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.

Parents' observed responses to children's emotional distress: Relations with social competence in preschool.

Although affective interactions in the family are important for development, home observational data are sparse. We replicated and extended one such study, Roberts & Strayer (1987, Developmental Psychology, 23, 415). Interactions in 33 two-parent families (mean child age = 4.8 years; 48% girls) were observed for four evenings, from suppertime until the child settled for the night. Parents completed the Child Rearing Practices Q-sort. Peer interactions and friendship networks in preschool were observed over four days. Teachers and observers completed the Preschool Behavior Q-Sort. Based on Q-rated peer competence and aggression, three expected groups of children were identified, one of them high on both aggression and peer competence. Although socially active and accepted by peers, they were, compared with other children, less cooperative with adults, less prosocial with peers, more impulsive, less achievement oriented, less purposive, and less happy (mean η2  = .52). Parenting, especially observed impatience, threats, and use of force when children were emotionally distressed, showed important differences across groups.

Aggressive Behavior in School-aged Children: Clusters based on Anger, Empathy and Testosterone and Cortisol Measures.

The aim of this piece of research was to study the existence of clusters based on anger, empathy and cortisol and testosterone measures associated with aggressive behavior in school-aged children. The sample group comprised 139 eight-year-old children (80 boys and 59 girls). Aggressive behavior was measured using the Direct and Indirect Aggression Scale. Both psychological and biological variables were used to determine psychobiological profiles. The psychological variables considered were trait anger, measured using the State-Trait Anger Expression Inventory for Children and Adolescents, and empathy, measured using the Empathy Quotient-Child Version. Testosterone and cortisol concentrations were measured through saliva samples and analyzed using an ELISA (Enzyme-linked immunosorbent assay). A Cluster Analysis revealed three clusters which were clearly different as regards their psychological and biological characteristics. The analysis of variance (ANOVA) revealed that the cluster characterized by having higher anger levels, lower empathy levels and higher testosterone and cortisol levels was more aggressive than the other two (p < .0001, η2 = .19). The results indicate that studying psychological and biological variables together may help establish differentiated aggression patterns among children.

Classification of postoperative behavior disturbances in preschool children: A qualitative study.

BACKGROUND/AIM: Negative postoperative changes in children are frequent and have been described for decades. However, there is currently no theoretical framework, nor any consensual operational criteria for identifying them. This study aims at characterizing the many dimensions involved in postoperative behavioral disturbances in early childhood, using a qualitative analysis applied for the first time to these symptoms. METHOD: Fifty-seven parents of preschool children (1-5 years old; 38 boys), who underwent general anesthesia, were interviewed 10 days after surgery. Semi-structured interviews investigated behavioral disturbances classically described in preschool children. Qualitative analysis of the transcripts allied both deductive and inductive reasoning, and inductive coding was carried out using constant comparison method with dedicated qualitative software. RESULTS: Parents reported both positive and negative postoperative changes. Negative changes were classified in four main categories: (a) Externalizing and (b) Internalizing problems behaviors, (c) Feeding sleeping disruption and (d) Somatic problems, each comprising different sub-categories. Importantly within these categories, the symptoms distribution changed in 5 years old children, compared to younger children. Finally, our method allowed defining whether these (negative or positive) changes were significant or not, that is, the importance of postoperative behavioral changes. CONCLUSION: The results of this study highlight the heterogeneity of postoperative disturbances in preschool children. These results are of primary importance for the definition and measurement of postoperative behavioral disturbances.

Multiple Trajectories in Anxious Solitary Youths: the Middle School Transition as a Turning Point in Development.

This study aimed to identify divergent patterns of individual continuity and change in anxious solitude (AS) in the last half of elementary school (3rd - 5th grade) and the first two years of middle school (6th - 7th grade), and test predictors and outcomes of these pathways. Participants were 688 youths (girls n = 354, 51.5%; M age at outset = 8.66 years, SD = 0.50). Latent class growth analyses identified two AS trajectory classes in elementary school (moderate-decreasing, high-increasing) and three in middle school (low-stable, low-increasing, high-decreasing). The elementary school moderate-decreasing class was two-and-a-half times more likely than others to end in the middle school low-stable class. In contrast, the elementary school high-increasing class was twice as likely as others to end in the middle school low-increasing class, and four times as likely to end in the middle school high-decreasing class. Peer exclusion predicted membership in increasing AS trajectory classes in both elementary and middle school, whereas the middle school high-decreasing AS trajectory class demonstrated decreasing peer exclusion during middle school. Likewise, inability to defend oneself predicted membership in increasing AS trajectory classes in both elementary and middle school, whereas membership in the middle school high-decreasing AS trajectory class was predicted by inability to defend oneself in elementary but not middle school. High-decreasing AS youths' improved ability to defend themselves in middle school appeared to be related to a cascade of improvements in related domains. In contrast, membership in increasing AS classes in elementary and middle school predicted symptoms of social anxiety and depression.

Development of Aggression Subtypes from Childhood to Adolescence: a Group-Based Multi-Trajectory Modelling Perspective.

The persistence of elevated subtypes of aggression beginning in childhood have been associated with long-term maladaptive outcomes. Yet it remains unclear to what extent there are clusters of individuals following similar developmental trajectories across forms (i.e., physical and indirect) and functions (i.e., proactive and reactive) of aggression. We aimed to identify groups of children with distinct profiles of the joint development of forms and functions of aggression and to identify risk factors for group membership. A sample of 787 children was followed from birth to adolescence. Parent and teacher reports, and standardised assessments were used to measure two forms and two functions of aggressive behaviour, between six and 13 years of age along with preceding child, maternal, and family-level risk-factors. Analyses were conducted using a group-based multi-trajectory modelling approach. Five trajectory groups emerged: non-aggressors, low-stable, moderate-engagers, high-desisting, and high-chronic. Coercive parenting increased membership risk in the moderate-engagers and high-chronic groups. Lower maternal IQ increased membership risk in both high-desisting and high-chronic groups, whereas maternal depression increased membership risk in the high-desisting group only. Never being breastfed increased membership risk in the moderate-engagers group. Boys were at greater risk for belonging to groups displaying elevated aggression. Individuals with chronic aggression problems use all subtypes of aggression. Risk factors suggest that prevention programs should start early in life and target mothers with lower IQ. Strategies to deal with maternal depression and enhance positive parenting while replacing coercive parenting tactics should be highlighted in programming efforts.

Aggressive behavior in school-aged children: clusters based on anger, empathy and testosterone and cortisol measures

The aim of this piece of research was to study the existence of clusters based on anger, empathy and cortisol and testosterone measures associated with aggressive behavior in school-aged children. The sample group comprised 139 eight-year-old children (80 boys and 59 girls). Aggressive behavior was measured using the Direct and Indirect Aggression Scale. Both psychological and biological variables were used to determine psychobiological profiles. The psychological variables considered were trait anger, measured using the State-Trait Anger Expression Inventory for Children and Adolescents, and empathy, measured using the Empathy Quotient-Child Version. Testosterone and cortisol concentrations were measured through saliva samples and analyzed using an ELISA (Enzyme-linked immunosorbent assay). A Cluster Analysis revealed three clusters which were clearly different as regards their psychological and biological characteristics. The analysis of variance (ANOVA) revealed that the cluster characterized by having higher anger levels, lower empathy levels and higher testosterone and cortisol levels was more aggressive than the other two (p < .0001, η2 = .19). The results indicate that studying psychological and biological variables together may help establish differentiated aggression patterns among children

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Developmental patterns of anger from infancy to middle childhood predict problem behaviors at age 8.

Anger is a central characteristic of negative affect and is relatively stable from infancy onward. Absolute levels of anger typically peak in early childhood and diminish as children become socialized and better able to regulate emotions. From infancy to school age, however, there are also individual differences in rank-order levels of anger. For example, although decreasing in absolute levels, some children may stay the same and others may increase in rank order relative to their peers. Although change in rank order of anger over time may provide unique insight into children's social development, little is known concerning variations in developmental patterns of anger from a rank-order perspective and how these patterns are related to children's behavioral adjustment. The current study (N = 361) used group-based trajectory analysis and identified 6 distinct patterns of parent-reported child anger by rank across 9 months to 7 years: low-stable rank, average-stable rank, average-decreasing rank, average-increasing rank, high-decreasing rank, and high-stable rank. Most children (65.1%) were in low- to average-rank groups. However, 28.2% and 6.7% of the children were in average-increasing and high-stable groups, respectively. Children in the high-stable group showed elevated levels of externalizing and internalizing problems at age 8 compared to children in the average-stable, average-decreasing, and high-decreasing groups. These findings help to clarify different patterns of anger development across childhood and how they may relate to later problem behaviors. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Item Generation and Content Validity of the Child-Adolescent Bullying Scale.

BACKGROUND: Healthcare providers do not uniformly screen young patients for exposure to bullying, and no screening instruments have been developed for widespread use in clinical settings. OBJECTIVES: The objectives of this study were to (a) generate scale items by identifying and eliciting concepts relevant to youths with potential exposure to bullying as well as to professionals who work with bullied youths and (b) assess the content validity of the new Child-Adolescent Bullying Scale (CABS) instrument. METHODS: A mixed-methods design was used to develop an initial pool of 52 items. The study was conducted in four phases: (I) comprehensive review of the existing literature; (II) concept elicitation through the conduct of focus groups with school-age youths and professionals who work with bullied youths; (III) concept selection and item construction; and (IV) content validation assessment of relevance, clarity, and dimension of each item by a panel of 30 international bullying and measurement experts through completion of an online survey. RESULTS: An initial pool of 52 potential items was developed during Phases I-III of the study. During Phase IV, item- and scale-level content validity indices were calculated and were used to refine the item pool. These strategies resulted in a new, 22-item tool, with scale-level content validity indices of .954 for clarity and .920 for representativeness. DISCUSSION: Evaluation of the CABS tool with a sample of youths drawn from healthcare settings will be necessary to assess the performance of the CABS items, further evaluate its psychometric properties, and further refine the tool.

Predictors of childhood trajectories of overt and indirect aggression: An interdisciplinary approach.

The aim of this study was to advance our understanding of the development of aggression in boys and girls by testing a model combining insights from both evolutionary theory and developmental psychology. A sample of 744 children (348 girls) between six and 13 years old was recruited in schools with high deprivation indices. Half of the sample (N = 372; 40.1% girls) had received special educational services for behavioral and/or socio-emotional problems. Two trajectories for overt aggression and two trajectories for indirect aggression were identified and binomial logistic regressions were used to identify environmental predictors and sex-specific patterns of these trajectories. Results indicated that peer rejection predicted overt aggression and indirect aggression and that extraversion and male sex predicted overt aggression. The results also showed that interaction between parental practices and some child temperament traits predicted overt aggression (coercion and lack of supervision associated with extraversion or low effortful control) or indirect aggression (coercion and neglect associated with negative affect or low effortful control), and the absence of a father figure predicted high indirect aggression in girls.

Distilling Heterogeneity among Children with Disruptive Behavior: Associations between Symptom Patterns and Social Functioning.

Children with disruptive behavior (DB) are a heterogeneous group who exhibit several characteristics that may contribute to poor social functioning. The present study identified profiles of reactive aggression, proactive aggression, callous-unemotional (CU) traits, and prosocial behavior in a sample of children with DB. Associations with social functioning (social interaction, social status) were then examined, along with sex differences in profile membership. Parent ratings of 304 clinic-referred children ages 6-12 years with DB were analyzed using latent profile analysis. Five profiles were identified: 1) Moderate prosocial behavior, reactive aggression, and CU, and low proactive aggression (labelled Moderate); 2) Relatively high prosocial behavior and low reactive and proactive aggression and CU traits (Prosocial); 3) High prosocial behavior and reactive aggression, moderate proactive aggression, and low-moderate CU (Reactive-Prosocial); 4) Low prosocial behavior, high CU, high-moderate reactive aggression, and low-moderate proactive aggression (Reactive-CU); and 5) Low prosocial behavior and high reactive and proactive aggression and CU (Aggressive-CU). Profiles characterized by CU traits, reactive aggression, and low prosocial behavior were associated with the most problematic parent-rated social interaction and social status. The results highlight the need to differentiate profiles of psychopathology in children with DB to better address factors most associated with social functioning.

Risk-Taking Behaviors in Iranian Children and Adolescents: A Latent Class Analysis Approach: Caspian IV Study.

BACKGROUND: Risk taking behaviors have several negative consequences. This study aimed to identify the subgroups of students based on risk-taking behaviors and to assess the role of demographic characteristics, depression, anxiety, socioeconomic status (SES), physical inactivity and screen time on membership of specific subgroup. STUDY DESIGN: Cross-sectional study. METHODS: This nationwide survey was conducted in 2011-2012 among 14880 students, aged 6-18 yr, selected by multistage, cluster-sampling method from 30 provinces of Iran. The students completed two sets of anonymous and validated questionnaires, obtained from the World Health Organization-Global School Health Survey questionnaires. Latent class analysis was performed to achieve the study objectives. RESULTS: Overall, 13486 children and adolescents participated were enrolled (response rate 90.6%). They consisted of 50.8% boys, with a mean age of 12.47 ±3.36 year. The prevalence of physical fight, bullying, victimization, active smoking, passive hookah and passive cigarette smoking was 39.7%, 17.4%, 27.2%, 5.9%, 21.1 and 33.8%, respectively. Five latent classes were identified: (a) low risk (46.7%), (b) passive smoker (25.2%), (c violence and aggression taker with passive smoking (13.5%), (d) violence and aggression taker without passive smoking (10.8%) and (e) high risk (3.8%). Higher age (OR=1.41), being male (OR=5.21), depression (OR=4.58), anxiety (OR=3.38) and screen time (OR=3.11) were associated with high-risk class. CONCLUSION: The prevalence of some risk-taking behaviors among Iranian students is high. Our findings emphasize the importance of planning and evaluating preventive interventions by considering different high-risk behaviors simultaneously.

Cross-Domain Symptom Development Typologies and Their Antecedents: Results From the UK Millennium Cohort Study.

OBJECTIVE: Typologies of symptom development have been used to identify individuals with different symptom development in the externalizing and internalizing domains of child psychopathology separately despite the domains' high comorbidity and shared common etiologic risk. This study identified typologies of development jointly across the 2 symptom domains in childhood and investigated their associated antecedents with a specific focus on the comparisons between overall severity of symptoms and symptom expression in one or the other domain. METHOD: Latent class analysis identified groups based on emotional and behavioral symptoms assessed at 3, 5, 7, and 11 years in the UK Millennium Cohort Study (N = 15,439). Different sociodemographic, family structure and environment, birth, infancy, and early childhood antecedents were examined. RESULTS: Five groups were identified: 1. low symptoms (57%), 2. moderate behavioral (21%), 3. moderate emotional (12.5%), 4. high emotional and moderate behavioral (5.5%), and 5. high behavioral and moderate emotional (4%). Higher symptoms were predicted by larger numbers of antecedents and risk factors compared with the low symptom group and compared with moderate and high levels of symptoms in either domain (groups 5 versus 2 and 4 versus 3). Comparisons of groups with similar overall symptom levels but different dominant symptom domain (groups 2 versus 3 and 4 versus 5) indicated that apart from gender and ethnicity, there were few unique antecedents of whether children mainly internalize or externalize their symptoms. CONCLUSION: It is possible and useful to define groupings or typologies jointly across externalizing and internalizing symptom development in childhood. Although numerous antecedents predict the experience of symptoms, there are few unique antecedents that differentiate individuals with similarly high levels of psychopathology expressed mainly as internalizing or externalizing symptoms. Identification of at-risk children and delivery of early intervention might benefit from a decreased focus on symptom domain with possible downstream effects through the life course for most common psychiatric disorders.

Parental embodied mentalizing: how the nonverbal dance between parents and infants predicts children's socio-emotional functioning.

Parental mentalizing - the parent's ability to envision the child's mental states (such as desires, thoughts, or wishes) - has been argued to underlie a parent's ability to respond sensitively to their child's emotional needs, and thereby promote advantageous cognitive and socio-emotional development. Mentalizing is typically operationalized in terms of how parents talk to or about their infants. This work extends research on mentalizing by operationalizing parental mentalizing exclusively in terms of nonverbal, bodily based, interactive behavior, namely parental embodied mentalizing(PEM). The purpose of the current research was twofold: (1) to establish the reliability and validity of the PEM coding system; and (2) to evaluate whether such measurement predicts infant and child cognitive and socio-emotional functioning. Assessing 200 mother-infant dyads at 6 months using the coding of PEM proved both reliable and valid, including predicting child attachment security at 15 and 36 months, and language abilities, academic skills, behavior problems, and social competence at 54 months, in many cases even after taking into consideration traditional measures of parenting, namely maternal sensitivity. Conceptual, empirical, and clinical implications are discussed.

Behavioral Profiles Associated with Objective Sleep Duration in Young Children with Insomnia Symptoms.

Based on previous studies reporting on the association of objective sleep duration and physiologic changes (i.e., increased cortisol) in children, we examined the role of objective sleep duration on differentiating behavioral profiles in children with insomnia symptoms. Seven hundred children (ages 5-12, 47.8% male) from the Penn State Child Cohort underwent a nine-hour polysomnography and parent completed Pediatric Behavior Scale. Insomnia symptoms were defined as parent report of difficulty falling and/or staying asleep, sleep disordered breathing as an AHI of ≥1, and objective short sleep duration as a total sleep time < 7.7 h. Children with insomnia symptoms demonstrated more overall behavioral problems than controls. Significant interactions between insomnia symptoms and objective sleep duration on scores of externalizing behaviors, mood variability and school problems were found. Profile analyses showed that children with insomnia symptoms and normal sleep duration were associated with clinically elevated externalizing behaviors, inattention, mood variability, and school problems, while children with insomnia and short sleep duration were associated with an overall elevated profile in which internalizing behaviors were more prominent. Childhood insomnia symptoms are associated with a wide array of behavioral problems, for which objective sleep duration is useful in differentiating behavioral profiles. Children with insomnia symptoms and normal sleep duration had a behavioral profile consistent with limit-setting and rule-breaking behaviors, while children with insomnia symptoms and short sleep duration had a behavioral profile more consistent with internalizing behaviors resembling that of psychophysiological disorders.

Cut-off values for classifying active children and adolescentes using the Physical Activity Questionnaire: PAQ-C and PAQ-A / Valores de corte para clasificar niños y adolescentes activos utilizando el Cuestionario de Actividad Física: PAQ-C y PAQ-A

Introduction: The Physical Activity Questionnaire for children and adolescents (PAQ-C & PAQ-A) has been widely used in research and fi eld settings. However, there is a lack of information about its fi nal score meaning. Objective: To determine PAQ-C and PAQ-A score cut-off values using physical activity (PA) thresholds objectively measured as reference criteria. Methods: 146 children (n = 83 boys, n = 63 girls) and 234 adolescents (n = 115 boys, n = 119 girls) participated in this study. Accelerometers (Actigraph GT3X) were used to assess objectively PA during one-week, afterwards PAQ was fi lled by the participants. As participants met or not the international PA recommendations for total, moderate-vigorous (MVPA) or light PA, three categorical variables of two levels were created. ROC curves procedure were carried out to obtain score cut-off points for identifying the positive category recommendation. Results: ROC curves analysis estimated 2.75 and 2.73 score cut-off points to discriminate > 60 minutes of MVPA for PAQ-A and PAQ-C respectively (PAQ-A AUC = 0.68, p < 0.001 and PAQ-C; AUC = 0.55, p > 0.05). Also 60 minutes of MVPA was achieved with a total volume of 10,664 steps/day in children and 9,701 steps/day in adolescents. Conclusions: Our results suggest that PAQ-A can be a useful tool to classify adolescents as active or inactive following international recommendations as criteria. However, we could not fi nd a signifi cant cut-off for PAQ-C score (AU)

Introducción: el Cuestionario de Actividad Física para Niños y Adolescentes (PAQ-C y PAQ-A) ha sido ampliamente utilizado en entornos de investigación y en el trabajo de campo. Sin embargo, existe una falta de información sobre el significado de su puntuación final. Objetivo: determinar los valores de corte del PAQ-C y el PAQ-A y el número de pasos diarios asociados utilizando una medida objetiva de actividad física como criterio de referencia. Metodología: 146 niños (n = 83 niños, n = 63 niñas) y 234 adolescentes (n = 115 niños, n = 119 niñas) participaron en el estudio. Se utilizó acelerometría triaxial (Actigraph GT3X) durante 7 días y los participantes completaron el PAQ-C y/o PAQ-A al entregar el acelerómetro. En base a las recomendaciones internacionales de AF se crearon tres criterios relativos a si los participantes cumplían o no con las mismas (AFMV > 60 min/día, AF vigorosa > 30 min/día, y AF total > 116 min/día; respectivamente). El análisis de las curvas ROC fue utilizado para identificar los valores de corte. Resultados: el análisis de las curvas ROC estimó un valor de 2,75 y 2,73 para discriminar > 60 minutos de actividad física moderada-vigorosa para el PAQ-A y el PAQ-C, respectivamente (PAQ-A AUC = 0,68, p < 0,001 y PAQ-C; AUC = 0,55, p > 0,05). Dicha intensidad se logró con un volumen total de 10.664 pasos/día en niños y 9.701 pasos/día en adolescentes. Conclusiones: nuestros resultados sugieren que el PAQ-A puede ser una herramienta útil para clasificar a los adolescentes activos siguiendo las recomendaciones internacionales de actividad física como criterio. Sin embargo, no pudimos encontrar un punto de corte significativo para el PAQ-C (AU)

Classes of Physical Activity and Sedentary Behavior in 5th Grade Children.

OBJECTIVES: We identified classes of physical activity (PA) and sedentary behaviors (SB) in 5th grade children, associated factors, and trajectories of change into 7th grade. METHODS: This study included N = 495 children (221 boys, 274 girls) who participated in the Transitions and Activity Changes in Kids (TRACK) Study. PA was assessed objectively as well as by self-report. Children, parents, and school administrators completed surveys to assess related factors. Latent class analysis, growth modeling, and adjusted multinomial logistic regression procedures were used to classify children based on self-reported PA and SB and examine associated factors. RESULTS: Three classes of behavior were identified: Class 1: Low PA/Low SB; Class 2: Moderate PA/ High SB; and Class 3: High PA/High SB (boys) or Class 3: High PA (girls). Class 3 children had higher levels of self-efficacy (boys), and enjoyment, parental support, and physical activity equipment at home (girls). Class 2 boys and Class 3 girls did not experience decline in PA (accelerometer) over time. CONCLUSIONS: Self-efficacy (boys) and home environment (girls) may play a role in shaping patterns of PA in children. Findings may help to inform future interventions to encourage children to meet national PA guidelines.

Grouping Youth With Similar Symptoms: A Person-Centered Approach to Transdiagnostic Subgroups.

OBJECTIVES: The present study extracted symptom profiles based on parent and youth report on a broad symptom checklist. Profiles based on parent-reported symptoms were compared to those based on adolescent self-report to clarify discrepancies. METHOD: The current study used archival data from 1,269 youth and parent dyads whose youth received services at a community mental health center. The mean age of the sample was 14.31 years (standard deviation = 1.98), and the youth sample was half male (50.1%) and primarily Caucasian (86.8%). Latent profile analysis was used to extract models based on parent and self-reported emotional and behavioral problems. RESULTS: Results indicated that a 5-class solution was the best fitting model for youth-reported symptoms and an adequate fit for parent-reported symptoms. For 46.5% of the sample, class membership matched for both parent and youth. CONCLUSION: Latent profile analysis provides an alternative method for exploring transdiagnostic subgroups within clinic-referred samples.

How Do Observational Scales Correlate the Ratings of Children's Behavior during Pediatric Procedural Sedation?

Background. There is little information regarding the ability of observational scales to properly assess children's behavior during procedural sedation. Aim. To evaluate the characteristics of the Houpt scales, the Ohio State University Behavioral Rating Scale (OSUBRS) and the Venham Behavior Rating Scale when applied to preschool children undergoing conscious dental sedation. Design. This study included 27 children, 4-6 years old with early childhood caries that participated in a clinical trial (NCT02284204) that investigated two sedative regimes using oral midazolam/ketamine. Dental appointments were video-recorded; five calibrated observers assessed 1,209 minutes of video recording to score the children's behavior, following the instructions of the investigated scales. Data were analyzed by descriptive analysis and Spearman correlation tests (P < 0.05). Results. The Houpt overall behavior and the Venham scale were highly correlated (rho = -0.87; P < 0.001). OSUBRS scores were better correlated with Houpt overall behavior and Venham ratings, when compared to Houpt scores in the categories for movement and crying. Conclusions. The Houpt overall behavior and the Venham scores are global scales that properly measure children's behavior during dental sedation. Continuous assessment with OSUBRS through videos has a chance to give more precise data, while the Houpt categories can easily demonstrate children's behavior during procedures.

A Novel Pilot Study of Internet-stored Videotapes and Pediatric Dentists Predicting Behavior of Preschoolers.

PURPOSE: The purpose of this pilot study was to evaluate a web-based technology as a means of clinical research in assessing pediatric dentists' accuracy in predicting patient behaviors during a clinical procedure based on pre-procedural behaviors shown in vignettes. METHODS: A private web-based server was used to house six two-minute vignettes and a questionnaire on children's behaviors and temperament characteristics. An electronic link via an e-mail invitation was sent to a sample of pediatric dentists. Six patients undergoing a clinical examination were pre-rated using the Ohio State Behavior Rating Scale and classified each as cooperative, potentially cooperative, and uncooperative. The vignettes displayed the children prior to undergoing an examination. Pediatric dentists were asked to predict the children's behaviors and temperament during the clinical examination based on the behavior in the vignettes. RESULTS: Results indicated that 89 percent of the respondents were able to correctly classify and predict behaviors in at least four of the six vignettes. Respondents were less confident and accurate in their predictions for children who were rated as uncooperative (48 percent and 33 percent, respectively). CONCLUSIONS: Web-based technology may be a promising tool for studies in pediatric dentistry. Pediatric dentists can rapidly perceive cues in classifying and discriminating behaviors.