儿童发育障碍的药物治疗

作用于中枢神经系统功能的药物也能治疗发育障碍的某些症状和肌肉痉挛、抽动症、张力障碍、自伤行为、破坏行为和注意缺陷多动障碍，本文分别讨论了大脑兴奋药、神经松弛药、抗痉挛药、抗抑郁药及其它神经递质药物在治疗中的作用。     

遗传性疾病与儿童生长发育障碍

许多遗传性疾病在临床上表现为生长发育障碍,随着遗传分子生物学的发展,应用新一代检测技术对病因及发病机制的研究,使越来越多以前不明原因的生长发育障碍得到了有效的病因诊断和鉴别。为提高儿童保健实践中对遗传性疾病的诊疗水平,需重视临床症状性资料的收集和分析、熟悉常规诊疗路径、充分理解和恰当选择新的诊断技术。     

儿童学习困难和学习技能发育障碍

儿童学习困难是指智力基本正常的学龄期儿童学业成绩明显落后的一类问题，有适当的学习机会，但由于环境、心理和素质等方面因素致使学习技能的获得和／或发展障碍，表现为经常性的学业成绩不良或因此而留级。     

语言发育障碍儿童53例脑干听觉诱发电位分析

目的：探讨脑干听觉诱发电位（BAEP）在语言发育障碍儿童中的应用价值。方法：对53例语言发育障碍儿童及30名健康儿童，进行BAEP描记分析。结果：语言发育障碍儿童BAEP总异常率为68％（36／53），其中双耳异常率为32％（17／53），单耳异常率为36％（19／53）。结论BAEP对于语言发育障碍儿童听力损伤及传导经路的异常可以提供客观指标。     

发育早期易被忽视的儿童发育障碍相关疾病

儿童早期机体的生长和心理的构建,为儿童早期相关发育障碍的纠治提供了多种干预机会。本专题就发育早期易被忽视的儿童发育障碍相关疾病——性发育异常、神经发育障碍性相关疾病做一介绍,期望在全面性的儿童保健体系中,儿童保健医师能熟悉个体发育行为的年龄特征,通过生长发育监测、儿童早期发育预警征象及标准化发育筛查量表等判断儿童是否有发育障碍相关疾病,提高相关疾病早期识别率,以促进早期干预、早期治疗、早期康复。     

儿童孤独症与特定性言语和语言发育障碍的鉴别诊断

儿童孤独症与特定性言语和语言发育障碍在语言沟通及社交功能,以及社交-情绪-行为紊乱等多个方面呈现出重叠,容易造成临床诊断混淆。本文分别从儿童孤独症、特定性言语和语言发育障碍的角度对两个疾病的行为学特征进行描述,并就这两个疾病的鉴别诊断进行了详细分析。     

儿童依恋模式的代际传递性研究

依恋的形成对儿童的一生有着深远的影响。作者以依恋的概念及其类型为起点,分析依恋模式代际传递性的理论背景,从照料者与依恋的代际传递性关系、成人依恋模式与其子女依恋模式的关系、"将心比心"对依恋模式代际传递性的解释、干预研究4个方面对儿童依恋模式代际传递性研究的新近成果进行介绍与归纳。     

儿童心理、行为和发育障碍概论

1　概　述随着社会的进步和医学的发达 ,危害儿童最为严重的传染病已被消灭或基本控制 ,以及营养不良也已大幅度下降 ,使疾病谱和死亡谱发生了改变。而今社会正处在急速变革中 ,给儿童发育增加了很多紧张因素。随之 ,家庭结构 ,亲子关系 ,养育观念和方法也发生改变 ,均影响儿童行为和个性的塑造。现今竞争意识加强 ,父母和教师对孩子以期望值普遍提高 ,常超过承受的能力 ,以及部分独生子女家庭的娇惯 ,外加社会的不良影响等 ,儿童心理 ,行为和发育疾病 (障碍 )的患病率有大幅度上升趋势 ,已经引起政府和全社会的关注。2　国际通用的命名和规…     

Lead exposure in a developmentally disabled workforce

Over-exposure to lead was identified among developmentally disabled workers engaged in furniture refinishing at two separate sites. The index case was identified at the first site by a public health nurse assigned to provide care to some of the workers. Referral to a regional occupational health clinic initiated an exposure assessment and medical consultation at both work sites. Blood lead levels (BLLs) among sanders and helpers at site A averaged 60 micrograms per deciliter of blood (mcg/dl). At site B, BLLs were lower, but 6 individuals had BLLs greater than 25 mcg/dl. Hand sanding of chemically stripped wood previously coated with lead-based paint was determined to be the exposure source. These incidents document potential lead overexposure in an underecognized setting. They also emphasize the importance of incorporating a workplace health risk assessment in the process of placing and protecting the developmentally disabled on the job. Am. J. Ind. Med. 34:191–196, 1998. © 1998 Wiley-Liss, Inc.     

Research into the lifeworld of physically disabled children

Summary This article presents a phenomenological study of the experiences of physically disabled children. The research focuses on elementary school aged children not suffering from additional intellectual disability. In previous research we noticed just how often the children we observed are considered and discussed from the point of view of professional expertise. There is, for instance, the medical account of the disorder, the paramedical view concerning the treatment of the physical limitations and the educational and psychological approach to learning disabilities. Our research aims to highlight the perspective of the disabled child him- or herself. We let the children speak for themselves on their three 'favourite' subjects: on their bodies, on friends and on parents and experts.     

Acknowledging the extra care parents give their disabled children

Around 150,000 families in the UK care for a severely disabled child under the age of 16. Many of these families receive assistance from the Family Fund Trust, which provides grants and information relating to the care of a severely disabled child. The aim of this study was to identify patterns of extra care needs among severely disabled children known to the Trust. Extra care needs are requirements for care not experienced by similarly aged non-disabled children. The research comprised analysis of 40,000 records from the Trust database and qualitative exploration of the extra care needs of disabled children with parents and Trust staff. Although all children require parenting, the care parents give disabled children generally exceeds that given to a non-disabled child. Quantitative analysis showed that the majority of children in the sample required extra assistance or supervision with multiple areas of daily life. With each of five activities (washing, dressing, meal times, during the night and keeping occupied), >70% of children needed extra help and, on average, each child needed extra help or supervision in six areas of daily life. Cluster analysis indicated distinctive combinations of extra care needs. Qualitative material indicated variety in extra care tasks undertaken (physical help, supervision, guidance) and causal factors (physical limitations, cognitive difficulties, behavioural problems). The findings confirm that severely disabled children have considerable extra care needs in many areas of daily life. Parents want professionals to recognize and offer explicit acknowledgement of the extra care they give their disabled children.     

Coping with the care of a severely disabled child

The unrelenting, and often overwhelming, stresses experienced by parents caring for a disabled child have been well charted, as have their impact on personal and family well-being. This paper reports on a study which took such research a step further by focusing on the ways parents cope with the stresses and strains of care. An in-depth qualitative approach was used in a longitudinal study of 20 families caring for a severely disabled child. The work was theoretically grounded in Lazarus & Folkman's (1984) process model of stress and coping, which emphasizes the importance of coping strategies and coping resources in mediating the adverse effects of stress. The paper reports on the way in which the negative aspects of caring for a disabled child were balanced by two positive factors: the parent-child relationship and the ways parents coped with the problems they encountered and the emotional distress they felt. Parents were found to have a wide range of coping strategies and they employed enormous creativity to deal with the problems they faced. These included strategies which acted directly on the source of stress, information-seeking, planning, taking control, and self-maintenance strategies. The role of services in supporting parents in the ways they chose to cope is illustrated.     

Does Respite Care Reduce Parental Stress in Families with Developmentally Disabled Children?

Caring for a developmentally disabled child can be extremely stressful for many parents. Respite care is designed in part to alleviate this stress. This paper reviews studies that have evaluated the effects of respite care services used by families who have children with developmental disabilities, with an emphasis on parental stress. In general the results of this review suggest that, at least in the short-term, respite care is associated with significant reductions in parental stress for the majority of parents who use it. However, the database on this issue is relatively small and many studies have significant limitations, particularly in their almost exclusive reliance on indirect measures of stress reduction and associated benefits (e.g., increased coping, improved quality of life). Additional research is needed to address these limitations. In the meantime, respite care providers should seek to evaluate the effects on, appropriateness for, and acceptability of its services at the level of the individual family.     

Peer relations and friendship in physically disabled children

This article presents the results of a literature study and qualitative fieldwork Into the way physically disabled children experience friendship. We discuss literature on how children make contact with peers, on the nature of their friendship and on what It is like to be excluded. Some aspects are complemented with information from the children themselves. Peer relations and friendship are the very essence of a happy childhood. This article therefore closes with a number of recommendations to improve peer relationships.     

Implementation of training to improve communication with disabled children on the ward: A feasibility study

BackgroundParents of disabled children report poorer inpatient experiences when they stay in hospital, and some staff report finding communicating with disabled children challenging. This study tested the feasibility of implementing a training package for staff on paediatric wards to improve communication with disabled children, especially those with communication difficulties, and their families. The package was developed with parent carers and clinicians, and comprises a manual, a video of parent carers talking about real experiences, discussion points and local resources. The 50‐minutes training is intended for in‐house delivery by local facilitators.MethodsThirteen training sessions were delivered in paediatric wards across four hospitals in England, totalling 123 staff who took part. Participants completed questionnaires before (n = 109) and after (n = 36) training, and a sample of champions (senior clinicians) and facilitators were interviewed at the end of the study.ResultsFacilitators found the training easy to deliver, and participants felt they took away important messages to improve their practice. After the training, further changes were reported at an organizational level, including offering further training and reviewing practices.ConclusionsThis study provides supporting evidence for the implementation of a low‐cost, minimal‐resource training package to support staff communication with children and their families in hospitals. It provides promising indication of impact on behavioural change at the individual and organizational level.Patient and public contributionParent carers identified the need and helped to develop the training, including featuring in the training video. They were also consulted throughout the study on research design, delivery and reporting.     

Care co-ordination and key worker schemes for disabled children: results of a UK-wide survey

AIM: To investigate the prevalence and nature of care co-ordination and key worker services for disabled children and their families. METHODS: Postal survey of 225 Children with Disabilities Teams across the UK. RESULTS: Out of 159 questionnaires returned (70%), 35 (22%) reported having a care co-ordination scheme, with 30 (19%) of these providing key workers for families. The majority had multiagency and parent involvement in setting up and overseeing the schemes. However, multiagency funding was less common and funding for many schemes was short term. Different models of key working were apparent. Five schemes employed full-time key workers. In 21 schemes, professionals key worked with a few families as part of a larger case load, and in three schemes, both types of key workers were employed. Most schemes provided initial or ongoing training for key workers, but a few provided neither of these. DISCUSSION: The proportion of areas having care co-ordination or key worker services is consistent with findings on research with parents of disabled children, which reports that less than one-third of families have a key worker. The extent of multiagency involvement in planning and overseeing the operation of the service was positive but joint funding was more problematic. There was considerable variation in service models and as yet, little is known about whether or how such variations relate to outcomes for children and families. Further research will investigate these issues.     

安徽省部分地区5 953例病残儿医学鉴定结果分析

【目的】 为了解安徽省部分地区出生缺陷现状,为提高人口素质提供科学依据。 【方法】 对1999-2009年各地市上报省人口计生委、经各市级专家委员会鉴定符合病残儿医学鉴定标准的病残儿资料进行整理分析。 【结果】 鉴定病残儿病例为5 953例,男性多于女性;遗传性疾病有2 140例,非遗传性疾病有3 813例;遗传性疾病中,智力低下最多,占遗传性疾病总数的31.54%;非遗传性疾病中,顺位位于前三的是脑瘫(24.81%)、癫痫(11.17%)和大脑发育不全(10.46%)。 【结论】 加强病残儿动态管理,积极开展优生优育工作,是降低病残儿发生的有效途径。     

深圳市2003～2005年申请医学鉴定的病残儿童病种分析

【目的】分析深圳市申请医学鉴定的病残儿童病种构成，探讨高发病种的防范措施。【方法】将深圳市病残儿医学鉴定小组过去三年审理的病残儿鉴定资料按先天与后天性疾病，遗传与非遗传性疾病分类，逐年比较男女两组遗传病的发生率。非遗传病组分为11种类型，与医学鉴定常见的14种疾病一起逐年列出患儿的例数，并标注国际疾病分类标准编码（ICD-10）。【结果】2003年1月～2005年12月，深圳市受理病残儿鉴定总数340例，每年平均占户籍人口0．069‰，其中男207例，女133例，男女性比1．56：1；先天性疾病124例，后天性疾病216例，分别占鉴定总数的36．5％和63．5％；遗传病17例，其中男8例，女9例，男女患病率差异无显著性（P〉0．05）。非遗传病组，例数排在前6位的疾病类型：神经系统疾病、先天畸形／变形和染色体异常、精神行为障碍、视觉与听力障碍、血液病与恶性肿瘤。例数排在前6位的常见鉴定病种：脑瘫、孤独症、弱智、先天性心脏病、视觉障碍与癫痫。【结论】要重视病残儿童病种变化的监测，加强高发病种的防范研究。