481 research outputs found
Managing bereavement in the classroom: a conspiracy of silence?
The ways in which teachers in British schools manage bereaved children are under-reported. This article reports the impact of students' bereavement and their subsequent management in primary and secondary school classrooms in Southeast London. Thirteen school staff working in inner-city schools took part in in-depth interviews that focused on the impact of bereaved children on the school and how teachers responded to these children. All respondents had previously had contact with a local child bereavement service that aims to provide support, advice, and consultancy to children, their parents, and teachers. Interviews were audiotaped, transcribed verbatim, and analyzed using ATLAS-ti. Three main themes were identified from analysis of interview data. Firstly, British society, culture, local communities, and the family were significant influences in these teachers' involvement with bereaved students. Secondly, school staff managed bereaved students through contact with other adults and using practical classroom measures such as "time out" cards and contact books. Lastly, teachers felt they had to be strong, even when they were distressed. Surprise was expressed at the mature reaction of secondary school students to deaths of others. The article recommends that future research needs to concentrate on finding the most effective way of supporting routinely bereaved children, their families, and teachers
Ethnicity as a Moderator of Treatment Effects on Parent-Child Interaction for Children With ADHD
Objective:
To examine ethnic differences in observed parenting and child behavior and the moderating effects
of ethnicity on the relationship between treatment and parent and child behavior.
Method:
Observations of 508 children with ADHD (ages 7–9) and their caregivers, collected during the
Multimodal Treatment Study of ADHD, were analyzed using univariate and mixed-model ANOVAs.
Results:
Although baseline parenting practices differed by ethnic group, ethnicity did not moderate the
relationship between treatment and either parenting or child behavior.
Conclusion:
Consistent with data from normative samples, parents of children with ADHD differed by ethnicity
in their utilization of certain parenting strategies. However, different ethnic groups did not differ on benefit
received from treatments for ADHD, measured by parent and child behavior. Although ethnicity did not
emerge as a moderator, ethnic minority family engagement in treatment may be increased by recognizing
different parenting strategies and modifying interventions accordingly. (J. of Att. Dis. 2010; 13(6) 592-600
Child and Parent Predictors of Perceptions of Parent–Child Relationship Quality
Objective/Method:
Predictors of perceptions of parent–child relationship quality were examined for 175 children with
ADHD, 119 comparison children, and parents of these children, drawn from the follow-up phase of the
Multimodal Treatment Study of Children with ADHD.
Results/Conclusion:
Children with ADHD perceived their mothers and fathers as more power assertive than comparison
children. Children higher on depressive symptomatology also perceived their mothers and fathers as less
warm and more power assertive. Mothers perceived themselves as more power assertive and fathers
perceived themselves as less warm if they were higher on depressive symptomatology themselves or had
children with ADHD or higher levels of depressive symptomatology. Several interactions indicated that the
association between child factors and parental perceptions of warmth and power assertion often depended on
parental depressive symptomatology. The findings resolve a previous contradiction in the literature regarding
the relationship between child depressive symptoms and parental perceptions of parent–child relationship
quality
Addressing cancer survivors\u27 cardiovascular health using the Automated Heart Health Assessment (AH-HA) EHR tool: Initial protocol and modifications to address COVID-19 challenges
BACKGROUND: The purpose of this paper is to describe the Automated Heart-Health Assessment (AH-HA) study protocol, which demonstrates an agile approach to cancer care delivery research. This study aims to assess the effect of a clinical decision support tool for cancer survivors on cardiovascular health (CVH) discussions, referrals, completed visits with primary care providers and cardiologists, and control of modifiable CVH factors and behaviors. The COVID-19 pandemic has caused widespread disruption to clinical trial accrual and operations. Studies conducted with potentially vulnerable populations, including cancer survivors, must shift towards virtual consent, data collection, and study visits to reduce risk for participants and study staff. Studies examining cancer care delivery innovations may also need to accommodate the increased use of virtual visits.
METHODS/DESIGN: This group-randomized, mixed methods study will recruit 600 cancer survivors from 12 National Cancer Institute Community Oncology Research Program (NCORP) practices. Survivors at intervention sites will use the AH-HA tool with their oncology provider; survivors at usual care sites will complete routine survivorship visits. Outcomes will be measured immediately after the study visit, with follow-up at 6 and 12 months. The study was amended during the COVID-19 pandemic to allow for virtual consent, data collection, and intervention options, with the goal of minimizing participant-staff in-person contact and accommodating virtual survivorship visits.
CONCLUSIONS: Changes to the study protocol and procedures allow important cancer care delivery research to continue safely during the COVID-19 pandemic and give sites and survivors flexibility to conduct study activities in-person or remotely
Peer-Assessed Outcomes in the Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder
Peer-assessed outcomes were examined at the end of treatment (14 months after study entry) for 285
children (226 boys, 59 girls) with attention deficit hyperactivity disorder (ADHD) who were rated by their
classmates (2,232 classmates total) using peer sociometric procedures. All children with ADHD were
participants in the Multimodal Treatment Study of Children with ADHD (MTA). Treatment groups were
compared using the orthogonal treatment contrasts that accounted for the largest amount of variance in
prior MTA outcome analyses: Medication Management + Combined Treatment versus Behavior Therapy +
Community Care; Medication Management versus Combined Treatment; Behavior Therapy versus
Community Care. There was little evidence of superiority of any of the treatments for the peer-assessed
outcomes studied, although the limited evidence that emerged favored treatments involving medication
management. Post hoc analyses were used to examine whether any of the four treatment groups yielded
normalized peer relationships relative to randomly selected- classmates. Results indicated that children
from all groups remained significantly impaired in their peer relationships
Parent-Reported Homework Problems in the MTA Study: Evidence for Sustained Improvement with Behavioral Treatment
Parent-report of child homework problems was examined as a treatment outcome variable in the
MTA-Multimodal Treatment Study of Children with Attention-Deficit/ Hyperactivity Disorder (ADHD).
Five hundred seventy-nine children ages 7.0 to 9.9 were randomly assigned to either medication
management, behavioral treatment, combination treatment, or routine community care. Results showed that
only participants who received behavioral treatment (behavioral and combined treatment) demonstrated
sustained improvements in homework problems in comparison to routine community care. The magnitude of
the sustained effect at the 10-month follow-up assessment was small to moderate for combined and
behavioral treatment over routine community care (d=.37, .40, respectively). Parent ratings of initial ADHD
symptom severity was the only variable found to moderate these effects
An exploratory analysis of the impact of family functioning on treatment for depression in adolescents.
This article explores aspects of family environment and parent-child conflict that may predict or moderate response to acute treatments among depressed adolescents (N = 439) randomly assigned to fluoxetine, cognitive behavioral therapy, their combination, or placebo. Outcomes were Week 12 scores on measures of depression and global impairment. Of 20 candidate variables, one predictor emerged: Across treatments, adolescents with mothers who reported less parent-child conflict were more likely to benefit than their counterparts. When family functioning moderated outcome, adolescents who endorsed more negative environments were more likely to benefit from fluoxetine. Similarly, when moderating effects were seen on cognitive behavioral therapy conditions, they were in the direction of being less effective among teens reporting poorer family environments
Towards a consensus-based classification of childhood arterial ischemic stroke.
Background and purposeThe implementation of uniform nomenclature and classification in adult arterial ischemic stroke (AIS) has been critical for defining outcomes and recurrence risks according to etiology and in developing risk-stratified treatments. In contrast, current classification and nomenclature in childhood AIS are often overlapping or contradictory. Our purpose was to develop a comprehensive consensus-based classification system for childhood AIS.MethodsUsing a modified-Delphi method, members of the International Pediatric Stroke Study (IPSS) developed the Childhood AIS Standardized Classification And Diagnostic Evaluation (CASCADE) criteria. Two groups of pediatric stroke specialists from the IPSS classified 7 test cases using 2 methods each: (1) classification typical of the individual clinician's current clinical practice; and (2) classification based on the CASCADE criteria. Group 1 underwent in-person training in the utilization of the CASCADE criteria. Group 2 classified the same cases via an online survey, including definitions but without training. Inter-rater reliability (IRR) was assessed via multi-rater unweighted Îş-statistic.ResultsIn Group 1 (with training), IRR was improved using CASCADE criteria (Îş=0.78, 95% CI=[0.49, 0.94]), compared with typical clinical practice (Îş=0.40, 95% CI=[0.11, 0.60]). In Group 2 (without training), IRR was lower than among trained raters (Îş=0.61, 95% CI=[0.29, 0.77]), but higher than current practice (Îş=0.23, 95% CI=[0.03, 0.36]).ConclusionsA new, consensus-based classification system for childhood AIS, the CASCADE criteria, can be used to classify cases with good IRR. These preliminary findings suggest that the CASCADE criteria may be particularity useful in the setting of prospective multicenter studies in childhood-onset AIS, where standardized training of investigators is feasible
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