Ambulatory Child Health最新文献

Objective To compare parenting stress among Malaysian mothers of children with mental retardation and a control group, and to determine factors associated with stress.

Method Seventy-five mothers of children with mental retardation aged 4 to 12 years and 75 controls (paediatric clinic attenders without disabilities) participated in the Parenting Stress Index (PSI). Intelligence quotient (IQ) and Child Behaviour Checklist (CBCL) scores, together with socio-economic data, were entered into a multiple stepwise regression analysis, using the PSI as the criterion.

Results Mothers of children with mental retardation scored significantly higher than control subjects in both the child-related domain (difference between means 26.1) and parent-related domain (difference between means 15.0) of the PSI. The total child behaviour scores from the CBCL (p < 0.01), IQ scores (p < 0.01) and sibship size (p < 0.01) were associated with child-related domain scores. For the patient-related domain, CBCL (p < 0.01) and IQ scores (p = 0.01) remained important factors, but Chinese ethnicity (p < 0.01) and maternal unemployment (p < 0.01) were also significant predictors of stress.

Conclusion A large proportion of mothers of children with mental retardation experienced substantial parenting stress, especially Chinese and unemployed mothers, and this warrants appropriate intervention.

A cohort study of a geographically defined population of survivors of < 1500 g birthweight born in 1980 and 1981 and age-, sex-, and school-matched controls. The aim was to compare the prevalence of childhood and adolescent behavioural problems. Rutter and Conners questionnaires, completed by parents and teachers at age 8 and 14 years were assessed.

From an initial 40 321 births, there were 399 of birthweight < 1500 g, of whom 219 survived to age 8 years. Forty-two were excluded because of clinical disability. 167 cases were compared with matched controls. At age 14, both parent and teacher questionnaires showed an increased prevalence of behavioural problems in cases compared with controls. Pervasive behavioural problems (parents’ and teachers’ responses concordant) were present in 9% of cases and 3% of controls.

The following extracts are first, from an article by the mother of a child who had died of neuorblastoma. In it, she argued that her general practitioner, although generally supportive, should have taken more of the initiative in offering help during her child’s illness. Second, are extracts from her general practitioner’s response.

The parent A call for help may be an obvious one, from parents trying to come to terms with their child having cancer, or a hidden plea from parents outwardly coping with the demands thrust upon them, but who are inwardly desperately struggling. Are both these calls for help recognized and responded to by their family doctor? Our family doctor, contrary to my expectations, did not maintain contact with us during our son’s illness until the final stages. We were surprised and hurt by his attitude and mistakenly took his lack of contact as a lack of interest. Regular contact with us should have been an integral part of his role as our family doctor. Poor communication is the root of many problems – communication between treatment centre and general practitioner; between local hospitals and general practitioner; and between general practitioner and family.

The doctor At the base of these (contradictory thoughts and emotions) is the unique and multilayered relationship between general practitioner and patient, whether an individual or a family. We are still a long way from a satisfactory team approach to serious and terminal childhood illnesses . . .

The aim of this study (from Massachusetts General Hospital and Harvard School of Public Health) was to assess the risk for substance use disorders (SUD) associated with previous exposure to psychotropic medication in a longitudinal study of boys with attention-deficit/hyperactivity disorder (ADHD). The incidence of SUD throughout adolescence was compared in a sample of 56 medicated subjects with ADHD, 19 nonmedicated subjects with ADHD, and 137 non-ADHD control subjects. Nonmedicated subjects with ADHD were at a significantly increased risk for any SUD at follow-up compared with non-ADHD control subjects. Subjects with medicated ADHD were at a significantly reduced risk for a SUD at follow-up relative to nonmedicated subjects with ADHD. The take-home message was that untreated ADHD was a significant risk factor for SUD in adolescence, but pharmacotherapy was associated with a significantly reduced risk.

CHARGE association (Coloboma, Heart defect, choanal Atresia, Retarded growth and development, Genital hypoplasia and Ear abnormalities) is thought to arise following an insult during early embryogenesis, probably around day 20–24. The pathogenesis of autism is not fully understood, but abnormalities in brain metabolism have been detected in the brainstem, cerebellum and mesolimbic system. The association with learning difficulties is well known.

The authors report the cases of three children with characteristic features of CHARGE association. Two of the children described had severe bilateral hearing loss and were assessed as having severe retardation; neither had any speech. The third had mild hearing impairment, an IQ of 80 and some verbal and sign language. All three fulfilled the criteria for autistic disorder (Diagnostic and Statistical Manual of Mental Disorders IV).