Suicide attempts in the "comprehensive community mental health services for children and their families" program.

OBJECTIVE: To compare clinical characteristics of youths who had attempted suicide recently, previously but not recently, repeatedly, or never. METHOD: The sample comprised 4,677 youths receiving services between 1993 to 1998 in 22 communities and participating in the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. Data on suicide attempts, demographics, and clinical characteristics were obtained from intake interviews and referring agencies. Chi-square and univariate analyses of variance were used for between-group comparisons. RESULTS: Twenty-one percent of the sample had a history of attempted suicide. Previous and repeat attempters were more likely to have a history of family violence and substance abuse. Repeat attempters were most likely to have depression, while never and previous (but not recent) attempters were more likely to have conduct disorder. Other clinical differences were also found. CONCLUSIONS: Among children receiving mental health services, those who attempt suicide experience more and different types of distress, depending on the recency and frequency of attempts. Clinicians should be aware that depression is not a necessary factor in predicting suicide attempts and that suicide risk is also associated with violent and aggressive behaviors.

Theory and concepts of prevention science as applied to clinical psychology.

This article provides an overview for this special issue on prevention science in clinical psychology. A brief historical perspective on prevention in clinical psychology is presented. An even greater emphasis on prevention in the future is related to changes in the current health-care system and their likely impact on psychological practice as we move into the next century. Conceptual and theoretical models of the prevention enterprise are addressed with a distinction drawn between health promotion and disease prevention in the areas of mental disorders and general physical health. The classification of preventive interventions is discussed and methodological challenges to outcomes research are outlined. The article concludes with a discussion of training and public policy implications and a brief overview of the other articles included in this special issue on prevention science.

The meaning of measures: pitfalls in behavioral and developmental research.

This article considers a number of issues encountered in the selection and use of measures in research in the area of behavioral and developmental pediatrics. In addition to considering basic psychometric principles, it is argued that problems inherent in the developmental process, the lack of correspondence between study and standardization samples, and methodological factors affecting measurement may threaten the validity of individual measures and bias research outcome. A number of recommendations are made to counter the effects of these common measurement problems that indirectly result from the absence of a "gold standard" for measuring behavior and development.

Reliability of neurological soft signs in children: reevaluation of the PANESS.

Test-retest reliability and intellectual-behavioral correlates of a revised version of the Physical and Neurological Examination for Soft Signs (PANESS) were evaluated. The WISC-R and PANESS were administered to a heterogeneous clinical sample of 28 6- to 8-year-old children. Test-retest interval for PANESS retest was approximately 28 days with 15 children retested by same testers and the remaining children retested by different testers. Results indicated that PANESS total score is a reliable indicator of overall performance; tester assignment and retest had negligible effects on total score. Grade of subcategory scores proved unreliable across examiners but occurrence/nonoccurrence scores were more robust. Performance on the PANESS was significantly correlated with WISC-R indices sensitive to brain dysfunction, and behavioral factors implicated in the description of minor neurological dysfunction. Further research evaluating discriminant validity of the examination and changes in performance as a result of development is recommended.

Recurrent pediatric headaches: assessment and intervention.

Assessment and intervention issues in recurrent pediatric headache are discussed. A broad overview of diagnostic and etiological issues is presented, with consideration of the application of functional models to recurrent headache patterns. Behavioral treatment outcome research is reviewed, and pharmacotherapy approaches are briefly addressed. Recommendations are made for clinical practice, and future research priorities in the area of recurrent pediatric headache are underscored.

Marital disturbance and child problems: a cautionary note regarding hyperactive children.

In previous work, investigators have found a relationship between marital discord and childhood conduct problems (aggression) in clinic samples. Given the wide variability of aggression found among hyperactive children, it would follow from previous work that child aggression may be associated with marital discord in a hyperactive population. This hypothesis was tested in a sample of 23 boys (ages 5 to 8) diagnosed as attention deficit with hyperactivity. Aggressive behaviors were tracked by the children's teachers for 12 school days. Parental and teacher ratings of conduct problems were also obtained. Additionally, the auditory version of the laboratory Continuous Performance Test was administered. Marital adjustment, overt hostility, and conflict tactics, as reported by the mothers, were not significantly correlated with any of the measures of aggression or conduct problems. In other words, marital discord in families with a hyperactive boy did not explain differential rates of aggressive behavior despite definite variability in both the marital and child behavioral measures. Marital discord was marginally related to severity of attentional deficit on the Continuous Performance Test. The results underscore the need for caution in attempting to extend findings from a general population (i.e., undifferentiated clinic-referred children) to a specific diagnostic subgroup (i.e., attention-deficit hyperactive children).

Neurodevelopmental outcomes in children surviving d-transposition of the great arteries.

We investigated the prevalence of neurological abnormalities and learning problems in a population cohort of children with dextro-transposition of the great arteries (d-TGA) born between January 1, 1981 and July 1, 1990. Fifty-seven of the 60 survivors and 35 siblings in the control group underwent neurodevelopmental assessments. As compared with population norms, children with d-TGA were more likely to have abnormal neurological examination findings, learning disabilities, and behavioral disorders. There was no significant difference in IQ or frequency of abnormal neurological examination results between children undergoing atrial as compared with arterial switch procedures. Compared with their siblings, the children with d-TGA had more neurological findings and learning disabilities. The siblings of children with d-TGA had more learning problems than expected. The findings suggest that ongoing surveillance is indicated for children surviving d-TGA. Furthermore, a familial tendency for learning differences should to be taken into consideration when neurodevelopmental outcomes of various perioperative parameters are examined.

Preliminary investigation of the direct and moderating effects of family and individual variables on the adjustment of children and adolescents with diabetes.

Investigated the direct and stress-moderating effects of mother and child coping skills, child Type A behavior, and mother's report of disease-related family interruption on both psychological and physiological adjustment in 64 children with insulin-dependent diabetes. Using hierarchical multiple regression analyses, relevant demographic variables (age, gender, disease duration) were first evaluated for effects on the outcome measures, followed by the stress variable, the individual difference and family factors, and the interaction term. Several direct relationships between demographic, individual and family factors, and outcome were identified, as well as one moderating relationship. Implications for research design and future study of children and adolescents with diabetes are discussed.

Chronic daily headache in children and adolescents: a 2-year prospective study.

Chronic daily headache in children and adolescents has not been well described. We analyzed data for 37 children and adolescents who presented with chronic daily headache to our Pediatric Headache Clinic over a 2-year period. These youngsters had five distinct headache patterns; 40% of them had the "comorbid" pattern, 35% were classified with new daily persistent headache, 15% with transformed migraine, 5% with chronic tension-type headache, and 5% could not be classified. There were no significant differences by diagnosis in externalizing and internalizing behaviors, type A behaviors, disability, pain severity, days missed from school, and number of coping skills employed. Children and adolescents with chronic daily headache have distinct clinical patterns, but for the most part, have similar disability. Differences between adult and childhood chronic daily headache are emphasized.

Empirically supported treatments in pediatric psychology: recurrent pediatric headache.

OBJECTIVE: To review the empirical research examining behavioral treatments for recurrent pediatric headache. METHODS: Thirty-one investigations published after 1980 were reviewed using predetermined criteria to evaluate the adequacy of research methodologies. A modification of criteria proposed for evaluating the efficacy of psychological interventions for adults (Task Force on Promotion and Dissemination of Psychological Procedures, 1995) was used to evaluate the adequacy of evidence available for individual intervention strategies. RESULTS: Sufficient evidence exists to conclude that relaxation/self-hypnosis is a well-established and efficacious treatment for recurrent headache. Furthermore, enough evidence exists to conclude that thermal biofeedback alone is a probably efficacious treatment. Other promising interventions have been tested that combine relaxation and biofeedback or integrate other cognitive-behavioral treatment approaches, but are limited by inadequate research methodologies. CONCLUSIONS: We discuss the importance of developmentally based conceptual models and the impact of diagnostic heterogeneity and offer specific recommendations for future intervention research in the area of recurrent pediatric headache.

Factor structure of the Heiby Self-Reinforcement Questionnaire.

In order to assess the psychometric properties of the Heiby Self-Reinforcement Questionnaire, 570 undergraduate student volunteers were administered the scale and a factor analysis was performed. The most interpretable analysis resulted in five factors, which are discussed relative to Rehm's formulations with regard to the components of self-reinforcement, with suggestions for the improvement of the questionnaire.

Diagnoses and symptom patterns in children presenting to a pediatric headache clinic.

The diagnosis of migraine headache in children and adolescents is complex and not well understood. This study was conducted to compare diagnostic rates, using various criteria for pediatric migraine, and specific symptom characteristics in a sample of children referred for care to a specialized pediatric headache clinic. A structured interview was used at the patient's initial assessment visit to elicit symptom patterns and therapies attempted for headache. Clinical diagnoses were based on consensus agreement reached by a multidisciplinary team. Statistically derived diagnostic rates based on International Headache Society (IHS), Prensky, Vahlquist and our own criteria were significantly lower than clinical diagnostic rates. IHS diagnostic rates were differentially distributed as a function of race, but no other effects were found for demographic variables on diagnostic rates. Specific symptom patterns, however, varied as a function of race, gender and age of the child. The results underscore the need for comprehensive, developmentally based models of the evolution of migraine headache as a foundation for future research and the further development of clinically sensitive diagnostic criteria for pediatric migraine.

Chronic daily headache in children and adolescents: current status and recommendations for the future. Pediatric Committee of the American Association for the Study of Headache.

The Pediatric Committee of the American Association for the Study of Headache was created in 1994 to develop a plan for comprehensively addressing global issues of headache in childhood. It was the impression of clinicians and researchers with an interest in childhood headaches that a clearer focus was needed to facilitate progress in the study and management of pediatric headache. It was further felt that approaches to treatment and outcomes, as well as assessment and classification schema for pediatric patients needed to be examined separately. The goal of the committee is to integrate anecdotal, clinical, and research expertise into a plan for addressing headaches in the pediatric population in the future. During the last 5 years, substantial attention has been devoted to chronic daily headache, primarily in adult populations. It is the purpose of this paper to review the literature of chronic daily headache in children, and propose areas for further exploration, given the recent emergence of interest in this diagnostic entity.

Chronic daily headache in children and adolescents.

Recurrent headache is a relatively frequent problem in children and adolescents, with the majority of the research attention focused on pediatric migraine. This study assessed differences in consequences to headaches, coping with headaches, and associated disability in children and adolescents attending a headache clinic who were diagnosed with migraine, chronic daily headache, or carried both diagnoses. Results, generally indicated higher levels of impairment for patient's with chronic daily headaches. These patients were also more likely to use blaming others and wishful thinking as coping mechanisms. Gender and racial status interacted with headache diagnosis to predict parent response patterns and disability outcomes. The results provide initial support for the applicability of Martin's functional model of chronic headaches to a pediatric population.

Chronic paroxysmal hemicrania in a child.

Chronic paroxysmal hemicrania (CPH) is a relatively new condition first described in 1973. Since its first description, over 80 cases have been reported worldwide. Very few cases have been reported in children. We report the presentation of an 8-year-old boy to illustrate the problems in diagnosis and treatment of this rare disease in childhood.

Parent responses to pediatric headache.

Evaluated child and parent report versions of a 16-item parent response to children's recurrent pain episodes scale (PR-PAIN) on a sample of 153 pediatric headache patients. Factor analyses yielded three factors--Solicitous, Affiliative/Distracting, and Negative responses--for each report form. Correlations among factor scores provided evidence for convergent and discriminant validity. Factor scores from the parent and child report scales were differentially related to levels of episode-specific disability and overall behavior problems, supporting the criterion-related validity of both the child and parent measures. The PR-PAIN scale may assist in performing a thorough functional analysis of pediatric headache and other pain-related problems.

Controlling for general and disease-specific effects in child and family adjustment to chronic childhood illness.

Investigated the differential associations of asthma and diabetes on children's self-competence, family functioning, and maternal coping. Interactions of gender with the presence of chronic childhood illness were also assessed. Seventy-two children with diabetes and 40 children with asthma participated as subjects. Mothers completed measures of family functioning, coping, and disease severity while children completed Harter's (1985) Self-Perception Profile for Children. Results indicated that gender and type of chronic illness were independently associated with children's self-competence and family functioning but not maternal coping. However, differences attributable to specific illnesses dissipated once general family factors and general chronic childhood illness variables were controlled statistically. Differences based on child gender remained robust. Results are discussed within the context of categorical and noncategorical approaches to the study of chronic childhood illness.

Predictors of developmental outcomes in children with complete transposition.

Cognitive, functional, educational achievement and behavioural measures were employed to assess neurobehavioral status in 57 of 60 participants who were initially enrolled in the Baltimore-Washington Infant Study, and who survived surgical correction of complete transposition (concordant atrioventricular and discordant ventriculo-arterial connections). Charts were reviewed to investigate the relationship between birth variables, surgical strategy and developmental outcomes. Higher preoperative weight was associated with better outcomes on the Stanford-Binet Short-term Memory subtest, while lower preoperative oxygen tension was associated with better outcomes on the Abstract/Visual Reasoning subtest and a test of Visual-Motor Integration. Longer total bypass time was associated with poor outcomes on the Short-term Memory subtests. Higher average flow rates during cooling and rewarming were associated with higher scores in the test of short term memory but poorer outcomes on a test for visual motor integration. Longer cooling times were associated with higher scores on the test for Visual-Motor Integration. Patients suffering seizures scored lower on the Stanford-Binet Composite, as well as in their tests of achievement. The data indicate that non-verbal skills may be particularly sensitive to variations in surgical strategies employed to correct complete transposition. Overt neurological events, such as seizures, were related to global deficits in intellectual functioning. Prospective studies evaluating systemic variations in surgical procedures and attempts to prevent and manage perioperative neurological events are important for further investigation of neurodevelopmental outcomes in children surviving surgical correction.

A randomized, double-blind, placebo-controlled trial of single-dose intravenous secretin as treatment for children with autism.

OBJECTIVE: To determine whether a single injection of intravenous secretin results in measurable improvements in socialization and/or communication skills in children with autism. STUDY DESIGN: Sixty subjects with autism were randomly selected and assigned to either treatment or placebo group. Subjects in the treatment group received 2.0 clinical units of secretin per kilogram of body weight as a single intravenous dose. Subjects in the placebo group received normal saline solution. Neurodevelopmental and behavioral assessments were performed for all subjects before injection and at 3 and 6 weeks after injection. RESULTS: Assessment of language skills and parents' behavioral assessments revealed no significant differences between the treatment and placebo groups. Raters' assessments of severity of autistic symptoms did not differ for the 2 groups at 6 weeks after injection. A marginally statistically significant improvement in autistic behaviors was seen in the treatment group at 3 weeks after injection (P =.051). CONCLUSIONS: A single dose of intravenous secretin does not appear to have significant effects on either parents' perception of autistic behaviors or language skills at 6 weeks after injection. Transient, marginally significant improvements in autistic behaviors may occur in some children.