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Fine Motor Skills for Children with Down Syndrome: A Guide for Parents and Professionals 唐氏综合症儿童的精细运动技能:给家长和专业人士的指南
Pub Date : 2017-04-01 DOI: 10.1097/DBP.0000000000000389
Jennifer Lucarelli, E. Davidson
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引用次数: 0
The Personal and Contextual Factors Affecting the Functional Ability of Children and Adolescents With Chronic Pain: A Systematic Review (vol 37, pg 327, 2016) 影响慢性疼痛儿童和青少年功能能力的个人和环境因素:系统回顾(vol 37, pg 327, 2016)
Pub Date : 2017-04-01 DOI: 10.1097/DBP.0000000000000442
Cate Sinclair, P. Meredith, J. Strong
center: family perspectives on decision making and ADHD and implications for ADHD care. J Atten Disord. 2012;16:675–684. 9. Taylor M, Donoghue T, Houghton S. To medicate or not to medicate? The decision-making process of western Australian parents following their child’s diagnosis with an attention deficit hyperactivity disorder. Int J Disabil Dev Educ. 2006;53:111–128. 10. Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49:980–989. 11. James AC, James G, Cowdrey FA, et al. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2015;CD004690. 12. Strawn JR, Welge JA, Wehry AM, et al. Efficacy and tolerability of antidepressants in pediatric anxiety disorders: a systematic review and meta-analysis. Depress Anxiety. 2015;32:149–157. 13. Pyke-Grimm KA, Degner L, Small A, et al. Preferences for participation in treatment decision making and information needs of parents of children with cancer: a pilot study. J Pediatr Oncol Nurs. 1999;16:13–24. 14. Mak L, Hiebert-Murphy D, Walker JR, et al. Parents’ decision making and their information needs concerning treatments for child anxiety: implications for family-centered practice. J Fam Soc Work. 2014;17:51–67. 15. Bernstein KI, Promislow S, Carr R, et al. The information needs and preferences of recently diagnosed patients with IBD. Inflamm Bowel Dis. 2011;17:590–598. 16. Stewart DW, Walker JR, Beatie B, et al. Postsecondary students’ information needs and pathways for help with stress, anxiety, and depression. Can J Couns Psychother. 2014;48:356–374. 17. Gardner MJ, Altman DG. Confidence intervals rather than P values: estimation rather than hypothesis testing. Br Med J (Clin Res Ed). 1986;292:746–750. 18. Cummings P, Koepsell TD. P values vs estimates of association with confidence intervals. Arch Pediatr Adolesc Med. 2010;164: 193–196. 19. Hummelinck A, Pollock K. Parents’ information needs about the treatment of their chronically ill child: a qualitative study. Patient Educ Couns. 2006;62:228–234. 20. Gregory AM, Eley TC. The genetic basis of child and adolescent anxiety disorders. In: Silverman WK, Field AP, eds. Anxiety Disorders in Children and Adolescents. 2nd ed. Cambridge, United Kingdom: Cambridge University Press; 2011:161–178. ch 8. 21. Murray L, Creswell C, Cooper PJ. The development of anxiety disorders in childhood: an integrative review. Psychol Med. 2009; 39:1413–1423. 22. Thon A, Ullrich G. Information needs in parents of children with a rheumatic disease. Child Care Health Dev. 2009;35:41–49. 23. Jackson R, Baird W, Davis-Reynolds L, et al. Qualitative analysis of parents’ information needs and psychosocial experiences when supporting children with health care needs. Health Info Libr J. 2008;25:31–37. 24. Watson PW, McKinstry B. A systematic review of i
中心:家庭观点对决策和ADHD的影响及其对ADHD护理的影响。[J] .音像学杂志,2012;16(6):675 - 684。9. Taylor M, Donoghue T, Houghton s。用药还是不用药?西澳大利亚父母在孩子被诊断患有注意力缺陷多动障碍后的决策过程。中华伤残教育杂志,2006;5(3):111 - 128。10. Merikangas KR, He JP, Burstein M,等。美国青少年精神障碍的终生患病率:来自国家共病调查复制-青少年补充(NCS-A)的结果[J] .中华精神病学杂志,2010;49(9):980 - 989。11. James AC, James G, Cowdrey FA,等。儿童和青少年焦虑症的认知行为疗法。Cochrane Database system Rev. 2015;CD004690。12. Strawn JR, Welge JA, Wehry AM,等。抗抑郁药在儿童焦虑症中的疗效和耐受性:一项系统综述和荟萃分析。抑郁焦虑。2015;32:49 - 157。13. 王晓明,王晓明,王晓明,等。癌症儿童父母参与治疗决策的偏好和信息需求:一项试点研究。[J]中华儿科护理杂志。1999;16:13-24。14. Mak L, Hiebert-Murphy D, Walker JR,等。关于儿童焦虑治疗的父母决策及其信息需求:对以家庭为中心的实践的启示。[J] .社会科学学报,2014;17(5):551 - 567。15. Bernstein KI, Promislow S, Carr R,等。新近诊断的IBD患者的信息需求和偏好。炎症肠病,2011;17:59 - 598。16. Stewart DW, Walker JR, Beatie B等。高等教育学生的信息需求和途径,以帮助压力,焦虑和抑郁。[J]中国心理医学杂志,2014;48(8):356 - 374。17. Gardner MJ, Altman DG。置信区间而不是P值:估计而不是假设检验。Br Med J(临床医学)。1986; 292:746 - 750。18. 卡明斯P,科普塞尔TD。P值与置信区间关联的估计值。中华儿科与青少年医学杂志。2010;32(4):393 - 396。19. 父母对慢性病儿童治疗的信息需求:一项定性研究。病人教育管理。2006;62:228-234。20.Gregory AM, Eley TC。儿童和青少年焦虑症的遗传基础。见:Silverman WK, Field AP,编辑。儿童和青少年焦虑症。第二版。剑桥,英国:剑桥大学出版社;2011:161 - 178。ch 8。21. 穆雷L,克雷斯韦尔C,库珀PJ。儿童焦虑症的发展:一项综合综述。精神医学2009;39:1413 - 1423。22. Thon A, Ullrich G.风湿病患儿家长的信息需求。儿童保健发展。2009;35:41-49。23. 刘建军,刘建军,刘建军,等。父母在支持有卫生保健需求的儿童时的信息需求和心理社会经验的定性分析。中华卫生杂志,2008;25(1):31 - 37。24. 在医疗保健咨询中提高医疗建议回忆的干预措施的系统评价。中华临床医学杂志,2009;32(2):391 - 391。25. Cunningham CE, Walker JR, Eastwood JD等。成年早期心理健康信息偏好建模:一个离散选择联合实验。卫生通讯J . 2014;19:413 - 440。26. 张建军,张建军,张建军,等。关于儿童焦虑的网站如何很好地回答了家长关于治疗选择的问题?临床儿童心理与精神病学。2015;20:555-569。27. 李建军,李建军,李建军,等。国际患者辅助决策标准合作的十年:评估患者辅助决策质量的核心维度的演变。BMC医学通报2013;13(增刊2):s1。28. Stacey D, lsamgarise F, Col NF,等。为面临健康治疗或筛查决定的人提供决策辅助。Cochrane Database system Rev. 2014;CD001431。29. Dunst CJ, Trivette CM, Hamby DW。以家庭为中心的帮扶实践研究的元分析。智力迟钝、发展和残疾,2007;13:370-378。
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引用次数: 0
Information Needs and Preferences of Parents Considering Treatment of Child Anxiety 考虑儿童焦虑治疗的家长的信息需求和偏好
Pub Date : 2017-04-01 DOI: 10.1097/DBP.0000000000000388
L. Mak, J. Walker, D. Hiebert-murphy, Gary Altman
Objective: To assess the information needs and preferences of parents who were making decisions concerning treatment for their child's anxiety. Methods: Ninety-three parents were recruited from hospital-based clinics, a parent group, and a public information meeting. They completed a survey about preference for decision-making involvement, information needs, and preferences concerning source and amount of information. Results: Most (69%) parents indicated that they prefer a collaborative decision-making role. They rated very highly the need for general information related to treatment and information related to psychosocial interventions and medication treatment. Fewer parents rated information about logistics of treatment (e.g., scheduling, cost) as highly important although this information was considered important by many parents. Direct discussions with a provider, written information, and information accessed through the internet were the most preferred sources of information. Many parents indicated a preference for substantial amounts of information about psychosocial and medication treatments. Conclusion: Much of the information that parents want concerning treatment is not widely available. It would be helpful to develop evidence-based brochures and web information resources that focus on answering parents' questions concerning treatment of children's anxiety.
目的:评估父母对儿童焦虑治疗决策的信息需求和偏好。方法:从医院诊所、家长小组和公共信息会议中招募93名家长。他们完成了一项关于决策参与偏好、信息需求以及对信息来源和数量的偏好的调查。结果:大多数(69%)家长表示他们更喜欢合作决策的角色。他们非常重视对与治疗有关的一般信息以及与心理干预和药物治疗有关的信息的需求。很少有家长认为治疗的后勤信息(例如,日程安排,费用)非常重要,尽管许多家长认为这些信息很重要。与提供者直接讨论、书面信息和通过互联网获取的信息是最受欢迎的信息来源。许多家长表示,他们更倾向于获得大量关于心理社会和药物治疗的信息。结论:很多家长想要的关于治疗的信息并没有被广泛获取。开发以证据为基础的小册子和网络信息资源,重点回答家长关于儿童焦虑治疗的问题,将会有所帮助。
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引用次数: 5
Income, Family Context, and Self-Regulation in 5-Year-Old Children. 收入、家庭背景与5岁儿童的自我调节。
Pub Date : 2017-02-01 DOI: 10.1097/DBP.0000000000000380
Mengying Li, Jenna L Riis, Sharon R Ghazarian, Sara B Johnson

Objective: Self-regulation (SR) is a core aspect of child development with enduring effects on health and wellbeing across the lifespan. Early childhood poverty may shape SR development. This study examined the cross-sectional relationship among family income, family context, and SR in 5-year-old children.

Methods: A total of 140 five-year-old children and their mothers participated in the study. Children completed a battery of SR tasks; mothers completed questionnaires. Cognitive and emotional SR composite scores were generated based on a principal component analysis of the SR tasks. The SR scores were first regressed on family income (in 10 levels ranging from <5000 to 150,000+) adjusting for age, sex, and race of the child; family context variables were subsequently added to the models.

Results: Controlling for age, sex, and race, each level increase in family income was associated with 0.04 SD increase in emotional SR (p = .32) and 0.08 SD increase in cognitive SR (p = .01). In fully adjusted models, exposure to household instability and experiencing 10 or more negative life events was associated with worse emotional SR; exposure to mother's depressive symptoms was associated with worse cognitive SR. Higher income buffered children's SR from some contextual risk factors. Family contextual variables explained 62% of the correlation between higher income and better cognitive SR scores.

Conclusion: Income-based cognitive SR disparities were associated with family contextual factors. Screening for family adversity in pediatric care and linking families to needed resources may protect children's developing SR capacities, with benefits to health and well-being.

目的:自我调节(SR)是儿童发展的一个核心方面,对整个生命周期的健康和幸福有着持久的影响。儿童早期贫困可能影响SR的发展。本研究考察了家庭收入、家庭背景与5岁儿童社会满意度的横断面关系。方法:140名5岁儿童及其母亲参与研究。孩子们完成了一系列的SR任务;母亲们完成了问卷调查。基于对SR任务的主成分分析,生成了认知和情绪SR综合得分。结果:在控制年龄、性别和种族的情况下,家庭收入每增加一级,情绪SR增加0.04 SD (p = 0.32),认知SR增加0.08 SD (p = 0.01)。在完全调整的模型中,暴露于家庭不稳定和经历10个或更多负面生活事件与更差的情绪SR相关;暴露于母亲的抑郁症状与较差的认知SR相关。较高的收入缓冲了某些背景风险因素对儿童SR的影响。家庭背景变量解释了高收入和更好的认知SR得分之间62%的相关性。结论:基于收入的社会责任认知差异与家庭背景因素有关。在儿科护理中筛查家庭逆境,并将家庭与所需资源联系起来,可以保护儿童的社会责任能力发展,从而有利于健康和福祉。
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引用次数: 21
Association of Food Insecurity with Children's Behavioral, Emotional, and Academic Outcomes: A Systematic Review 食物不安全与儿童行为、情绪和学业成绩的关系:一项系统综述
Pub Date : 2017-02-01 DOI: 10.1097/DBP.0000000000000383
P. Shankar, Rainjade Chung, D. Frank
Objective: Food Insecurity (FI) occurs in 21% of families with children and adolescents in the United States, but the potential developmental and behavioral implications of this prevalent social determinant of health have not been comprehensively elucidated. This systematic review aims to examine the association between FI and childhood developmental and behavioral outcomes in western industrialized countries. Method: This review provides a critical summary of 23 peer reviewed articles from developed countries on the associations between FI and adverse childhood developmental behavioral outcomes including early cognitive development, academic performance, inattention, externalizing behaviors, and depression in 4 groups–infants and toddlers, preschoolers, school age, and adolescents. Various approaches to measuring food insecurity are delineated. Potential confounding and mediating variables of this association are compared across studies. Alternate explanatory mechanisms of observed effects and need for further research are discussed. Results: This review demonstrates that household FI, even at marginal levels, is associated with children's behavioral, academic, and emotional problems from infancy to adolescence across western industrialized countries - even after controlling for confounders. Conclusions: While the American Academy of Pediatrics already recommends routine screening for food insecurity during health maintenance visits, the evidence summarized here should encourage developmental behavioral health providers to screen for food insecurity in their practices and intervene when possible. Conversely, children whose families are identified as food insecure in primary care settings warrant enhanced developmental behavioral assessment and possible intervention.
目的:食物不安全(FI)发生在美国21%的有儿童和青少年的家庭中,但这一普遍的健康社会决定因素的潜在发展和行为影响尚未得到全面阐明。本系统综述旨在研究在西方工业化国家,FI与儿童发育和行为结果之间的关系。方法:本综述对来自发达国家的23篇同行评议文章进行了批判性总结,内容涉及FI与儿童不良发展行为之间的关系,包括婴幼儿、学龄前儿童、学龄儿童和青少年的早期认知发展、学业表现、注意力不集中、外化行为和抑郁。描述了衡量粮食不安全的各种方法。在研究中比较了这种关联的潜在混淆变量和中介变量。讨论了观察到的效应的其他解释机制和进一步研究的必要性。结果:本综述表明,在西方工业化国家,家庭FI,即使是边际水平,也与儿童从婴儿期到青春期的行为、学业和情感问题有关——即使在控制混杂因素之后。结论:虽然美国儿科学会已经建议在健康维护访问期间对食物不安全进行常规筛查,但这里总结的证据应该鼓励发育行为健康提供者在他们的实践中筛查食物不安全并在可能的情况下进行干预。相反,在初级保健机构中被确定为粮食不安全家庭的儿童需要加强发展行为评估和可能的干预。
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引用次数: 245
Editor-in-Chief's Note. 主编的注意。
Pub Date : 2017-02-01 DOI: 10.1097/DBP.0000000000000431
L. Pachter
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引用次数: 0
Relationship of Sleep Duration and Regularity with Dietary Intake Among Preschool-Aged Children with Obesity from Low-Income Families 低收入家庭学龄前肥胖儿童睡眠时间、规律性与饮食摄入的关系
Pub Date : 2017-02-01 DOI: 10.1097/DBP.0000000000000369
M. Petrov, Kiley B Vander Wyst, Corrie M. Whisner, Mihyun Jeong, Michaela Denniston, Michael W. Moramarco, M. Gallagher, E. Reifsnider
Objective: Diet is a modifiable factor associated with pediatric obesity outcomes, but few studies have evaluated the relationships of sleep duration and regularity on dietary intake of young preschool-aged children. The goal of this study was to evaluate whether short sleep duration and irregular sleep timing were associated with greater calorie, carbohydrate and fat consumption among young children with obesity from low-income families. Methods: Fifty-one ethnically diverse children aged 2 to 4 years were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children clinics in a southeast Texas county. Sleep behaviors were parent reported using the Child Sleep Assessment tool. Dietary intake data were obtained by 24-hour recall interviews (2 weekdays and 1 weekend day). Results: Short sleep duration (<11 hr) was highly prevalent among this cohort of preschool-aged children. Short sleep duration was associated with greater fat and decreased carbohydrate consumption. Children with greater variability in sleep duration and timing had greater energy intake from fat and protein sources. Conclusion: Allowing for the opportunity to educate parents on the importance of maintaining regular, adequate sleep and relationships between sleep and dietary intake may decrease the risk of childhood obesity in this high-risk pediatric population.
目的:饮食是与儿童肥胖结局相关的可改变因素,但很少有研究评估睡眠时间和规律性与学龄前儿童饮食摄入的关系。这项研究的目的是评估低收入家庭肥胖儿童的睡眠时间短和睡眠时间不规律是否与更多的卡路里、碳水化合物和脂肪消耗有关。方法:从德克萨斯州东南部一个县的妇女、婴儿和儿童特殊补充营养计划诊所招募了51名年龄在2至4岁的不同种族的儿童。父母使用儿童睡眠评估工具报告睡眠行为。膳食摄入数据通过24小时回忆访谈(2个工作日和1个周末)获得。结果:短睡眠时间(<11小时)在这组学龄前儿童中非常普遍。睡眠时间短与脂肪增加和碳水化合物消耗减少有关。睡眠时间和时间变化较大的儿童从脂肪和蛋白质来源中摄入的能量更多。结论:提供机会教育家长保持规律、充足睡眠的重要性,以及睡眠和饮食摄入之间的关系,可能会降低这一高危儿科人群的儿童肥胖风险。
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引用次数: 26
Qualitative Analysis of Parental Observations on Quality of Life in Australian Children with Down Syndrome 澳大利亚唐氏综合症儿童父母生活质量观察的定性分析
Pub Date : 2017-01-01 DOI: 10.1097/DBP.0000000000000385
N. Murphy, A. Epstein, H. Leonard, E. Davis, D. Reddihough, A. Whitehouse, P. Jacoby, J. Bourke, Katrina Jane Williams, J. Downs
Objective: There are many challenges to health, functioning, and participation for children with Down syndrome; yet, the quality-of-life (QOL) domains important for this group have never been clearly articulated. This study investigated parental observations to identify QOL domains in children with Down syndrome and determined whether domains differed between children and adolescents. Methods: The sample comprised 17 families whose child with Down syndrome was aged 6 to 18 years. Primary caregivers took part in semistructured telephone interviews to explore aspects of their child's life that were satisfying or challenging. Qualitative thematic analysis was implemented using a grounded theory framework to identify domains. The coded data set was divided into 2 groups (childhood and adolescence) at 3 age cut points to observe whether differences existed between the coded domains and domain elements: (1) 6 to 11 years with 12 to 18 years; (2) 6 to 13 years with 14 to 18 years; and (3) 6 to 15 years with 16 to 18 years. Results: Eleven domains were identified: physical health, behavior and emotion, personal value, communication, movement and physical activity, routines and predictability, independence and autonomy, social connectedness and relationships, variety of activities, nature and outdoors, and access to services. No differences in domains and domain elements were identified across childhood and adolescence. Conclusion: Our data form a preliminary framework from which to design investigations of the child's perspectives on life quality and suggest a range of necessary supports and services.
目的:唐氏综合症儿童的健康、功能和参与面临许多挑战;然而,对这一群体重要的生活质量(QOL)领域从未得到明确阐述。本研究调查了父母的观察,以确定唐氏综合征儿童的生活质量域,并确定这些域在儿童和青少年之间是否存在差异。方法:选取唐氏综合征患儿年龄在6 ~ 18岁的17个家庭为样本。主要照顾者参加了半结构化的电话访谈,以探索孩子生活中令人满意或充满挑战的方面。定性专题分析是使用一个扎根的理论框架来确定领域。将编码后的数据集在3个年龄切割点分为儿童和青少年两组,观察编码域与域元素之间是否存在差异:(1)6 ~ 11岁与12 ~ 18岁;(二)有期徒刑6年以上13年以上,有期徒刑14年以上18年以上;(3) 6至15年,16至18年。结果:确定了11个领域:身体健康、行为和情感、个人价值、沟通、运动和身体活动、常规和可预测性、独立性和自主性、社会联系和关系、活动的多样性、自然和户外活动,以及获得服务的机会。在儿童期和青春期,在领域和领域要素方面没有发现差异。结论:我们的数据形成了一个初步的框架,据此设计儿童对生活质量的看法的调查,并提出一系列必要的支持和服务。
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引用次数: 36
Predictors of Long-Term Victimization After Early Pediatric Traumatic Brain Injury 儿童早期创伤性脑损伤后长期受害的预测因素
Pub Date : 2017-01-01 DOI: 10.1097/DBP.0000000000000366
Anna Hung, A. Cassedy, H. Schultz, K. Yeates, H. Taylor, T. Stancin, N. Walz, S. Wade
Objective: Pediatric traumatic brain injuries (TBIs) adversely affect long-term functional and social outcomes. Limited research suggests children with TBI are more likely to be victimized by peers than noninjured children. Deficits in social information processing (SIP), cognitive ability, and executive functioning (EF) may contribute to increased victimization risk. This study examined rates of peer victimization/bullying in children with early TBI compared with children with orthopedic injuries (OIs) and the role of processing speed, executive function (EF), and SIP as mediators of the association of TBI and peer victimization. Method: Children ages 10 to 14 years who sustained a complicated mild/moderate or severe TBI (N = 58) or OI (N = 72) during early childhood (ages 3–7 yr) and their parents participated in a longitudinal prospective follow-up 6.8 years postinjury. SIP, EF and processing speed, and peer victimization were assessed. Results: Parents of children with severe TBI reported greater rates of peer victimization than parents of children with OIs. Children with severe TBI demonstrated greater EF deficits than children with complicated mild/moderate TBI or OI and poorer processing speed than children with OI. No significant indirect relationships were found between groups and any outcome variables to indicate mediation. Conclusion: Based on parent report, children with severe TBI have higher risk of peer victimization than those with less severe injuries. In addition, children with severe TBI have more impaired EF and cognitive ability than counterparts with less severe TBI. Further research is needed to explore predictors of long-term victimization after early TBI to create interventions aimed at providing social, emotional, and behavioral skill building for victimized youth.
目的:儿童创伤性脑损伤(tbi)对长期功能和社会预后有不利影响。有限的研究表明,患有创伤性脑损伤的儿童比没有受伤的儿童更容易受到同伴的伤害。社会信息处理(SIP)、认知能力和执行功能(EF)的缺陷可能会增加受害风险。本研究考察了早期创伤性脑损伤儿童与骨科损伤儿童的同伴伤害/欺凌发生率,以及处理速度、执行功能(EF)和SIP在创伤性脑损伤和同伴伤害之间的中介作用。方法:在儿童早期(3-7岁)发生合并轻/中度或重度TBI (N = 58)或OI (N = 72)的10 - 14岁儿童及其父母在伤后6.8年进行纵向前瞻性随访。评估SIP、EF、处理速度和同伴受害程度。结果:重度脑外伤儿童的父母报告的同伴受害率高于OIs儿童的父母。严重创伤性脑损伤的儿童比复杂轻度/中度创伤性脑损伤或成骨不全的儿童表现出更大的EF缺陷,并且比成骨不全的儿童表现出更差的处理速度。各组和任何结果变量之间没有发现显著的间接关系来表明中介作用。结论:根据家长报告,严重创伤性脑损伤儿童同伴受害的风险高于轻伤儿童。此外,严重创伤性脑损伤的儿童比轻度创伤性脑损伤的儿童有更多的EF和认知能力受损。需要进一步的研究来探索早期创伤性脑损伤后长期受害的预测因素,以创造旨在为受害青年提供社会、情感和行为技能建设的干预措施。
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引用次数: 11
It Is Just Attention-Deficit Hyperactivity Disorder…or Is It? 这只是注意力缺陷多动障碍……还是真的?
Pub Date : 2017-01-01 DOI: 10.1097/DBP.0000000000000386
Dana C. Won, C. Guilleminault, P. Koltai, Stacey D. Quo, M. Stein, I. Loe
CASE Carly is a 5-year-old girl who presents for an interdisciplinary evaluation due to behaviors at school and home suggestive of attention-deficit hyperactivity disorder (ADHD). Parent report of preschool teacher concerns was consistent with ADHD. Psychological testing showed verbal, visual-spatial, and fluid reasoning IQ scores in the average range; processing speed and working memory were below average. Carly's behavior improved when her mother left the room, and she was attentive during testing with a psychologist. Tests of executive function (EF) skills showed mixed results. Working memory was in the borderline range, although scores for response inhibition and verbal fluency were average. Parent ratings of ADHD symptoms and EF difficulties were elevated.Carly's parents recently separated; she now lives with her mother and sees her father on weekends. Multiple caregivers with inconsistent approaches to discipline assist with child care while her mother works at night as a medical assistant. Family history is positive for ADHD and learning problems in her father. Medical history is unremarkable. Review of systems is significant for nightly mouth breathing and snoring, but no night waking, bruxism, or daytime sleepiness. She has enlarged tonsils and a high-arched palate on physical examination.At a follow-up visit, parent rating scales are consistent with ADHD-combined type; teacher rating scales support ADHD hyperactive-impulsive type. Snoring has persisted. A sleep study indicated obstructive sleep apnea. After adenotonsillectomy, Carly had significant improvement in ADHD symptoms. She developed recurrence of behavior problems 1 year after the surgery.
CASECarly是一名5岁的女孩,由于在学校和家里的行为暗示了注意缺陷多动障碍(ADHD),她提出了跨学科评估。家长对幼儿教师关注的报告与ADHD一致。心理测试显示,语言、视觉空间和流动推理的智商得分在平均范围内;处理速度和工作记忆低于平均水平。当她妈妈离开房间时,卡莉的行为有所改善,在心理学家的测试中,她很专心。执行功能(EF)技能测试的结果好坏参半。虽然反应抑制和语言流畅性得分一般,但工作记忆处于边缘范围。父母对ADHD症状和EF困难的评分升高。卡莉的父母最近分居了;她现在和妈妈住在一起,周末去看爸爸。当她的母亲在晚上作为医疗助理工作时,多个照顾者以不一致的方式帮助照顾孩子。她父亲有ADHD和学习问题家族史。病史一般。检查系统对夜间口呼吸和打鼾有重要意义,但没有夜间醒来、磨牙或白天嗜睡。经体格检查,她扁桃体肿大,上颚弓高。在随访中,父母评定量表与adhd合并型一致;教师评定量表支持多动症多动冲动型。鼾声持续不断。一项睡眠研究表明阻塞性睡眠呼吸暂停。在腺扁桃体切除术后,卡莉的ADHD症状有了显著改善。术后1年再次出现行为问题。
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引用次数: 3
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Journal of Developmental & Behavioral Pediatrics
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