Perspectives on neuropsychology and clinical care in paediatric and adolescent medicine.

As a child and adolescent neuropsychology service based within a paediatric psychology team at a large teaching hospital, we meet children and young people across the age range who experience cognitive impairment as a result of long-term health conditions or traumatic brain injury. We have a remit of providing a neuropsychological assessment and report. Typically, a neuropsychology report includes recommendations for home and for school. However, research suggests that their uptake is variable and depends on the understanding and resources of families and school systems. As a stretched service, we have very limited capacity to follow the work through to the extent that we might like. Therefore, we are always seeking effective ways to support the ongoing adaptation and implementation of the assessment recommendations in the child's various day-to-day contexts. We address both the cognitive functioning and the psychological well-being of the child as a unified whole. Drawing on systemic ideas influences our communications with children, families, schools and the medical teams in ways which help bridge the gap between hospital-based assessment and everyday life. This article describes how we are integrating our systemic and neurodevelopmental perspectives to make the assessment and the findings a meaningful intervention in themselves. We consider ways of sharing neuropsychology findings which promote the child's psychological well-being in their different contexts: hospital, home, school, community and culture.

Adolescent Neurological Development and Implications for Health and Well-Being.

Adolescence is evolution's solution to bringing the capacity of our large, complex brains to fruition. It is a critical period for brain development and the experiences of each adolescent during this time helps to shape their adult brain. Brain developments lead to both the hormonal changes and the emotional, cognitive, and behavioral characteristics of the teenage years. They drive a growth towards independence via more complex reasoning skills, increased importance of social affiliations outside the family, and an urge to experiment and explore boundaries. In the context of still incomplete inhibitory systems, a heightened sensitivity to rewards, including the need for social acceptance, can mean risk-taking or impulsive behaviour in some. The continued plasticity of the brain can also mean a creativity and openness to novel solutions. These normative steps of adolescence are especially relevant to young people with chronic health conditions. An understanding of brain development at this time can help us appreciate the perspective and priorities of adolescents with health conditions. It can also guide us towards better ways of collaborating with them.

Programmatic impact of 5 years of mortality surveillance of New York City homeless populations.

A homeless mortality surveillance system identifies emerging trends in the health of the homeless population and provides this information to key stakeholders in a timely and ongoing manner to effect evidence-based, programmatic change. We describe the first 5 years of the New York City homeless mortality surveillance system and, for the first time in peer-reviewed literature, illustrate the impact of key elements of sustained surveillance (i.e., timely dissemination of aggregate mortality data and real-time sharing of information on individual homeless decedents) on the programs of New York City's Department of Homeless Services. These key elements had a positive impact on the department's programs that target sleep-related infant deaths and hypothermia, drug overdose, and alcohol-related deaths among homeless persons.

Transsylvian selective amygdalohippocampectomy in children with hippocampal sclerosis: seizure, intellectual and memory outcome.

PURPOSE: This study investigates the efficacy of transylvian selective amygdalohippocampectomy (TS SAH) in children with medically intractable epilepsy due to unilateral hippocampal sclerosis. Post-surgical seizure control, intellectual and memory outcomes are examined. METHOD: This study reports on pre- and post-surgical clinical data from 10 patients who underwent TS SAH between 2002 and 2010 after 24 months follow-up. Pre- and post-operative change in seizure frequency, AED use, intellect and memory are compared. RESULTS: At 12 months and 24 months post-surgery, 9/10 (90%) and 7/8 (87.5%) patients respectively, were seizure free (Engel I). No patients were classed as Engel III or IV. No significant improvement or decline at a group level was found on measures of intellect or verbal or visual memory. One hundred per cent improved or remained within 1 SD of their pre-operatives score on verbal and perceptual reasoning learning and reasoning measures. Significant improvement was found post-operatively for both immediate and delayed facial memory. CONCLUSION: Our findings of good post-surgical seizure control and favourable cognitive outcome provides evidence against previous findings that SAH in children may not be effective.

Urine collected from diapers can be used for 2-D PAGE in infants and young children.

Urinary proteomic profiling has potential to identify candidate biomarkers of renal injury in infants provided an adequate urine sample can be obtained. Although diapers are used to obtain urine for clinical evaluation, their use for proteomic analysis has not been investigated. We therefore performed feasibility studies on the use of diaper-extracted urine for 2-D PAGE. Pediatric waste urine (2-20 mL) was applied to gel-containing, non-gel and cotton-gauze diapers and then mechanically expressed. Urine volume and total protein were measured pre- and post-extraction. Proteins were separated via 2-D PAGE following application of urine (20-40 mL) to each matrix. 2-D PAGE was also performed on clinical specimens collected using each diaper type. Differences in the adsorption and retention of urine volume and protein were noted between matrices. Non-gel and cotton-gauze diapers provided the best protein/volume recovery and the lowest interference with the Bradford assay. 2-D PAGE was also successfully completed using urine samples from both cotton fiber matrices. Conversely, samples from low-gel diapers demonstrated poor protein separation and reproducibility. Diapers containing cotton-fiber matrices appear adequate for 2-D PAGE. Qualitative and quantitative analyses of resolved proteins using replicate, high-resolution gels will be required, however, before diaper-extracted urine can be applied in proteomic profiling.

Association of the histamine N-methyltransferase C314T (Thr105Ile) polymorphism with atopic dermatitis in Caucasian children.

STUDY OBJECTIVE: To investigate potential associations between the histamine N-methyltransferase (HNMT) gene, HNMT, C314T (Thr105Ile) polymorphism and atopic dermatitis in a cohort of Caucasian children. DESIGN: Prospective, multicenter, genotype-association study. SETTING: Four academic, tertiary care medical centers within the Pediatric Pharmacology Research Unit network. PARTICIPANTS: Two hundred forty-nine Caucasian children aged 6 months-5 years with atopic dermatitis (127 patients) or without (122 control subjects). INTERVENTION: Buccal swabs (one swab/cheek) were performed to obtain epithelial cells for extraction of genomic DNA. MEASUREMENTS AND MAIN RESULTS: Data were collected on severity of atopic dermatitis, oral antihistamine treatment, and treatment response through parental report. The HNMT genotypes were successfully obtained in 116 control subjects and 122 patients with atopic dermatitis. Frequencies of the T314 variant allele (0.12 vs 0.06, p=0.04) and combined CT/TT genotype (0.24 vs 0.12, p=0.02) were significantly higher in children with atopic dermatitis compared with control subjects. Children with genotypes conferring reduced HNMT activity were 2 times more likely to have atopic dermatitis than those who were homozygous for the C314 reference allele. CONCLUSION: Increased histamine levels in patients with atopic dermatitis may result, at least in part, from reduced enzymatic inactivation via HNMT. Genetically associated reduction in histamine biotransformation may therefore contribute to the pathogenesis, persistence, and progression of atopic dermatitis. If confirmed, these data indicate that HNMT genotype might represent a common risk factor for development of atopic dermatitis, asthma, and allergic rhinitis and may be useful in identifying individuals who are candidates for early preventive pharmacotherapeutic intervention. Additional longitudinal studies will be required to assess the relationship between genotype, disease severity, and antihistamine response.

Taking the psycho out of psychosomatic: using systemic approaches in a paediatric setting for the treatment of adolescents with unexplained physical symptoms.

Difficulty expressing emotional distress verbally is widely thought to underlie the presentation of physical symptoms which cannot be explained in medical terms. Children presenting with so called psychosomatic symptoms therefore bridge both the medical and psychological domains and create a conundrum for professionals from either field if working with them alone. A multidisciplinary rehabilitative approach has long been considered the treatment of choice for children exhibiting chronic physical problems. However, there has been little focus on the use of this approach with children diagnosed as suffering from nonorganic physical symptoms, or on the nuts and bolts of the psychological interventions which have been found beneficial. This article outlines a psychological model which has been integrated into a multidisciplinary team approach with good outcomes. The unique features of each case means that evidence for treatment is limited and relies upon such examples of good practice.

Taking a systemic perspective on cognitive assessments and reports: reflections of a paediatric and adolescent psychology service.

This article discusses current approaches in the neuropsychological assessment of children and young people. An audit of assessments found that nearly a quarter of referrals for neuropsychological assessments could have been resolved more effectively without completing a cognitive assessment. The audit also found that families and young people often found the report difficult to understand or unhelpful. We highlight the difficulties we have had with specific aspects of this process in a paediatric and adolescent medicine psychology service, and discuss the approaches we have taken in the light of feedback from children, young people and parents. The article describes how a systemic framework has been used in processing and responding to referrals. It also gives case examples illustrating how systemic theory and principles have been incorporated into the written reports. Families have responded very favourably to the use of creative and child friendly language in the feedback.

Thinking, feeling and moving: drama and movement therapy as an adjunct to a multidisciplinary rehabilitation approach for chronic pain in two adolescent girls.

Chronic Pain without an identifiable organic basis represents a substantial element of referrals to both medical and mental health professionals. Chronic pain can compromise independence, school attendance, physical and social activities. The tendency to label 'nonorganic' pain as having a psychological origin is usually strongly resisted by parents and young people with treatment creating a significant challenge for health care professionals. Collaborative, multidisciplinary treatment programmes encourage families to find ways of getting on with their lives by taking a proactive approach to challenging pain. The family is invited to join with the team in the task of challenging the pain through the use of physiotherapy to increase strength, stamina and suppleness alongside a range of individual and group activities that can include relaxation training, hypnotherapy, systemic and cognitive-behavioural approaches. This article describes how drama and movement therapy was introduced as an additional component of the treatment programme of two adolescents who had been long-term inpatients on a medical adolescent ward. The experiences of adding a complementary therapy to the programme are described to illustrate a creative way of contributing to established treatment programmes through the use of sound, movement and gesture in order to provide a space to explore new ways of being and expanding abilities.

Stereotype Directionality and Attractiveness Stereotyping: Is Beauty Good or is Ugly Bad?

Dion, Berscheid, and Walster (1972), in their seminal article, labeled the attribution of positive characteristics to attractive people the "beauty-is-good" stereotype. The stereotyping literature since then provides extensive evidence for the differential judgment and treatment of attractive versus unattractive people, but does not indicate whether it is an advantage to be attractive or a disadvantage to be unattractive. Two studies investigated the direction of attractiveness stereotyping by comparing judgments of positive and negative attributes for medium vs. low and medium vs. high attractive faces. Taken together, results for adults (Experiment 1) and children (Experiment 2) suggest that most often, unattractiveness is a disadvantage, consistent with negativity bias (e.g., Rozin & Royzman, 2001) but contrary to the "beauty-is-good" aphorism.

The role of facial attractiveness and facial masculinity/femininity in sex classification of faces.

We tested whether adults (experiment 1) and 4 - 5-year-old children (experiment 2) identify the sex of highly attractive faces faster and more accurately than not very attractive faces in a reaction-time task. We also assessed whether facial masculinity/femininity facilitated identification of sex. Results showed that attractiveness facilitated adults' sex classification of both female and male faces and children's sex classification of female, but not male, faces. Moreover, attractiveness affected the speed and accuracy of sex classification independently of masculinity/femininity. High masculinity in male faces, but not high femininity in female faces, also facilitated sex classification for both adults and children. These findings provide important new data on how the facial cues of attractiveness and masculinity/femininity contribute to the task of sex classification and provide evidence for developmental differences in how adults and children use these cues. Additionally, these findings provide support for Langlois and Roggman's (1990 Psychological Science 1 115 121) averageness theory of attractiveness.

Truncating BRCA1 mutations are uncommon in a cohort of hereditary prostate cancer families with evidence of linkage to 17q markers.

PURPOSE: A genome-wide scan of 175 hereditary prostate cancer families from the University of Michigan Prostate Cancer Genetics Project provided evidence of prostate cancer linkage to 17q markers near the BRCA1 gene. To examine the possibility that germ-line BRCA1 mutations were associated with hereditary prostate cancer, individuals from 93 families with evidence of linkage to chromosome 17q were screened for germ-line BRCA1 mutations. EXPERIMENTAL DESIGN: One individual from each of the 93 families, the majority with three or more cases of prostate cancer, were screened for BRCA1 mutations with denaturing high-performance liquid chromatography (HPLC). Fragments exhibiting denaturing HPLC variant patterns were additionally analyzed by direct sequencing. RESULTS: Sixty-five of the individuals selected for sequencing from 65 unrelated families were determined to have wild-type BRCA1 sequence by denaturing HPLC. One individual from a family with both prostate and ovarian cancer was found to have a truncating BRCA1 mutation (3829delT). An additional 27 germ-line variants were identified, including 15 missense variants. CONCLUSIONS: These sequencing results suggest that BRCA1 truncating mutations do not account for the linkage evidence on chromosome 17 observed in University of Michigan Prostate Cancer Genetics Project families. A recently completed combined genome scan has also detected linkage to 17q22, and studies are ongoing to identify the relevant prostate cancer susceptibility gene in this region.

Origins of a stereotype: categorization of facial attractiveness by 6-month-old infants.

Like adults, young infants prefer attractive to unattractive faces (e.g. Langlois, Roggman, Casey, Ritter, Rieser-Danner & Jenkins, 1987; Slater, von der Schulenburg, Brown, Badenoch, Butterworth, Parsons & Samuels, 1998). Older children and adults stereotype based on facial attractiveness (Eagly, Ashmore, Makhijani & Longo, 1991; Langlois, Kalakanis, Rubenstein, Larson, Hallam & Smooth, 2000). How do preferences for attractive faces develop into stereotypes? Several theories of stereotyping posit that categorization of groups is necessary before positive and negative traits can become linked to the groups (e.g. Taifel, Billig, Bundy & Flament, 1971; Zebrowitz-McArthur, 1982). We investigated whether or not 6-month-old infants can categorize faces as attractive or unattractive. In Experiment 1, we familiarized infants to unattractive female faces; in Experiment 2, we familiarized infants to attractive female faces and tested both groups of infants on novel faces from the familiar or novel attractiveness category. Results showed that 6-month-olds categorized attractive and unattractive female faces into two different groups of faces. Experiments 3 and 4 confirmed that infants could discriminate among the faces used in Experiments 1 and 2, and therefore categorized the faces based on their similarities in attractiveness rather than because they could not differentiate among the faces. These findings suggest that categorization of facial attractiveness may underlie the development of the 'beauty is good' stereotype.

Trials and triumphs, stories and solutions: using systemic therapy techniques to facilitate paediatric and community nurses' groups.

Staff groups for nurses are seen as useful for stress reduction and team building, with a widely-held belief that they should be made available and used by staff. However, while usually requested by service managers, staff have varying views regarding their need and varying levels of comfort with participation. This article considers the challenges that are faced in setting up staff support groups for two different groups of nurses. The first group, for paediatric nurses working on an adolescent medical in-patient unit, is now a settled and established entity. The second group, for a community paediatric nursing team, continues to evolve in response to changing needs. Ways to adapt the group model to increase attendance rates and ensure the groups are helpful are presented. This article is intended as a resource for professionals who are already running groups or are considering establishing one.