusions Treatment for unilateral visual impairment is not easy to implement and is commonly associated with some degree of distress. Despite this, no impact on the child's global well-being or behavior was seen either during or after the treatment period.

The Role of Stimulants in the Treatment of Preschool Children with Attention-Deficit Hyperactivity Disorder

The symptoms of attention-deficit hyperactivity disorder (ADHD) can have an early onset, beginning before the age of 6 years. Despite the significant number of preschool-aged children that can be diagnosed with ADHD, there are limited controlled data available on the pharmacological interventions being increasingly used in this population. A 1990 review showed that 34% of paediatricians and 15% of family physicians had prescribed psychostimulant medications to preschoolers with ADHD, and pharmacoepidemiological studies indicate growing use of stimulants in preschoolers during the 1990s. Unfortunately, only six controlled trials, with a total enrollment of less than 200 children, have been conducted using these drugs in preschoolers. While these small studies provide some evidence of benefit from the use of methylphenidate in preschoolers with ADHD, more data are critically needed. Practice parameters developed by the American Academy of Child & Adolescent Psychiatry and the American Academy of Pediatrics provide some guidance regarding the diagnosis and treatment of young children with ADHD, but are mainly based upon research in children of primary-school age. The ongoing PATS (Preschool ADHD Treatment Study), funded by the National Institute of Mental Health, will provide important clinical guidance for diagnostic considerations and intervention strategies for children with ADHD aged 3-5 years. Pending the release of data from the PATS study, clinicians must rely on developmental assessment skills, available standardised rating instruments, reports about the child from multiple informants, and knowledge of the risks and benefits of available pharmacological and behavioural treatments, in order to treat preschool children with ADHD effectively.

Cephalometric evaluation of facial types in preschool children without sleep-related breathing disorder

Objective: this study was aimed at characterizing the craniofacial structures, i.e. the facial skeleton, cranial base, dentition, pharyngeal airway space, and the hyoid bone position, in healthy preschool children without sleep-related breathing disorder. Materials and methods: from lateral cephalometric radiographs taken of 92 children for diagnostic purposes, 45 were selected for the present investigation on the basis of head position, and divided according to the classification of Siriwat and Jarabak (Angle Orthod. 55 (1985) 127) into groups representing counter-clockwise (CC), straight downward (SD), and clockwise (C) facial types. Results: the findings showed that, in comparison with the other groups, CC is associated with larger facial taper and posterior facial height, smaller mandibular line angle, ramus position, lower facial height and cranial base angle. By a similar comparison, C is associated with larger mandibular line, gonial angles and convexity, and with a smaller L–1 to mandibular line angle. There were no significant differences in hyoid bone position among the three groups. However, the distance of the lower pharynx was smaller in CC than in C, while the tongue base of CC was noted to be in a posterior position. Conclusions: thus, the results indicate that there are significant differences in the madibular position and form among the present three groups of children. It is proposed that the objective of vertical facial control ought to be included in the treatment of preschool children with malocclusion and respiratory disorder.