Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure

Children and adolescents affected by prenatal exposure to alcohol who have brain damage that is manifested in functional impairments of neurocognition, self-regulation, and adaptive functioning may most appropriately be diagnosed with neurobehavioral disorder associated with prenatal exposure. This Special Article outlines clinical implications and guidelines for pediatric medical home clinicians to identify, diagnose, and refer children regarding neurobehavioral disorder associated with prenatal exposure. Emphasis is given to reported or observable behaviors that can be identified as part of care in pediatric medical homes, differential diagnosis, and potential comorbidities. In addition, brief guidance is provided on the management of affected children in the pediatric medical home. Finally, suggestions are given for obtaining prenatal history of in utero exposure to alcohol for the pediatric patient

A Longitudinal Analysis of Violence and Housing Insecurity

Violence and housing insecurity are horrible events that may be intertwined, with violence possibly forcing victims to abandon their accommodations and housing insecurity depriving people of the safety of a home or placing them in compromised circumstances. This study uses national, prospective, longitudinal data from the Journeys Home Survey to examine how violence, housing insecurity, and other characteristics in one period affect disadvantaged Australian men's and women's chances of experiencing violence and housing insecurity in subsequent periods. The study is one of the first to investigate these relationships prospectively and unusual in considering how violence among adult men contributes to their housing insecurity. We estimate dynamic multivariate models that control for observed and time-invariant unobserved characteristics and find that men's chances of being housing secure without experiencing violence are 24-45 percent lower and women's chances are 12- 20 percent lower if they experienced housing insecurity, violence or both in the previous period. Heavy drinking, marijuana use, psychological distress, and a history of childhood abuse and neglect also increase the risks of violence and housing insecurity for both genders, while the presence of children reduces these risks. Women who are bisexual or lesbian and women with homeless friends also face elevated risks of housing insecurity, while men's sexual orientation and friend networks seem less relevant

Constructing impairment and disability in school reading schemes.

This paper examines the cultural construction of disability detailed within school reading schemes. The study by the employment of proto text analysis followed the ‘reading journeys’ that a four and five year old child experienced during the course of one academic year. The study examined 61 reading books that contained 2199 illustrations, 100 photographs and 1006 pages of text. The major finding of the research is that the reading schemes contained a limited construction of disability and one which was contextualised within medical deficit and narrative prosthesis. The research concludes that school reading schemes are potentially acting as a Trojan horse to introduce a page thin hegemonic that inculcates young children into the systems of dominance and ‘ableist’ agendas which are seemingly replete in our society

Promoting Optimal Development: Screening for Behavioral and Emotional Problems

By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States. Behavioral and emotional problems and concerns in children and adolescents are not being reliably identified or treated in the US health system. This clinical report focuses on the need to increase behavioral screening and offers potential changes in practice and the health system, as well as the research needed to accomplish this. This report also (1) reviews the prevalence of behavioral and emotional disorders, (2) describes factors affecting the emergence of behavioral and emotional problems, (3) articulates the current state of detection of these problems in pediatric primary care, (4) describes barriers to screening and means to overcome those barriers, and (5) discusses potential changes at a practice and systems level that are needed to facilitate successful behavioral and emotional screening. Highlighted and discussed are the many factors at the level of the pediatric practice, health system, and society contributing to these behavioral and emotional problems

When clinicians and a parent disagree on the extent of medical care

TG is a 32-month-old girl with a rare lysosomal storage disease. The diagnosis was confirmed at 8 months of age; she underwent bone marrow transplant at 14 months. TG's father remained at home with her siblings whereas her mother lived at the transplant hospital with TG for 1 year. Significant respiratory infections led to dependency on a tracheotomy and ventilator. She was transferred to the current hospital 10 months ago for respiratory rehabilitation, which has been complicated by pulmonary hemorrhages. On examination, TG was in a wheelchair with truncal support and leg splints. She is a small child with coarse facial features, generalized hypotonia, and significant joint restriction. She exhibited intermittent repetitive arm movements. A tracheotomy was in place, and she did not vocalize. Variable levels of alertness were observed although she rarely signaled to others for social engagement or to express her needs. Eye contact was limited and she responded inconsistently to her name. TG's mother states that her daughter interacts well with her and uses a number of signs for communication. The rehabilitation staff reported limited progress and recommends withdrawal of services. TG's mother expressed frustration with her daughter's poor developmental improvement and believes she needs more intensive therapy, not less. Staff members are now frustrated with TG's mother's level of involvement with her daughter's care. Although TG's mother spends full weekdays at her daughter's bedside, she is often working on her computer managing her business. TG's father works full time and visits on the weekends, when her mother returns home. TG's mother has expressed frustration with her daughter's level of improvement; she believes TG needs more intensive therapy that the hospital is not providing. She informed the staff that other children with this type of storage disease may have delays, but are often higher functioning. TG's mother made the point to the staff that the family's reason for pursuing a bone marrow transplant was to attempt to correct the enzyme deficiency and improve her daughter's outcome

International Interprofessional Collaborative Office Rounds (iiCOR): Addressing Children's Developmental, Behavioral, and Emotional Health Using Distance Technology

10.3389/fpubh.2021.657780FRONTIERS IN PUBLIC HEALTH

Gender Differences in Parental Strain

This article examines gender differences in the strains associated with parenting. We hypothesize that due to the different role experiences of being a parent, mothers are more likely than fathers to experience greater role strain. Women who parent are more likely than their male counterparts to be exposed to strain-inducing experiences because they spend more time in child care and other household chores, because they are more likely to be doing so as a “single-parent,” because they are more likely to be juggling family responsibilities and work commitments, and because being a parent has greater role salience for women. We also hypothesize that by taking into account the different role experiences of mothers and fathers we can partially account for the expected gender differences in parental strain. These hypotheses are explored using survey data from a probability sample of Detroit parents obtained in 1982-83 (n = 1,040) which assessed their parental role experiences and psychological well-being. The results confirm the hypothesized difference between mothers and fathers in reported strain, among both blacks and whites, with mothers expressing significantly greater role demands and parental strain than fathers. We find, however, that little of this difference is attributable to the differential role experiences we analyzed. We conclude that gender differences in parental strain may be linked more strongly to “gender role” than “parental role,” in that women are socialized more than men into taking responsibilities for relationships and are therefore more likely to experience the greater stresses associated with intimacy and emotional involvement with others. The greater strains of parenting felt by mothers as opposed to fathers may, thus, be due as much to the differential orientations they bring to the parental role as it is due to the objectively-assessed differences in role experience.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67967/2/10.1177_019251389010004004.pd