The treatment of elective mutism as stranger reaction.

Discusses the treatment of 15 preschool children with elective mutism (EM), which involves a fixation at or a regression to an earlier developmental stage when children typically exhibit stranger anxiety. It is suggested that the treatment of EM children should be determined by developmental considerations as well as etiological theories and that treatment should focus on unblocking of maturational processes. Treatment techniques and setting are described. Case examples illustrate that there were subtypes of EM children who were compliant and who were noncompliant and aggressively avoidant. The former responded to slow, psychodynamically oriented treatment and the latter responded to group therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reflux esophagitis in infants and children: a report from the Working Group on Gastro-Oesophageal Reflux Disease of the European Society of Paediatric Gastroenterology and Nutrition

In this article, the Working Group on Gastro-Oesophageal Reflux of the European Society of Paediatric Gastroenterology and Nutrition presents and discusses a definition of reflux esophagitis and recommends a diagnostic approach and therapeutic management for this condition. Histologic criteria for reflux esophagitis, modified and adapted to the particular needs of infants and children, are suggested. Upper gastrointestinal endoscopy is recommended as the technique of choice in infants and children presenting with symptoms suggestive of reflux esophagitis. Prokinetics, although still a relatively new drug family, have already established a definitive place in the treatment of gastroesophageal reflux disease in infants and children and could also be used in the treatment of nonulcerative esophagitis, as suggested in the literature. If the esophagitis is more severe (ulcerative), treatment should initially consist of H2 blockers and then be continued with prokinetics. New drugs, such as omeprazole, are suggested in cases refractory to H2 blockers. Surgery is indicated in life-threatening conditions or if the esophagitis is resistant to adequate medical management.     

A brief reminder about documenting the psychological consultation.

The documentation of clinical services has taken on unprecedented importance for practicing psychologists. Structuring quality care, decreasing liability exposure, and fulfilling requirements for reimbursement are primary objectives in pursuing thorough documentation practices. As a practice aid and a brief reminder, the authors review the basic structure for documenting an initial evaluation, highlighting content areas that are felt to be important for attaining the objectives noted above. The authors suggest that psychologists use the term psychological consultation to specify this procedure, designating it as a distinct process from psychological testing or psychological treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spondylolisthesis in childhood and adolescence

Isthmic spondylolisthesis occurs in 4.4% of children. In general it is a benign condition. The majority of individuals with mild or moderate isthmic vertebral slip remain free of symptoms or get only mild symptoms. In children and adolescents with mild slip, primary treatment of pain symptoms is non-operative. Young children before the growth spurt need radiological follow-up for documentation of possible slip progression. If the slip exceeds 25% in a child, segmental fusion to prevent further progression should be considered. Uninstrumented posterolateral fusion is the method of choice for treatment of pain symptoms not responding to conservative measures in slips up to 50%. In severe slips (> 50%), anterior or combined fusion is necessary to prevent further progression of lumbosacral kyphosis. The clinical and subjective results of in situ fusion in this age group are satisfactory in 80-90% of cases. Slip reduction is possible. It requires internal fixation and is connected with a higher risk of complications. The results of slip reduction have not yet been shown to be superior to results after in situ fusion. It may be performed in cases of spondyloptosis with severe impairment of function and sagittal malalignment of the spine.     

Behavioral treatment of childhood obesity.

[Correction Notice: An erratum for this article was reported in Vol 103(3) of Psychological Bulletin (see record 2008-10688-001). Tables 1 and 2 contain several errors. The correct data is provided in the erratum. These errors do not influence any of the main points or conclusions in this article.] Obesity is a common problem in children and is associated with an increased risk of adult obesity. Twenty-four studies on the behavioral treatment of childhood obesity are reviewed. Studies involving comparisons of behavioral treatment with no treatment or placebos have shown the superiority of behavioral treatment. In addition, the effects of a number of treatment factors on outcome are suggested. These factors include parental involvement, the arrangement of treatment contingencies, and exercise. Several directions for future research are presented, including selecting which children to treat, individualizing treatment, prevention, community programs, and the side effects of weight control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnosis, assessment, and treatment of internalizing problems in children: The role of longitudinal data.

Examines the role of longitudinal data in the diagnosis, assessment, and treatment of internalizing disorders in children and adolescents. On the basis of the limited longitudinal data available, it is suggested that internalizing disorders in children and adolescents are highly prevalent, frequently comorbid with other childhood disorders, and, arguably so, persistent over time. However, it is also noted that a considerable amount of instability characterizes these disorders and that the developmental course is not fully understood at this time. In addition, these disorders are responsive to treatment, at least on a short-term basis. Finally, a plea is made for longitudinal studies that use a developmental perspective in examining internalizing disorders in children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reading at the instructional level with children identified as learning disabled: Potential implications for response-to-intervention.

Curriculum-based assessment assesses the match between curriculum and student skill by computing the percentage of known words in a reading task and comparing it to the instructional level criterion of 93% to 97% known. The current study examined the effect of preteaching unknown words to 29 third-grade children identified as learning disabled (LD) to facilitate an instructional level within a third-grade curriculum. Second, the study examined the potential implications for implementing response-to-intervention. Results suggested that children within the treatment condition were more likely to read at the instructional level and demonstrated progress within a local curriculum that significantly exceeded a control group who received guided reading activities. The correlation between number of passages read at the instructional level and reading progress within the curriculum was .80. Finally, 65.5% of the children who received the treatment were identified as responding to treatment, as compared to 27.6% of the control group. Potential implications for practice and suggestions for future research are included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing discrimination against volunteers in prophylactic HIV vaccine trials: lessons from a phase II trial

OBJECTIVE: This was a randomized, double-blind, crossover study of 30 children with attention-deficit/hyperactivity disorder (ADHD) that evaluated the time course effects of four doses of Adderall (5, 10, 15, and 20 mg), an inactive control (placebo), and a positive control (clinical dose of methylphenidate). METHOD: For each treatment condition, a capsule was administered in the morning and assessments were performed in an analog classroom setting every 1.5 hours across the day. Subjective (teacher ratings of deportment and attention) and objective (scores on math tests) measures were obtained for each classroom session, and these measures were used to evaluate time-response and dose response effects of Adderall. RESULTS: For doses of Adderall greater than 5 mg, significant time course effects were observed. Rapid improvements on teacher ratings and math performance were observed by 1.5 hours after administration, and these effects dissipated by the end of the day. The specific pattern of time course effects depended on dose: the time of peak effects and the duration of action increased with dose of Adderall. CONCLUSIONS: This documentation of efficacy in a controlled study supports the addition of Adderall to the armamentarium of psychotropic medications for the treatment of ADHD. The differences in time-response patterns of Adderall and methylphenidate may help tailor treatment to meet specific clinical needs of different children with ADHD.     

Using fine-grained indexes of therapists' experience and training to predict treatment outcomes in a university-based training clinic for children and families.

Over several decades, researchers have debated whether a clinician's training and experience are associated with treatment outcome. Recent studies have suggested that fine-grained variables representing training or experience are better predictors of clinical effectiveness than broader measures, such as level of education. The present study addressed whether a therapist's number of direct client contact hours, days in doctoral training, and number of settings in which services were delivered were positively associated with meeting treatment goals in a university-based training clinic serving children and families. Results suggested each of these variables significantly predicted successful treatment completion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent-child interaction therapy: A comparison of standard and abbreviated treatments for oppositional defiant preschoolers.

Families of 54 behaviorally disturbed preschool-aged children (3 to 5 years) were randomly assigned to 1 of 3 treatment conditions: standard parent-child interaction therapy (PCIT; STD); modified PCIT that used didactic videotapes, telephone consultations, and face-to-face sessions to abbreviate treatment, and a no-treatment waitlist control group (WL). Twenty-one nondisturbed preschoolers were recruited as a social validation comparison condition. Posttreatment assessment indicated significant differences in parent-reported externalizing behavior in children, and parental stress and discipline practices from both treatment groups on most measures compared with the WL group. Clinical significance testing suggested a superior effect for the STD immediately after intervention, but by 6-month follow-up, the two groups were comparable. The findings indicate that abbreviated PCIT may be of benefit for families with young conduct problem children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Behavioral treatment of childhood obesity": Correction to Epstein and Wing.

Reports an error in "Behavioral treatment of childhood obesity" by Leonard H. Epstein and Rena R. Wing (Psychological Bulletin, 1987[May], Vol 101[3], 331-342). Tables 1 and 2 contain several errors. The correct data is provided in the erratum. These errors do not influence any of the main points or conclusions in this article. (The following abstract of the original article appeared in record 1987-25951-001.) Obesity is a common problem in children and is associated with an increased risk of adult obesity. Twenty-four studies on the behavioral treatment of childhood obesity are reviewed. Studies involving comparisons of behavioral treatment with no treatment or placebos have shown the superiority of behavioral treatment. In addition, the effects of a number of treatment factors on outcome are suggested. These factors include parental involvement, the arrangement of treatment contingencies, and exercise. Several directions for future research are presented, including selecting which children to treat, individualizing treatment, prevention, community programs, and the side effects of weight control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Filmed versus live delivery of full-spectrum home training for primary enuresis: Presenting the information is not enough.

To extend availability of a behavioral treatment package for enuresis, two outcome studies compared the effectiveness of live versus videotape delivery. In Study 1, 40 primary enuretics were randomly assigned to live or film delivery. Outcome was superior for the live delivery. Overall, pretreatment measures of family and child psychosocial adjustment failed to predict treatment response. The results were replicated with 18 children, and an impact assessment suggested that film delivery resulted in higher confidence of children in their parents but lower confidence of parents in their children. Delivery of treatments by videotape may provide a way to identify nonspecific factors in psychological interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of artemether/benflumetol, a new antimalarial and pyrimethamine/sulfadoxine in the treatment of uncomplicated falciparum malaria in African children

We report here the results of a randomized double blind trial comparing coartemether (CGP56697), a combination of artemether and benflumetol, with pyrimethamine/sulfadoxine (P/S). Two hundred eighty-seven children 1-5 years of age with uncomplicated falciparum malaria were enrolled at two centers in The Gambia between July 1996 and December 1996. Following treatment, children were visited at home every 24 hr until a blood film free of asexual parasites was obtained. Genotyping of parasites was used to distinguish recrudescence from new infections. Three days after the start of treatment, 133 (100%) of the CGP56697-treated children compared with 128 (93.4%) of children treated with P/S had cleared their parasites (P = 0.003). The day 15 cure rate was 93.3% for CGP56697 and 97.7% for P/S (P = 0.13). Within the third and fourth week after initiation of therapy, 20 children treated with CGP56697 and one of the P/S-treated children returned with second malaria episodes (P < 0.0001). Genotyping suggested that the majority (19 of 23 [82.6%]) of these second episodes were due to new infections, supporting the World Health Organization recommendation that longer follow-up is not relevant for the assessment of drug efficacy. At the two-week follow-up, 28.9% of the P/S treated children but none of the CGP56697-treated children carried gametocytes (P < 0.0001). This study showed that CGP56697 is safe in African children with acute uncomplicated falciparum malaria, clears parasites more rapidly than P/S, and results in fewer gametocyte carriers. More frequent new infections within the third and fourth week following treatment with CGP56697 than treatment with P/S are likely to be due to the short prophylactic effect of CGP56697.     

Acute upper respiratory tract infections and indications for tonsillectomy in children. I. Immunoglobulin synthesis in the palatine tonsil tissue

Current viewpoints and practice concerning indications for tonsillectomy are presented. The annual specific risk for upper respiratory infection in children aged up to 15 is 1.1. The risk is higher in the youngest age group, in whom it rises to 1.8, decreasing with age and being lowest among children aged 12-15 years (0.5). The proportion of tonsillitis among acute upper respiratory tract infections is highest in the age group up to 3 years (36.9%); at the age of 4-5 years it is 37.1%, and is lowest among children aged 12-15 years (21.9%). The risk of tonsillitis caused by streptococci is highest among children aged up to 5 years. Statistical significance of differences in the synthesis of immunoglobulins (G, M, A and sA) and lysozymes in the palatine tonsil tissue of tonsillectomized children and healthy volunteers was tested by non-parametric tests for independent samples. Significant differences of the above mentioned syntheses were found in all entities studied. Any contribution to the documentation on the nature and cause of each tonsillitis in childhood is of great clinical value, because it is the only basis for rational consideration of indications for tonsillectomy.     

Effect of oral sensorimotor treatment on measures of growth and efficiency of eating in the moderately eating-impaired child with cerebral palsy

Thirty-five children with cerebral palsy and moderate eating impairment were studied to determine the effect of oral sensorimotor treatment (OST) on eating efficiency and measures of growth (weight gain). After taking effects of maturation into account, 11 children who received OST (group A) exceeded their expected centile line by 1.7 percentile points after 10 weeks of treatment. Chewing exercises alone (group B) had no effect on weight gain. Although small decreases occurred in the time needed to eat three standard textures of food (solid, viscous, puree) in groups A and B, these were not significant. Children maintained their weight-for-age percentile line although at the lower end of expected norms. These children will be at risk of growth failure because of the increased energy demands once they enter their teenage growth spurt. The clinical implications of these findings are that prolonged mealtime and oral-motor therapies may be adequate through the childhood years. Thereafter, children's growth must be monitored carefully, and oral caloric supplementation is suggested to provide the necessary energy for growth.     

The effect of family variables on child weight change.

Analyzed the effects of family variables (e.g., family size, family weight composition, parental weight) on child weight loss in a series of family-based, behaviorally oriented weight control programs for children from 102 families. Results show that the amount of relative weight change was related to initial treatment success, the number of children in the family, and the gender of the child. Children who were more successful lost more weight initially, had fewer siblings, and were female. It is suggested that family size may interact with treatment to determine weight change, possibly by reducing the amount of time a parent has to spend promoting behavior change or the effectiveness of parents in managing their children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnosis of disturbed children.

Asserts that although there has been agreement that diagnosis of disturbed children is an important part of professional concern and service, activities labeled "diagnostic" or "evaluative" have not always been clearly in the disturbed child's interest. Psychology and psychologists have much to offer in developing more effective diagnostic procedures for disturbed children, especially in terms of identifying those children vulnerable or at risk for severe disturbance of adult adjustment. It is suggested that concerns with cost-effectiveness may have been responsible for such practices as inadequate testing. Guidelines are suggested for proper diagnostic evaluation of disturbed children. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of aging on gastrointestinal mucosal immunity

More than two million tympanotomy tubes are placed annually in the United States, making this operation the most common performed on children. This article provides an overview of the applications of tympanotomy tubes for the treatment for otitis media in childhood. The indications for tube placement are discussed; a visual guide for managing children with tympanostomy tubes is presented; an approach to dealing with tube complications is outlined; and guidelines for referral to a pediatric otolaryngologist are suggested.     

Short communication: skeletal maturation of children with sex chromosome abnormalities

Skeletal maturity, or "bone age," is one of the several criteria used to determine developmental or physiologic age as opposed to chronologic age. The purpose of this study of skeletal maturation of children with sex chromosome abnormalities (45,X, 47,XXX, 47,XXY, X-chromosomal mosaics) and controls is 2c-fold: (1) to investigate if children with sex chromosome aneuploidy ascertained in an unbiased fashion differ in skeletal maturation from their siblings and other normal healthy children born in Denver, Colorado, and (2) to assess if the skeletal age standards currently in use (Greulich-Pyle; Tanner- Whitehouse) are applicable to Denver children when evaluating radiographs for skeletal maturation. Mean chronologic and skeletal age were measured. Mean differences between skeletal and chronologic age for all groups across all measures were calculated. The 45,X females constitute the only group studied with bone ages lower than expected (0.05 greater than P greater than 0.01; two-tailed test). We found no other significant differences in skeletal maturation between Denver children with sex chromosome abnormalities and their siblings or the control sample of Denver children. Although we found the Tanner-Whitehouse standards to be more applicable for use with this population, all the Denver groups investigated yielded consistently lower bone ages than expected published norms. This is the first documentation in a group of children with sex chromosome abnormalities, ascertained in an unbiased fashion, that, with the exception of those with a 45,X karyotype, bone age is not significantly different from that of the normal population.     

Roles of approval motivation and social reinforcement in children's discrimination learning.

144 3rd- and 4th-grade children were given a 2-choice discrimination learning task. The 2 major factors were (a) the 3 levels of social desirability (high, moderate, and low) on the Children's Social Desirability scale; and (b) the 2 types of treatment conditions (monetary-social reinforcement and monetary-no social reinforcement). In opposition to D. P. Crowne and D. Marlowe's (1961) model of the approval-motivated individual, the high-social-desirability group made significantly fewer errors than both the moderate and low groups. It is suggested that for young children, social desirability scores may require a different interpretation than scores for older children and adults. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)