Factors Associated With Reasons for Living Among Suicidal Adolescents.

OBJECTIVE: The objective of this study was to identify baseline demographic and clinical factors associated with higher scores on the Reasons for Living Inventory for Adolescents (RFL-A) at baseline and over follow-up. METHOD: Using data from a pilot clinical trial of a brief intervention for suicidal youth transitioning from inpatient to outpatient, we identified univariate associations of baseline characteristics with RFL-A and used regression to identify the most parsimonious subset of these variables. Finally, we examined to what extent changes in these characteristics over time were related to changes in RFL-A. RESULTS: Univariate analyses found that better external functional emotion regulation and social support were associated with higher RFL-A scores; more self-reported depression, internal dysfunctional emotion regulation, sleep disturbance, anxiety, and distress tolerance were associated with lower RFL-A scores. Multiple linear regression identified internal dysfunctional emotion regulation and external functional emotion regulation as the most parsimonious set of characteristics associated with RFL-A. Improvement in internal emotion regulation, sleep, and depression were related to improvements in RFL-A over time. CONCLUSION: Our findings indicate that emotion regulation-specifically maladaptive internal strategies and use of external resources-is strongly associated with RFL-A. Improvements in internal emotion regulation (r = 0.57), sleep (r = -0.45), and depression (r = -0.34) were related to increases in RFL-A.HIGHLIGHTSIn the literature, greater reasons for living are associated with lower risk for future suicidal ideation and suicide attempts.The most salient correlate of concurrent and future lower RFL-A was dysfunctional internal emotion regulation. Improved sleep and decreases in depression were correlated with increases in RFL-A.

Academic outcome in long-term survivors of pediatric liver transplantation.

Fifty long-term (3-9 year) survivors of pediatric liver transplantation were assessed using IQ, achievement, and school history measures. Forty-seven of these children had been evaluated before transplantation on intellectual measures, with mean scores for the group found to be in the low average range. At follow-up evaluation, the scores remained in the low average range on all intellectual measures; performance on academic tests was also within the low average range. Thirteen children (26%) were classified as having learning problems based on discrepancies between intellectual and academic function, but only five of them (38%) had received special education services. Nine of the children (18%) had IQ scores less than 70. Academic outcome did not relate to diagnosis, time between diagnosis and transplantation, age at time of transplantation, or average levels of cyclosporin A. Careful assessment and appropriate special education services are indicated to optimize the educational outcome of children who survive liver transplantation.

Psychiatric illness and family support in children and adolescents with diabetic ketoacidosis: a controlled study.

OBJECTIVE: To compare compliance, psychiatric disorders, and family support in children with insulin-dependent diabetes mellitus (IDDM) hospitalized with diabetic ketoacidosis (DKA) and clinic controls. METHOD: Twenty-five youths hospitalized with DKA and 25 matched outpatient subjects with IDDM with no history of DKA during the preceding year were assessed cross-sectionally, using the Diagnostic Interview Schedule for Children, measures of general and diabetes-specific family functioning, and measures of self-esteem and social competence. Levels of glycosylated hemoglobin and information about compliance with the treatment regimen were obtained. RESULTS: A significantly higher number of psychiatric disorders was observed in the hospitalized children, with 88% meeting criteria for at least one disorder (versus 28% of controls). Self-esteem and social competence were lower in the hospitalized group, and their families scored lower on problem-solving and diabetes-specific "warmth-caring." CONCLUSIONS: Children with recurrent DKA may be at greater risk of associated psychopathology than diabetic controls with no such history. DKA children's reports of noncompliance may be more sensitive than their parents' reports, and their families may lack warm, caring parent-child relationships.

A survey of psychosocial adaptation in long-term survivors of pediatric liver transplants.

We assessed 41 children and adolescents who had received liver transplants at least 4 years ago, for social, behavioral, and emotional adaptation; physical function; and family stress. We compared their level of adaptive functioning to published data from chronically ill and medically well children. On many measures, transplant recipients had equivalent levels of function to the comparison groups. However, 6- to 11-year-old patients showed mild social and scholastic deficits. Patients' parents report less negative impact of the illness on the family than do parents of other chronically ill children. A listing of medication side effects and the degree to which they are problematic was obtained.

Cognitive function in children who receive organ transplantation.

The number of children who undergo cardiac, renal, and liver transplantation continues to increase. This review of the literature describing their cognitive function indicates that deficits ranging from gross IQ delay to subtle neuropsychological dysfunction are present in some of these children both before and after transplantation. However, with the exception of certain definite contributors to vulnerability, such as cyanotic heart disease, early onset of disease, and growth deficits in infancy (particularly in head circumference and height), the correlates of cognitive deficits are not clear. Problems with determining contributing variables include significant heterogeneity within study populations, difficulties obtaining appropriate control groups, and the need for longitudinal, long-term studies. Additional research is required to address limitations of past studies.

Identifying factors in post-operative successful adaptation to pediatric liver transplantation.

In order to identify variables contributing to successful adaptation to liver transplantation, 38 families, at least six months post-transplant, were divided according to transplant team members' rating into two groups: those with successful adaptation to transplant and those families at risk for difficulties. Families who had successful follow-up periods tended to be characterized by intact marriages, private insurance coverage, less subjective financial stress, and higher intellectual and developmental functioning in the child. Single-parent families who had no pre-evaluation involvement with liver transplant organizations and had lengthy post-operative hospital stays more frequently had complications post-transplant. Case studies are presented illustrating the application of this information.

Mental and motor development, social competence, and growth one year after successful pediatric liver transplantation.

We measured intellectual and motor function, social competence, and growth in 29 children (mean age 4 years 7 months) before liver transplantation and 1 year later. We used either the Bayley Scales, the Stanford-Binet Intelligence Scale, and the Minnesota Child Development Inventory (MCDI), Motor Age Quotient, or the Wechsler Scales, depending on the age of the child at testing. Social function was measured with the MCDI or the Child Behavior Checklist. All anthropometric measures were expressed relative to normal values for age and sex. Patients whose intellectual and motor scores were less than 80 before transplantation gained an average of 8 points, but these changes were not statistically significant, nor were the changes on these measures for the group as a whole. The development of children with onset of liver disease in the first year of life was more likely to remain delayed after transplantation. Older subjects improved significantly in social competence (p less than 0.008). There were significant increments after transplantation in weight, head circumference, and arm anthropometrics (p less than 0.0001 to 0.04), but there was no change in linear growth rate. Increments in length correlated negatively with steroid dosage, and change in head circumference was associated with age at time of transplantation (p less than 0.005 to 0.10).

Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials.

We enrolled 200 infants and older children with bacterial meningitis in two prospective double-blind, placebo-controlled trials to evaluate the efficacy of dexamethasone therapy in addition to either cefuroxime (Study 1) or ceftriaxone (Study 2). Altogether, 98 patients received placebo and 102 received dexamethasone (0.15 mg per kilogram of body weight every six hours for four days). At the beginning of therapy, the clinical and demographic characteristics of the patients in the treatment groups were comparable. The mean increase in the cerebrospinal fluid concentration of glucose and the decreases in lactate and protein levels after 24 hours of therapy were significantly greater in those who received dexamethasone than in those who received placebo (glucose, 2.0 vs. 0.4 mmol per liter [36.0 vs. 6.9 mg per deciliter], P less than 0.001; lactate, 4.0 vs. 2.1 mmol per liter [38.3 vs. 19.8 mg per deciliter], P less than 0.001; and protein, 0.64 vs. 0.25 g per liter [64.0 vs. 25.3 mg per deciliter], P less than 0.05). One patient in the placebo group in Study 1 died. As compared with those who received placebo, the patients who received dexamethasone became afebrile earlier (1.6 vs. 5.0 days; P less than 0.001) and were less likely to acquire moderate or more severe bilateral sensorineural hearing loss (15.5 vs. 3.3 percent; P less than 0.01). Twelve patients in the two placebo groups (14 percent) had severe or profound bilateral hearing loss requiring the use of a hearing aid, as compared with 1 (1 percent) in the two dexamethasone groups (P less than 0.001). We conclude that dexamethasone is beneficial in the treatment of infants and children with bacterial meningitis, particularly in preventing deafness.

Mental development and growth in children with chronic liver disease of early and late onset.

Comparison was made of the mental function and physical growth of 21 children in whom liver disease occurred in the first year of life with 15 patients with late (17 months of age to 12 years of age) manifestation of liver disease. Ages (mean +/- SD) at testing for the two groups was 8 +/- 3 years for the early group and 11 +/- 5 years for the late group. Wechsler verbal, performance, and full-scale IQ scores were lower for the early group (range of mean scores: early, 85 to 86 v late, 96 to 103). Growth measures were significantly different in the two groups. Means +/- SD (percentage of standard) were: length for early group, 92 +/- 9; for late, 99 +/- 7; and head circumference for early, 98 +/- 4; for late, 101 +/- 2. The groups were similar in severity of liver disease and acute nutritional status, however. Patients with intellectual impairment had a longer duration of illness, poor nutritional status, and vitamin E deficiency; 82% of impaired patients were in the early group. The data suggest that liver disease during early life has pernicious effects on intellectual function and linear growth. Careful monitoring of nutritional status of children with early-onset liver disease and aggressive nutritional support beginning at the time of diagnosis may help reduce delays in growth and mental development.

Mental and motor development correlates in patients with end-stage biliary atresia awaiting liver transplantation.

We measured mental and motor development in 27 infants and 14 children with end-stage biliary atresia who were awaiting liver transplantation, and we measured disease-related variables (physical growth, liver function, and severity and duration of disease) that may relate to development. We then determined the relationship between development and the disease-related variables. Infants were assessed with the Bayley scales, and children were assessed with the Stanford-Binet scales of intelligence and the Minnesota Child Development Inventory. The mean +/- SD mental and motor scores for infants were 79.5 +/- 19.6 and 69.7 +/- 17.6, respectively. The mean +/- SD IQ and motor development scores for children were 76.1 +/- 16.6 and 56.9 +/- 18.1, respectively. For infants, mental and motor development were related significantly to height and weight (r values ranged from .42 to .72). Mental development in infants was also related significantly to serum vitamin E levels (P = .03). Multiple regression analyses combining growth and disease-related indices predicted 70% of the variance in mental and motor development in infants (P = .001). For children, development was related to measures of liver function (ie, to serum bilirubin, r = -.51, P = -.08, and to serum albumin, r = .54, P = .06) but not to growth. Careful nutritional support during infancy and aggressive management of liver disease prior to transplantation may be important in optimizing the development of children with biliary atresia who subsequently undergo liver transplantation.