"If I had been given that information back then": An interpretive description exploring the information needs of adults with cerebral palsy looking back on their transition to adulthood.

BACKGROUND: Young people with cerebral palsy (CP) and their families have identified lack of information received during the transition to adulthood as a barrier to successful outcomes. To date, few studies have explored the information needs, preferences, timing, and method of provision from the perspective of individuals with CP. METHOD: The methodological approach to this qualitative study was interpretive description. Nine adults living with CP, between the ages of 20 and 40, were purposively recruited in Ontario, Canada, to explore, retrospectively, their information needs during the transition to adulthood. Participants completed a 1-hour interview that explored their experiences seeking and receiving information. Interviews were transcribed verbatim, and data were analysed to create a thematic description of adults' experiences with information. RESULTS: Three themes emerged: (a) "Recognizing and supporting information needs," which highlighted the importance of support systems to assist young people in receiving and seeking information throughout the transition; (b) "Getting creative," which highlighted strategies young people use when confronted with environmental barriers when seeking information; and (c) "Gaps and advice for the future," which highlighted the need for real-life opportunities, during the transition to adulthood, to experience some of the responsibilities of adult life. CONCLUSION: Clinicians assisting young people with CP need purposefully to foster knowledge and skills during the transition to adulthood. They should be not only providers of information but also enablers of opportunities for immersion in real-life experiences to prepare for adult life. It is important for young people to have the opportunity to discuss challenges and exchange information with their peers.

The effects of methylphenidate on the mother-child interactions of hyperactive children.

Twenty hyperactive boys were observed while interacting with their mothers during a free play and task period on each of three occasions (no drug, drug, placebo). A triple-blind, drug-placebo crossover design was used to study the effects of methylphenidate on these interactions. A complex objective coding system was used to score the children's responses to various maternal behaviors as well as the mother's responses to a variety of children's behaviors. Results indicated that these children were more compliant with maternal commands during drug treatment. In response, mothers displayed increased attention to compliance while reducing their directiveness toward the boys. However, the hyperactive boys receiving methylphenidate initiated fewer social interactions and tended to show greater nonresponding. Thus, methylphenidate may improve the compliance of hyperactive children but tends to decrease their sociability.

Coping modeling problem solving versus mastery modeling: effects on adherence, in-session process, and skill acquisition in a residential parent-training program.

This trial compared two approaches used to introduce parenting skills in a residential staff training program. Fifty staff were randomly assigned to: mastery modelling in which videotaped models demonstrated new skills, coping modelling problem solving (CMPS) in which participants formulated their own solutions to the errors depicted by videotaped models, or a waiting-list control group. In both, leaders used modelling, role playing, and homework projects to promote mastery and transfer of new skills. The skills of all groups improved, but CMPS participants attended more sessions, were late to fewer sessions, completed more homework, engaged in more cooperative in-session interaction, rated the program more positively, and reported higher job accomplishment scores. These data suggest that CMPS allowing participants to formulate their own solutions may enhance adherence and reduce the resistance observed in more didactic programs.

Tri-ministry study: correlates of school-based parenting course utilization.

This study examined factors associated with the utilization of universally available school-based parent training. In a randomly selected, prospectively screened, unreferred community sample of 1,498 5- to 8-year-olds, 28% to 46% of families of children with high parent-reported externalizing problems enrolled. Externalizing problems, first-child status, and a high school education were associated with increased enrollment. Single-parent status, immigrant background, and limited extracurricular child activities were associated with lower enrollment. Economic disadvantage, stress, family dysfunction, and parental depressive symptoms were not associated with participation. Most families attributed nonparticipation to busy personal schedules, inconvenient times, and logistical difficulties.

Peer interactions of normal and attention-deficit-disordered boys during free-play, cooperative task, and simulated classroom situations.

Groups of 30 ADD-H boys and 90 normal boys were divided into 30 mixed dyads composed of a normal and an ADD-H boy, and 30 normal dyads composed of 2 normal boys. Dyads were videotaped interacting in 15-minute free-play, 15-minute cooperative task, and 15-minute simulated classroom settings. Mixed dyads engaged in more controlling interaction than normal dyads in both free-play and simulated classroom settings. In the simulated classroom, mixed dyads completed fewer math problems and were less compliant with the commands of peers. ADD-H children spent less simulated classroom time on task and scored lower on drawing tasks than normal peers. Older dyads proved less controlling, more compliant with peer commands, more inclined to play and work independently, less active, and more likely to remain on task during the cooperative task and simulated classroom settings. Results suggest that the ADD-H child prompts a more controlling, less cooperative pattern of responses from normal peers.

Low birth weight and home intervention strategies: preterm infants.

We investigated the effects of a 1-year home intervention on premature infants with low (less than 1500 g) and higher (1500-2000 g) birth weights. Infants from each weight condition were block randomly assigned to a control or to one of two treatment groups. One treatment group focused on the development of the infant; the other treatment group focused on the parent-infant interaction. The low birth weight infants obtained significantly lower Bayley mental and motor scores, and were more passive and less intense than the higher birth weight infants. However, the low birth weight infants and their parents were more responsive to the home intervention than were the higher birth weight infants, as demonstrated by changes in the Bayley mental scores and the Home Observation for Measurement of the Environment (HOME) inventory. These findings exemplify the reciprocal relationship between the child's characteristics and parental responding. The importance of selecting the most high-risk premature infants for early home intervention is outlined.

Dyadic peer interaction and task orientation in attention-deficit-disordered children.

A sequential observational approach was used to compare peer interactions in 10 mixed dyads of ADD-H and non-Add-H boys and 10 dyads of non-ADD-H boys in laboratory cooperative and school classroom task analogue activities. Mixed dyads were found to have a greater frequency of aggression and less joint activity than control dyads in specific situations. No differences were found for measures of functional attention as measured by frequency, duration, and mean duration of task-oriented behavior. Lag sequential analyses revealed two major sequences that differentiated mixed from normal dyads. These were Verbal Reciprocity (a measure of reciprocal verbal interaction) and Retreat (a measure of social withdrawal following aggression).

Parents' attributions for achieving compliance from attention-deficit-disordered children.

Ninety-one parents provided reasons for the compliance and noncompliance of either their attention-deficit-disordered, hyperactive (ADDH) or non-ADDH child in six different situations. These attributions were rated on Weiner's (1979) dimensions of locus, stability, and controllability. While parents used the same categories to explain the reasons for their children's compliance behavior, they used different dimensional ratings for these explanations. Mothers rated attributions for noncompliance as more external than did fathers. Mothers of ADDH children viewed the causes of their children's behavior to be more unstable than did mothers of control children. Also, ADDH parents had lower expectations of achieving future compliance from their child than did non-ADDH parents. Results were discussed in terms of parental experiences, the need to consider an idiosyncratic approach to attributional meaning, and treatment implications.

The influence of parenting stress and child behavior problems on parental estimates of expressive and receptive language development.

This study examined the relative contributions of parental reports of child-related and parent-related stress to their estimates of expressive and receptive language skills on the Minnesota Child Development Inventory in 152 children referred to a communicative disorders clinic. Correlational analysis showed moderately high agreement between parental estimates and objective measures of expressive and receptive language ability. Multiple-regression analyses revealed that independent measures of language acquisition accounted for the greatest amount of variance in parental estimates of expressive and receptive language skills. Stressful child behavior accounted for a small but statistically significant proportion of the variance in estimates of expressive and receptive language skills. Parental stress, in contrast, did not contribute significantly to language estimates. These findings suggest that parents are able to formulate estimates of language development which are relatively independent of personal or child-related stressors.

In vivo desensitization in the management of self-injurious behavior.

In vivo desensitization procedures were used successfully to manage self-injurious face slapping in a 10 yr old retarded boy. Face slapping had increased and persisted at self-injurious intensity following a surgical dental evaluation and had initially been prevented by the use of a hockey helmet. Parent's efforts to remove the helmet resulted in increased agitation, severe self-injurious behavior, and repeated efforts by the child to replace the helmet to restrain himself, or prompt adult restraint. An in vivo desensitization procedure involving increasingly extended periods without the helmet was introduced by the parents into a hierarchy of situations at home. Progress was monitored across four situations using a multiple baseline design with 6, 9, 12 and 15 month follow-up on each baseline. During treatment, self-injurious behavior was eliminated and the child developed a self-control response of wearing the helmet when agitated and spontaneously removing it when relaxed. Continued improvement was noted at 6, 9 and 12 month follow-ups. At the 15 month follow-up, no self-injurious behavior was observed and the use of the helmet was discontinued.

Changes in general health and musculoskeletal outcomes in the workforce of a hospital undergoing rapid change: a longitudinal study.

This article aimed to examine changes in general health and time with back pain and neck pain and to identify predictors of any such changes. Hospital workers were studied longitudinally with surveys in 1995, 1996, and 1997 (N = 712). Back and neck pain were reported only at the 2nd and 3rd surveys. There was a significant decline in general health and significant increases in time with neck pain and back pain. Predictors of changes in these outcomes were mainly work-related variables (initial or change values), such as job interference with family, job influence, work psychological demands, and hours worked.

Do stimulant drugs improve the academic performance of hyperkinetic children? A review of outcome studies.

Stimulant drug studies based primarily on measures of teacher opinion have frequently concluded that these drugs improve the achievement of hyperkinetic children. However, a review of those studies using more objective measures of academic performance revealed few positive short-term or long-term drug effects on these measures. What few improvements have been noted can be readily attributed to better attention during testing. The major effect of the stimulants appears to be an improvement in classroom manageability rather than academic performance. It would seem that the stimulants are not able to influence those etiologic factors, other than overactivity and inattentiveness, which predispose hyperkinetic children toward school difficulties. Hence, since the goal of pediatric intervention with these children should be to enhance school performance as well as reducing hyperactive behavior, the two should be independently and objectively monitored. Since stimulant medications fail to improve the academic performance of most of these children, additional educational assistance must be provided.

Determinants of job stress and job satisfaction among supervisory and non-supervisory employees in a large Canadian teaching hospital.

This article explores the extent to which hospital workers at a large teaching hospital at different managerial/supervisory levels (designated and non-designated supervisors, and non-supervisory staff), experienced job stress and job satisfaction prior to the re-engineering of hospital services. For all groups, increased levels of job demands were associated with higher levels of stress. Lower levels of decision latitude were associated with increased job stress for designated supervisors. Increasing levels of decision latitude were associated with both job stress and satisfaction for the other two groups. Co-worker support and teamwork contributed to increased job satisfaction for all groups.

In the wake of the MTA: charting a new course for the study and treatment of children with attention-deficit hyperactivity disorder.

This paper considers 3 questions addressed by the National Institute of Mental Health's Collaborative Multimodal Treatment Study of Children With Attention-Deficit Hyperactivity Disorder (ADHD), the MTA study, of pharmacological and behavioural interventions for 7- to 9-year-old ADHD children. First, do behavioural interventions represent a viable treatment option for families of children with ADHD? Second, what are the relative benefits of behavioural and pharmacological interventions? Finally, are there advantages to combining behavioural and pharmacological interventions for children with ADHD? In the absence of secondary analyses, the MTA's primary intent-to-treat analyses released to date are difficult to interpret. While behavioural interventions represented a viable option for many families, the doses achieved via systematic titration and follow-up medication-management protocols yielded larger effect sizes on unblinded primary symptom reports than did behavioural treatments or the medication management used by most families in the community control conditions. Finally, while combined medication and behavioural management demonstrates some benefits, a more definitive conclusion awaits a detailed presentation of secondary analyses and follow-up data.

The interactions of normal and hyperactive children with their mothers in free play and structured tasks.

Groups of 20 normal and 20 hyperactive boys ranging in age from 6 to 12 years were observed interacting with their mothers in 15-min free-play and 15-min structured-task situations. Using a 15-sec interval coding procedure, 1 observer recorded the mother's response to specific antecedent behaviors of the child while a second observer recorded the child's response to specific behaviors of the mother. Hyperactive boys proved more active, less compliant, and less likely to remain on task than nonhyperactive peers. Mothers of hyperactive boys were less likely to respond positively to the child's social interactions, solitary play activities, or compliant on-task behavior. In addition, mothers of hyperactive boys imposed more structure and control on the child's play, social interactions, and task-oriented activities. It is suggested that the controlling intrusive style observed among the mothers of hyperactive boys, while initially a response to the child's overactive, impulsive, inattentive style, may further contribute to the child's behavioral difficulties.

A dose-response analysis of the effects of methylphenidate on the peer interactions and simulated classroom performance of ADD children with and without conduct problems.

To examine the social effects of methylphenidate, groups of 15 attention-deficit disordered boys with (ADD) and 15 ADD boys without conduct problems (ADD/CP) were paired with normal peers. ADD and ADD/CP children showed a different pattern of responses to methylphenidate. While on task behavior in ADD/CP dyads increased at 0.15 mg/kg doses, increases in ADD dyads were not observed until doses reached 0.50 mg/kg. Although controlling interaction in ADD children decreased at 0.15 mg/kg, the controlling behavior of ADD/CP children did not decline at either dose. Peers of both ADD and ADD/CP children showed reciprocal declines in controlling behavior. In both free play and cooperative task situations, 0.15 mg/kg increased social interaction in ADD boys and decreased social interaction in ADD/CP boys.

A developmental dose-response analysis of the effects of methylphenidate on the peer interactions of attention deficit disordered boys.

Mixed dyads of 42 normal and 42 ADD boys were videotaped in free play, co-operative task, and simulated classrooms. ADD boys received placebo, 0.15 mg/kg, and 0.50 mg/kg of methylphenidate. ADD boys were more active and off task, watched peers less, and scored lower on mathematics and visual-motor tasks. Older boys interacted less, ignored peer interactions and play more frequently, were less controlling, and more compliant. In class, methylphenidate improved visual motor scores, and reduced the controlling behaviour, activity level, and off task behaviour of ADD boys. Normal peers displayed reciprocal reductions in controlling behaviour, activity level, and off task behaviour.