Are families of children with reading difficulties at risk for immune disorders and nonrighthandedness?

This study used questionnaire data to examine immune disorders and nonrighthandedness in the families of children enrolled in a learning disabilities school and children attending regular classrooms in public schools. Groups were organized according to their performance on a standardized test of reading comprehension to avoid overlap. In total, 468 questionnaires were returned, from which we were able to derive a final sample of carefully matched subjects: 55 subjects undergoing remediation for reading problems and 55 age- and sex-matched control subjects. The results indicated that children with reading problems and their families more frequently suffered from some immune and autoimmune disorders, particularly those involving the gastrointestinal tract and the thyroid gland. In addition, symptoms of attention deficit hyperactivity disorder were associated with Crohn's disease and migraine headache in the families. There was no evidence of an elevated prevalence of nonrighthandedness in the children with reading problems and their families.     

Emotional self-regulation in preschoolers: The interplay of child approach reactivity, parenting, and control capacities.

This study examined whether child temperamental approach reactivity moderated the association between 2 factors, parenting and child control capacities and child emotional self-regulation. Participants (N=113) were 3- and 4-year-olds (M=48 months, SD=5.78) and their mothers. Emotional self-regulation was measured as observed persistence and frustration and as maternal report of compliance. Parental approach, avoidance, control, and warmth were observed during play and a frustrating wait. Child approach reactivity and control capacities (inhibitory control and soothability) were assessed via maternal report. Results suggested that maternal approach during the wait was associated with persistence and frustration, whereas maternal warmth during the play was associated with compliance. These effects, and those of child control capacities, depended on the level of child approach. The implications of reactivity-control interactions and parent-child goodness-of-fit for emotional self-regulation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The long-term effectiveness and clinical significance of three cost-effective training programs for families with conduct-problem children.

We evaluated the long-term effectiveness of three cost-effective parent training programs for conduct-problem children. One year posttreatment, 93.1% of families (94 mothers and 60 fathers) were assessed on the basis of teacher and parent reports and home observations. Results indicated that all the significant improvements reported immediately posttreatment were maintained one year later. Moreover, approximately two thirds of the entire sample showed ""clinically significant" improvements. There were very few differences between the three treatment conditions except for the ""consumer satisfaction" measure indicating that the treatment combining group discussion and videotape modeling was superior to treatments without both components. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cytogenetic and molecular biology for acute leukemias at diagnosis: a cost/effectiveness comparison

This article presents a cost-effectiveness study comparing cytogenetic and molecular analyses for detection of chromosomal abnormalities which are prognostic factors in acute leukemia. The aim of the study was to determine how these two techniques could substitute or complement one another. The study sample consisted of 107 adult patients with de novo myeloid or lymphoid acute leukemias, tested by both techniques in 1994 and 1995, for identification of translocations t(9;22), t(8;21), t(15;17), t(4;11), t(1;19), the inversion of chromosome 16 and for monosomy 5 or 7 (or deletion of their long arms) and trisomy 8. The criterion for diagnostic effectiveness of these strategies was the rate of detection of true positive anomalies which are clinically relevant, according to the current state of knowledge. On the basis of these observations six alternative strategies at diagnosis were compared (each technique alone or different combinations of the two techniques). The study shows that:-for ALL, PCR alone appears the most cost-effective strategy;-for AML, cytogenetic analysis alone is the best strategy;-sequential strategies are more cost effective than simultaneous use of both techniques for minimising risk of false negatives.     

Neonatal screening for inborn errors of metabolism: cost, yield and outcome

OBJECTIVES. To systematically review the literature on inborn errors of metabolism, neonatal screening technology and screening programmes in order to analyse the costs and benefits of introducing screening based on tandem mass-spectrometry (tandem MS) for a wide range of disorders of amino acid and organic acid metabolism in the UK. To evaluate screening for cystic fibrosis, Duchenne muscular dystrophy and other disorders which are tested on an individual basis. HOW THE RESEARCH WAS CONDUCTED. Systematic searches were carried out of the literature on inborn errors of metabolism, neonatal screening programmes, tandem MS-based neonatal screening technology, economic evaluations of neonatal screening programmes and psychological aspects of neonatal screening. Background material on the biology of inherited metabolic disease, the basic philosophy, and the history and current status of the UK screening programme was also collected. Relevant papers in the grey literature and recent publications were identified by hand-searching. Each paper was graded. For each disease an aggregate grade for the state of knowledge in six key areas was awarded. Additional data were prospectively collected on activity and costs in UK neonatal screening laboratories, and expert clinical opinion on current treatment modalities and outcomes. These data were used to construct a decision-analysis model of neonatal screening technologies, comparing tandem MS with the existing phenylketonuria screening methods. This model determined the cost per additional case identified and, for each disease, the additional treatment costs per case, and the cost per life-year saved. All costs and benefits were discounted at 6% per annum. One-way sensitivity analysis was performed showing the effect of varying the discount rate, the incidence rate of each disorder, the number of neonates screened and the cost of tandem MS, on the cost per life-year gained. RESEARCH FINDINGS. The UK screening programmes for phenylketonuria and congenital hypothyroidism have largely achieved the expected objectives and are cost-effective. Current concerns are the difficulty of maintaining adequate coverage, perceived organisational weaknesses, and a lack of overview. For many of the organic acid disorders it was necessary to rely on data obtained from clinically-diagnosed cases. Many of these diseases can be treated very effectively and a sensitive screening test was available for most of the diseases. Except for cystic fibrosis, there have been no randomised controlled trials of the overall effectiveness of neonatal screening. Despite the anxiety generated by the screening process, there is strong parental support for screening. The effects of diagnosis through screening on subsequent reproductive behaviour is less clear. Conflicts exist between current concepts and the traditional principles of screening. The availability of effective treatment is not an absolute prerequisite: early diagnosis is of value to the family concerned and, to the extent that is leads to increased use of prenatal diagnosis, may help to reduce the overall burden of disease. Neonatal screening is also of value in diseases which present early but with non-specific symptoms. Indeed, almost all of the diseases considered could merit neonatal screening. The majority of economic evaluations failed to incorporate the health benefits from screening, and therefore failed to address the value of the information which the screening programmes provided to parents. The marginal cost of changing from present technology to tandem MS would be approximately 0.60 pounds per baby at a workload of 100,000 samples a year, and 0.87 pounds at 50,000 samples per year. The ability to screen for a wider range of diseases would lead to the identification of some 20 additional cases per 100,000 infants screened, giving a laboratory cost per additional diagnosis of 3000 pounds at an annual workload of 100,000 babies per year.(ABSTRACT TRUNCATED)     

A prospective four-year follow-up study of children at risk for ADHD: psychiatric, neuropsychological, and psychosocial outcome

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a familial disorder that places the siblings of ADHD children at high risk for ADHD, conduct, mood, and anxiety disorders. Although the pattern of psychiatric risk has been well documented by prior family studies, neither the short- nor long-term outcome of these high-risk siblings has been prospectively examined. OBJECTIVE: To document the 4-year psychiatric, psychosocial, and neuropsychological outcome of the siblings of children with ADHD. METHOD: DSM-III-R structured diagnostic interviews and blind raters were used to conduct a 4-year follow-up of siblings from ADHD and control families. The siblings were also evaluated for cognitive, achievement, social, school, and family functioning. RESULTS: At follow-up, significant elevations of behavioral, mood, and anxiety disorders were found among the siblings of ADHD children. The high-risk siblings had high rates of school failure and showed evidence of neuropsychological and psychosocial dysfunction. These impairments aggregated among the siblings who had ADHD. CONCLUSIONS: The siblings of ADHD children are at high risk for clinically meaningful levels of psychopathology and functional impairment. In addition to supporting hypotheses about the familial transmission of ADHD, the results suggest that the high-risk siblings might be appropriate targets for primary preventive interventions.     

At risk for language disorders? Correlates and course of language disorders in preschool children born at risk

The language abilities of 324 children of an at-risk population were investigated at age 2 and 4.5 y. Modified research criteria of the ICD-10 for specific developmental disorders of speech and language were applied. Frequencies between 4% and 7%, depending on age and type of disorder, were diagnosed among children whose performance on the language measure was only 1 instead of ICD-10's 2 SD below group mean, but the discrepancy measure of 1 SD between non-verbal language score and language measure was retained. Psychosocial aspects of a child's environment proved to be better predictors of later language disorders than obstetric complications. Stability of specific language disorders was on the whole fairly low, but children who perform below age level on language measures remained at risk. Gender differences are almost compensated by the age 4.5 y.     

Adolescents'' judgements of the seriousness of disruptive behaviour at school and of the sanction appropriate for dealing with it

Experiments on hippocampal slices were carried out in order to find out whether the release of noradrenaline in the hippocampus can be modulated through P2-receptors. The slices were preincubated with [3H]-noradrenaline, superfused with medium containing desipramine (1 microM), and stimulated electrically, in most experiments by 4 pulses/100 Hz. The adenosine A1-receptor agonist N6-cyclopentyl-adenosine (CPA) and the nucleotides ATP, adenosine-5'-O-(3-thiotriphosphate) (ATP gamma S) and adenosine-5'-O-(2-thiodiphosphate) (ADP beta S) decreased the evoked overflow of tritium by up to 55%. The adenosine A2a-agonist 2-p-(2-carboxyethyl)-phenethylamino-5'-N-ethylcarboxamido-adenosin e (CGS 21680; 0.003-0.3 microM) caused no change. The concentration-response curve of CPA was shifted to the right by the A1-antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX; 3 nM) but not by the P2-receptor antagonists cibacron blue 3GA (30 microM) and reactive blue 2 (30 microM); the apparent pKB value of DPCPX against CPA was 9.0. In contrast, the concentration-response curve of ATP was shifted to the right by DPCPX (3 nM), apparent pKB 8.7, as well as by cibacron blue 3GA (30 microM), apparent pKB 5.2, and reactive blue 2 (30 microM), apparent pKB 5.6; the antagonist effects of DPCPX and cibacron blue 3GA were additive in a manner compatible with the blockade of two separate receptors for ATP. The same pattern was obtained with ATP gamma S: its concentration-response curve was shifted to the right by DPCPX as well as by cibacron blue 3GA and reactive blue 2. Suramin (300 microM) antagonized neither the effect of ATP nor that of ATP gamma S. The 5'-nucleotidase inhibitor alpha, beta-methylene-ADP (100 microM) did not change the effect of ATP. Only cibacron blue 3GA (30 microM) but not reactive blue 2 (30 microM), given alone, consistently caused a small increase of the evoked overflow of tritium. Hippocampal slices degraded exogenous ATP, and this degradation was reduced by cibacron blue 3GA (30 microM), reactive blue 2 (30 microM) and suramin (300 microM). The results indicate that the noradrenergic terminal axons of the rat hippocampus possess P2-receptors in addition to the known A1-adenosine receptors. The presynaptic P2-receptors mediate an inhibition of noradrenaline release, are activated by nucleotides but not nucleosides, and are blocked by cibacron blue 3GA and reactive blue 2. ATP and ATP gamma S act at both the A1- and the P2-receptors. An autoreceptor function of cerebral presynaptic P2-receptors remains doubtful.     

Transporting an evidence-based classroom management program for preschoolers with disruptive behavior problems to a school: An analysis of implementation, outcomes, and contextual variables.

The transportability of an evidence-based teacher professional development program, the Incredible Years Classroom Management Program, was evaluated. This study compared the impact of two training methods: self-administered videotape modeling (VM) and self-administered videotape modeling plus consultation (VMC) on teachers' use of classroom management strategies, reductions in disruptive behaviors, acceptability, and contextual barriers of sustaining EBIs in practice settings. Four pairs of teachers (N = 8) were randomly assigned to VM or VMC conditions in a multiple probe design. Students (1-2 per classroom; N = 13) displaying high levels of externalizing problems also participated. Statistically significant between-groups differences in teacher confidence ratings, use of positive instructional practices, and acceptability favored the VMC condition. Positive trends favoring VMC students, including clinically significant increases in social competence, were also found. Although students in both groups exhibited reductions in disruptive behaviors, significant between-groups differences related to disruptive behavior were not observed. Findings related to contextual variables (e.g., time, cost, institutional support, adaptability of the program) have implications for future adoption of this program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: Individuals with symptoms of attention-deficit/hyperactivity disorder are uniquely at risk.

Most prior literature examining the relations among attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use and abuse suggests that CD fully accounts for the ADHD-substance abuse relation. This study sought to test an alternate theory that individuals with symptoms of both ADHD and CD are at a special risk for substance abuse. Relations between childhood ADHD and CD symptoms, and young adult tobacco, alcohol, marijuana, and hard drug use and dependence symptoms, were examined in a sample of 481 young adults. ADHD and CD symptoms interacted to predict marijuana dependence symptoms and hard drug use and dependence symptoms, such that individuals with high levels of both ADHD and CD had the highest levels of these outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for disruptive behavior syndromes in children: The application of latent class analyses and implications for prevention programs.

The predictive accuracy of classifying children at risk for disruptive disorders through latent class analyses (LCA) was evaluated. Child Behavior Checklist/4-18 (T. M. Achenbach, 1991) items, reflecting symptoms of Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) defined disruptive disorders, alone and in combination with other child and familial risk factors, were used to predict children's risk for disruptive disorder. Predictive accuracy reached a positive predictive value of 69%. Children incorrectly classified (false positive and false negative) were compared with correctly classified children (true positive and true negative) on risk factors in the family context to test whether the screening procedure could be improved through a multiple-gating procedure. The differences in familial context factors between these children were limited, and no clear indications were found on how to use familial context factors to improve the screening procedure after the initial classification by LCA. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification of patients at risk for nonresponse and negative outcome in psychotherapy.

This study evaluated the use of pretherapy patient variables as correlates of 3 categorical types of outcome: negative response (negative change of more than 1 normative SEest on depression measure): nonresponse (change within?±?1 SEest on depression measure); and positive response (positive change of more than 1 SEest on depression measure) to psychotherapy among 62 patients with major depressive disorder. By using 4 scales from the Brief Symptom Inventory, the Inventory of Interpersonal Problems, age, and sex, 75.8% of the Ss were correctly classified into the 3 groups. Negative responders were characterized by high levels of interpersonal difficulty and low levels of subjective distress. Nonresponders displayed moderate levels of both interpersonal difficulties and subjective distress. Positive responders displayed high levels of both interpersonal difficulties and subjective distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unexplained physical symptoms: outcome, utilization of medical care and associated factors

BACKGROUND: Measurement of intracardiac hemodynamic parameters has been limited to brief periods in the acute care setting. We developed and evaluated an implantable hemodynamic monitor that is capable of measuring chronic right ventricular oxygen saturation and pulmonary artery pressure. METHODS AND RESULTS: The device consists of an electronic controller placed subcutaneously and two transvenous leads placed in the right ventricle (reflectance oximeter) and pulmonary artery (variable capacitance pressure sensor). Implantation was performed in 10 patients with severe left ventricular dysfunction. Average implant pulmonary artery pressures were systolic, 52 +/- 16 mm Hg; diastolic, 29 +/- 11 mm Hg; and mean, 40 +/- 12 mm Hg. The mean right ventricular oxygen saturation at implant was 51%. Provocative maneuvers, including postural changes, sublingual nitroglycerin, and bicycle exercise, demonstrated expected changes in measured oxygen saturation and pulmonary artery pressures over time. At follow-up of 0.5 to 15.5 months, there were no significant differences between pulmonary artery pressures or oxygen saturation values transmitted from the device and simultaneous measurement with balloon flotation catheters. Four of the pulmonary artery leads dislodged and three demonstrated sensor drift, whereas two of the oxygen saturation sensors failed. Four patients died and four received transplants. Pathological study did not demonstrate injury to the right ventricular outflow tract or pulmonic valve. CONCLUSIONS: Chronic measurement of hemodynamic parameters in the outpatient setting with implantable sensor technology appears to be feasible. The devices are well tolerated without significant untoward effects, and the sensors generally function well over time, providing reliable information. Clinical usefulness remains to be established.     

Detection of youth at high risk for substance use disorders: A longitudinal study.

This study extends prior research (D. Clark, J. Cornelius, L. Kirisci, & R. Tarter, 2005) by determining whether variation in the developmental trajectories of liability to substance use disorder (SUD) is contributed by neurobehavioral disinhibition, parental substance use involvement, and demographic variables. The sample, participants in a long-term prospective investigation, consisted of 351 boys, evaluated at ages 10-12, 12-14, 16, 19, and 22, whose parents either had SUD or no adult psychiatric disorder. Neurobehavioral disinhibition in childhood, in conjunction with parental lifetime substance use/SUD, place the child at very high risk for SUD by age 22 if psychosocial maladjustment progresses in severity in early adolescence. These results indicate that monitoring social adjustment during the transition from childhood to mid-adolescence is important for identifying youth at very high risk for succumbing to SUD by young adulthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Greater reinforcement from alcohol for those at risk: Parental risk, personality risk, and sex.

The effects of a high dose of alcohol (1 g ethanol/kg body weight) on physiological and self-report responses to two stressors (electric shock and self-disclosing speech) were compared with the effects of a placebo in three groups of nonalcoholic subjects considered to be at heightened risk for alcoholism by virtue of their (a) having an alcoholic parent (parental risk) or (b) matching a prealcoholic personality profile (personality risk), or (c) having an alcoholic parent and matching a prealcoholic personality profile. These high-risk groups were contrasted with a low-risk group that had neither risk factor. Male and female subjects were tested in each group with appropriate controls for drinking experience and, for female subjects, phase of menstrual cycle. Results indicated that a potentially reinforcing effect of alcohol (its capacity to attenuate physiological responses to stress) was more pronounced in high-risk subjects than in low-risk subjects. This relation was found for both parental risk and personality risk factors and in both male and female subjects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal communication: Predictors of outcome at follow-up in a sample of children at high and low risk for depression.

Separate lines of investigation have shown the increased risk of dysfunction for children of depressed women and impaired interaction between depressed mothers and their children. The link between the two was examined in 57 children at high and low risk for depression. Children of unipolar depressed, bipolar depressed, chronically medically ill, and normal, mothers were evaluated at a 6-mo follow-up. Hierarchical regression analyses suggested a relation between maternal interaction behavior on 2 dimensions, task focus and affective quality, and children's subsequent depression and school behavior; academic performance was related only to affective quality of interaction. Chronic stress was predictive of more negative, critical maternal behavior, whereas depressed mood was associated with less task involvement. Maternal interactions are viewed as a marker of a complex, mutual process involving interpersonal relationships in an adverse environmental context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Food, mood, and attitude: Reducing risk for eating disorders in college women.

Food, Mood, and Attitude (FMA) is a CD-ROM prevention program developed to decrease risk for eating disorders in college women. Female 1st-year students (N = 240) were randomly assigned to the intervention (FMA) or control group. Equal numbers of students at risk and of low risk for developing an eating disorder were assigned to each condition. Participants in the FMA condition improved on all measures relative to controls. Significant 3-way interactions (Time × Condition × Risk Status) were found on measures of internalization of sociocultural attitudes about thinness, shape concerns, and weight concerns, indicating that at-risk participants in the intervention group improved to a greater extent than did low-risk participants. At follow-up, significantly fewer women in the FMA group reported overeating and excessive exercise relative to controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aiding troubled employees: the prevalence, cost, and characteristics of employee assistance programs in the United States

Bilirubin neurotoxicity can be mediated by numerous mechanisms due to its increased permeability in neuronal membranes. The present study tests the hypothesis that a prolonged bilirubin infusion modifies the N-methyl-D-aspartate (NMDA) receptor/ ion channel complex in the cerebral cortex of newborn piglets. Studies were performed in seven control and six bilirubin-exposed piglets, 2-4 d of age. Piglets in the bilirubin group received a 35 mg/kg bolus of bilirubin followed by a 4-h infusion (25 mg/kg/h) of a buffer solution containing 0.1 N NaOH, 5% human albumin, and 0.055 Na2HPO4 with 3 mg/mL bilirubin. The final mean bilirubin concentration in the bilirubin group was 495.9 +/- 85.5 mumol/L (29.0 +/- 5.0 mg/dL). The control group received a bilirubin-free buffer solution. Sulfisoxazole was administered to animals in both groups. P2 membrane fractions were prepared from the cerebral cortex. [3H]MK-801 binding assays were performed to study NMDA receptor modification. The Bmax in the control and bilirubin groups were 1.20 +/- 0.10 (mean +/- SD) and 1.32 +/- 0.14 pmol/mg protein, respectively. The value for Kd in the control brains was 6.97 +/- 0.80 nM compared with 4.80 +/- 0.28 nM in the bilirubin-exposed brains (p < 0.001). [3H]Glutamate binding studies did not show a significant difference in the Bmax and Kd for the NMDA-specific glutamate site in the two groups. The results show that in vivo exposure to bilirubin increases the affinity of the receptor (decreased Kd) for [3H]MK-801, indicating that bilirubin modifies the function of the NMDA receptor/ion channel complex in the brain of the newborn piglet. We speculate that the affinity of bilirubin for neuronal membranes leads to bilirubin-mediated neurotoxicity, resulting in either short- or long-term disruption of neuronal function.