Evaluating medication response in ADHD: cognitive, behavioral, and single-subject methodology

Although evidence supports the use of double-blind placebo medication trials to evaluate methylphenidate (MPH) effects on the core behavioral symptoms of attention-deficit/hyperactivity disorder (ADHD), few studies have demonstrated their utility in examining MPH effects on the cognitive deficits associated with ADHD. This article presents a technique for evaluating behavioral and cognitive dose-response relationships at the single-subject level of analysis. Case study results and multivariate analyses suggest that systematic evaluation of behavioral and cognitive MPH dose-response relationships could lead to more accurate MPH titration and greater long-term multimodal treatment efficacy.

Comparison of temperaments of children with and without baby bottle tooth decay

Several demographic studies have been done to identify children at risk for Baby Bottle Tooth Decay (BBTD). Discussions have described these children with Baby Bottle Tooth Decay as strong tempered, cranky, restless, and fussy. The parents of these children have acknowledged these behaviors. To determine whether there were differences in temperament, children with Baby Bottle Tooth Decay were compared with children without Baby Bottle Tooth Decay by assessing the nine temperament components described by the Toddler Temperament Scale (TTS) questionnaire. Parents completed the temperament questionnaire and ninety-two children between twelve and thirty-six months old were studied. Scores for the nine temperament components were tabulated and temperament difficulty was determined as defined by the authors of the toddler Temperament Scale. At-test comparison between the two groups revealed no significant difference for the nine temperament components. There was also no difference when comparing clusters of the nine components. The conclusion is that there is no difference in the temperaments between the group of children with Baby Bottle Tooth Decay and the comparison group of children without Baby Bottle Tooth Decay.

Blowing away shot pain: a technique for pain management during immunization

OBJECTIVE

To study the effect of an active distraction technique on pain in preschool children receiving diphtheria, pertussis, and tetanus immunization.

DESIGN

Randomized, unblinded controlled study.

SETTING

Columbus Public Health Department Immunization Clinics.

PARTICIPANTS

One hundred forty-nine 4- to 7-year-old children.

INTERVENTION

Children were taught to blow out air repeatedly during the injection, as if they were blowing bubbles.

RESULTS

Children who were taught to blow out air during their shots had significantly fewer pain behaviors (P < .04) and demonstrated a trend toward lower subjectively reported pain (P = .06). There was no significant difference in the nurse or parent visual analog scale scores.

CONCLUSIONS

A simple distraction technique can be effective in helping children cope with the pain of immunization. The use of such a technique to relieve the pain and distress associated with even a brief painful procedure should be encouraged.

Temperament as a predictor of behavior during initial dental examination in children

Temperament refers to children's behavioral style, or the manner in which they interact with their environment. Temperament has been quantified into nine temperament categories and five temperament constellations by Thomas and Chess. Temperament categories and constellations of children can be measured using one of several parental questionnaires, each of which focuses on age-appropriate behavior. For this study the Behavioral Style Questionnaire (BSQ) was administered to the parents of 50 healthy children (mean age 48.8 months) receiving initial dental examinations. The examinations were videotaped and The Ohio State Behavior Rating Scale (OSUBRS) was used to rate each child's behavior into one of four behavioral categories: 1) quiet; 2) crying only; 3) disruptive movement only; and 4) crying and disruptive movement. For data analysis the percentage duration of each behavioral category was calculated. Using one-way ANOVA, significant differences between constellations were found for quiet (P = 0.03) and combination behavior (P = 0.03). Using a stepwise linear regression, the temperament category of approach/withdrawal was found to predict the percentage of quiet (multiple R = 0.42357, R2 = 0.17941, and P = 0.002), crying (multiple R = 0.42124, R2 = 0.17744, and P = 0.002), and combination behaviors (multiple R = 0.30008, R2 = 0.09005, and P = 0.03). Additionally, significant regressions were found with temperament categories predicting behavioral categories depending on the child's age. The results of this pilot study suggest that the BSQ temperament constellations and categories appear to be modest predictors of a child's specific behaviors in the dental environment. Knowledge of a child's temperament may prepare the clinician to predict patient behaviors in the dental environment.

Temperament as a predictor of behavior for conscious sedation in dentistry

Temperament can be defined as the behavioral style of a child or the manner in which a child interacts with the environment. Nine temperament categories have been identified: activity level, biological rhythmicity, initial approach/withdrawal, adaptability, intensity, mood, persistence/attention span, distractibility, and sensory threshold. Temperament categories can be quantified using the Toddler Temperament Scale (TTS), a written questionnaire completed by the caretaker. For this study, 29 healthy children, 14 males and 15 females, aged 18 to 36 months (mean age 30 = 6.2 months) and a mean weight of 13.8 kg = 2.1 kg were sedated with 2 mg/kg hydroxyzine pamoate (p.o.) and 2 mg/kg body weight of meperidine (submucosal). Parents completed the TTS during dental treatment in an adjoining room. The recording of baseline vital statistics, the mirror and explorer examination, and the entire operative procedure were videotaped. The Ohio State University Behavior Rating Scale was used to rate the videotapes of each child's behavior according to the following discrete categories: quiet behavior, crying without struggling, and struggling movement with or without crying. For data analysis, all negative behavior (struggling and for crying) was summed. Using a stepwise linear regression, approach/withdrawal tendency (multiple R = 0.38, r2 = 0.15, and P = 0.0015) and adaptability (multiple R = 0.58, r2 = 0.34, and P = 0.009) were found to predict the total percentage of struggling behavior, and approach/withdrawal also approached significance in predicting the percentage of all negative behavior (multiple R = 0.35, r2 = 0.12, and P = 0.055).(ABSTRACT TRUNCATED AT 250 WORDS)

Educators' knowledge and attitudes regarding stimulants in the treatment of attention deficit hyperactivity disorder

Educators often are asked to provide information regarding students' responses to medication used for the treatment of attention deficit hyperactivity disorder (ADHD). We designed a questionnaire to determine the knowledge and attitudes of educators regarding stimulants. Two hundred ninety-one regular classroom and special education teachers in two Ohio school systems received the questionnaire; the overall response rate was 65%. Our findings suggest that educators generally believe stimulants are useful for students with ADHD and that they frequently recommend them to parents. However, educators indicated their knowledge of the effects of stimulants was limited and that they had received little education about stimulants. Physicians requesting input from educators regarding students taking stimulants should be aware of the limitations of educators' knowledge and participate in the development of programs to improve that knowledge.

A guide to critical reading of the literature in behavioral and developmental pediatrics

The field of behavioral-developmental pediatrics covers a wide range of topics, problems, and conditions. A variety of professionals including pediatricians, psychologists, child psychiatrists, social workers, nurses, and educators are involved in research and clinical care. Each of these disciplines uses a variety of methodologies, each of which has its advantages and disadvantages. Different categories of research and methods of critiquing the literature in behavioral and developmental pediatrics are described.

Characteristics of fatal gunshot wounds in the home in Oklahoma: 1982-1983

Children are a unique group at risk of injury from firearms because of their immaturity, curiosity, and imitative behavior. All unintentional firearm deaths in persons younger than age 20 years that occurred in Oklahoma in 1982 and 1983 were reviewed. There were 32 unintentional deaths from firearms in children from birth to age 19 years. The death rate in rural counties was four times that of urban counties. Twenty-seven deaths (85%) occurred at home, with an adult present in only two cases. The home death rate for males was 5.2 times that of females, with 15- to 19-year-old males most at risk. The rates among whites and Native Americans were similar, at 1.5 and 1.2 per 100,000, respectively, with no deaths among the black population. This review concurs with previous studies that firearms are a significant cause of mortality in the pediatric age group. Counseling parents about the hazards of firearms may prevent deaths through better supervision and more responsible gun care and storage.

Test-retest reliability of the Revised Children's Manifest Anxiety Scale

Test-retest reliabilities of the Revised Children's Manifest Anxiety Scale over 1- and 5-wk. intervals were examined for two samples of students, 73 boys and 88 girls in regular sixth, seventh and eighth grade classrooms (11 yr. to 14 yr.). For raw scores the test-retest Pearson r was .88 (1-wk.) and .77 (5-wk.), indicating good reliability. For both samples there was a small difference between test (12.2 for 1-wk. sample; 11.4 for 5-wk. sample) and retest (11.2 for 1-wk. sample; 9.8 for 5-wk. sample) mean raw scores. Implications for test use are discussed.

The Children's Depression Rating Scale for normal and depressed outpatients

The Children's Depression Rating Scale (CDRS) was devised by Poznanski, Cook, and Carroll in 1979, to diagnose depression in 6- to 12-year-olds. The authors state a score of 30 indicates significant depression, with scores in the 20 to 30 range indicating borderline depression. Normative outpatient data for the CDRS have not, however, been established. In this study, 25 apparently well-adjusted children from a pediatric primary care unit were evaluated by the CDRS. Their scores (ranging from 16 to 18) differed significantly from the normal values noted by the founders of the scale, based on the study of inpatients. On the other hand, a study of six of our clinically depressed children indicated scores of 22 to 49. With this definition of the normal score the outpatient child who scores greater than 20 is classified as in need of close follow up to determine if he is depressed.

Cardiac manifestations of Rocky Mountain spotted fever

An increasing incidence of Rocky Mountain spotted fever is being noted across the United States. From 1955 to 1978 80 children with this disease were seen in a children's hospital. Autopsies were performed in six of the nine fatal cases, and cardiac lesions were seen in each. Multifocal myocarditis with petechiae was present in four cases, and in two of them there were areas of myocardial necrosis. In four of the necropsied cases there were electrocardiographic changes and cardiac enlargement on chest roentgenogram. Among survivors five patients manifested at least one cardiac abnormality. ST-T changes were noted in two patients, atrioventricular conduction disturbance in two, and severe left ventricular hypertrophy in one patient. Cardiomegaly was observed in three patients, and one had severe cardiac failure that responded to medical management. Cardiac involvement is frequently present in Rocky Mountain spotted fever, and close observation seems to be warranted.