The Journal of Rural Health Official Journal of the American Rural Health Association and the National Rural Health Care Association, Feb 1, 2001
Screening results for the Child Development Review (CDR) and the Denver II Developmental Screenin... more Screening results for the Child Development Review (CDR) and the Denver II Developmental Screening Test (Denver II) were compared in two locations: the Cheyenne River Reservation in South Dakota and Sioux Falls, S.D. Seventy-three white, Native American and other minority children, half originating from the reservation and half from Sioux Falls, were randomly assigned to take one developmental screening test. A chi-square analysis indicated a significant difference in results across tests. Specifically, more CDR than Denver II subjects passed the screening and more Denver II than CDR subjects failed the screening. This pattern held for subjects living on, but not off, the reservation. Thus, for Native American, white and other minority children living on the Cheyenne River Reservation, the CDR may be undersensitive and/or the Denver II oversensitive to suspect presentations. Medical practitioners are advised to use these instruments with caution in rural settings.
The primary aim of this investigation was to assess the correlation between the POSNA Musculoskel... more The primary aim of this investigation was to assess the correlation between the POSNA Musculoskeletal Functional Health Questionnaire (POSNA) and gait analysis in children with cerebral palsy (CP). POSNA and computerized gait analysis were used to evaluate individuals with CP. Correlations were investigated between POSNA scales, gait parameters, and the Gillette Functional Assessment Questionnaire (FAQ) in 63 children (31 males, 32 females; mean age 9.17 years [SD 3.06], age range 3.75 to 16.44 years) with spastic CP. Twelve participants had hemiplegia, 29 diplegia, 12 quadriplegia, and 10 triplegia. The result of backwards stepwise multiple regression analysis indicated that the Log normalcy index (NI) was a significant predictor of the POSNA Global Function and Comfort scale. Energy expenditure (EE) did not add significantly to the prediction. The POSNA scales differentiated between the different topographical types of CP. The POSNA scale is a valid and useful clinical measure. Used in conjunction with the NI, EE, and FAQ, the POSNA scale provides a more complete appraisal of change in functioning.
The purpose of this study was to identify group differences in children with attention-deficit-hy... more The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [DOSAGE ERROR CORRECTED], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.
Canadian family physician Médecin de famille canadien, 1986
The disabled young adult strives to be independent when preparing to leave home and family. This ... more The disabled young adult strives to be independent when preparing to leave home and family. This article provides a checklist that can help the disabled young adult and his/her family to make this transition. In some cases, a transitional rehabilitation program may also be of help. The family physician who is familiar with the issues that pertain to adolescent development can play a central part in addressing patient and family problems that present at this time.
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2001
Screening results for the Child Development Review (CDR) and the Denver II Developmental Screenin... more Screening results for the Child Development Review (CDR) and the Denver II Developmental Screening Test (Denver II) were compared in two locations: the Cheyenne River Reservation in South Dakota and Sioux Falls, S.D. Seventy-three white, Native American and other minority children, half originating from the reservation and half from Sioux Falls, were randomly assigned to take one developmental screening test. A chi-square analysis indicated a significant difference in results across tests. Specifically, more CDR than Denver II subjects passed the screening and more Denver II than CDR subjects failed the screening. This pattern held for subjects living on, but not off, the reservation. Thus, for Native American, white and other minority children living on the Cheyenne River Reservation, the CDR may be undersensitive and/or the Denver II oversensitive to suspect presentations. Medical practitioners are advised to use these instruments with caution in rural settings.
Clonidine, oral and patch, has been used in adults for the treatment of hypertension and Tourette... more Clonidine, oral and patch, has been used in adults for the treatment of hypertension and Tourette's Syndrome. Recently clinicians have begun to employ it in several oft label usages in children, especially behavioral syndromes. This article is a guide to its usage in children and includes discussion of its indications, contraindications, pre-treatment laboratory studies, dosing and drug interactions.
The person-item map from Rasch analysis of the Gillette Functional Assessment Questionnaire (FAQ)... more The person-item map from Rasch analysis of the Gillette Functional Assessment Questionnaire (FAQ) was used to determine sets of activity items that individuals at each GMFCS level and FAQ walking level could be expected to perform with a 50% probability. Data demonstrate that the 22-item skill set of the FAQ spans the household to community levels of the FAQ walking scale and GMFCS. Items map to a level in either system consistent with expected level of motor or walking difficulty.
Dewlopmental Screening Test (Denver 11) were compared in two locations: the Cheyenne River Reserz... more Dewlopmental Screening Test (Denver 11) were compared in two locations: the Cheyenne River Reserzution in South Dakota and Sioux Falls, S.D. Seventy-three zuhite, Native American and ol'lier miriority children, half originating from the reservation and half from Sioux Falls, roere rrindomly assigned to take one developmental screening test. A chi-square analysis indicated a signifcant difference in results across tests. Specifically, more CDR than Denver 11 subjects passed the screening and more Denver 11 than CDR subjects failed tke screening. Tkis pattcrn kdd for subjects living on, but not offr the reservation. Thus, for Native American, white and ofker minority children living on the Cheyenne River Reseruation, the CDR mny be undersensitive and/or tke Denver 11 oversensitive to suspect presentations. Medical practitioners are advised to use tkese instruments with caution in rural settings.
A 10-level, parent-report walking scale encompassing a range of walking abilities from nonambulat... more A 10-level, parent-report walking scale encompassing a range of walking abilities from nonambulatory to ambulatory in all community settings and terrains was developed at Gillette Children's Specialty Healthcare (GCSH) as part of the Gillette Functional Assessment Questionnaire (FAQ). The reliability and validity of the walking-scale portion of the FAQ were tested on a group of individuals seen in the Motion Analysis Laboratory at GCSH between May 1996 and January 1997. A complete data set on 41 individuals with neuromuscular conditions represented the community ambulation levels (6-10) of the walking scale. Good test-retest reliability among parents and good interrater reliability between parents and community caregivers was demonstrated. Content and concurrent validity were also high, as assessed by correlation to standardized functional outcome measures, energy expenditure, and gait-analysis information. A reliable and valid scale specific to the task of walking such as the FAQ can assist clinicians in documenting functional change in children with chronic neuromuscular conditions.
Well-intended efforts to diagnose a child's developmental delay may have ... more Well-intended efforts to diagnose a child's developmental delay may have unintended negative consequences for a child and his family. Consequently, clinicians may feel caught in a moral dilemma: between doing the good they seek and avoiding the harm they foresee. The dilemma is that when investigating global developmental delay it is not possible to avoid all the anticipated negative outcomes of genetic testing and concurrently fulfill our obligations to do the good from which these harmful effects result. It is imperative to recognize dilemmas especially where the moral questions or relevant facts are not as clear cut as in ethics textbooks and to bring their moral questions into a structured dialogue with the patient and his or her family. A modified principle of double effect is a useful method for deliberating about these moral cases. Three case examples illustrate the utility of the principle of double effect when investigating global developmental delay.
The aim of this article is to characterize the neurobehavior of young children at risk for develo... more The aim of this article is to characterize the neurobehavior of young children at risk for developmental delay and attention problems. Two hundred and eighty-one children, ages 18 to 70 months, were evaluated. All parents/guardians completed the Child Development Inventory, Child Behavior Checklist for Ages 1½ to 5, Inventory for Client and Agency Planning, and Parenting Stress Index-Short Form. All children had significant delays (developmental ratios <.70). A Mann-Whitney U test compared those with and without attention problems (T score >70). A 2-tailed P value of <.05 indicated statistical significance. Children with attention problems were more likely to have withdrawn behavior, sleep problems, and aggressive behavior. All had severe problem behaviors, and their families experienced significant stress. Attention problems and other serious problem behaviors occur frequently in young children at risk for developmental delay. Parental stress warrants prompt intervention for their children and positive supports for them.
Data were collected parenting stress, adaptive behavior, pain, and health issues from the caregiv... more Data were collected parenting stress, adaptive behavior, pain, and health issues from the caregivers of 35 girls and women with Rett syndrome (mean age = 20.3). A majority (60%) of parents reported stress in the clinical range on at least 1 subscale of the Parenting Stress Index-Short Form. Seizures and uncertainty about their daughter's gastrointestinal pain experience were significantly associated with higher levels of parenting stress. No other child factors (adaptive behavior, age, residential status) were significantly related to parenting stress. Factors related to chronic health concerns (seizures, ambiguous pain presentation) may be important when considering family stress issues in relation to general outcomes for girls with Rett syndrome and related developmental disorders.
To identify parent-reported symptoms that predict parenting stress in preschoolers with global de... more To identify parent-reported symptoms that predict parenting stress in preschoolers with global developmental delay, 201 parents/guardians of 142 boys and 59 girls with global delay, mean age 39.1 months (range, 18 to 63 months) were studied retrospectively. Parents completed the following: (a) a semistructured interview; (b) the Child Development Inventory, (c) Child Behavior Checklist 1½-5, and the (d) Parenting Stress Index-Short Form. Forty-two percent of parents described clinically significant parenting stress (≥ 85th percentile). The Parenting Stress Index-Short Form subscales Difficult Child and Parent-Child Dysfunctional Interactions were elevated. Parental stress increased with higher gross motor development and decreased as social and fine-motor ratios increased. Furthermore, stress increased when parents reported higher levels on the Emotionally Reactive and Withdrawn scale scores and when parents reported Pervasive Developmental and Oppositional Defiant Problems. In mobile children with global delay, behavior problems predict parenting stress.
Journal of Child and Adolescent Psychopharmacology, 1997
This retrospective chart review examined the relative effectiveness of fluoxetine and trazodone i... more This retrospective chart review examined the relative effectiveness of fluoxetine and trazodone in relieving insomnia associated with depressive disorders in adolescents (aged 13-17 years). We reviewed the hospital charts of consecutively admitted adolescents with a depressive disorder and insomnia, who received one of three treatments: fluoxetine (20 +/- 2.2 mg), trazodone (71 +/- 32 mg), or a fluoxetine-trazodone combination (fluoxetine 29 +/- 2.2 mg, trazodone 68 +/- 29 mg). Each treatment was examined in 20 patients. Insomnia was defined as a change in sleep patterns characterized by decreased total sleep time that was sufficient to cause clinical concern, and insomnia resolution was defined as sleep starting by midnight and lasting 6 hours. Mean time to resolution of insomnia was significantly faster in adolescents treated with trazodone rather than fluoxetine (2.5 vs. 5.1 days, p < 0.05). Trazodone seemed to save only about 3 days and insomnia resolved in all subjects by the 11th day of antidepressant treatment. Median time to insomnia resolution was 2 days (range 1-5 days) in the trazodone group and 4 days (range 1-11 days) in the fluoxetine group. This difference between trazodone and fluoxetine, although statistically significant, was generally not clinically significant in the management of insomnia associated with depressive disorders in adolescents. The resolution of insomnia was not faster for treatment with a combination of fluoxetine and trazodone in comparison to fluoxetine monotherapy. Insomnia resolution was slightly later in older children. These clinical findings await confirmation by a controlled study. Both drugs seemed effective in ameliorating sleep symptoms in this sample, although it is likely that they produced these changes by different mechanisms.
Journal of Child and Adolescent Psychopharmacology, 1998
This pilot study was designed to assess the short-term effectiveness and side effects of methylph... more This pilot study was designed to assess the short-term effectiveness and side effects of methylphenidate in treating symptoms of attention deficit hyperactivity disorder (ADHD) in Native American children (5 to 12 years old) with documented fetal alcohol syndrome (FAS) or partial fetal alcohol syndrome. Using strict criteria for the diagnosis of FAS and ADHD, a randomized double-blind cross-over study of two placebos and a fixed dose of methylphenidate was completed in 4 Native American children in a residential school. Each treatment condition lasted 5 days, and daily observational outcome measures, the Conners Parent Rating Scale (CPRS-48), and the Conners Teacher Rating Scale (CTRS-39), were employed. Methylphenidate significantly improved scores of the Hyperactivity Index Scale on the CPRS-48 and the CTRS-39 but not the Daydreaming-Attention score on the CTRS-39. Side effects were similar to those traditionally found in other populations. The promising preliminary results suggest that a more definitive study of methylphenidate in Native and non-Native children with FAS and ADHD is warranted.
Journal of Applied Research in Intellectual Disabilities, 2007
ABSTRACT Background Although treatment acceptability scales in intellectual and developmental di... more ABSTRACT Background Although treatment acceptability scales in intellectual and developmental disabilities research have been used in large- and small-scale applications, large-scale application has been limited to analogue (i.e. contrived) investigations. This study extended the application of treatment acceptability by assessing a large sample of care givers’ perceptions of treatment for children with cerebral palsy (CP) in a real-world setting and tested if responses differed across child characteristics, type of medical service or respondent demographics.Method One hundred and fifty four care givers’ for children with CP rated the acceptability of treatments and related medical services by clinicians working in a multi-disciplinary children's specialty setting using Kazdin's (Journal of Applied Behavior Analysis, 13, 1980, 259) Treatment Evaluation Inventory.Results There were significant (P < 0.05) differences between male and female respondents’ ratings of treatment acceptability. There were no other significant differences for caregiver ratings in relation to child characteristics, type of appointment, severity of CP or other respondent demographic characteristics.Conclusion Mothers and fathers of children with developmental disabilities may differ in their perceptions of the acceptability of medical treatment services for children with developmental disabilities. Future studies addressing treatment acceptability should expand the scope of demographic information assessed and include items specific to the roles respondents have in providing and coordinating therapeutic regimens for their children's medical needs.
The Gillette Functional Assessment Questionnaire [1] (FAQ) is a tool used to measure the function... more The Gillette Functional Assessment Questionnaire [1] (FAQ) is a tool used to measure the functional impact of walking limitations in children with disabilities. This study evaluates the performance of typically developing (TD) pre-school children using the tool. Results suggest that TD children exhibit a developmental progression across all levels of the FAQ walking scale and the 22-item skill set. This understanding provides a basis for enhanced interpretation when used with children with disabilities.
A survey was made of the clinical characteristics of wheelchair-users at the Children's R... more A survey was made of the clinical characteristics of wheelchair-users at the Children's Rehabilitation Centre in Saskatoon, Saskatchewan. 261 patients were studied, of whom 214 had cerebral palsy, 34 had myelomeningocele and 13 had Duchenne muscular dystrophy. Among the patients with cerebral palsy it was found that the attributes likely to define a wheelchair-user were spastic quadriplegia, functional level III and IV, seizures and severe sensory handicap; among patients with myelomeningocele, wheelchair use ws related to level of lesion; and in the muscular dystrophy group it ws related to age. These results have been of help to rehabilitation centres and related service agencies in formulating long-term plans to meet the needs of wheelchair-users.
The Journal of Rural Health Official Journal of the American Rural Health Association and the National Rural Health Care Association, Feb 1, 2001
Screening results for the Child Development Review (CDR) and the Denver II Developmental Screenin... more Screening results for the Child Development Review (CDR) and the Denver II Developmental Screening Test (Denver II) were compared in two locations: the Cheyenne River Reservation in South Dakota and Sioux Falls, S.D. Seventy-three white, Native American and other minority children, half originating from the reservation and half from Sioux Falls, were randomly assigned to take one developmental screening test. A chi-square analysis indicated a significant difference in results across tests. Specifically, more CDR than Denver II subjects passed the screening and more Denver II than CDR subjects failed the screening. This pattern held for subjects living on, but not off, the reservation. Thus, for Native American, white and other minority children living on the Cheyenne River Reservation, the CDR may be undersensitive and/or the Denver II oversensitive to suspect presentations. Medical practitioners are advised to use these instruments with caution in rural settings.
The primary aim of this investigation was to assess the correlation between the POSNA Musculoskel... more The primary aim of this investigation was to assess the correlation between the POSNA Musculoskeletal Functional Health Questionnaire (POSNA) and gait analysis in children with cerebral palsy (CP). POSNA and computerized gait analysis were used to evaluate individuals with CP. Correlations were investigated between POSNA scales, gait parameters, and the Gillette Functional Assessment Questionnaire (FAQ) in 63 children (31 males, 32 females; mean age 9.17 years [SD 3.06], age range 3.75 to 16.44 years) with spastic CP. Twelve participants had hemiplegia, 29 diplegia, 12 quadriplegia, and 10 triplegia. The result of backwards stepwise multiple regression analysis indicated that the Log normalcy index (NI) was a significant predictor of the POSNA Global Function and Comfort scale. Energy expenditure (EE) did not add significantly to the prediction. The POSNA scales differentiated between the different topographical types of CP. The POSNA scale is a valid and useful clinical measure. Used in conjunction with the NI, EE, and FAQ, the POSNA scale provides a more complete appraisal of change in functioning.
The purpose of this study was to identify group differences in children with attention-deficit-hy... more The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [DOSAGE ERROR CORRECTED], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.
Canadian family physician Médecin de famille canadien, 1986
The disabled young adult strives to be independent when preparing to leave home and family. This ... more The disabled young adult strives to be independent when preparing to leave home and family. This article provides a checklist that can help the disabled young adult and his/her family to make this transition. In some cases, a transitional rehabilitation program may also be of help. The family physician who is familiar with the issues that pertain to adolescent development can play a central part in addressing patient and family problems that present at this time.
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2001
Screening results for the Child Development Review (CDR) and the Denver II Developmental Screenin... more Screening results for the Child Development Review (CDR) and the Denver II Developmental Screening Test (Denver II) were compared in two locations: the Cheyenne River Reservation in South Dakota and Sioux Falls, S.D. Seventy-three white, Native American and other minority children, half originating from the reservation and half from Sioux Falls, were randomly assigned to take one developmental screening test. A chi-square analysis indicated a significant difference in results across tests. Specifically, more CDR than Denver II subjects passed the screening and more Denver II than CDR subjects failed the screening. This pattern held for subjects living on, but not off, the reservation. Thus, for Native American, white and other minority children living on the Cheyenne River Reservation, the CDR may be undersensitive and/or the Denver II oversensitive to suspect presentations. Medical practitioners are advised to use these instruments with caution in rural settings.
Clonidine, oral and patch, has been used in adults for the treatment of hypertension and Tourette... more Clonidine, oral and patch, has been used in adults for the treatment of hypertension and Tourette's Syndrome. Recently clinicians have begun to employ it in several oft label usages in children, especially behavioral syndromes. This article is a guide to its usage in children and includes discussion of its indications, contraindications, pre-treatment laboratory studies, dosing and drug interactions.
The person-item map from Rasch analysis of the Gillette Functional Assessment Questionnaire (FAQ)... more The person-item map from Rasch analysis of the Gillette Functional Assessment Questionnaire (FAQ) was used to determine sets of activity items that individuals at each GMFCS level and FAQ walking level could be expected to perform with a 50% probability. Data demonstrate that the 22-item skill set of the FAQ spans the household to community levels of the FAQ walking scale and GMFCS. Items map to a level in either system consistent with expected level of motor or walking difficulty.
Dewlopmental Screening Test (Denver 11) were compared in two locations: the Cheyenne River Reserz... more Dewlopmental Screening Test (Denver 11) were compared in two locations: the Cheyenne River Reserzution in South Dakota and Sioux Falls, S.D. Seventy-three zuhite, Native American and ol'lier miriority children, half originating from the reservation and half from Sioux Falls, roere rrindomly assigned to take one developmental screening test. A chi-square analysis indicated a signifcant difference in results across tests. Specifically, more CDR than Denver 11 subjects passed the screening and more Denver 11 than CDR subjects failed tke screening. Tkis pattcrn kdd for subjects living on, but not offr the reservation. Thus, for Native American, white and ofker minority children living on the Cheyenne River Reseruation, the CDR mny be undersensitive and/or tke Denver 11 oversensitive to suspect presentations. Medical practitioners are advised to use tkese instruments with caution in rural settings.
A 10-level, parent-report walking scale encompassing a range of walking abilities from nonambulat... more A 10-level, parent-report walking scale encompassing a range of walking abilities from nonambulatory to ambulatory in all community settings and terrains was developed at Gillette Children's Specialty Healthcare (GCSH) as part of the Gillette Functional Assessment Questionnaire (FAQ). The reliability and validity of the walking-scale portion of the FAQ were tested on a group of individuals seen in the Motion Analysis Laboratory at GCSH between May 1996 and January 1997. A complete data set on 41 individuals with neuromuscular conditions represented the community ambulation levels (6-10) of the walking scale. Good test-retest reliability among parents and good interrater reliability between parents and community caregivers was demonstrated. Content and concurrent validity were also high, as assessed by correlation to standardized functional outcome measures, energy expenditure, and gait-analysis information. A reliable and valid scale specific to the task of walking such as the FAQ can assist clinicians in documenting functional change in children with chronic neuromuscular conditions.
Well-intended efforts to diagnose a child's developmental delay may have ... more Well-intended efforts to diagnose a child's developmental delay may have unintended negative consequences for a child and his family. Consequently, clinicians may feel caught in a moral dilemma: between doing the good they seek and avoiding the harm they foresee. The dilemma is that when investigating global developmental delay it is not possible to avoid all the anticipated negative outcomes of genetic testing and concurrently fulfill our obligations to do the good from which these harmful effects result. It is imperative to recognize dilemmas especially where the moral questions or relevant facts are not as clear cut as in ethics textbooks and to bring their moral questions into a structured dialogue with the patient and his or her family. A modified principle of double effect is a useful method for deliberating about these moral cases. Three case examples illustrate the utility of the principle of double effect when investigating global developmental delay.
The aim of this article is to characterize the neurobehavior of young children at risk for develo... more The aim of this article is to characterize the neurobehavior of young children at risk for developmental delay and attention problems. Two hundred and eighty-one children, ages 18 to 70 months, were evaluated. All parents/guardians completed the Child Development Inventory, Child Behavior Checklist for Ages 1½ to 5, Inventory for Client and Agency Planning, and Parenting Stress Index-Short Form. All children had significant delays (developmental ratios <.70). A Mann-Whitney U test compared those with and without attention problems (T score >70). A 2-tailed P value of <.05 indicated statistical significance. Children with attention problems were more likely to have withdrawn behavior, sleep problems, and aggressive behavior. All had severe problem behaviors, and their families experienced significant stress. Attention problems and other serious problem behaviors occur frequently in young children at risk for developmental delay. Parental stress warrants prompt intervention for their children and positive supports for them.
Data were collected parenting stress, adaptive behavior, pain, and health issues from the caregiv... more Data were collected parenting stress, adaptive behavior, pain, and health issues from the caregivers of 35 girls and women with Rett syndrome (mean age = 20.3). A majority (60%) of parents reported stress in the clinical range on at least 1 subscale of the Parenting Stress Index-Short Form. Seizures and uncertainty about their daughter's gastrointestinal pain experience were significantly associated with higher levels of parenting stress. No other child factors (adaptive behavior, age, residential status) were significantly related to parenting stress. Factors related to chronic health concerns (seizures, ambiguous pain presentation) may be important when considering family stress issues in relation to general outcomes for girls with Rett syndrome and related developmental disorders.
To identify parent-reported symptoms that predict parenting stress in preschoolers with global de... more To identify parent-reported symptoms that predict parenting stress in preschoolers with global developmental delay, 201 parents/guardians of 142 boys and 59 girls with global delay, mean age 39.1 months (range, 18 to 63 months) were studied retrospectively. Parents completed the following: (a) a semistructured interview; (b) the Child Development Inventory, (c) Child Behavior Checklist 1½-5, and the (d) Parenting Stress Index-Short Form. Forty-two percent of parents described clinically significant parenting stress (≥ 85th percentile). The Parenting Stress Index-Short Form subscales Difficult Child and Parent-Child Dysfunctional Interactions were elevated. Parental stress increased with higher gross motor development and decreased as social and fine-motor ratios increased. Furthermore, stress increased when parents reported higher levels on the Emotionally Reactive and Withdrawn scale scores and when parents reported Pervasive Developmental and Oppositional Defiant Problems. In mobile children with global delay, behavior problems predict parenting stress.
Journal of Child and Adolescent Psychopharmacology, 1997
This retrospective chart review examined the relative effectiveness of fluoxetine and trazodone i... more This retrospective chart review examined the relative effectiveness of fluoxetine and trazodone in relieving insomnia associated with depressive disorders in adolescents (aged 13-17 years). We reviewed the hospital charts of consecutively admitted adolescents with a depressive disorder and insomnia, who received one of three treatments: fluoxetine (20 +/- 2.2 mg), trazodone (71 +/- 32 mg), or a fluoxetine-trazodone combination (fluoxetine 29 +/- 2.2 mg, trazodone 68 +/- 29 mg). Each treatment was examined in 20 patients. Insomnia was defined as a change in sleep patterns characterized by decreased total sleep time that was sufficient to cause clinical concern, and insomnia resolution was defined as sleep starting by midnight and lasting 6 hours. Mean time to resolution of insomnia was significantly faster in adolescents treated with trazodone rather than fluoxetine (2.5 vs. 5.1 days, p < 0.05). Trazodone seemed to save only about 3 days and insomnia resolved in all subjects by the 11th day of antidepressant treatment. Median time to insomnia resolution was 2 days (range 1-5 days) in the trazodone group and 4 days (range 1-11 days) in the fluoxetine group. This difference between trazodone and fluoxetine, although statistically significant, was generally not clinically significant in the management of insomnia associated with depressive disorders in adolescents. The resolution of insomnia was not faster for treatment with a combination of fluoxetine and trazodone in comparison to fluoxetine monotherapy. Insomnia resolution was slightly later in older children. These clinical findings await confirmation by a controlled study. Both drugs seemed effective in ameliorating sleep symptoms in this sample, although it is likely that they produced these changes by different mechanisms.
Journal of Child and Adolescent Psychopharmacology, 1998
This pilot study was designed to assess the short-term effectiveness and side effects of methylph... more This pilot study was designed to assess the short-term effectiveness and side effects of methylphenidate in treating symptoms of attention deficit hyperactivity disorder (ADHD) in Native American children (5 to 12 years old) with documented fetal alcohol syndrome (FAS) or partial fetal alcohol syndrome. Using strict criteria for the diagnosis of FAS and ADHD, a randomized double-blind cross-over study of two placebos and a fixed dose of methylphenidate was completed in 4 Native American children in a residential school. Each treatment condition lasted 5 days, and daily observational outcome measures, the Conners Parent Rating Scale (CPRS-48), and the Conners Teacher Rating Scale (CTRS-39), were employed. Methylphenidate significantly improved scores of the Hyperactivity Index Scale on the CPRS-48 and the CTRS-39 but not the Daydreaming-Attention score on the CTRS-39. Side effects were similar to those traditionally found in other populations. The promising preliminary results suggest that a more definitive study of methylphenidate in Native and non-Native children with FAS and ADHD is warranted.
Journal of Applied Research in Intellectual Disabilities, 2007
ABSTRACT Background Although treatment acceptability scales in intellectual and developmental di... more ABSTRACT Background Although treatment acceptability scales in intellectual and developmental disabilities research have been used in large- and small-scale applications, large-scale application has been limited to analogue (i.e. contrived) investigations. This study extended the application of treatment acceptability by assessing a large sample of care givers’ perceptions of treatment for children with cerebral palsy (CP) in a real-world setting and tested if responses differed across child characteristics, type of medical service or respondent demographics.Method One hundred and fifty four care givers’ for children with CP rated the acceptability of treatments and related medical services by clinicians working in a multi-disciplinary children's specialty setting using Kazdin's (Journal of Applied Behavior Analysis, 13, 1980, 259) Treatment Evaluation Inventory.Results There were significant (P < 0.05) differences between male and female respondents’ ratings of treatment acceptability. There were no other significant differences for caregiver ratings in relation to child characteristics, type of appointment, severity of CP or other respondent demographic characteristics.Conclusion Mothers and fathers of children with developmental disabilities may differ in their perceptions of the acceptability of medical treatment services for children with developmental disabilities. Future studies addressing treatment acceptability should expand the scope of demographic information assessed and include items specific to the roles respondents have in providing and coordinating therapeutic regimens for their children's medical needs.
The Gillette Functional Assessment Questionnaire [1] (FAQ) is a tool used to measure the function... more The Gillette Functional Assessment Questionnaire [1] (FAQ) is a tool used to measure the functional impact of walking limitations in children with disabilities. This study evaluates the performance of typically developing (TD) pre-school children using the tool. Results suggest that TD children exhibit a developmental progression across all levels of the FAQ walking scale and the 22-item skill set. This understanding provides a basis for enhanced interpretation when used with children with disabilities.
A survey was made of the clinical characteristics of wheelchair-users at the Children's R... more A survey was made of the clinical characteristics of wheelchair-users at the Children's Rehabilitation Centre in Saskatoon, Saskatchewan. 261 patients were studied, of whom 214 had cerebral palsy, 34 had myelomeningocele and 13 had Duchenne muscular dystrophy. Among the patients with cerebral palsy it was found that the attributes likely to define a wheelchair-user were spastic quadriplegia, functional level III and IV, seizures and severe sensory handicap; among patients with myelomeningocele, wheelchair use ws related to level of lesion; and in the muscular dystrophy group it ws related to age. These results have been of help to rehabilitation centres and related service agencies in formulating long-term plans to meet the needs of wheelchair-users.
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Papers by Raymond Tervo