儿童行为问题干预的研究新进展

现从心理干预、家庭干预、社会技能训练干预、感觉统合训练干预4个视角探讨国内外近年来儿童行为问题干预的研究成果,在此基础上提出现有研究的问题与未来研究的展望。     

儿童血脂紊乱的饮食干预

血脂紊乱是造成动脉粥样硬化(AS)的重要原因之一。既往人们普遍认为AS和冠状动脉粥样硬化性心脏病(CHD)完全是发生在成人,尤其是老年人群体中的疾病。但近年来美国多个研究机构在对390例青少年血脂进行检测后发现,AS与血清总胆固醇(TC)、极低密度脂蛋白及低密度脂蛋白(LDL)呈正     

Cognitive-Functional (Cog-Fun) Dyadic Intervention for Children with ADHD and Their Parents: Impact on Parenting Self-Efficacy

Aim: The family context of children with ADHD plays a role in intervention outcomes, especially when parents are involved in treatment. Parental participation in evidence-based treatment for ADHD may play a role in improving their own parenting self-efficacy (PSE) as well as child outcomes. This study examined the impact of Cognitive-Functional (Cog-Fun) intervention in occupational therapy (OT) for school-aged children with ADHD, on PSE. Methods: In this randomized controlled trial with crossover design, 107 children were allocated to intervention and waitlist control groups. Intervention participants (n = 50) received Cog-Fun after baseline assessment and waitlist controls (n = 49) received treatment 3 months later. Intervention participants received 3-month follow-up assessment. Treatment included 10 parent-child Cog-Fun weekly sessions. PSE was assessed with the Tool to measure Parenting Self-Efficacy (TOPSE). Results: All children who began treatment completed it. Mixed ANOVA revealed significant Time x Group interaction effects on TOPSE scales of Play and Enjoyment, Control, Self-Acceptance, Knowledge and Learning and Total score, which showed significant improvement with moderate treatment effects for the intervention group. Results were replicated in the control group after crossover. Conclusion: The findings of this study suggest that Cog-Fun OT intervention may be effective for improving aspects of PSE among parents of children with ADHD.     

儿童发育性语言延迟的干预

20世纪中叶,儿童语言发育及语言问题研究渐兴盛起来。这是因为儿童的环境及遗传差异造成语言学习的明显差别,使得人们对此感到极为惊讶;更因为语言发育迟缓是学龄前儿童最常见的问题之一,常使父母寻求儿科医师的帮助。我国儿科也在20纪末期开展儿童语言研究和语言问题的早期干预,近年来发展较快。     

An Epidemic of Meningococcal Disease in Karachi (Pakistan): A Study of Children

A prospective study of 112 cases of epidemic meningococcal infection in the paediatric population is presented. The natural course of the disease, its complications, prognostic factors and therapeutic agents were studied. The cases were graded according to fixed criteria of severity which correlated well with the outcome of the disease. The gram-stain of the CSF was a sensitive and a quick method of diagnosis and crystalline penicillin a cost-effective therapy giving a good response within 48 hours in 90% of the cases.     

Deep Granuloma Annulare (Pseudorheumatoid Nodule) in Children: Clinicopathologic Study of 35 Cases

Deep granuloma annulare (DGA) is one of several lesions of skin and superficial soft tissues whose histologic character is a palisading granuloma with a small central focus of necrosis or necrobiosis. Unlike the other palisading necrobiotic lesions, DGA has a predilection for children in the first 5 to 6 years of life. A painless subcutaneous nodule(s) in the lower anterior tibial region or foot and the scalp, typically in the occiput, was the most common presenting feature in this study of 35 cases. Additional or recurrent lesions were reported in approximately 70% of cases with clinical follow-up. All lesions showed the presence of necrobiosis; however, one of the characteristic features was the multinodular character of the predominantly mononuclear cellular aggregates. The presence of vascular spaces at the periphery of the nodular profiles served as a clue to the diagnosis of DGA. The palisading arrangement of the mononuclear cells was evident only in those foci with central necrobiosis. A histiocytic disorder or fibrohistiocytic process was a common consideration in the differential diagnosis, especially in those cases with less apparent foci of necrosis. Palisading histiocytes with prominent eosinophilic cytoplasm and some nuclear atypism were problematic with regard to possible epithelioid sarcoma. Our study failed to identify any underlying or predisposing factors in the development of DGA. Despite the fact that DGA is a well-documented lesion in children, it occurs sufficiently infrequently that it is often not considered clinically when it presents as a subcutaneous mass or masses in a child. Its recognition by the pathologist is especially important as the occurrence of additional lesions in a high proportion of children can be anticipated without undue concern. Received June 16, 1997; accepted October 28, 1997.     

Dietary management of persistent diarrhea: comparison of a traditional rice-lentil based diet with soy formula

Recent studies have indicated that enteral diets can play an important role in the treatment of persistent diarrhea. Khitchri, a local weaning food in Pakistan, is composed of rice and lentils, which have previously been shown to be well tolerated in many children with acute diarrhea. The effectiveness of a khitchri and yogurt (KY) diet, which is inexpensive and widely available in Pakistan, was studied. One hundred two weaned boys (6 to 36 months old) with persistent diarrhea were randomly assigned to receive either soy formula (group A) or the KY diet (group B) for 14 days. Group A also received the KY diet in addition to formula for days 8 through 14. Twenty-nine children did not complete the study because of severe infection (13) or their family's decision to leave the study early (9 in group A and 7 in group B). Sixty-six children successfully completed the study protocol; there were five clinical failures in group A and two in group B. On a comparable caloric intake, there was a significantly lower stool volume (group B: 38 +/- 16 [mean +/- SD] vs group A: 64 +/- 75 g/kg per day, P less than .05) and frequency (B: 4.4 +/- 2.0 vs. A: 6.6 +/- 4.2 stools per day, P less than .005) in children fed KY during the first week of therapy. Group B children also had a significantly greater weight gain than children in group A during the first week (B: 468 +/- 373 g/wk vs A: 68 +/- 286 g/wk, P less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)     

Newer Concepts of Dietary Therapy in IDDM in Children

The most important aspects of the diet for diabetic children are: 1. The timing of the meals. For the main meals, the time of the school meal and of the family dinner should be followed. Smaller meals will be necessary in between, with a total of about 6 meals daily. 2. The size of the meals and total amount of energy must be adjusted to the need of the children, and to the insulin type, dose and time of injection. A reasonable variation in energy intake is supported. Extra intake related to exercise will not only be taken on the days of exercise but also on the day after. This is supported by our own investigation. The appetite of the children should also be used in this regulation. Newer studies are summarized about the change in absorbability of starch by heating and cooking, and the effect on blood glucose of potatoes, rice and bread, different fruits and sorbitol. A long-term study of different fibres in bread is presented. A decrease both in mean bloodglucose and HbAl was found to be induced both by bran and by guar. The practical accomplishment of the diet is a larger problem than the theoretical ones.     

儿童脑发育与行为干预

儿童期是大脑发育的关键时期,特别是在婴幼儿期,大脑不仅发育快,而且具有很强的可塑性,同时也是智力发展的关键期.良好的行为干预对开发儿童智力,减轻及补偿脑损伤儿童的脑功能损害,具有十分重要的意义.     

Dietary Therapies: Emerging Paradigms in Therapy of Drug Resistant Epilepsy in Children

About one-third of childhood epilepsy ultimately becomes drug resistant epilepsy. Only about one-third of drug resistant epilepsy is amenable for epilepsy surgery. Epilepsy surgery and vagal nerve stimulation is still beyond the reach of huge proportion of children with pharmacoresistant epilepsy. Ketogenic diet (KD) has been in use for almost a century now all over the world for drug resistant epilepsy, although in between there was a decline in its popularity with advent of newer antiepileptic drugs like valproate, phenytoin and carbamazepine. Again from 1990s there was resurgence of interest in KD for pharmacoresistant epilepsy and in the last two decades several randomized controlled trials and systemic reviews have proved its efficacy beyond any suspicion. Ketogenic diet is a high fat low carbohydrate and low protein diet, which has been found to reduce epileptogenesis in body most probably by production of ketone bodies. Modified Atkin’s Diet (MAD) first introduced in 2003 and Low Glycemic Index Treatment (LGIT) first introduced in 2005 are another two dietary therapies, which are less restrictive, more palatable with fewer adverse effects and comparable efficacy. MAD is also a high fat, low carbohydrate diet, in which high sugar foods are discouraged and protein and fluids are unrestricted. In LGIT, only carbohydrates with Glycemic Index <50 are allowed and carbohydrate intake is restricted to 40–60 g per day. Medium Chain Triglyceride KD (MCT KD) is another alternative, in which there are more food choices as compared to classic KD, with comparable efficacy.     

Parental Occupation Executive Training (POET): An Efficient Innovative Intervention for Young Children with Attention Deficit Hyperactive Disorder

Abstract

Background: The American Academy of Pediatrics strongly recommends first-line treatment of preschool aged children with attention deficit hyperactivity disorder (ADHD) be parent- or teacher-administered behavior therapy.

Aim: To assess the efficacy of Parental Occupation Executive Training (POET), a new intervention for young children with ADHD symptomatology.

Materials and Methods: We implemented a controlled, counterbalanced design with a study and comparison group (72 children with mean age of 5.42?years identified as having ADHD symptomatology. using the DSM-IV and Conners Parents and Teachers Rating Scales). Intervention included parental-training sessions focused on children's occupational goals and capitalized on the assumed relationship between daily activities and executive functions. We evaluated achievement with the Canadian Occupational Performance Measure (COPM), Behavioral Rating Inventory of Executive Functions, and a questionnaire we developed related to parental knowledge and skills.

Results: Executive functions and preselected daily functions significantly improved following the POET intervention. Parent perceptions related to their knowledge of their children's executive difficulties and appropriate management strategies changed significantly following the intervention, and significantly correlated with the COPM scores.

Conclusions: A short-term parental training program, the POET improved daily functioning of young children with ADHD symptomatology by focusing on their parents' ability to cope with the children's executive delays.     

Change in Parent-Identified Goals in Young Children with Cerebral Palsy Receiving a Context-Focused Intervention: Associations with Child,Goal and Intervention Factors

ABSTRACT

The purpose of this study was to examine the relationship between goal achievement measured by the Canadian Occupational Performance Measure (COPM) and child, goal, and intervention factors. Participants were 41 preschool children with cerebral palsy (CP) who were in the context-focused therapy arm of a randomized controlled trial. Factors including child age, Gross Motor Function Classification System (GMFCS) level, type and complexity of goals, and intervention strategies were analyzed. Children made large, positive mean changes on the COPM over 6 months (Performance = 3.8, SD = 1.9; Satisfaction = 4.3, SD 4.3) with younger children showing greater change. The COPM scores had low to moderate correlations with change on the Pediatric Evaluation of Disability Inventory and the Gross Motor Function Measure (GMFM-66). Regression analysis indicated that age, but not GMFCS level influenced COPM change scores. Goal complexity and intervention strategies were not significantly related to COPM change scores. The results provide support for using the COPM as an individualized measure of change in young children with CP receiving intervention.     

Evaluation of Effectiveness of Integrated Intervention in Autistic Children

Objectives

To assess the effectiveness of integrated therapy over the past 3 y on the recipient autistic children and its correlation with the following variables - age at admission, duration of therapy given and initial severity of symptoms.

Methods

The index study was a retrospective study with 18 autistic children as subjects; the maximum duration of intervention was 3 y. The integrated approach consisted of special education using principles of applied behavior analysis, occupational and speech therapy. The progress records, the occupational therapy and the speech therapy progress reports were tabulated as data. The Childhood Autism Rating Scale (Schopler, Reichler and Renner, 1986) was used for evaluation of severity of symptoms at admission and in present day. The data was then compared and analyzed.

Results

The present study showed significant positive results. Only few domains requiring very high integrated cognitive and sensorimotor functioning showed non-significant results. Age at intervention correlated negatively and, duration of therapy given and initial severity of symptoms correlated positively with effectiveness of therapy.

Conclusions

Continuous feedback and modification of the therapy is required to maintain performance and develop target interventions for problematic areas identified. Longitudinal as well as comparative studies are required to better understand the benefits of integrated approach.     

Parental Knowledge of Trampoline Safety in Children

Objective

Recreational trampoline use is increasing in popularity, with a resulting increase in significant trampoline-related injuries in children. Parents are the best advocates for the safety of their children during recreational trampoline use. Our primary objective was to determine the proportion of parents who were aware of 5 key recommendations for safer recreational trampoline use in children.

Methodological challenges when monitoring the diet of pregnant women in a large study: experiences from the Norwegian Mother and Child Cohort Study (MoBa)

The aim of this article is to describe the main methodological challenges in the monitoring of dietary intake in the Norwegian Mother and Child Cohort Study (MoBa), a pregnancy cohort aiming to include 100 000 participants. The overall challenge was to record dietary patterns in sufficient detail to support future testing of a broad range of hypotheses, while at the same time limiting the burden on the participants. The main questions to be answered were: which dietary method to choose, when in pregnancy to ask, which time period should the questions cover, which diet questions to include, how to perform a validation study, and how to handle uncertainties in the reporting. Our decisions were as follows: using a semi-quantitative food frequency questionnaire (FFQ) (in use from 1 March 2002), letting the participants answer in mid-pregnancy, and asking the mother what she has eaten since she became pregnant. The questions make it possible to estimate intake of food supplements, antioxidants and environmental contaminants in the future. Misreporting is handled by consistency checks. Reports with a calculated daily energy intake of <4.5 and >20 MJ day(-1) are excluded, about 1% in each end of the scale. A validation study confirmed that the included intakes are realistic. The outcome of our methodological choices indicates that our FFQ strikes a reasonable balance between conflicting methodological and scientific interests, and that our approach therefore may be of use to others planning to monitor diet in pregnancy cohorts.