Psychopathology in children: Improvement of quality of life without psychiatric symptom reduction

Objective: The aim of this study was to assess the association between change in psychopathology and Quality of Life (QoL) across time in children with high levels of psychopathology. Methods: A referred sample of 126 seven- to 19-year-olds was studied across a 1-year follow-up period. Information concerning QoL and psychopathology was obtained from parents. Results: Overall, 38.1% of children showed neither psychiatric symptom reduction nor QoL improvement, 33.3% of children showed both a clinically significant psychiatric symptom reduction and QoL improvement, and 28.6% of children showed either psychiatric symptom reduction or QoL improvement. In 11.1% of all children,QoL improved, while the level of psychopathology remained high. Age, gender, or psychiatric diagnosis did not predict a poor outcome of persistently high psychopathology scores and poor QoL. Conclusion: QoL in children with psychiatric problems may be improved by reducing psychiatric symptoms in a number of children, but it is also possible to improve QoL without psychiatric symptom reduction. This implicates that QoL should become an important aim and treatment outcome measure of psychiatric treatment programs, especially since psychopathology tends to persist. © Steinkopff Verlag 2005

Phonological Working Memory Limitations and Agrammatism: Is There a Causal Relationship between the Two?

Syntactic processing in sentence comprehension requires some form of Working Memory (WM) resources. However, the nature of the relation between WM and sentence comprehension is controversial. One of the questions is whether WM for language is a single resource, or, alternatively, it consists of different components, each entrusted with a different linguistic function (Caplan & Waters, 1999). The aim of the study is to investigate the nature of the relation between WM and sentence comprehension by comparing sentence comprehension abilities with performance on WM tasks of four Greek-speaking patients with Broca’s aphasia. The experimental hypothesis is that patients with different performance patterns in sentence comprehension will present with different verbal WM capacity

Syntactic predictions and asyntactic comprehension in aphasia: Evidence from scope relations

People with aphasia (PWA) often fail to understand syntactically complex sentences. This phenomenon has been described as asyntactic comprehension and has been explored in various studies cross-linguistically in the past decades. However, until now there has been no consensus among researchers as to the nature of sentence comprehension failures in aphasia. Impaired representations accounts ascribe comprehension deficits to loss of syntactic knowledge, whereas processing/resource reduction accounts assume that PWA are unable to use syntactic knowledge in comprehension due to resource limitation resulting from the brain damage. The aim of this paper is to use independently motivated psycholinguistic models of sentence processing to test a variant of the processing/resource reduction accounts that we dub the Complexity Threshold Hypothesis. According to this hypothesis, PWA are capable of building well-formed syntactic representations, but, because their resources for language processing are limited, their syntactic parser fails when processing complexity exceeds a certain threshold. The source of complexity investigated in the experiments reported in this paper is syntactic prediction. We conducted two experiments involving comprehension of sentences with different types of syntactic dependencies, namely dependencies that do not require syntactic prediction (i.e. unpredictable dependencies in sentences that require Quantifier Raising) and dependencies whose resolution requires syntactic predictions at an early stage of processing based on syntactic cues (i.e. predictable dependencies in movement-derived sentences). In line with the predictions of the Complexity Threshold Hypothesis, the results show that the agrammatic patients that participated in this study had no difficulties comprehending sentences with the former type of dependencies, whereas their comprehension of sentences with the latter type of dependencies was impaired

Exploring views on satisfaction with life in young children with chronic illness: an innovative approach to the collection of self-report data from children under 11

The objective of this study was to explore young children’s views on the impact of chronic illness on their life in order to inform future development of a patient-based self-report health outcome measure. We describe an approach to facilitating self-report views from young children with chronic illness. A board game was designed in order to obtain qualitative data from 39 children with a range of chronic illness conditions and 38 healthy controls ranging in age from 3 to 11 years. The format was effective in engaging young children in a self-report process of determining satisfaction with life and identified nine domains. The board game enabled children aged 5–11 years with chronic illness to describe the effects of living with illness on home, family, friends, school and life in general. It generated direct, non-interpreted material from children who, because of their age, may have been considered unable or limited their ability to discuss and describe how they feel. Obtaining this information for children aged 4 and under continues to be a challenge

Major surgery within the first 3 months of life and subsequent biobehavioral pain responses to immunization at later age: A case comparison study. [IF 3.4]

Objectives. Pain exposure during early infancy affects the pain perception beyond infancy into childhood. The objective of this study was to examine whether major surgery within the first 3 months of life in combination with preemptive analgesia alters pain responses to immunization at 14 or 45 months and to assess whether these alterations are greater in toddlers with a larger number of negative hospital experiences. Methods. Two groups of 50 toddlers each were compared: index group and control group. All index toddlers had participated within the first 3 months of their life in a randomized, clinical trial that evaluated the efficacy of preemptive morphine administration for postoperative analgesia. The controls were matched by type of immunization and community health care pediatrician. Pain reactions were recorded at routine immunization at either 14 (measles-mumps-rubella immunization) or 45 months (diphtheria-tetanus-trivalent polio immunization) of age. Outcome measures were facial reaction, coded by the Maximum Discriminative Facial Movement Coding System; heart rate (HR); and cortisol saliva concentration. Negative hospital experiences included number of operations requiring postoperative morphine administration, cumulative Therapeutic Intervention Scoring System scores, and length of stay in the intensive care unit or total hospitalization days. Results. No differences were found between the index and control groups in the facial display of pain, anger, or sadness or in physiologic parameters such as HR and cortisol concentrations. Intragroup analyses of the index group showed that after measles-mumps-rubella vaccination, the number of negative hospital experiences correlated positively with the facial responsiveness and negatively with HR responses. No effect was seen after diphtheria-tetanus-trivalent polio immunization. Conclusions. Major surgery in combination with preemptive analgesia within the first months of life does not alter pain response to subsequent pain exposure in childhood. Greater exposure to early hospitalization influences the pain responses after prolonged time. These responses, however, diminish after a prolonged period of nonexposure

‘Ik dacht van: ik ga gewoon naar de middelbare school’. Over de betekenis van hulpbronnen in de schoolloopbaan van leerlingen

Dit artikel betreft een longitudinaal, overwegend kwalitatief onderzoek naar de schoolloopbaan van leerlingen. Het gehanteerde onderwijspedagogisch perspectief gaat uit van een visie op de taak van de school en op de hulpbronnen (resources) die bij de ontwikkeling van leerlingen een rol spelen. Uit een databestand van 239 basisschoolleerlingen op de leeftijd van tien jaar zijn drie casus-leerlingen gekozen. Deze leerlingen zijn na de basisschool op drie schooltypen terechtgekomen: vmbo, havo en vwo. Vervolgens zijn zij als jongvolwassenen uitgestroomd naar diverse situaties. Het onderzoeksdesign kan worden getypeerd als een embedded case study waarbij een methode van narrative inquiry wordt gehanteerd. Naast gegevens omtrent de cognitieve ontwikkeling zoals Cito-scores en andere toetsgegevens, zijn gegevens verzameld aan de hand van diepte-interviews met leerlingen, hun ouders en leraren. De leerlingen zijn in drie onderzoeksronden gevolgd gedurende de leeftijdsfase van 10 - 21 jaar. De vraagstelling is: Hoe verloopt de schoolloopbaan van leerlingen van 10-21 jaar, hoe wordt dit verloop door hen ervaren en wat is de betekenis van ‘resources’ in de ontwikkeling van deze leerlingen? Het artikel beschrijft vanuit het perspectief van de leerling hoe schoolloopbanen verlopen. Bij de analyse wordt ingegaan op de betekenis van resources in de schoolloopbaan. Het talent van een leerling - zoals dat tot uitdrukking komt in de prestaties op een reeks objectieve toetsen - lijkt doorslaggevend. Van motivatie en inzet kan een compenserende werking uitgaan. Gezondheid of ziekte speelt soms een cruciale rol in de schoolloopbaan. De betekenis van ouders en leraren wordt vooral zichtbaar op de breukvlakken in de schoolloopbaan. Summary In the last few decades considerable progress has been made in the empirical study of school careers. Somewhat surprisingly perhaps, students themselves have hardly had a voice in the majority of these large scale quantitative studies. This article is an attempt to redress the balance: not only will the students, their parents and their teachers receive a voice, they will also be given ‘a face’. We follow the students on their journeys through educational institutions from the ages of 10 to 21, presenting their learning results as measured by a range of objective tests and placing their stories in the light of a resource theory. Some of the students will be seen advancing smoothly from primary education to the tertiary sector, while others will be seen falling by the wayside. The following main questions will be addressed in the investigation: (1) How do the school careers of 10-to-21 year-old students develop? (2) How are these careers experienced by the students themselves? (3) What explanations can be given from a resource-theoretical perspective? We will describe and analyse in detail the school careers of five students in a longitudinal research framework characterisable as a longitudinal ‘embedded case study’. In the context of this design the stories of the students and their teachers will be the main focus. However, this statement of focus does not imply a simple description of the experiences and perspectives of the people concerned. Rather, in this work we endeavour to connect the students’ ‘small stories’ to the ‘grand stories’ of the theory of school careers. The main conclusion from this research is that talent - as measured by scores on a series of objective tests at the ages of ten and twelve years – is the most influential resource in later school success, but that strong motivation has a compensating effect. Real ‘survivors’ sometimes achieve their aim by overcoming great barriers. Parents and teachers also play a very important role in particular at the transition points

Effectiveness of a Comprehensive Health Literacy Consultation Skills Training for Undergraduate Medical Students:A Randomized Controlled Trial

Comprehensible communication by itself is not sufficient to overcome health literacy related problems. Future doctors need a larger scope of capacities in order to strengthen a patient's autonomy, participation, and self-management abilities. To date, such comprehensive training-interventions are rarely embedded in curricula, nor systematically evaluated. We assessed whether comprehensive training increased these health literacy competencies, in a randomized controlled trial (RCT), with a waiting list condition. Participants were international undergraduate medical students of a Dutch medical faculty (intervention: 39; control: 40). The 11-h-training-intervention encompassed a health literacy lecture and five interactive small-group sessions to practise gathering information and providing comprehensible information, shared decision-making, and enabling of self-management using role-play and videotaped conversations. We assessed self-reported competencies (knowledge and awareness of health literacy, attitude, self-efficacy, and ability to use patient-centred communication techniques) at baseline, after a five and ten-week follow-up. We compared students' competencies using multi-level analysis, adjusted for baseline. As validation, we evaluated demonstrated skills in videotaped consultations for a subsample. The group of students who received the training intervention reported significantly greater health literacy competencies, which persisted up to five weeks afterwards. Increase was greatest for providing comprehensible information (B: 1.50; 95% confidence interval, CI 1.15 to 1.84), shared decision-making (B: 1.08; 95% CI 0.60 to 1.55), and self-management (B: 1.21; 95% CI 0.61 to 1.80). Effects regarding demonstrated skills confirmed self-rated competency improvement. This training enhanced a larger scope of health literacy competences and was well received by medical students. Implementation and further evaluation of this training in education and clinical practice can support sustainable health literacy capacity building of future doctors and contribute to better patient empowerment and outcomes of consultations

Do children with autism acknowledge the influence of mood on behaviour?

We tested whether children with and without high-functioning autism spectrum disorders (HFASD) differ in their understanding of the influence of mood states on behaviour. A total of 122 children with HFASD or typical development were asked to predict and explain the behaviour of story characters during hypothetical social interactions. HFASD and typically developing children predicted at equal rates that mood states likely result in similar valenced behaviour. 'Explicit' descriptions were used to explain predictions more often by children with HFASD than by typically developing children. However, 'implicit' and 'irrelevant' descriptions elicited fewer mood references among HFASD children. Furthermore, they less often referred to the uncertainty of the influence of mood on behaviour, and less often used mood-related explanations, in particular when they had to rely on implicit information. This may indicate a rote- rather than self-generated understanding of emotions in children with HFASD. © SAGE Publications, Inc. 2007