Social competence and behavioral adjustment of children who are long-term survivors of cancer.

Relatively little is known about the special needs of long-term survivors of childhood cancer or the factors that make this growing population vulnerable to chronic psychologic disorders. We therefore surveyed 183 children who had been treated for cancer at St Jude Children's Research Hospital and were free of the disease for greater than or equal to 2 years after completing therapy. Parental responses to the Child Behavior Checklist, a standardized inventory of social competence and behavioral problems, were analyzed in relation to demographic and medical variables, as well as the children's appearance and functional status. School-related problems and somatic complaints of undetermined origin were increased fourfold relative to age- and gender-adjusted rates for peer groups in the general population. The presence of functional but not cosmetic impairments increased the risk of academic and adjustment problems. An older age at evaluation, treatment with cranial irradiation, and residence in a single-parent household were also associated with an increased risk of psychologic problems. General pediatricians must eventually assume responsibility for the extended follow-up care of children who have survived a malignancy. Their awareness of the high-risk groups described in this report should facilitate more timely identification of problems and referral of the children to appropriate services.

Ipecac abuse: a serious complication in bulimia.

Ipecac abuse among bulimics is being increasingly reported. The case presented is a 19-year-old female with significant eating-related problems, including frequent binges and daily use of ipecac to induce vomiting. Medical evaluation revealed significant muscle weakness, cardiac impairment, and altered levels of serum enzymes. The physical debilitation caused by the ipecac use dissipated following apparent discontinuation of ipecac ingestion. The symptom presentation and management problems in this case are discussed to alert clinicians involved in consultation about ipecac abuse.

Acute lymphoblastic leukemia: long-term psychological outcome.

Children diagnosed with acute lymphoblastic leukemia (ALL) now have an excellent chance for a medical cure. Nearly 90% can expect to attain an initial remission and the majority of those will remain disease-free. There is increasing concern about the long-term consequences of ALL and its treatment on the psychological adjustment of the survivor. This article selectively reviews the available literature on the neuropsychological and psychosocial adjustment of long-term survivors of ALL. The risk of neuropsychologic deficiencies among children who have remained in continuous remission has been the focus of conflicting findings, while the risk among those who have survived CNS relapse is clearly elevated. Generally, long-term survivors of childhood cancer have a 30-40% risk of school-related problems. Moreover, children treated for ALL with cranial irradiation have 3-4 times the risk of school problems relative to those who are not irradiated. Early identification of problems would facilitate referrals for appropriate intervention and hopefully minimize future difficulties.

Experimentally induced taste aversions in humans: effects of overshadowing on acquisition.

This study used vection-induced symptoms of motion sickness as an unconditioned stimulus to condition food aversions in humans and to evaluate the efficacy of an overshadowing agent (novel flavored candy: CS2) to attenuate acquisition of the aversion. Subjects unfamiliar with a target food (CS1) were assigned to one of the following three groups which were identical except for order of exposure to stimuli: Taste Aversion Group (CS1-US-CS2-Test), Control Group (US-CS1-CS2-Test), and Overshadowing Group (CS1-CS2-US-Test). Subjects were tested on aversion ratings and consumption of the target flavor and ratings of the overshadowing agent. Subjects in the Taste Aversion group rated the target flavor as significantly more aversive and consumed less of it, although not significantly so, that did those in the Control group. The Overshadowing group consumed significantly more of the target food than did the Taste Aversion Group. Considering only subjects unfamiliar with the overshadowing agent, those in the Overshadowing group rated the agent (CS2) as significantly more aversive than the Taste Aversion and Control groups. Implications of these findings to taste aversions in humans are discussed.

An investigation of the test-retest reliability of the Stroop Color-Word Test across two intervals.

The Stroop Color- Word Test is frequently used in neuropsychological settings. However, there has been no rigorous evaluation of the test-retest reliability of the commercially available version of the Stroop. The present study investigated the test-retest reliability of the Stroop across two different time intervals. In addition, the standard error of prediction and the standard error of differences were computed, and applications of the results to the use of the Stroop to document change in cognitive rehabilitation are discussed.

Treatment programs for severe night-time fears: a methodological note.

A multiple baseline design across subjects was used to examine the efficacy of a treatment package consisting of relaxation, reinforcement, and cognitive self-instruction in the reduction of severe night-time fears in six children. Although the disruptive bedtime behaviors of five of the six children were reduced, the multiple baseline analysis revealed that changes were not solely due to treatment. For children with extended baselines, improvement preceded treatment. The implications of these findings for the treatment of fear of the dark and multicomponent treatment programs are discussed.

Improving dietary habits of children: effects of nutrition education and correspondence training.

Evidence that a significant number of children are exposed to risk factors associated with coronary heart disease has prompted health care professionals to develop programs designed to encourage the early development of a healthy life style. The present study used a multiple baseline approach to examine the effects of two procedures on the snack selection behavior of 25 third grade children. In children who selected non-nutritious rather than nutritious snacks for more than 40% of the baseline observations, nutrition education alone had little or no impact on their selection of snacks. However, with the implementation of correspondence training, in which a reward was made contingent upon carrying out a stated intent to choose a nutritious snack, the children consistently chose nutritious snacks. These results indicate that correspondence training may be an efficient and cost-effective way to improve dietary habits of young people.

Multi-dimensional child behavior therapy in the treatment of medically-related anxiety: a practical illustration.

This paper provides a practical illustration of a four-component model for conducting child behavior therapy. It describes the treatment of a 7-year-old boy, whose fears and anxieties regarding impending surgery were interfering with his sleep, concentration, and academic performance. Such childhood difficulties are encountered in primary care medical settings and it is likely that mental health practitioners will be increasingly called upon to treat them. The model provides a framework for selecting, organizing, and implementing strategies based on behavioral principles, with the goal of: (a) reducing the probability of the behavior by ecological change; (b) manipulating the immediate consequences of the problem behavior; (c) facilitating acquisition of new, more adaptive behaviors; and (d) long-term prevention by remedying fundamental deficits. The strategies used for each goal and the success of the overall intervention are described.

The relationship of daily stress and health-related behaviors to adolescents' cholesterol levels.

It has been well established that some of the major risk factors for coronary heart disease are related to lifestyle, that is, behaviors that are potentially modifiable. Although studies have identified psychosocial stress as a factor associated with elevated cholesterol levels in adults, this relationship has not been thoroughly examined in adolescents. The present study investigated the relationship between daily life events and total cholesterol levels among 104 high school students. The contributions of health-related behaviors, such as dietary patterns, physical activity, smoking, and television viewing, were also examined. Hierarchical multiple regression analyses showed that scores on a scale of daily life events explained a significant portion of the variance in cholesterol measurements. However, when the sample was stratified by gender, this effect remained significant for adolescent females but not males. Overall, females reported a greater degree of negative health behaviors than did males. Implications of these findings are discussed.

Neuropsychological status of children with acute lymphoblastic leukemia treated for central nervous system relapse.

Approximately 10% of children treated with contemporary therapy for acute lymphoblastic leukemia (ALL) will experience an isolated relapse in the central nervous system (CNS). From 5 to 25% of this group will become long-term survivors, but only after additional, more aggressive therapy. A review of the limited number of studies of children surviving treatment for CNS relapse disclosed a strikingly higher incidence of intellectual impairment than was found in similarly treated patients who remain in complete remission. Specific risk factors for this complication included the number of courses of cranial irradiation, a young age at treatment, increasing time since treatment, neuropathological changes apparent on abnormal computed tomography scans of the brain, and seizures. The methodological problems inherent in neurobehavioral research in childhood acute lymphoblastic leukemia are critically reviewed and suggestions for future studies are offered. Children with a CNS relapse should be serially evaluated for psychoeducational performance to facilitate early intervention in cases of learning difficulties.

Midazolam premedication for pediatric bone marrow aspiration and lumbar puncture.

The ability of midazolam, a benzodiazepine, to reduce the distress associated with lumbar puncture and bone marrow aspiration was examined in 23 children with acute lymphocytic leukemia. Patients were randomized to receive 0.2 mg/kg midazolam HCl or placebo intravenously 3-5 min before the procedures, under double-blind conditions. Based on prior experiences, children in both groups anticipated severe pain from these procedures. Postprocedure pain ratings by patients were markedly reduced in the midazolam but not the placebo group. Both physicians and parents judged the midazolam group as significantly less distressed than controls during and after the procedures. Trained observers recorded significantly fewer pain- and anxiety-related behaviors in the midazolam group immediately before and after, but not during the procedures. The amnestic effects of midazolam, confirmed in a visual recall/recognition test, appear to account for the decreased pain ratings since the behavioral manifestations were similar in the two groups. There were no adverse drug reactions or significant changes in vital signs. Midazolam warrants further investigation as a premedication for painful diagnostic and treatment procedures in children with cancer.