Predictors of Health-related Quality of Life and Psychological Adjustment in Children and Adolescents With Congenital Melanocytic Nevi: Analysis of Parent Reports.

Objectives This cross-sectional study assessed health-related quality of life (HRQOL) and psychological adjustment in children and adolescents affected by congenital melanocytic nevi (CMN) and identified potential predictors of adjustment. Methods Participants were recruited worldwide with the help of patient organizations. Data were obtained from parents of 235 children affected by CMN, aged between 1 month and 18 years (M = 6.3 y; SD = 5.0 y), using a web-based survey. Measures included the Pediatric Quality of Life InventoryTM 4.0 and the Strengths and Difficulties Questionnaire. Sample scores were compared to normative data. Demographic characteristics as well as CMN-related variables were examined as possible predictors of outcome, using multivariate analyses. Results Parents of children and adolescents born with a CMN reported significantly lower HRQOL and somewhat higher emotional and behavioral problems compared to community norms. Impairments in HRQOL and psychological adjustment were predicted by lower socioeconomic status, neurological problems, skin-related discomfort (e.g., itch or pain), and perceived stigmatization. The size of the CMN and whether or not the CMN had been (partially) removed by surgery were no significant predictors. The relationship between visibility of the skin lesion and psychological adjustment and psychosocial health was found to be mediated by perceived stigmatization. Conclusions In children and adolescents affected by CMN, those experiencing neurological problems, skin-related discomfort or high levels of perceived stigmatization are particularly vulnerable for impaired HRQOL and psychological maladjustment and therefore might need special monitoring and support.

Longitudinal Evaluation of a Parent and School Team-Mediated Workshop Intervention for Reducing Challenging Behaviours in Children with Autism Spectrum Disorder.

Children with autism spectrum disorder often develop persistent challenging behaviours. A previous study in this journal (Reynolds et al. 2011) reported effective implementation of strategies immediately following involvement in a comprehensive positive behaviour support workshop for parents/school personnel. The current study assessed long-term efficacy more than six months after workshop completion. Parent and school behaviour scores suggested maintained improvement in child behaviour. Parent responses to a verbal questionnaire revealed important perceptions of what made workshop participation beneficial. This study provides evidence for long-term benefits from this innovative approach for caregivers working with children with challenging behaviours.

Social communication features in children following moderate to severe acquired brain injury: a cross-sectional pilot study.

We compared the social communication deficits of children with moderate to severe acquired brain injury or autism spectrum disorder, while accounting for the role of attention-deficit hyperactivity disorder (ADHD) symptoms. Parents of 20 children aged 6 to 10 years (10 acquired brain injury; 10 autism spectrum disorder) completed the Social Communication Questionnaire, and Conners 3 Parent Short. A multivariate analysis of covariance revealed significant differences between groups in Social Communication Questionnaire restricted repetitive behavior scores, but not reciprocal social interaction or social communication. Multiple linear regressions indicated diagnosis did not predict reciprocal social interaction or social communication scores and that Conners 3 Parent Short Form hyperactivity scores were the strongest predictor of Social Communication Questionnaire reciprocal social interaction scores after accounting for age and Intelligence Quotient. The lack of difference in social communication deficits between groups may help in understanding the pathophysiology underlying the behavioral consequences of acquired brain injury. The link between hyperactivity and reciprocal interaction suggests that targeting hyperactivity may improve social outcomes in children following acquired brain injury.

Acute sphenoid sinusitis induced blindness: a case report.

BACKGROUND: Acute, isolated sphenoid sinusitis is a rare but potentially devastating clinical entity. Missing this diagnosis can lead to permanent vision loss due to injury of the optic nerve. Patients may present with preseptal inflammation, lid edema, chemosis, or ophthalmoplegia. OBJECTIVE: We report a case of acute sphenoid sinusitis in a 10-year-old child who presented to the Emergency Department with essentially painless vision loss. CASE REPORT: Previously healthy, the patient reported progressive decrease in vision in her right eye for the 5 days prior. Other than blurred vision in the right eye, she complained of a mild frontal headache and right eye irritation the past week, which had abated. On examination, she was reading a book with her head tilted to one side. She had no photophobia, or facial or eyelid swelling. Her pupils were 5 mm bilaterally, but the right was non-reactive to light. She was unable to see two fingers 6 inches in front of her face (right eye), whereas her visual acuity on the left was 20/25. She had bilateral elevated intraocular pressures and a Marcus Gunn pupil on the right. Ophthalmology was consulted and the diagnosis of acute sphenoid sinusitis causing compression and vascular compromise to the optic nerve was diagnosed ultimately by magnetic resonance imaging. The patient was transferred to the nearest pediatric specialty hospital, where an emergent endoscopic sphenoidotomy was performed. The patient's vision subsequently returned. CONCLUSION: Sphenoid sinusitis should be considered in patients presenting with acute vision loss. Awareness, early diagnosis, and intervention help prevent permanent complications.

Training care teams of children with autism spectrum disorders in positive behaviour support: an innovative approach.

As part of a team, the authors developed a workshop to help parents and teams address the behavioural needs of children with autism using a positive behaviour support (PBS) approach. Teams received comprehensive training in PBS and completed weekly homework assignments. Measures of participant satisfaction, parent satisfaction and efficacy and child behaviour suggested this training as an effective intervention for these teams. Participants reported improvements and the effective implementation of strategies after involvement in the workshops. This innovative model suggests potential for teams struggling with communication challenges in addressing problem behaviours in children with autism.

A longitudinal, controlled study of patient complaints following treated mild traumatic brain injury.

This study provided 3-month follow-up data to a previous paper that compared symptom complaints of patients with mild traumatic brain injury (MTBI) with those of non-injured control participants within 1 month of injury. The 110 MTBI patients and 118 control participants were group-matched on age, gender, education level, and socioeconomic status. As a group, MTBI patients no longer endorsed significantly more symptoms (M = 14.09, S.D. = 10.77) than did the control group (M = 12.56, S.D. = 8.46, P = .232). Only 3 of the 43 queried symptoms were endorsed by significantly more (Bonferroni-corrected P < .00116) MTBI patients than controls. Using the same Bonferroni-corrected criteria, 10 of the 43 symptoms were endorsed at a significantly higher severity level by MTBI patients. Overall, the treated MTBI group's symptom complaints diminished from baseline to 3 months post-injury, with relatively few differences remaining between the two groups.

A longitudinal study of compensation-seeking and return to work in a treated mild traumatic brain injury sample.

OBJECTIVE: In patients with mild traumatic brain injury (MTBI), to assess: (1) changes in financial compensation-seeking status over time and (2) the relationship between compensation-seeking and return to work. DESIGN: Longitudinal evaluation of financial compensation-seeking status (i.e., at intake, 3 months postinjury, and 12 months postinjury) and relationship of such status to return to work. SETTING: Outpatient rehabilitation clinic. SUBJECTS: Ninety-seven patients with MTBI. MAIN OUTCOME MEASURES: Compensation-seeking status at 3 and 12 months and days taken to return to preinjury vocational activity. RESULTS: Those in litigation at intake generally continued to be in litigation at 3 and 12 months postinjury. Those seeking or receiving compensation via administrative means (e.g., sick pay or workers' compensation) at intake were generally not seeking or receiving compensation by 3 months or later, as was the case for most of those not seeking any financial compensation at intake. Patients seeking or receiving financial compensation via litigation and/or administrative means at intake took longer to return to work than did people who were not seeking or receiving compensation at intake. CONCLUSION: The present study design does not allow for determination of the reasons for the strong relationship between financial compensation-seeking soon post-MTBI and a slow return to work. However, the strength of the present findings indicates that the presence or absence of financial compensation-seeking soon post-MTBI should be routinely evaluated when return to work is an issue.

A longitudinal study of the relationship between financial compensation and symptoms after treated mild traumatic brain injury.

Demographic, injury-related, and symptom variables at intake, 3 months, and 12 months postinjury were compared between 50 treated adults with mild traumatic brain injury (MTBI) who were not seeking or receiving financial compensation at any time and 18 who were at each time. Compensation seekers/receivers reported symptom incidence and severity as approximately 1 SD higher at each time. The level of difference between the groups did not significantly differ across time. No demographic variables distinguished the groups. No injury-related variable other than more immediate postinjury prescription medication use was predictive of the greater symptom complaints for the patients seeking or receiving compensation. However, this medication effect did not explain away the compensation effect when medication use was co-varied in an analysis. Our study appears to be the first to examine the relationship between financial compensation and symptom report in an MTBI sample specifically treated for their condition. Our results indicate that even highly patient-rated treatment is not adequate to wash out the strong relationship between financial compensation status and symptom report after MTBI.

Patient complaints within 1 month of mild traumatic brain injury: a controlled study.

Symptom complaints of 118 patients with mild traumatic brain injury (MTBI), within 1 month postinjury, were compared with those of 118 control participants without a MTBI. The MTBI and control subjects were group-matched on age, gender, socioeconomic status (SES), and education status. Differences in symptom endorsements and severity ratings were found between the groups, with 16 of the 43 queried symptoms endorsed significantly more often (Bonferroni-corrected P<.00116) by MTBI patients than by controls. A total of 23 of the 43 symptoms were endorsed at a significantly higher severity by MTBI patients. The MTBI sample showed significantly higher within-group variability, with severity ranging from minimal to high. Perhaps because of this high variability, a logistic regression used to discriminate MTBI patients from controls was only moderately successful. This indicates that subjective complaints probably cannot be used, even soon after injury, to decisively distinguish individual MTBI patients from uninjured persons.