El diseño curricular de cursos en Educación Médica / Curriculum design in medical education courses

Se presenta un trabajo que aborda la superación profesional en la Educación Superior en la forma organizativa de "Curso", de acuerdo a lo establecido en el Reglamento de la Educación de Posgrado del Ministerio de Educación Superior, (Res 132/2004), con aplicación específica a la Educación Médica. Se profundiza en los componentes didácticos y metodológicos para el diseño de los cursos, partiéndose de forma necesaria de la identificación de necesidades aprendizaje de los profesionales de la salud sobre determinados problemas de salud y/o docentes que demandan solución en una institución de salud o a cualquier otro nivel del Sistema Nacional de Salud. Se detallan los componentes de la estructura curricular, con énfasis en la redacción de los objetivos, -el general del curso y los temáticos- con un enfoque constructivista, las tareas docentes incluidas dentro del propio diseño, la utilización de métodos problémicos y de discusiones grupales que propicien la autopreparación, y el intercambio entre los profesionales, la evaluación del aprendizaje y la evaluación del curso(AU)

We present a paper that addresses the professional improvement in higher education in the course as an organizational form, according to the Regulations of Postgraduate Education of the Ministry of Higher Education (Regulation 132/2004), with specific application to medical education. The teaching and methodological components for the design of the courses are deepened, starting from a necessary way of identifying the learning needs of the health professionals on certain health problems, and/or teachers who demand a solution in a health institution or at any other level of the National Health System. It details the components of the curricular structure, with emphasis on the writing of the objectives --the general of the course and the subjects--, with a constructivist approach, the teaching tasks included within the own design, the use of problematic methods and group discussions for self-training, and the exchange among professionals, assessment of learning, and evaluation of the course(AU)

El diseño curricular de cursos en Educación Médica / Curriculum design in medical education courses

Se presenta un trabajo que aborda la superación profesional en la Educación Superior en la forma organizativa de "Curso", de acuerdo a lo establecido en el Reglamento de la Educación de Posgrado del Ministerio de Educación Superior, (Res 132/2004), con aplicación específica a la Educación Médica. Se profundiza en los componentes didácticos y metodológicos para el diseño de los cursos, partiéndose de forma necesaria de la identificación de necesidades aprendizaje de los profesionales de la salud sobre determinados problemas de salud y/o docentes que demandan solución en una institución de salud o a cualquier otro nivel del Sistema Nacional de Salud. Se detallan los componentes de la estructura curricular, con énfasis en la redacción de los objetivos, -el general del curso y los temáticos- con un enfoque constructivista, las tareas docentes incluidas dentro del propio diseño, la utilización de métodos problémicos y de discusiones grupales que propicien la autopreparación, y el intercambio entre los profesionales, la evaluación del aprendizaje y la evaluación del curso(AU)

We present a paper that addresses the professional improvement in higher education in the course as an organizational form, according to the Regulations of Postgraduate Education of the Ministry of Higher Education (Regulation 132/2004), with specific application to medical education. The teaching and methodological components for the design of the courses are deepened, starting from a necessary way of identifying the learning needs of the health professionals on certain health problems, and/or teachers who demand a solution in a health institution or at any other level of the National Health System. It details the components of the curricular structure, with emphasis on the writing of the objectives --the general of the course and the subjects--, with a constructivist approach, the teaching tasks included within the own design, the use of problematic methods and group discussions for self-training, and the exchange among professionals, assessment of learning, and evaluation of the course(AU)

Necesidades de superación pedagógica de docentes del Hospital Hermanos Ameijeiras: eficacia del Diplomado de Educación Médica / Pedagogic upgrading requirements of professors in Hermanos Ameijeiras hospital: efficacy of the diploma's course in medical education

Introducción: la docencia de posgrado en el Hospital Hermanos Ameijeiras ocupa un rol muy importante en la formación de los profesionales. Resulta necesario atender las necesidades de superación profesoral sobre todo en los docentes noveles, con vistas a perfeccionar su desempeño en esta tarea. Objetivos: conocer cuáles son estas necesidades y la eficacia del Diplomado de Educación Médica en su solución. Métodos: aplicación de un cuestionario personal y anónimo a los profesores matriculados en la edición del diplomado que se impartió durante el año 2012: la primera aplicación el día de inicio y la segunda, al finalizar. Resultados: las necesidades detectadas afectan el campo de la didáctica, fundamentalmente, y no guardan relación con la categoría docente ni la experiencia acumulada como profesional. Conclusiones: el diplomado resultó insuficiente para resolver las necesidades encontradas. Se recomienda hacer un proyecto de intervención para elevar las competencias pedagógicas de nuestros docentes.(AU)

Introduction: graduate education plays a very important role in the formation of professionals at Hermanos Ameijeiras hospital. Therefore, it is necessary to pay attention to the professorial upgrading requirements mainly those of the novel teaching staff, with a view to improving their performance. Objectives: to find out the upgrading requirements and the efficacy of the diploma's course on medical education to meet them. Methods: anonymous individual questionnaire administered to professors who participated in the diploma's course given in 2012 at the beginning and at the end of the course. Results: the detected requirements fundamentally affected the students in the field of didactics and were neither associated to the teaching category nor to the professional experience. Conclusions: the diploma's course proved to be inefficacious to meet the detected upgrading requirements. It was recommended to design an interventional project to raise the pedagogic competencies of our educators(AU)

Necesidades de superación pedagógica de docentes del Hospital Hermanos Ameijeiras: eficacia del diplomado de educación médica / Pedagogic upgrading requirements of professors in Hermanos Ameijeiras hospital: efficacy of the diploma's course in medical education

Introducción: la docencia de posgrado en el Hospital Hermanos Ameijeiras ocupa un rol muy importante en la formación de los profesionales. Resulta necesario atender las necesidades de superación profesoral sobre todo en los docentes noveles, con vistas a perfeccionar su desempeño en esta tarea. Objetivos: conocer cuáles son estas necesidades y la eficacia del Diplomado de Educación Médica en su solución. Métodos: aplicación de un cuestionario personal y anónimo a los profesores matriculados en la edición del diplomado que se impartió durante el año 2012: la primera aplicación el día de inicio y la segunda, al finalizar. Resultados: las necesidades detectadas afectan el campo de la didáctica, fundamentalmente, y no guardan relación con la categoría docente ni la experiencia acumulada como profesional. Conclusiones: el diplomado resultó insuficiente para resolver las necesidades encontradas. Se recomienda hacer un proyecto de intervención para elevar las competencias pedagógicas de nuestros docentes.

Introduction: graduate education plays a very important role in the formation of professionals at Hermanos Ameijeiras hospital. Therefore, it is necessary to pay attention to the professorial upgrading requirements mainly those of the novel teaching staff, with a view to improving their performance. Objectives: to find out the upgrading requirements and the efficacy of the diploma's course on medical education to meet them. Methods: anonymous individual questionnaire administered to professors who participated in the diploma's course given in 2012 at the beginning and at the end of the course. Results: the detected requirements fundamentally affected the students in the field of didactics and were neither associated to the teaching category nor to the professional experience. Conclusions: the diploma's course proved to be inefficacious to meet the detected upgrading requirements. It was recommended to design an interventional project to raise the pedagogic competencies of our educators.

Integrative Consensus: A Systematic Approach to Integrating Comprehensive Assessment Data for Young Children With Behavior Problems.

Comprehensive assessments that include parents and teachers are essential when assessing young children vulnerable to emotional and behavioral problems given the multiple systems and contexts that influence and support optimal development (U. Bronfenbrenner & P. A. Morris, 2006; M. J. Guralnick, 2011). However, more data complicate clinical and educational decision making given the challenge of integrating comprehensive data. We report on initial efforts to develop and apply Integrative Consensus procedures designed to synthesize comprehensive assessment data using developmentally informed guidelines. Mother-teacher dyads (N = 295) reported on disruptive behavior in a sample of 295 low-income 3- to 5-year-olds; one-third referred for disruptive behaviors, one-third nonreferred with behavioral concerns, and one-third nonreferred. Two clinicians trained in Integrative Consensus procedures independently applied the framework, with findings highlighting that children identified as disruptive by Integrative Consensus ratings plus mother or teacher ratings significantly predicted behavior problems and impaired social skills. Children identified as disruptive via Integrative Consensus were 4 times more likely to be rated as impaired by their mother at follow-up than by mother or teacher report. Reliability estimates were high (κ = 0.84), suggesting that the method has promise for identifying young children with behavior problems while systematically integrating comprehensive data.

Satisfacción y retención de los contenidos del Curso Agentes Físicos del Diplomado en Rehabilitación / Satisfaction and retention of the contents of the course on Physical Agents given in the Diploma Course on Rehabilitation

Se realizó una investigación educacional para identificar la satisfacción de residentes y profesores de la especialidad en Medicina Física y Rehabilitación con el Curso Agentes Físicos (AF) impartido en el Diplomado de Rehabilitación en la Atención Primaria de Salud y evaluar la retención de los contenidos recibidos, así como la necesidad de abordarlos nuevamente en el programa de la especialidad, por su importancia. Para medir la satisfacción se aplicaron encuestas a los 23 residentes de segundo año de la especialidad y a 16 profesores, que impartieron clases en el curso. Se aplicó un examen teórico a todos los residentes, para evaluar la retención de dichos contenidos. Para el análisis de la información se procesaron los datos mediante frecuencias y porcentajes y se presentaron en tablas, para darles significación se realizó una triangulación de los datos con elementos teóricos. Los resultados mostraron satisfacción baja respecto a los contenidos de agentes físicos del diplomado, los que son insuficientes, no están actualizados y presentan dificultades con su profundización y aplicación, por lo que deben ser abordados nuevamente y con mayor profundidad en el programa de la especialidad. Los residentes demostraron no tener suficiente dominio de los contenidos recibidos

An education research was conducted to identify the satisfaction of residents and professors of the specialty of Physical Medicine and Rehabilitation with the course on Physical Agents given in the Diploma Course on Rehabilitation in Primary Health Attention and evaluate retention of the contents studied as well as the need to deal with these contents again, because of their importance, in the course design of the specialty. To measure the level of satisfaction, inquiries were applied to the 23 second year residents of the specialty and 16 professors who gave lessons in the course. A theory exam was applied to all residents to evaluate retention of the above contents. For information analysis, all data were processed by means of frequencies and percentages, they were shown in tables and, to emphasize their importance, a triangulation of data with theoretical elements was presented. The results showed low satisfaction with the contents on physical agents given in the Diploma Course which are not sufficient; they are not updated and present difficulties in their depth and application what means that they should be undertaken again in depth in the course design of the specialty. Residents showed not to have enough knowledge of the contents received

Satisfacción y retención de los contenidos del Curso Agentes Físicos del Diplomado en Rehabilitación / Satisfaction and retention of the contents of the course on Physical Agents given in the Diploma Course on Rehabilitation

Se realizó una investigación educacional para identificar la satisfacción de residentes y profesores de la especialidad en Medicina Física y Rehabilitación con el Curso Agentes Físicos (AF) impartido en el Diplomado de Rehabilitación en la Atención Primaria de Salud y evaluar la retención de los contenidos recibidos, así como la necesidad de abordarlos nuevamente en el programa de la especialidad, por su importancia. Para medir la satisfacción se aplicaron encuestas a los 23 residentes de segundo año de la especialidad y a 16 profesores, que impartieron clases en el curso. Se aplicó un examen teórico a todos los residentes, para evaluar la retención de dichos contenidos. Para el análisis de la información se procesaron los datos mediante frecuencias y porcentajes y se presentaron en tablas, para darles significación se realizó una triangulación de los datos con elementos teóricos. Los resultados mostraron satisfacción baja respecto a los contenidos de agentes físicos del diplomado, los que son insuficientes, no están actualizados y presentan dificultades con su profundización y aplicación, por lo que deben ser abordados nuevamente y con mayor profundidad en el programa de la especialidad. Los residentes demostraron no tener suficiente dominio de los contenidos recibidos(AU)

An education research was conducted to identify the satisfaction of residents and professors of the specialty of Physical Medicine and Rehabilitation with the course on Physical Agents given in the Diploma Course on Rehabilitation in Primary Health Attention and evaluate retention of the contents studied as well as the need to deal with these contents again, because of their importance, in the course design of the specialty. To measure the level of satisfaction, inquiries were applied to the 23 second year residents of the specialty and 16 professors who gave lessons in the course. A theory exam was applied to all residents to evaluate retention of the above contents. For information analysis, all data were processed by means of frequencies and percentages, they were shown in tables and, to emphasize their importance, a triangulation of data with theoretical elements was presented. The results showed low satisfaction with the contents on physical agents given in the Diploma Course which are not sufficient; they are not updated and present difficulties in their depth and application what means that they should be undertaken again in depth in the course design of the specialty. Residents showed not to have enough knowledge of the contents received(AU)

Preschool children's observed disruptive behavior: variations across sex, interactional context, and disruptive psychopathology.

Sex differences in disruptive behavior and sensitivity to social context are documented, but the intersection between them is rarely examined empirically. This report focuses on sex differences in observed disruptive behavior across interactional contexts and diagnostic status. Preschoolers (n = 327) were classified as nondisruptive (51%), clinically at risk (26%), and disruptive (23%) using parent and teacher reports on developmentally validated measures of disruptive behavior and impairment. Observed disruptive behavior was measured with the Disruptive Behavior Diagnostic Observation Schedule, a developmentally sensitive observational paradigm characterizing variation in preschoolers' disruptive behavior across two interactional contexts (parent and examiner). Repeated measures analyses of variance revealed a three-way interaction of child sex by diagnostic status by interactional context (F = 9.81, p < .001). Disruptive boys were the only subgroup whose behavior was not sensitive to interactional context: They displayed comparable levels of disruptive behavior with parents and examiners. In contrast, disruptive girls demonstrated the strongest context effect of any group. Specifically, with the examiner, disruptive girls' behavior was comparable to nondisruptive boys (though still more elevated than nondisruptive girls). However, in interactions with their mothers, disruptive girls displayed the highest rates of disruptive behavior of any subgroup in any context, although the difference between disruptive boys and disruptive girls in this context was not statistically significant. Findings suggest the importance of sex-specific conceptualizations of disruptive behavior in young children that take patterns across social contexts into account.

Predictive validity of DSM-IV oppositional defiant and conduct disorders in clinically referred preschoolers.

BACKGROUND: Diagnostic validity of oppositional defiant and conduct disorders (ODD and CD) for preschoolers has been questioned based on concerns regarding the ability to differentiate normative, transient disruptive behavior from clinical symptoms. Data on concurrent validity have accumulated, but predictive validity is limited. Predictive validity is critical to refuting the hypothesis that diagnosing ODD and CD in young children leads to pathologizing normal behavior. ODD and CD have emerged as gateway disorders to many forms of adult psychopathology. Establishing how early we can identify symptoms and disorders that herald poor prognosis is one of the most important goals for research on etiology and prevention. METHODS: Subjects were 3-5-year-old consecutive referrals to a child psychiatry clinic (n=123) and demographically matched children from a pediatric clinic (n=100). A diagnostic interview was used to assess DSM-IV ODD and CD in a prospective follow-up design from preschool to school age. Stability of ODD and CD diagnoses and level of impairment were tested as a function of preschool diagnosis. RESULTS: Over 80% of preschoolers diagnosed with ODD and approximately 60% of preschoolers diagnosed with CD met criteria for the same disorder during follow-up. Impairment over time varied significantly as a function of stability of diagnosis across three years. CONCLUSIONS: These results provide the first evidence of the predictive validity of DSM-IV ODD and CD in clinically referred preschool children. The findings challenge the assumption that symptoms of disruptive behavior disorders that occur during the preschool period tend to be transient.

Viewing preschool disruptive behavior disorders and attention-deficit/hyperactivity disorder through a developmental lens: what we know and what we need to know.

Empirical investigation into disruptive behavior disorders (DBDs) and attention deficit/hyperactivity disorder (ADHD) in early childhood has expanded considerably during the past decade. Although there have been considerable gains in the understanding of the presentation and course of these psychiatric disorders in early childhood, the lack of a developmental framework to guide nosologic issues likely impedes progress in this area. The authors propose that enhanced developmental sensitivity in defining symptoms of DBDs and ADHD may shed light on outstanding issues in the field. In particular, developmental specification may enhance specificity, sensitivity, and stability of DBDs and ADHD symptoms as well as inform our understanding of which type of treatment works best for whom. This article provides an overview of these critical issues.

Observational Assessment of Preschool Disruptive Behavior, Part II: validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS).

OBJECTIVE: To examine the validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior. METHOD: A total of 327 behaviorally heterogeneous preschoolers from low-income environments comprised the validation sample. Parent and teacher reports were used to identify children with clinically significant disruptive behavior. The DB-DOS assessed observed disruptive behavior in two domains, problems in Behavioral Regulation and Anger Modulation, across three interactional contexts: Examiner Engaged, Examiner Busy, and Parent. Convergent and divergent validity of the DB-DOS were tested in relation to parent and teacher reports and independently observed behavior. Clinical validity was tested in terms of criterion and incremental validity of the DB-DOS for discriminating disruptive behavior status and impairment, concurrently and longitudinally. RESULTS: DB-DOS scores were significantly associated with reported and independently observed behavior in a theoretically meaningful fashion. Scores from both DB-DOS domains and each of the three DB-DOS contexts contributed uniquely to discrimination of disruptive behavior status, concurrently and predictively. Observed behavior on the DB-DOS also contributed incrementally to prediction of impairment over time, beyond variance explained by meeting DSM-IV disruptive behavior disorder symptom criteria based on parent/teacher report. CONCLUSIONS: The multidomain, multicontext approach of the DB-DOS is a valid method for direct assessment of preschool disruptive behavior. This approach shows promise for enhancing accurate identification of clinically significant disruptive behavior in young children and for characterizing subtypes in a manner that can directly inform etiological and intervention research.

Observational Assessment of Preschool Disruptive Behavior, Part I: reliability of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS).

OBJECTIVE: To examine the reliability of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior. METHOD: The DB-DOS is a structured clinic-based assessment designed to elicit clinically salient behaviors relevant to the diagnosis of disruptive behavior in preschoolers. Child behavior is assessed in three interactional contexts that vary by partner (parent versus examiner) and level of support provided. Twenty-one disruptive behaviors are coded within two domains: problems in Behavioral Regulation and problems in Anger Modulation. A total of 364 referred and nonreferred preschoolers participated: interrater reliability and internal consistency were assessed on a primary sample (n = 335) and test-retest reliability was assessed in a separate sample (n = 29). RESULTS: The DB-DOS demonstrated good interrater and test-retest reliability. Confirmatory factor analysis demonstrated an excellent fit of the DB-DOS multidomain model of disruptive behavior. CONCLUSIONS: The DB-DOS is a reliable observational tool for clinic-based assessment of preschool disruptive behavior. This standardized assessment method holds promise for advancing developmentally sensitive characterization of preschool psychopathology.

Validation of a Clinically Sensitive, Observational Coding System for Parenting Behaviors: The Parenting Clinical Observation Schedule.

Objective: The psychometric properties of a newly developed, clinically-sensitive, observational measure of parenting behavior, the Parenting Clinical Observational System (P-COS), are presented. The P-COS expands on existing observational coding systems by integrating qualitative and quantitative aspects of parenting behavior to directly inform clinical decision-making with parents of young children with disruptive behaviors. Design: Reliability and validity data were examined in a sample of mother-preschooler dyads (N = 335), and test-re-test reliability was assessed on an independent sample (N = 29). Results: Evidence was found for the reliability and validity of the P-COS, including evidence of inter-rater reliability, internal consistency, and distinctness of the three theorized P-COS domains: Responsive Involvement, Constructive Discipline, and Problematic Discipline. Convergent and divergent validity data are presented as well. The P-COS demonstrated incremental validity in predicting child disruptive behavior over and above self-reported parenting and was associated with change in child clinical status over time. Conclusions: Clinically informative observation methods that assess multiple dimensions of parenting within the context of a child disruptive behavior assessment provide useful information for directing treatment efforts.

A developmental framework for distinguishing disruptive behavior from normative misbehavior in preschool children.

BACKGROUND: Attaining a developmentally sensitive nosology for preschool disruptive behavior requires characterization of the features that distinguish it from the normative misbehavior of this developmental period. We hypothesize that quality of behavior and its pervasiveness across contexts are critical dimensions for clinical discrimination in young children and propose that structured diagnostic observation provides a systematic method for their identification. We use the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) to examine whether: (a) observed quality and pervasiveness of behavior distinguishes preschoolers with clinically concerning disruptive behavior from typically developing preschoolers, and (b) observed pattern of clinically salient behavior predicts impairment above and beyond maternal report of behavioral frequency. METHODS: Participants are a behaviorally heterogeneous sample of preschoolers (N = 327). Diagnostic methods developed for clinical assessment of preschoolers were used to classify children as (a) Non-Disruptive, (b) Sub-Clinical, or (c) Disruptive. Child behavior was coded based on interactions with parent and examiner during the DB-DOS. RESULTS: Quality and pervasiveness of observed behaviors during the DB-DOS significantly distinguished the three behavioral groups. Discriminative utility varied depending on the comparison. With few exceptions, clinically concerning patterns on the DB-DOS added significant incremental utility in predicting impairment. CONCLUSIONS: Observed patterns of clinically salient behavior show promise for advancing developmentally-informed characterization of disruptive behavior within the preschool period.

Further evidence of the reliability and validity of DSM-IV ODD and CD in preschool children.

OBJECTIVE: To test the reliability and validity of DSM-IV oppositional defiant and conduct disorders (ODD and CD) and symptoms using the Kiddie Disruptive Behavior Disorders Schedule and generate data on the manifestation of symptoms of ODD and CD in 3- to 5-year-old children. METHOD: One hundred twenty-three consecutive referrals to a child and adolescent psychiatry clinic and 100 children recruited from a pediatric clinic and their biological mothers participated. Mothers were interviewed about current ODD and CD symptoms, and mother and teachers completed measures of impairment. Twenty-five percent of the interviews were randomly selected and coded by a second rater to test interrater reliability. A separate sample of 31 children was recruited for a 1-week test-retest study. RESULTS: Overall, reliability of ODD and CD symptoms as measured by interrater and test-retest reliability was moderate to high. Reliability was not affected by age or sex of the child. Validity was demonstrated via associations with impairment and differentiation between referred and nonreferred children. CONCLUSIONS: Most DSM-IV ODD and CD symptoms can be reliably and validly assessed in preschool children. Some developmental modifications are recommended. The results add to the literature on best methods of assessment of preschool psychopathology.

Impact of visual impairment on measures of cognitive function for children with congenital toxoplasmosis: implications for compensatory intervention strategies.

OBJECTIVES: The purpose of this work was to determine whether visual impairment caused by toxoplasmic chorioretinitis is associated with impaired performance of specific tasks on standardized tests of cognitive function. If so, then we worked to determine whether there are patterns in these difficulties that provide a logical basis for development of measures of cognitive function independent of visual impairment and compensatory intervention strategies to facilitate learning for such children. METHODS: Sixty-four children with congenital toxoplasmosis with intelligence quotient scores > or = 50 and visual acuity sufficient to cooperate with all of the intelligence quotient subscales had assessments of their vision, appearance of their retinas, and cognitive testing performed between 3.5 and 5 years of age. These evaluations took place between 1981 and 1998 as part of a longitudinal study to determine outcome of congenital toxoplasmosis. Children were evaluated at 3.5 or 5 (37 children) or both 3.5 and 5 (27 children) years of age. Cognitive function was measured using the Wechsler Preschool and Primary Scale of Intelligence-Revised. Wechsler Preschool and Primary Scale of Intelligence-Revised scale scores were compared for children grouped as those children who had normal visual acuity in their best eye (group 1), and those who had impaired vision in their best eye (acuity < 20/40) because of macular disease (group 2). Demographic characteristics were compared for children in the 2 groups. Test scores were compared between groups using all of the 3.5-year-old visits, all of the 5-year-old visits, and using each child's "last" visit (ie, using the 5-year-old test results when a child was tested at both 3.5 and 5 years of age or only at 5 years, otherwise using the 3.5-year-old test results). The results were similar and, therefore, only the results from the last analysis are reported here. RESULTS: There were 48 children with normal visual acuity in their best eye (group 1) and 16 children with impaired vision because of macular involvement in their best eye (group 2). Ethnicity and socioeconomic scores were similar. There was a significantly greater proportion of males in group 2 compared with group 1 (81% vs 46%). There was no significant diminution in Wechsler Preschool and Primary Scale of Intelligence-Revised test scores between 3.5 and 5 years of age for the 27 children tested at both of these ages. Verbal intelligence quotient, performance intelligence quotient, full-scale intelligence quotient scores, and all of the scaled scores except arithmetic and block design were significantly lower for children in group 2 compared with group 1. The majority of the differences remained statistically significant or borderline significant after adjusting for gender. However, the difference in overall verbal scores does not remain statistically significant. Mean +/- SD verbal (98 +/- 20) and performance (95 +/- 17) intelligence quotients were not significantly different for children in group 1. However, verbal (88 +/- 13) and performance intelligence quotients (78 +/- 17) were significantly different for children in group 2. For children in group 2, their lowest scale scores were in object assembly, geometric design, mazes, and picture completion, all timed tests that involved visual discrimination of linear forms with small intersecting lines. In the 2 scales scored that did not differ between groups 1 and 2, arithmetic and block design, timing and vision but not linear forms were components of the tasks. Children with monocular and binocular normal visual acuity did not differ in verbal, performance, or full-scale intelligence quotients or any of the subscale tests. Difficulty with sight or concomitant neurologic involvement also seemed to impact the ability to acquire information, comprehension skills, and vocabulary and performance in similarities testing. After controlling for gender, however, these differences were diminished, and there were no longer differences in overall verbal scores. As noted above, results were generally similar when all of the tests for 3.5-year-olds or 5-year-olds were analyzed separately. At the 3.5-year visit there were fewer significant differences between the 2 groups for the verbal components than at the 5-year visit. CONCLUSIONS: In children with congenital toxoplasmosis and bilateral macular disease (group 2) because of toxoplasmic chorioretinitis, scaled scores were lowest on timed tests that require discrimination of fine intersecting lines. Although the severity of ocular and neurologic involvement is often congruent in children with congenital toxoplasmosis, ophthalmologic involvement seems to account for certain specific limitations on tests of cognitive function. Children with such visual impairment compensate with higher verbal skills, but their verbal scores are still less than those of children with normal vision, and in some cases significantly so, indicating that vision impairment might affect other aspects of cognitive testing. Patterns of difficulties noted in the subscales indicate that certain compensatory intervention strategies to facilitate learning and performance may be particularly helpful for children with these impairments. These patterns also provide a basis for the development of measures of cognitive function independent of visual impairment.

Defining the "disruptive" in preschool behavior: what diagnostic observation can teach us.

This paper presents the clinical/developmental framework underlying a new diagnostic observational tool, the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). The special importance of observation for clinical assessment during the preschool period is delineated. The developmental rationale for a multi-dimensional assessment of disruptive behavior in young children, including problems in modulation of negative affect and low competence is discussed. The ways in which the DB-DOS will elucidate distinctions between normative and atypical behavior during this developmental period via (a) the integration of qualitative and quantitative dimensions of behavior within a clinically-sensitive coding system, (b) the observation of child behavior both within, and outside of, the parent-child context and (c) the use of specially designed tasks to "press" for clinically salient behaviors are addressed. The promise of this new method for yielding a more precise, developmentally based description of the phenotype of early onset disruptive behavior problems and for providing a standardized clinical tool for observational assessment of disruptive behavior in young children is presented. Large-scale validation of the measure is currently underway.