Clinical training within an Indigenous community: a qualitative description of pediatric residents' learning experiences.

Objectives: Indigenous children and families experience inequities across health domains. Calls to action from the Truth and Reconciliation Commission of Canada and the Indigenous Physicians Association of Canada have highlighted the need for medical professionals to better understand these inequities and improve the provision of culturally safe services through collaboration between Indigenous communities and medical residency programs. There are currently no published evaluations of clinical training for Canadian medical residents within Indigenous communities. The current study was conducted at an on-reserve pediatric outreach clinic (Maskwacis Pediatric Outreach Clinic; MPOC). Methods: From the perspectives of pediatric residents, the researchers explored the impacts of attending MPOC during resident training. Residents completed anonymous surveys over an 18-month period that addressed patient and caregiver encounters, the value of MPOC on resident training, significant pediatric health issues in the community, and limitations of MPOC in contributing to training. Seven residents participated in a focus group that expanded upon survey results. Results: Thirty-four surveys were completed. Responses reflected an enhanced understanding of social, environmental, and systemic contributors to health issues, and learning regarding the complexity of circumstances that Indigenous children and families face. Focus group results were organized into the impacts of MPOC on (1) residents and (2) patients, with several sub-categories. Conclusions: Findings suggest that direct clinical exposure to Indigenous child health issues is a valuable educational experience for pediatric residents. The importance of strength-based approaches to educating medical residents regarding the social determinants of health and colonial contexts of Indigenous health disparities is also identified.

Primary Substance Use Prevention Programs for Children and Youth: A Systematic Review.

CONTEXT: An updated synthesis of research on substance abuse prevention programs can promote enhanced uptake of programs with proven effectiveness, particularly when paired with information relevant to practitioners and policy makers. OBJECTIVE: To assess the strength of the scientific evidence for psychoactive substance abuse prevention programs for school-aged children and youth. DATA SOURCES: A systematic review was conducted of studies published up until March 31, 2020. STUDY SELECTION: Articles on substance abuse prevention programs for school-aged children and youth were independently screened and included if they met eligibility criteria: (1) the program was designed for a general population of children and youth (ie, not designed for particular target groups), (2) the program was delivered to a general population, (3) the program only targeted children and youth, and (4) the study included a control group. DATA EXTRACTION: Two reviewers independently evaluated study quality and extracted outcome data. RESULTS: Ninety studies met eligibility criteria, representing 16 programs. Programs evaluated with the largest combined sample sizes were Drug Abuse Resistance Education, Project Adolescent Learning Experiences Resistance Training, Life Skills Training (LST), the Adolescent Alcohol Prevention Trial, and Project Choice. LIMITATIONS: Given the heterogeneity of outcomes measured in the included studies, it was not possible to conduct a statistical meta-analysis of program effectiveness. CONCLUSIONS: The most research has been conducted on the LST program. However, as with other programs included in this review, studies of LST effectiveness varied in quality. With this review, we provide an updated summary of evidence for primary prevention program effectiveness.

Integrating preventive dental care into general Paediatric practice for Indigenous communities: paediatric residents' perceptions.

This qualitative study aimed to explore paediatric residents' perceptions of the feasibility of incorporating preventive dental care into a general paediatric outreach clinic for a First Nations community. Four focus groups were conducted with paediatric residents and attending paediatricians. Interviews were recorded, transcribed verbatim and analysed using a basic interpretive qualitative approach. Three major themes emerged from the data: advantages of integration, barriers to integration and strategies for integration. Comprehensive care and service delivery were the two identified advantages of integration. Three categories of barriers emerged including patient and caregiver-related, resident-related and setting-related barriers. Training and practice, patient education, support and policy were the suggested strategies for successful integration. Providers were found to be open to integrating preventive dental care into their practice. However, barriers impeded the success of this integration. Multiple strategies including oral health care training for medical providers, office support and policy changes would facilitate successful integration.

Mindfulness-based stress reduction for mental health in youth: a cluster randomized controlled trial.

BACKGROUND: Mental illness is among the most common causes of morbidity, mortality, and disability in childhood. Mindfulness-based stress reduction (MBSR) has shown significant benefit in mental health; however, evidence of its effectiveness in youth is limited. The objective of this study was to compare the efficacy of MBSR plus usual care versus usual care alone for reducing mental health symptoms in youth. METHODS: A two-arm, mixed methods, randomized cluster-controlled trial of 12-18 year olds who were residents of CASA House, a voluntary residential treatment program for adolescents, between January 2011 and March 2013 (clinicaltrials.gov, NCT01307943). INTERVENTIONS: Treatment terms were randomized to usual care, or MBSR plus usual care, which included eight MBSR sessions of 2 hr/week. OUTCOMES: The primary outcome was impact on emotions and behavior at the end of the program, using the Behavior Assessment System for Children, Second Edition (BASC-2). Secondary outcomes included perceived stress levels, mindfulness, and emotional regulation. RESULTS: A total of 85 participants were randomized to either the MBSR arm (n = 45) or control arm (n = 40). Significant differences in favor of MBSR were found on Teacher ratings of the Internalizing Problems (p = .038) and Adaptive Skills subscales (p = .022) on the BASC-2. No significant differences were found on other outcomes. A post hoc analysis found that the MBSR arm had a significantly shorter time to discharge (p = .02). CONCLUSION: The results of this study indicate that MBSR is effective for improved coping with internalizing problems and adaptive emotional skills in our sample. Future studies should focus on larger, longer-term studies in youth.

Promoting the strengths and resilience of an Indigenous community through photovoice.

In the face of negative media attention, community members and Elders from the First Nation community of Maskwacis identified the importance of promoting community strengths and reframing perceptions of their community. Two research questions were addressed: (1) How do youth in Maskwacis view their community strengths? and (2) To what extent can photographs be used as a tool for reframing perceptions of an Indigenous community? A community-based participatory research approach was used for the current photovoice project, through which two Elders and eleven youth were engaged. Indigenous photographers trained youth participants, and Elders mentored youth to capture photographs that represented their community's strengths and resilience. Youth selected forty photos to display at a total of six photo exhibits, where feedback was gathered from 392 attendees using brief questionnaires. The content of their photos was analyzed using thematic analysis. This resulted in four themes that described the strengths of Maskwacis, reflecting the community's strong relationships, commitment to culture, the beautiful natural world that is a part of Maskwacis, and the community's ability to look toward the future. In addition, findings provide foundational support for the use of photographs to reframe perceptions of an Indigenous community. The majority (93%) of survey respondents provided examples of ways that viewing the photos had positively changed their perceptions of Maskwacis. This study prompts consideration of the strengths and resilience of other Indigenous communities facing similar social and health issues. Therefore, findings are highly relevant to paediatric health care providers seeking to provide culturally responsive care.

Complementary and alternative medicine: a survey of its use in pediatric cardiology.

BACKGROUND: The use of complementary and alternative medicine is high among children and youth with chronic illnesses, including patients with cardiac conditions. Our goal was to assess the prevalence and patterns of such use among patients presenting to academic pediatric cardiology clinics in Canada. METHODS: A survey instrument was developed to inquire about current or previous use of complementary and alternative medicine products and practices, including indications, beliefs, sources of information and whether this use was discussed with physicians. Between February and July 2007, the survey was administered to patients (or their parents/guardians) presenting to 2 hospital-based cardiology clinics: the Stollery Children's Hospital in Edmonton, Alberta, and the Children's Hospital of Eastern Ontario in Ottawa, Ontario. RESULTS: At the Stollery Children's Hospital, 64.1% of the 145 respondents had used complementary and alternative medicine compared with 35.5% of the 31 respondents at the Children's Hospital of Eastern Ontario (p = 0.003). Overall, the most common products in current use were multivitamins (70.6%), vitamin C (22.1%), calcium (13.2%), unspecified "cold remedies" (11.8%) and fish oil or omega-3 fatty acids (11.8%). The most common practices in current use were massage (37.5%), faith healing (25.0%), chiropractic (20.0%), aromatherapy (15.0%) and Aboriginal healing (7.5%). Many patients (44.9%) used complementary and alternative medicine products at the same time as conventional prescription drugs. Concurrent use was discussed with physicians or pharmacists by 64.3% and 31.3% of respondents, respectively. INTERPRETATION: Use of complementary and alternative medicine products and practices was high among patients seen in the pediatric cardiology clinics in our study. Most respondents believed that the use of these products and practices was helpful; few reported harms and many did not discuss this use with their physicians, increasing the potential for interactions with prescribed medications.

Partnership, knowledge translation, and substance abuse prevention with a First Nations community.

BACKGROUND: Having identified substance abuse as an issue of concern in their community, the Alexis Nakota Sioux Nation invited University of Alberta researchers to partner on the cultural adaptation, delivery, and evaluation of a school-based drug and alcohol abuse prevention program. Researchers conducted a literature review of available drug and alcohol prevention programs for children and youth, identifying the Life Skills Training (LST) program as a viable model for cultural adaptation. OBJECTIVES: Four program objectives were developed: (1) Review and cultural adaptation of the elementary and junior high LST programs, (2) delivery of the adapted programs, (3) measurement of changes in students' knowledge of the negative effects of drug and alcohol use, attitudes toward drugs and alcohol, drug and alcohol refusal and life skills, and changes in self-esteem/self-concept, and (4) documentation of the community's experience of the project. METHODS: Using the principles of community-based participatory research (CBPR), we employed both qualitative and quantitative methods to evaluate the impact of the project. RESULTS: Qualitative evaluation of the program adaptation and implementation were both positive. Qualitative measures of program impact on students revealed a positive effect, whereas results of the quantitative measures were mixed. CONCLUSIONS: Culturally adapted, evidence-based programs can have a positive effect on Aboriginal youth and their communities. Strategies to expand knowledge translation (KT) when working with Aboriginal communities include working to create an "ethical space" that draws on the strengths of both Western and Indigenous worldviews.

Patterns of utilization of complementary and alternative medicine in 2 pediatric gastroenterology clinics.

OBJECTIVES: The aim of the present study was to assess the prevalence and patterns of complementary and alternative medicine (CAM) use among pediatric patients with gastrointestinal (GI) disorders at academic clinics in Canada. METHODS: The survey was carried out at 2 hospital-based gastroenterology clinics: the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa. RESULTS: CAM use at the Stollery was 83% compared with 36% at CHEO (P < 0.001). The most common reason for not using CAM was lack of knowledge about it. Most respondents felt comfortable discussing CAM in their clinic and wanted more information on CAM. The most common CAM products being taken were multivitamins (91%), calcium (35%), vitamin C (32%), probiotics (14%), and fish oil/omega-3 fatty acids (13%). The most common CAM practices being used were massage (43%), chiropractic (27%), faith healing (25%), and relaxation (18%). Most respondents believed that CAM was helpful, and most of the 23 reported adverse effects were minor. Seven were reported as moderate, and 3 were reported as severe. Many (42%) patients used CAM at the same time as prescription medicines, and of these patients, concurrent use was discussed with their physician (76%) or pharmacist (52%). CONCLUSIONS: CAM use is high among pediatric patients with GI disorders and is much greater among those in Edmonton than in Ottawa. Most respondents reported their CAM use as helpful, with little or no associated harm. Many patients fail to disclose their concurrent use of CAM and conventional medicines to their doctors, increasing the likelihood of interactions.

CAM use in pediatric neurology: an exploration of concurrent use with conventional medicine.

BACKGROUND: Previous studies have found that up to 60% of children with neurologic conditions have tried complementary and alternative medicine (CAM). OBJECTIVE: To assess the use of CAM among patients presenting to neurology clinics at two academic centers in Canada. METHODS: A survey instrument was developed to inquire about use of CAM products and therapies, including reasons for use, perceived helpfulness, and concurrent use with conventional medicine, and administered to patients or their parents/guardians at the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa. RESULTS: Overall CAM use at the Stollery was 78%, compared to 48% at CHEO. The most common CAM products used were multi-vitamins (84%), vitamin C (37%), homeopathic remedies (24%), and fish oil/omega 3 s (22%). The most common CAM practices used were massage (47%), chiropractic (37%), faith healing (18%), aromatherapy (16%), homeopathy (16%), and relaxation (16%). Many patients used CAM products at the same time as conventional medicine but just over half (57%) discussed this concurrent use with their physician. CONCLUSION: CAM use is common in pediatric neurology patients and most respondents felt that it was helpful, with few or no harms associated. However, this use is often undisclosed, increasing possibility of interactions with conventional drugs. We urge clinicians to inquire about CAM use during routine history taking at every patient visit. Parents would clearly like more information about CAM from their specialty clinics; such information would be easier to share if more primary data were available about the safety and effectiveness of commonly used therapies.

Health research involving First Nations, Inuit and Métis children and their communities.

Canadian and international guidelines address the ethical conduct of health research in general and the issues affecting Indigenous populations in particular. This statement summarizes, for clinicians and researchers, relevant ethical and practical considerations for health research involving Aboriginal children and youth. While not intended to duplicate findings arising from lengthy collaborative processes, it does highlight 'wise practices' that have successfully generated knowledge relevant to, respectful of and useful for Aboriginal children, youth and their communities. Further research on current health issues and inequities should lead to practical, effective and culturally relevant applications. Expanding our knowledge of ways to address the health disparities facing Canada's Aboriginal children and youth can inform health policy and the provision of services. Community-based participatory research is proposed as a means to achieve this goal.

Les lignes directrices canadiennes et internationales portent sur la tenue éthique de la recherche en santé en général et les problèmes touchant les populations autochtones en particulier. Le présent document de principes contient un résumé des considérations éthiques et pratiques pertinentes liées à la recherche en santé auprès des enfants et des adolescents autochtones, à l'intention des cliniciens et des chercheurs. Il ne vise pas à dédoubler les résultats découlant de longs processus coopératifs, mais il expose les « pratiques judicieuses ¼ qui ont suscité des connaissances pertinentes, respectueuses et utiles pour les enfants, les adolescents et les communautés autochtones. D'autres recherches sur les enjeux et les inégalités en matière de santé devraient donner lieu à des applications pratiques, efficaces et pertinentes sur le plan culturel. Le fait d'accroître nos connaissances sur les moyens d'éliminer les disparités en santé dont sont victimes les enfants et les adolescents autochtones du Canada peut étayer les politiques en santé et la prestation des services. Les recherches participatives menées dans les communautés sont présentées comme un moyen de réaliser cet objectif.

Complementary and alternative medicine: A survey of its use in children with chronic respiratory illness.

BACKGROUND: The use of complementary and alternative medicine (CAM) has increased in recent years, with especially high prevalence in individuals with chronic illnesses. In the United States, the prevalence of CAM use in pediatric asthma patients is as high as 89%. OBJECTIVE: To investigate the epidemiology of pediatric CAM use in respiratory subspecialty clinics. METHODS: A survey was conducted at two hospital-based respiratory clinics in Edmonton (Alberta) and Ottawa (Ontario). Caregivers (most often parents) of children <18 years of age were asked questions regarding child and caregiver use of CAM, including products and practices used, beliefs about CAM, trust in information sources about CAM and characteristics of the respondents themselves. RESULTS: A total of 202 survey questionnaires were completed (151 from Edmonton and 51 from Ottawa). Pediatric CAM use in Edmonton was 68% compared with 45% in Ottawa, and was associated with caregiver CAM use, poorer health and health insurance coverage for CAM. The majority (67%) of children using CAM had taken prescription drugs concurrently and 58% of caregivers had discussed this with their doctor. DISCUSSION: Lifetime use of CAM at these pediatric clinics was higher than reported for children who do not have chronic diseases. CAM practices that are popular may be worthy of further research to evaluate their effectiveness and safety profile with regard to drug interactions. Health care providers should be encouraged to discuss CAM use at every visit, and explore their patient's health-related beliefs, behaviours and treatment preferences.

HISTORIQUE: L'utilisation de la médecine complémentaire et parallèle (MCP) a augmenté ces dernières années. Sa prévalence est particulièrement élevée chez les personnes atteintes d'une maladie chronique. Aux États-Unis, sa prévalence chez les patients asthmatiques d'âge pédiatrique atteint les 89 %. OBJECTIF: Examiner l'épidémiologie de l'utilisation de la MCP en pédiatrie dans des cliniques spécialisées en santé respiratoire. MÉTHODOLOGIE: Les chercheurs ont effectué un sondage dans deux cliniques de santé respiratoire en milieu hospitalier, à Edmonton (Alberta) et à Ottawa (Ontario). Les personnes qui s'occupaient d'enfants de 18 ans ou moins (en général, les parents) se sont fait poser des questions sur l'utilisation de la MCP par l'enfant et par elles, y compris les produits et pratiques utilisés, les croyances au sujet de la MCP, la confiance envers les sources d'information sur la MCP et leurs caractéristiques personnelles. RÉSULTATS: Au total, 202 sondages ont été remplis (151 à Edmonton et 51 à Ottawa). L'utilisation de la MCP en pédiatrie à Edmonton s'élevait à 68 %, et à 45 % à Ottawa. Elle s'associait à l'utilisation de MCP par la personne qui s'occupait de l'enfant, à une moins bonne santé et à une couverture d'assurance pour la MCP. La majorité des enfants (67 %) qui utilisaient la MCP prenaient simultanément des médicaments sur ordonnance, et 58 % des personnes qui s'occupaient d'eux en avaient parlé avec leur médecin. EXPOSÉ: À ces cliniques de pédiatrie, l'utilisation générale de MCP était plus élevée que celle déclarée chez les enfants qui n'ont pas de maladie chronique. Les pratiques de MCP qui sont populaires devraient peut-être faire l'objet de recherches supplémentaires pour en évaluer l'efficacité et le profil d'innocuité en matière d'interactions médicamenteuses. Il faut encourager les dispensateurs de soins à parler de MCP à chaque rendez-vous et à explorer les croyances de leurs patients liées à la santé, leurs comportements et leurs préférences thérapeutiques.

Complementary and alternative medicine: a survey of its use in pediatric oncology.

Background. The use of complementary and alternative medicine (CAM) is high among children and youths with chronic illnesses, including cancer. The objective of this study was to assess prevalence and patterns of CAM use among pediatric oncology outpatients in two academic clinics in Canada. Procedure. A survey was developed to ask patients (or their parents/guardians) presenting to oncology clinics at the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa about current or previous use of CAM products and practices. Results. Of the 137 families approached, 129 completed the survey. Overall CAM use was 60.5% and was not significantly different between the two hospitals. The most commonly reported reason for not using CAM was lack of knowledge about it. The most common CAM products ever used were multivitamins (86.5%), vitamin C (43.2%), cold remedies (28.4%), teething remedies (27.5%), and calcium (23.0%). The most common CAM practices ever used were faith healing (51.0%), massage (46.8%), chiropractic (27.7%), and relaxation (25.5%). Many patients (40.8%) used CAM products at the same time as prescription drugs. Conclusion. CAM use was high among patients at two academic pediatric oncology clinics. Although most respondents felt that their CAM use was helpful, many were not discussing it with their physicians.

"Making a place of respect": lessons learned in carrying out consent protocol with First Nations elders.

BACKGROUND: This article explores the issue of informed consent by First Nations Elders modifying and implementing a substance abuse prevention program for youth, Nimi Icinohabi, among the Alexis Nakota Sioux Nation. The Elders who approved and guided the research maintained that informed consent procedures carried out by the Western academic institutions were redundant given adherence to their own culturally based protocol. OBJECTIVES: The objective of this article is to present lessons learned regarding the cultural basis of consent involving First Nations Elders to improve our own and other researchers' ethical practice in this context. METHODS: Two focus groups were held with our team of community and university-based researchers (n = 6) to discuss our experience of the Elder consent procedures used during the project. RESULTS: Elder involvement was integral to the success of the program. Using methods of consent originating from Western thought and given historical and ongoing issues of trust with Western institutions, signing consent forms was unacceptable to them and perceived as undermining their own ethical practices. An oral consent process utilizing cultural protocol and a tool to keep track of participation in this process was subsequently approved by our Research Ethics Board (REB) and used successfully. CONCLUSIONS: When researchers use standard informed consent practices, they risk losing the trust of community partners by undermining cultural values and practices. As academic researchers, it is our ethical responsibility, in the spirit of restorative justice, to honor the principles of beneficence and justice in research by ensuring consent within the context of cultural protocol.

Complementary and alternative medicine use by pediatric specialty outpatients.

OBJECTIVE: Complementary and alternative medicine (CAM) use is high among children and youth with chronic illnesses. The objective of this study was to assess the prevalence and patterns of CAM use in 10 subspecialty clinics in Canada and to compare CAM use between 2 geographically diverse locations. METHODS: This survey was carried out at 1 Children's Hospital in western Canada (Edmonton) and 1 Children's Hospital in central Canada (Ottawa). Questionnaires were completed by parents in either French or English. RESULTS: Although demographic characteristics of the 2 populations were similar, CAM use at the western hospital was 71% (n = 704) compared with 42% (n = 222) at the central hospital (P < .0001). Most respondents agreed or strongly agreed that they feel comfortable discussing CAM in their clinic. The most common CAM products currently used were multivitamins/minerals, herbal products, and homeopathic remedies. The most common CAM practices currently used were massage, chiropractic, relaxation, and aromatherapy. Eighty adverse effects were reported, and 55 (68.8%) of these were self-assessed as minor. CONCLUSIONS: Results of this study indicate that CAM use is high among pediatric specialty clinic outpatients and is much greater in the western than in the central hospital. Most respondents felt that their CAM use was helpful with few or no harms associated. Many patients, using CAM alongside their conventional medicines, are still not discussing their CAM use with their physicians and are increasing the likelihood for potential interactions and preventable harms.

A culturally adapted drug and alcohol abuse prevention program for aboriginal children and youth.

BACKGROUND: In response to substance abuse within their community, the Alexis Nakota Sioux Nation invited the University of Alberta (UofA) to partner in a collaborative effort to establish a school-based substance abuse prevention program. OBJECTIVES: An evidence-based substance abuse prevention program was reviewed and adapted by the community to ensure that it incorporated their cultural beliefs, values, language, and visual images. The adapted program was delivered to students at Alexis Nakota Sioux Nation School and changes in student participants' knowledge, attitudes, refusal skills, and self-beliefs were measured. Benefits and challenges of adapting the program were documented. METHODS: The principles of community-based participatory research (CBPR) and the Canadian Institute for Health Research, Guidelines for Research Involving Aboriginal People, provided a frame of reference for the work throughout the research process. A pre-/posttest questionnaire was used to measure changes in student participants' drug and alcohol refusal skills, self-beliefs, and knowledge of the negative effects of drug and alcohol use. Focus groups (FGs) documented community members' experiences of and responses to the program adaptations and delivery. RESULTS: Results included (1) positive changes in students' drug and alcohol refusal skills, self-beliefs, and knowledge of the negative effects of drug and alcohol use, (2) ownership of and investment in the program by the community, (3) teaching approaches that correspond with the learning contexts, worldview, and relationships of the community, and (4) participation of community Elders. CONCLUSION: Quantitative and qualitative measures provide evidence for the importance, benefits, and challenges of employing a culturally adapted evidence-based substance abuse prevention program with Aboriginal students attending a First Nations school.

Safety and tolerability of North American ginseng extract in the treatment of pediatric upper respiratory tract infection: a phase II randomized, controlled trial of 2 dosing schedules.

BACKGROUND: Upper respiratory tract infections are the most common childhood illness. Panax quinquefolius (American ginseng root extract) standardized to contain 80% poly-furanosyl-pyranosyl-saccharides is purported to be effective in adult upper respiratory tract infection but has not been evaluated yet in a pediatric population. OBJECTIVES: Our primary objective was to document the safety and tolerability of 2 weight-based dosing schedules (standard dose versus low dose versus placebo) in children. We also used the Canadian Acute Respiratory Infection Flu Scale, a quantitative scoring sheet for measuring the severity and duration of upper respiratory symptoms, to establish the SD of the treatment effect to allow sample-size calculations for future clinical trials. METHODS: We conducted a randomized, double-blind dose-finding 3-arm trial (2 dosing schedules of American ginseng extract with 1 placebo control) during the winter months (November 2005 to March 2006) in children 3 to 12 years of age. RESULTS: Seventy-five subjects were prerecruited from the general population in Edmonton. Of these, 46 subjects developed an upper respiratory tract infection and were randomly assigned (15 standard dose, 16 low dose, and 15 placebo), with 1 subject withdrawing from the low-dose arm before beginning the intervention. No serious adverse events were reported. The frequency, severity, and degree of association between the intervention and reported adverse events were not significantly different among each of the 3 treatment arms. CONCLUSIONS: Standard doses of ginseng were well tolerated and merit additional evaluation with regard to treatment of pediatric upper respiratory tract infection.

ADHD characteristics in Canadian Aboriginal children.

OBJECTIVE: The authors examine how many Aboriginal children attending two reservation-based elementary schools in Northern Alberta, Canada, would demonstrate symptoms associated with ADHD using standardized parent and teacher questionnaires. METHOD: Seventy-five Aboriginal children in Grades 1 through 4 are tested. Seventeen of the 75 (22.7%) Aboriginal children demonstrated a match on parent and teacher forms, with T-scores greater than 1.5 standard deviations from the mean on the Conners' ADHD Index, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Hyperactive/Impulsive Index, DSM-IV Inattentive Index, and/or DSM-IV Total Combined T-score. RESULTS: The number of Aboriginal children found to have symptoms associated with ADHD is significantly higher than expected based on prevalence rates in the general population. CONCLUSION: These findings suggest either a high prevalence of ADHD in Aboriginal children or unique learning and behavioral patterns in Aboriginal children that may erroneously lead to a diagnosis of ADHD if screening questionnaires are used.