Acute and chronic pelvic pain in female adolescents

Pelvic pain in adolescents is a common and frequently puzzling symptom with many possible causes. The patients who suffer from this symptom, by and large, have diagnosable and treatable causes. A sensible, studied, and progressive approach by a warm and accepting physician usually is the key to successful diagnosis and management of this condition.

Psychological adjustment and coping in a population of children with recurrent syncope

The authors examined the association of psychological adjustment, styles of coping, and disease severity for children with recurrent syncope. Participants were 44 children and adolescents with a history of recurrent syncope and 40 healthy comparison control children. Dependent variables were measures of internalizing adjustment (e.g., anxiety, depression, withdrawal) reported by children and their parents and styles of coping reported by children. Parents reported higher frequencies of the internalizing of behavioral symptoms (i.e., anxiety, withdrawal) for children with recurrent syncope compared with their healthy counterparts. Children's self-reports did not reveal significant differences between the syncope and comparison groups in psychological adjustment and styles of coping. The authors conclude from these findings that adjustment difficulties, including symptoms of anxiety and social withdrawal, may occur with recurrent syncope. Implications for clinical practice and future research are discussed.

Castleman's disease of the left triceps in a child suspected to be a small round cell tumor of childhood

Castleman's disease (CD) is histologically characterized by a proliferation of polyclonal small lymphocytes and plasma cells. The clinical presentation varies widely, but most commonly manifests as a solitary mediastinal mass, incidentally found on radiographic examination. We present a case of a 10-year-old girl who exhibited a left arm mass which, preoperatively and on frozen section, was diagnosed as a small round cell tumor of childhood (SRCT). This report emphasizes the unusual location of CD in the soft tissue and as a rare entity to be considered in the differential diagnosis of SRCT.

Uleine and demethoxyaspidospermine from the bark of Plumeria lancifolia

The isolation of (+)-uleine (1) and (+)-demethoxyaspidospermine (2) from the bark of Plumeria lancifolia is reported along with (1)H- and (13)C-NMR data.

Identity in adolescent survivors of childhood cancer

OBJECTIVE

To investigate identify formation among adolescent survivors of childhood cancer. Family functioning, perceived emotional support from family and peers, life stress, and anxiety produced by the cancer experience also were examined as they influenced identity development.

METHOD

Participants were 52 adolescent survivors and their mothers recruited from a medical center and 42 healthy adolescent counterparts and their mothers recruited from the community.

RESULTS

A greater frequency of survivors than their healthy peers was found within the foreclosed identity status. Factors associated with the foreclosed identity status included the cancer diagnosis, symptoms of posttraumatic stress disorder (PTSD), and family functioning characterized by greater levels of conflict.

CONCLUSIONS

Data were interpreted to suggest that the foreclosed identity status may serve a protective function in assisting survivors to cope with the stressors of the cancer experience.

Social skills and psychological adjustment of child and adolescent cancer survivors

Social skills and psychological adjustment for survivors of childhood cancer were investigated. Cancer survivors included 42 children and adolescents ranging in age at evaluation from 6 to 18 years with a mean age of 13.1 years. Measures included teacher and parent ratings of social skills and adjustment and parent ratings of family functioning. The findings showed that social skills and psychological adjustment as rated by both parents and teachers were primarily associated with academic functioning. In addition, family cohesiveness was found to account for nearly one third of the variance in survivors' adjustment when rated by teachers, and length of time off treatment accounted for a significant percentage of the variance in children's adjustment when rated by parents. The findings underscore the importance of a multi-informant approach to the assessment of psychological adjustment of pediatric cancer survivors and demonstrate the role of learning difficulties and family functioning in influencing social skills and adjustment for these children and adolescents.

Adolescent sexuality at the dawn of the 21st century

Human sexuality can be defined as including the physical characteristics of and capacities for specific sex behaviors, together with psychosocial values, norms, attitudes, and learning processes that influence these behaviors. It also includes a sense of gender identity and related concepts, behaviors, and attitudes about the self and others as women or men in the context of one's society. At the dawn of the new century, adolescent sexuality remains a topic of concern to adults throughout the world. This concern is not unique to this new age. In each era of recorded history, adults have been concerned about adolescent sexual behavior, particularly sexual intercourse and its consequences. Things have not changed all that much in the realm of adolescent sexual behavior. What has changed is our ability to prevent the serious consequences of this behavior and, hopefully, to help adolescents avoid behaviors that put them at risk for the negative consequences of expressing their burgeoning sexuality. This article reviews the major influences on adolescents developing' sexuality, the data on adolescent sexual activity, some tips on caring for adolescents comprehensively, and ends with some predictions of how this issue will be addressed in the new century.

Evaluation of methods for transient transfection of a murine macrophage cell line, RAW 264.7

Monocyte/macrophage cell lines are fastidious cells commonly used in transient transfection experiments. In the course of a study of gene regulation by lipopolysaccharide (LPS), we have compared several methods for DNA-mediated cell transfection to determine which would be optimally applicable to the macrophage line, RAW 264.7. Both the response level (LPS inducibility) and the degree of inter-assay variation were evaluated for each transfection technique. The following methods were compared: Lipofectin, LipofectAMINE, LipofectAMINE PLUS, SuperFect, Ca3(PO4)2 DNA co-precipitation, DEAE dextran-mediated transfection and electroporation. The transfected plasmid DNA included a luciferase reporter construct containing the junB minimal promoter under the control of an LPS-inducible 1300-bp regulatory fragment downstream of junB 5'-flanking sequence, as well as a beta-galactosidase reporter construct under the adenovirus promoter and enhancer used as an internal control. Electroporation, followed by a resting period of 16-24 h before stimulation with LPS, had the highest inducibility of all methods. DEAE dextran and Ca3(PO4)2 precipitation showed the least and the greatest inter-assay variation, respectively. For all other methods, inter-assay variability fell within this range. The results presented may serve as both a general reference and a guide for reporter gene studies in this or other macrophage cell lines.

Longitudinal follow-up of the intellectual and academic functioning of children receiving central nervous system-prophylactic chemotherapy for leukemia: a four-year final report

This longitudinal investigation extends our prospective study of the intellectual and academic functioning of children treated for cancer to 4 years after diagnosis. In the longer term, the children who received central nervous system (CNS) chemotherapy experienced greater neurocognitive deficits, particularly in the area of academic achievement, than did the children who did not receive CNS chemotherapy. Specifically, the CNS chemotherapy-treated children scored lower on academic tests of reading at 3 and 4 years after diagnosis. The results suggest that CNS chemotherapy prophylaxis may adversely effect the development of higher-order mental abilities and cognitive skills during the late-effects period and may also impair academic achievement.

Stimulant medication for the child with attention-deficit/hyperactivity disorder

Stimulant medications have been used to manage the associated symptoms of ADHD including inattention, developmentally inappropriate levels of activity, distractibility, and impulsivity. To date, clinical trials clearly have established the efficacy of the stimulants on the core symptoms of ADHD and associated aggression. Although the stimulants improve classroom productivity and behavior, few data have demonstrated the effectiveness of the stimulants on academic achievement. Finally, there has been a paucity of data on the long-term efficacy and safety of stimulants. Recommendations are made for future research studies that examine the integration of stimulant medication with other psychosocial therapies, particularly behavior management.

Knowledge of physician prescriptions and adherence to treatment among children with cystic fibrosis and their mothers

This investigation examined factors related to adherence to treatment regimens for children with cystic fibrosis (CF) and their mothers. Subjects were 45 children with CF who ranged in age from 6 to 10 years and their mothers. Findings revealed that children's and parents' reports of level of adherence were related to their knowledge of the specific details associated with medically prescribed treatments. In this sample, 12% to 32% of mothers did not have an accurate understanding of physician recommendations for their children's treatments. When controlling for individual differences in the prescribed treatment regimens, parents' and children's knowledge of what had been prescribed accounted for a significant portion of the variance in the children's reported treatment-related behaviors. Results are discussed in terms of implications for future intervention research aimed at enhancing adherence to treatment as well as for future directions for clinical efforts in this area.

Case studies: psychological test findings for two children with X-linked adrenoleukodystrophy

Psychological evaluations were performed on two children with X-linked adrenoleukodystrophy. Case histories are presented that describe the natural history of the disorder and its symptom patterns, some of which mirror psychiatric disorders of childhood. Psychological evaluation test scores for both boys are displayed in a table, and commonalities and differences are discussed. Findings are reviewed to expedite the referral process for a definitive diagnosis. Guidelines are provided regarding the differential diagnosis of adrenoleukodystrophy and other neurodegenerative disorders of childhood from the more prevalent disorders of behavior and learning that may present in a developmental clinic. Finally, recommendations for psychological interventions with the affected child and family members are provided.

Family functioning and social support in the adaptation of caregivers of children with sickle cell syndromes

OBJECTIVE

To examine moderating effects of family functioning and social support on the relationship of child-related stressors to caregivers' psychological adaptation in a sample of caregivers of children with a chronic illness.

METHOD

Participants were 67 caregivers of children and adolescents with sickle cell syndromes. We conducted MANOVAs and subsequent effect size calculations to determine if family functioning would buffer the effects of caring for difficult-to-manage children with this illness.

RESULTS

Findings supported a moderator effect of family functioning on the association of children's externalizing behavioral problems to caregivers' symptoms of hostility. Greater levels of cohesive and adaptive family functioning buffered the potential detrimental effects of caring for children perceived as hard to manage. No significant associations were obtained between measures of caregivers' psychological adaptation and the severity of their children's disease.

CONCLUSIONS

We make recommendations for family systems interventions, particularly for caregivers of children with behavior problems.

Cognitive and academic late effects among children previously treated for acute lymphocytic leukemia receiving chemotherapy as CNS prophylaxis

OBJECTIVE

Examine cognitive and academic late effects among children and adolescents who had received central nervous system (CNS) prophylactic chemotherapy alone for acute lymphocytic leukemia (ALL); none had received whole brain radiation therapy (RT).

METHOD

Subjects included 47 children and adolescents from 5 to 22 years of age who were treated on the same protocol and had been off treatment from 2 to 7 years at the time of assessment.

RESULTS

As a group the survivors displayed generally average performance on measures of cognitive and academic abilities, although they differed from normative means on tests of nonverbal skills. Girls performed more poorly than the normative sample on nonverbal tasks, while no differences were found for boys. Age at diagnosis and time off treatment were not significantly associated with cognitive and academic functioning for survivors of this particular chemotherapy-only protocol.

CONCLUSIONS

Data were interpreted to support generally modest potential late effects in specific areas for children and adolescents surviving ALL. These findings suggest a need for monitoring nonverbal cognitive skills for childhood survivors of ALL, particularly for girls.

Psychological adaptation and adjustment of mothers of children with congenital heart disease: stress, coping, and family functioning

OBJECTIVE

Investigate support for the transactional stress and coping model for mothers of children with congenital heart defects, in accounting for the variance in maternal adjustment.

METHODS

Participants were 52 mothers of children recruited from a university medical center. Measures included illness variables, cognitive processes (i.e., appraisals of stress, expectations, methods of coping, family functioning, and maternal psychological adjustment).

RESULTS

Maternal adjustment was associated with high levels of daily stress and palliative coping techniques and was not significantly associated with severity of the cardiac defect. Together, the variables of the model accounted for approximately 38% of the variance in maternal adjustment.

CONCLUSIONS

The findings are in accord with previous research among other chronically ill populations in suggesting an association between stress, coping, and maternal adjustment. Within the limitations of the study, the data were interpreted to support the utility of theoretical models in identifying areas in need of intervention across chronic illness groups.

The development of decoding of emotions in children with externalizing behavioral disturbances and their normally developing peers

This investigation examined children's capacity to decode verbal and nonverbal emotional stimuli. Children with externalizing behavioral symptoms were compared to two types of controls, including chronically ill and normally developing children. Children were requested to identify whether video scenes were happy, angry, sad, or neutral, across four different modalities including verbal, prosody, facial, and combined. Findings were that chronological age was a significant predictor of children's ability to decode emotions with older children having better developed abilities than their younger peers. Verbal intelligence also was found to be a significant predictor of the ability to decode facial expressions and combined scenes. Although the data did not support the original hypotheses that children with externalizing behavior disorders would be less accurate than controls in the decoding of emotions, findings did support a developmental progression of decoding accuracy. Recommendations within the limitations of the study design are provided which support a developmental framework in children's acquisition of the decoding of emotions.

Growth and development: physical, mental, and social aspects

This article details normal adolescent growth and development, including Tanner staging. Problems of abnormal adolescent growth and development are also discussed, along with treatment of short stature. Tables and graphs outlining these topics are included.

The pediatrician and the sexually active adolescent. Sexual activity and contraception

Sexuality and its resultant consequences continue to be major issues for adolescents and for those who provide their health care. This article discusses current sexual behavior in adolescents and describes the various forms of hormonal contraception that sexually active adolescents should use.

Attributions, coping, and adjustment in children with cancer

Assessed the influence of children's attribution style, coping style, social competence, parent coping, and demographic variables on the psychosocial adjustment of 86 pediatric oncology patients. Utilizing hierarchical multiple regression procedures, nearly one half of the variance in child depression was predicted by children's avoidance coping, depressive attributional style, and social competence. Child anxiety was predicted by a depressive attributional style, avoidance coping, and age at diagnosis. Child externalizing behavior was predicted by a depressive attributional style, parents' anxiety and SES. Implications for interventions and future research are discussed.

A comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorder

Behavioral deficits are often noted in children with fetal alcohol syndrome (FAS) and other individuals with prenatal alcohol exposure, including mental retardation, learning problems, social problems, and deficits in attention. Because attention deficit, hyperactivity disorder (ADHD) has been diagnosed so frequently in children with FAS and other alcohol related birth defects, there has been speculation that alcohol is an etiological factor in ADHD. To examine the relationship between behavior characteristics of children with fetal alcohol exposure and those seen in children with a diagnosis of ADHD, 149 low socioeconomic status (SES), African-American children (mean age = 7.63 years) were given a battery of neuropsychological and behavioral tests. One hundred and twenty-two were a sub-sample from a longitudinal study of prenatal alcohol exposure, whereas twenty-seven were identified in an ADHD Clinic. Children were given two sets of tests: (1) "traditional model" of conventional behavioral and psychiatric measures of ADHD and externalizing behavior; and (2) measures of neurocognitive functioning reflecting a four-factor model of the neurological basis of the components of attention (Mirsky AF, in Integrated Theory and Practice in Clinical Neuropsychology, Hillsdale, NJ, Lawrence Erlbaum Associates, 1989). Results indicated that children with the physical characteristics associated with prenatal alcohol exposure and those with a diagnosis of ADHD had equivalent intellectual abilities with both clinical groups performing more poorly than contrast children from the same SES and ethnic groups. However, there were clear distinctions on behavioral and neurocognitive measures between the two clinical groups with those with ADHD performing more poorly on conventional tests sensitive to attentional problems and conduct disorder. When these two groups were compared on measures designed to measure the model of the four factors of attention by Mirsky, they were noted to have distinct patterns of deficits. These results suggested that the alcohol-affected children did not have the same neurocognitive and behavioral characteristics as children with a primary diagnosis of ADHD.

A 3-year follow-up of the intellectual and academic functioning of children receiving central nervous system prophylactic chemotherapy for leukemia

This prospective study compared the intellectual and academic functioning of two groups of children treated for cancer over the 3 years after their diagnosis. One group consisted of children who received central nervous system (CNS) prophylactic chemotherapy, and the other group consisted of children with cancer who did not receive CNS chemotherapy. The results suggest that the children who received CNS chemotherapy experienced more adverse effects from their treatment in the area of academic functioning than the children who did not receive CNS chemotherapy. Although there were no differences in the academic functioning of the two groups of children immediately after their diagnosis, 3 years postdiagnosis, the CNS-treated children scored more poorly on academic tests of reading, spelling, and arithmetic than the non-CNS-treated children. The results suggest that CNS chemotherapy prophylaxis may impede academic achievement.

Attributional styles of aggressive boys and their mothers

To determine if mothers of aggressive boys have the same propensity as their sons to infer hostile intentions in ambiguous interpersonal situations, 50 mothers of aggressive and nonaggressive boys were each asked to interpret hypothetical situations involving themselves with their child, their partner, and a peer as well as hypothetical situations involving their child in interaction with classmates and teachers. Their sons also were each requested to interpret hypothetical situations involving themselves with their mother, a teacher, and a classmate. The results indicated that mothers of aggressive boys do share the propensity to infer hostility in ambiguous situations and may, in effect, model a hostile attributional bias. Mothers of aggressive boys failed to differentiate ambiguous from hostile situations and were as likely to infer hostile intentions in ambiguous as in hostile situations. The results also suggest a generalized tendency on the part of mothers of aggressive boys to infer negative motives and/or dispositions when accounting for the noxious behavior of their sons. Further, for the aggressive boys, the hostile attributional bias was evident with both peers and teachers. The presence of a hostile attribution was predictive of an aggressive response for the aggressive boys. Even in the face of clearly hostile, provocative behavior, nonaggressive boys were less likely to offer aggressive solutions than aggressive boys.

Adolescents as witnesses to violence

A questionnaire, adapted from Gladstein assessed the teen's personal witnessing of certain violent acts or personal knowledge of victims of violent acts. The population as a whole personally knew more victims of violence compared to having actually witnessed violent acts. More than one-third of the surveyed population responded positively to each question about knowing victims, except with regard to victims of rape. Our study was conducted in a general adolescent medicine clinic in a large Midwestern city, and our data were compared to those of a previous study done in Baltimore, Maryland. Both studies showed similar positive responses in 10 of the 18 items surveyed. Further study is needed to determine the potential impact of this widespread exposure to violence on psychosocial functioning.