Karate Kata training: A promising intervention for behavioral problems in elementary school children.

Behavioral issues frequently arise in primary school children, affecting their academic performance, social interactions, and general welfare. These concerns encompass challenges related to attention, concentration, aggression, oppositional behavior, and social maladaptation. The purpose of the current study was to examine the impacts of karate Kata training on extrinsic behavioral problems of elementary school students. The Achenbach Child Behavior Checklist (CBCL) questionnaire was given to all fourth- to sixth-grade students from a male elementary school, totaling 241 students, in Mashhad, Iran. A total of 76 eligible school-aged children with a total score of 65 and above in attention, aggression, oppositional defiance, and social maladaptation issues were selected and randomly assigned to an exercise group (n = 38) or a no-exercise control group (n = 38). Participants in the exercise group were instructed to engage in Kata training, which consists of a series of choreographed movements designed to enhance physical and mental discipline, for a duration of 12 60-min sessions, whereas the participants in the control group followed their daily activities. The CBCL from the Achenbach System of Empirically Based Assessment was used to assess dependent variables such as attention and concentration, aggression, oppositional defiance, and social maladaptation at baseline and post-intervention. The repeated-measures analysis of variance indicated that Kata training results in significant improvements in attention and concentration and significant reductions in aggression, oppositional defiance, and social maladaptation among elementary school students (all ps < .001). These results highlight the potential benefits of incorporating Kata training into interventions aimed at improving the behavioral outcomes of children.

Ateneo General de la Residencia de Psicopedagogía: Abordaje psicopedagógico en pacientes con perfil externalizante / General Athenaeum of the Psychopedagogical Residence: Psychopedagogical approach in patients with externalizing profile

Ateneo centrado en la intervención psicopedagógica en niños y niñas con conductas externalizantes, En una pirmera parte, se desarrollan algunos conceptos que forman parte del marco teórico del equipo, y más adelante, los referidos a la Terapia Cognitivo Conductual. Se define la conducta y sus funciones, diferenciando conductas internalizantes y externalizantes. Luego se ejemplifican las estrategias de la Terapia Cognitivo Conductual utilizadas en cada uno de los tres subsistemas (familia, escuela y niño/a) a partir de diferentes casos clínicos. Por último, se reflexiona invitando a seguir repensando las intervenciones y prácticas clínicas con pacientes con estas características.

Behavioral Health in Primary Care: Brief Screening and Intervention Strategies for Pediatric Clinicians.

Despite the high prevalence of behavioral health concerns presenting in pediatric primary care and the growing support for integrating behavioral health services into this setting, a majority of primary care providers do not have access to on-site behavioral health specialists. Fortunately, primary care providers can implement some services typically provided by behavioral health clinicians. This article outlines screening, brief intervention, and referral guidelines for prominent behavioral health problems seen in primary care. The evidence-based approaches have the potential to supplement typical management of behavioral health problems in primary care and provide a foundation for future integrated behavioral health practice.

Improving Pediatrician's Behavioral Health Competencies Through the Project ECHO Teleconsultation Model.

Project ECHO (Extension for Community Healthcare Outcomes) is a teleconsultation model for enhancing the treatment of underserved patients in primary care. Previous behavioral health (BH) adaptations of Project ECHO have primarily focused on adults or specific diagnoses and have relied on self-reported outcomes. The purpose of this pilot was to adapt Project ECHO to support pediatric primary care providers in addressing common BH needs and to conduct an initial evaluation of its effectiveness. Overall, participants reported high levels of satisfaction and a statistically significant improvement in their overall knowledge and skills (P = 0.001). Participation was also associated with a reduction in the use of psychotropic polypharmacy. This pilot adds to a growing body of literature suggesting that Project ECHO is a promising workforce development approach to build competencies for the management of BH issues in primary care.

Pediatric Prevention: Academic Behavior.

Many children in the United States are performing below basic standards in reading, mathematics, and writing. Children at risk for academic problems often have comorbid classroom behavior problems and/or are diagnosed with high-incidence disabilities. Early intervention to prevent academic problems is a key goal of school-wide response-to-intervention models. The goal of school-based instructional intervention is to increase children's strength of responding so basic academic skills can be combined to solve more complex tasks. Parents and caregivers can support intervention efforts at school by engaging in frequent communication with student assistance teams and helping children with academic work completion at home.

Neurological Complications of Sturge-Weber Syndrome: Current Status and Unmet Needs.

OBJECTIVE: We aimed to identify the current status and major unmet needs in the management of neurological complications in Sturge-Weber syndrome. METHODS: An expert panel consisting of neurologists convened during the Sturge-Weber Foundation Clinical Care Network conference in September 2018. Literature regarding current treatment strategies for neurological complications was reviewed. RESULTS: Although strong evidence-based standards are lacking, the implementation of consensus-based standards of care and outcome measures to be shared across all Sturge-Weber Foundation Clinical Care Network Centers are needed. Each patient with Sturge-Weber syndrome should have an individualized seizure action plan. There is a need to determine the appropriate abortive and preventive treatment of migraine headaches in Sturge-Weber syndrome. Likewise, a better understanding and better diagnostic modalities and treatments are needed for stroke-like episodes. As behavioral problems are common, the appropriate screening tools for mental illnesses and the timing for screening should be established. Brain magnetic resonance imaging (MRI) preferably done after age one year is the primary imaging modality of choice to establish the diagnosis, although advances in MRI techniques can improve presymptomatic diagnosis to identify patients eligible for preventive drug trials. CONCLUSION: We identified the unmet needs in the management of neurological complications in Sturge-Weber syndrome. We define a minimum standard brain MRI protocol to be used by Sturge-Weber syndrome centers. Future multicenter clinical trials on specific treatments of Sturge-Weber syndrome-associated neurological complications are needed. An improved national clinical database is critically needed to understand its natural course, and for retrospective and prospective measures of treatment efficacy.

Psychosocial Issues in Children With Thalassemia: From Identification to a Model for Management in a Developing Country.

INTRODUCTION: Children with chronic disorders like ß thalassemia major (TM) and their care givers are known to face various psychosocial problems. This study used screening tests to detect these psychosocial issues so that prompt referral for counseling is possible. METHODS: A semistructured demographic questionnaire, Pediatric Symptom Checklist (PSC-17) and the Strengths and Difficulties Questionnaire (SDQ) were administered to 30 children with TM, on regular treatment at a tertiary care hospital. The same questionnaires were administered to age-matched and sex-matched controls. Parents were administered the General Health Questionnaire (GHQ). Children with TM scored higher on both PSC-17 (9.93 vs. 4.87; P<0.001) and SDQ (14.9 vs. 10.9; P=0.008). The parents of children with TM scored higher on the GHQ (10.3 vs. 8.0; P=0.027). RESULTS: Psychosocial morbidity was higher in children with TM and their care-givers. Screening tools help detect children and care givers in need of formal counseling. CONCLUSIONS: The study makes a case for management of these issues by the pediatrician in tandem with mental health professionals. Some strategies that can be used in managing these children and their families are presented. In addition, issues in management with particular focus on a developing country context are highlighted and discussed.

The aggressive child.

Aggression in children is a common transdiagnostic symptom associated with a wide range of developmental and mental health problems. It emerges early and without intervention, may increase in severity as the child grows stronger. Aggressive children are more likely to experience physical and mental illness, unemployment, poverty and forensic problems as adults. Strategies to prevent aggression must address risk factors: low maternal education, adolescent pregnancy, in utero exposure to tobacco and alcohol, poverty, coercive parenting, childhood maltreatment and bullying victimisation. The aggressive child requires a comprehensive assessment to identify and manage underlying or comorbid problems, to understand the reasons for the aggressive behaviour and to detect modifiable factors that exacerbate or perpetuate the aggression. Psychosocial interventions include parenting skills training and child-directed cognitive behavioural therapy, whereas pharmacotherapy may be used to treat underlying developmental or mental health problems or to manage the aggression.

Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System.

Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system's six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists. Additional work remains to be done in improving family engagement, further expanding services, and ensuring sustainability.

The Impact of the Massachusetts Behavioral Health Child Screening Policy on Service Utilization.

OBJECTIVE: In 2008, Massachusetts Medicaid implemented a pediatric behavioral health (BH) screening mandate. This study conducted a population-level, longitudinal policy analysis to determine the impact of the policy on ambulatory, emergency, and inpatient BH care in comparison with use of these services in California, where no similar policy exists. METHODS: With Medicaid Analytic Extract (MAX) data, an interrupted time-series analysis with control series design was performed to assess changes in service utilization in the 18 months (January 2008-June 2009) after a BH screening policy was implemented in Massachusetts and to compare service utilization with California's. Outcomes included population rates of BH screening, BH-related outpatient visits, BH-related emergency department visits, BH-related hospitalizations, and psychotropic drug use. Medicaid-eligible children from January 1, 2006, to December 31, 2009, with at least ten months of Medicaid eligibility who were older than 4.5 years and younger than 18 years were included. RESULTS: Compared with rates in California, Massachusetts rates of BH screening and BH-related outpatient visits rose significantly after Massachusetts implemented its screening policy. BH screening rose about 13 per 1,000 youths per month during the first nine months, and BH-related outpatient visits rose to about 4.5 per 1,000 youths per month (p<.001). Although BH-related emergency department visits, hospitalization and psychotropic drug use increased, there was no difference between the states in rate of increase. CONCLUSIONS: The goal of BH screening is to identify previously unidentified children with BH issues and provide earlier treatment options. The short-term outcomes of the Massachusetts policy suggest that screening at preventive care visits led to more BH-related outpatient visits among vulnerable children.

Behavioral Adjustment of School-Age Children with and without Single-Suture Craniosynostosis.

BACKGROUND: Previous research has observed higher than average rates of behavior problems in school-age children with single-suture craniosynostosis. However, most studies used a single informant (mothers) and did not include comparison groups to control for sociodemographic factors. METHODS: The authors gave standardized behavior checklists to the mothers, fathers, and teachers of 179 elementary school children with single-suture craniosynostosis and 183 controls. We used linear regression to compare children with and without single-suture craniosynostosis on continuous measures of adjustment, and logistic regression to compare the proportions of children who scored above a well-established clinical threshold based on the report of one or more informants. All analyses were adjusted for demographic confounds (age, sex, socioeconomic status, maternal intelligence quotient). RESULTS: Cases received higher average behavior problem scores than controls from all informants. However, differences were small in magnitude (0.01 to 0.2 SD; p = 0.12 to p = 0.96). Thirty-three percent of children with single-suture craniosynostosis were rated above a clinical threshold by one or more informants, compared with 21 percent of controls (adjusted odds ratio, 1.67; p = 0.04). Among cases, children with metopic synostosis had the highest level of observed behavior problems (41 percent greater than threshold); those with sagittal synostosis had the lowest level (29 percent). CONCLUSIONS: The authors observed little difference in average ratings of behavior problems between children with and without single-suture craniosynostosis. However, children with single-suture craniosynostosis were more likely to score above a clinical threshold than unaffected controls. No specific areas of maladjustment were associated with case status or location of suture fusion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Metodologias participativas em pesquisa com crianças: abordagens criativas e inovadoras / Metodologías de investigación participativa con niños: enfoques creativos e innovadores / Participatory methodologies in research with children: creative and innovative approaches

RESUMO Objetivo Relatar a experiência da utilização de metodologias participativas em pesquisa com crianças. Métodos Relato de experiência com abordagem qualitativa, realizado com crianças entre seis e onze anos de uma escola municipal, em Pelotas, e do Centro de Atenção Psicossocial Infantojuvenil, em São Lourenço do Sul, ambos municípios do Estado do Rio Grande do Sul. A coleta de dados foi baseada em registros feitos em diários de campo e observação, realizada de abril a julho de 2016. Resultados O relato apontou que o Photovoice promoveu a motivação entre o grupo e elevou a autoestima e a autoconfiança das crianças. O Mapa dos Cinco Campos possibilitou às crianças expressar sentimentos por intermédio do jogo. Conclusão Compreende-se que o Photovoice e o Mapa dos Cinco Campos são instrumentos que viabilizam novas abordagens metodológicas nas pesquisas com crianças, facilitando a construção das propostas de atividades que visam processos inovadores e criativos de pesquisa em saúde/enfermagem.

RESUMEN Objetivo Presentar la experiencia de usar enfoques participativos en la investigación con niños. Métodos Informe de experiencia con un enfoque cualitativo, realizado con niños de entre seis y once años, de una escuela municipal en Pelotas y en el Cuidado de Niños y Jóvenes Centro Psicosocial, en São Lourenço do Sul, ambos municipios de Rio Grande do Sul. La recogida de datos se basa en los registros realizados en diarios de campo y observación, de abril a julio de 2016. Resultados el informe señaló que la Fotovoz promueve la motivación entre el grupo, el aumento de la autoestima, autoconfianza de los niños. El Mapa de cinco campos y ayudan a los niños a expresar sus sentimientos por medio del juego. Conclusión Se entiende que el Fotovoz y mapa de cinco campos son herramientas que permiten los nuevos enfoques metodológicos de la investigación con los niños, lo que facilita la construcción de las actividades propuestas dirigidas a los procesos creativos e innovadores de la investigación en salud/enfermería.

ABSTRACT Objective To describe the use of participatory methodologies in research with children. Methods Experience report with a qualitative approach, conducted with children between six and eleven years of age, from a municipal school in Pelotas and in the Psychosocial Children and Youth Care Center, in São Lourenço do Sul, both municipalities of the Rio Grande do Sul State. Data collection was based on records made in field and observation diaries, held from April to July 2016. Results The report pointed out that the Photovoice promoted motivation in the group, in addition to increasing the self-esteem and self-confidence of children. The Five Field Map made it possible to help children express feelings through the game. Conclusion Photovoice and the Five Field Map are seen as tools that enable new methodological approaches in research with children, facilitating the construction of the proposed activities aimed at innovative and creative research processes in health/nursing.

Polygenic score × intervention moderation: an application of discrete-time survival analysis to modeling the timing of first tobacco use among urban youth.

The present study examines the interaction between a polygenic score and an elementary school-based universal preventive intervention trial. The polygenic score reflects the contribution of multiple genes and has been shown in prior research to be predictive of smoking cessation and tobacco use (Uhl et al., 2014). Using data from a longitudinal preventive intervention study, we examined age of first tobacco use from sixth grade to age 18. Genetic data were collected during emerging adulthood and were genotyped using the Affymetrix 6.0 microarray. The polygenic score was computed using these data. Discrete-time survival analysis was employed to test for intervention main and interaction effects with the polygenic score. We found a main effect of the intervention, with the intervention participants reporting their first cigarette smoked at an age significantly later than controls. We also found an Intervention × Polygenic Score interaction, with participants at the higher end of the polygenic score benefitting the most from the intervention in terms of delayed age of first use. These results are consistent with Belsky and colleagues' (e.g., Belsky, Bakermans-Kranenburg, & van IJzendoorn, 2007; Belsky & Pleuss, 2009, 2013; Ellis, Boyce, Belsky, Bakermans-Kranenburg, & van IJzendoorn, 2011) differential susceptibility hypothesis and the concept of "for better or worse," wherein the expression of genetic variants are optimally realized in the context of an enriched environment, such as provided by a preventive intervention.

Parent perceptions of managing child behavioural side-effects of cancer treatment: a qualitative study.

BACKGROUND: Very little research has examined the role of parenting in managing behavioural side-effects of cancer treatment. The purpose of this paper was to explore parent perceptions of (a) parenting in the context of childhood cancer; (b) the parenting strategies used in the context of managing child behavioural side-effects of cancer treatment; and (c) the perceived impact that cancer-specific parenting strategies have on child behaviour. METHODS: Participants were 15 mothers of children aged 2-6 years in the maintenance phase of treatment for acute lymphoblastic leukaemia at the Royal Children's Hospital Children's Cancer Centre, Melbourne, Australia. Mothers participated in a one-on-one semi-structured telephone interview using an interview guide which included questions on parenting in the context of childhood cancer, specifically in relation to behavioural side-effects (problems with behaviour, sleep and eating) and any perceived impact cancer-specific parenting may have on the ill child. RESULTS: Many parents reported that following their child's cancer diagnosis, they had to implement a suite of 'new' strategies that 'pre-diagnosis' were used only in moderation, if at all. The most salient theme that emerged was parents' perception that their parenting became more lax since their child's diagnosis. Parents further reported specific parenting strategies for each of the main child behavioural side-effects of cancer treatment. CONCLUSION: Data from the current qualitative exploratory study highlight the role of specific parenting strategies in managing or assisting child behavioural side-effects of cancer treatment. Further quantitative research is needed to more fully examine the association between parenting and child behavioural outcomes in order to develop modifiable approaches to improving child behavioural side-effects in a paediatric oncology context.

Cognitive and behavioral problems in children with neurofibromatosis type 1: challenges and future directions.

Cognitive and behavioral disorders affect nearly 80% of all children with the neurofibromatosis type 1 inherited cancer syndrome, and are among the most significant clinical manifestations for patients and their families. One of the barriers to successful therapeutic intervention is the wide spectrum of clinical phenotypic expression, ranging from visuospatial learning problems to social perceptual deficits (autism). Leveraging numerous small-animal models of neurofibromatosis type 1, several promising targets have been identified to treat the learning, attention, and autism spectrum phenotypes in this at-risk population. In this review, we provide an up-to-date summary of our current understanding of these disorders in NF1, and propose future research directions aimed at designing more effective therapeutic approaches and clinical trials.

Estrategias para la modificación conductual en niños / Strategies for behavior modification in children

Los trastornos de conducta en niños son motivo de consulta frecuente. Sus causas son variadas incluyendo desde factores biológicos hasta condiciones psicosociales particulares. La intervención psicológica debe considerar características individuales del niño y su familia, previo a suimplementación. Así se entregan orientaciones generales para el manejo conductual de niños y adolescentes, siendo la base de estas estrategias: las prácticas de buen trato, vinculación positiva con los niños, la congruencia y la constancia en el tiempo.

Conduct disorder in children are frequent consultation. Its causes are varied including from biological factors to specific psychosocial conditions. Psychological intervention should consider individual characteristics of the child and his / her family, prior to implementation. So general guidelines for behavior management of children and adolescents are given, being the basis of these strategies: good treatment practices, positive relationship with children, consistency and constancy in time.

School-readiness profiles of children with language impairment: linkages to home and classroom experiences.

BACKGROUND: This study represents an effort to advance our understanding of the nature of school readiness among children with language impairment (LI), a population of children acknowledged to be at risk of poor academic achievement. The academic, social-emotional, and behavioural competencies with which children arrive at kindergarten affect the nature of their future educational experiences, and their overall academic achievement. AIMS: To examine whether there are reliable profiles that characterize children with LI just prior to kindergarten entrance, and the extent to which profile membership is associated with characteristics of children's homes and preschool experiences. Questions addressed were twofold: (1) To what extent are there reliable profiles of children with LI with respect to their school readiness? (2) To what extent is children's profile membership associated with characteristics of their homes and preschool classrooms? METHODS & PROCEDURES: Participants were 136 children with LI from early childhood special education classrooms. We utilized latent class analysis (LCA) to classify individuals into profiles based on individual responses on school readiness measures. We then used multilevel hierarchical generalized linear models to examine the relations between profile membership and children's home/classroom experiences. OUTCOMES & RESULTS: LCA analyses revealed that a four-profile solution was the most appropriate fit for the data and that classroom experiences were predictive of these profiles, such that children in classrooms with more instructional/emotional support were more likely to be placed in profiles characterized by higher school readiness skills. CONCLUSIONS & IMPLICATIONS: These results suggest that the school readiness profiles of young children with LI are associated with the quality of children's classroom experiences, and that high-quality classroom experiences can be influential for ensuring that young children with LI arrive in kindergarten ready to learn.

O caso da "pequena sereia": uma reflexão sobre diagnóstico diferencial e final de análise com crianças / The case of "little mermaid": a reflection on diferential diagnosis and the end of the analysis with / El caso de la "sirenita": una reflexión sobre diagnóstico diferencial y final de análisis con niños

O artigo propõe uma reflexão clínica sobre o diagnóstico estrutural de psicose e as dificuldades em se considerar tal diagnóstico na ausência de delírios e alucinações. A constatação foi embasada na noção de estruturas psíquicas, baseadas na teoria psicanalítica de Lacan. Discutem-se, com passagens do atendimento clínico, a consequência desorganizadora de uma intervenção que consistiu em uma hipótese diagnóstica de neurose e os efeitos da mudança no manejo, produzidos ao se reformular a hipótese diagnóstica, encaminhando o caso para o final de análise.

The article proposes a clinical reflection on the psychosis structural diagnosis and also on the difficulties of considering this diagnosis for lack of delirium and hallucinations. The finding was based on the notion of such as psychic structures, based on Lacan's psychoanalytic theory. It is discussed, with clinical service events, the disorganizer consequence of an intervention that consisted of a diagnosis hypothesis of neurosis and the effects of change in management, produced by reformulating the diagnosis hypothesis, referring the case to the end of analysis.

El articulo propone una reflexión clínica sobre el diagnostico estructural de psicosis y las dificultades en considerar tal diagnóstico, en la ausencia de delirios y alucinaciones. Esa observación fue basada en la noción estructuras psíquicas, basadas en la teoría psicoanalítica de Lacan, se discute, con ejemplos del atendimiento clínico, la consecuencia desorganizadora de una intervención que se constituyó en una hipótesis diagnostica de neurosis y los efectos de los cambios en el manejo, producidos al reformularse la hipótesis diagnostica, encaminando el caso para el final del análisis.

Opening the "Black Box": family check-up intervention effects on self-regulation that prevents growth in problem behavior and substance use.

Family-school interventions are a well-established method for preventing and remediating behavior problems in at-risk youth, yet the mechanisms of change underlying their effectiveness are often overlooked or poorly understood. The Family Check-Up (FCU), a school-based, family-centered intervention, has been consistently associated with reductions in youth antisocial behavior, deviant peer group affiliation, and substance use. The purpose of this study was to explore proximal changes in student-level behavior that accounts for links between implementation of the FCU and changes in youth problem behavior. Data were drawn from a randomized controlled trial study of the efficacy of the FCU among 593 ethnically diverse middle school students followed longitudinally from 6th through 8th grades. Latent growth curve analyses revealed that random assignment to the FCU intervention condition was related to increased mean levels of students' self-regulation from 6th to 7th grades, which in turn reduced the risk for growth in antisocial behavior, involvement with deviant peers, and alcohol, tobacco, and marijuana use through the 8th grade. Overall, these findings highlight the robust implications of self-regulation as a proximal target for family-centered interventions.