Contingent negative variation in children with orthostatic dysregulation

BACKGROUND: Children with orthostatic dysregulation (OD) appear to have hypodynamia, as well as the symptoms described in the OD criteira. Hypodynamia, which is greatly influenced by motivation, volition and concentration, is unexceptionally recognized in their everyday life. It has been suggested that the symptoms and hypodynamia aggravate considerably the quality of life (QOL) of children with OD. The purpose of this study was to distinguish the characteristics of contingent negative variation (CNV) and post imperative negative variation, which may reflect the level of attention and motivation in children with OD. METHODS: Twelve patients with OD aged 10-15 years and 23 age-matched healthy children were included. The CNV was recorded from Fz, Cz and Pz linked to earlobes during 30 trials consisting of a warning stimulus and an imperative stimulus with an interstimulus interval (ISI) of 2 s and an intertrial interval (ITI) of 10 s. The imperative stimulus of each trial required a button to be pressed. RESULTS: The untreated children with OD did not have a significantly smaller CNV amplitude than healthy children. Children with OD treated with midodrine and autonomic training had a significantly larger CNV amplitude than the untreated children, in the area of early, late and total CNV at the three sites. CONCLUSION: The present study confirms that children with OD have diminished motivation and deterioration of concentration, which cause hypodynamia in everyday life. Treatment for OD improves the symptoms, diminished motivation and deterioration of concentration, consequently restoring dynamia. Treatment for OD should be recommended to ameliorate QOL of children with OD.     

Making the connection: randomized controlled trial of social skills at school for children with autism spectrum disorders

Background: This study compared two interventions for improving the social skills of high functioning children with autism spectrum disorders in general education classrooms. One intervention involved a peer‐mediated approach (PEER) and the other involved a child‐assisted approach (CHILD). Method: The two interventions were crossed in a 2 × 2 factorial design yielding control, PEER, CHILD, and both PEER and CHILD conditions. Sixty children participated from 56 classrooms in 30 schools. Interventions involved 12 sessions over 6 weeks, with a 3‐month follow‐up. Outcome measures included self, peer and teacher reports of social skills and independent weekly observations of children on their school playground over the course of the intervention. Results: Significant improvements were found in social network salience, number of friendship nominations, teacher report of social skills in the classroom, and decreased isolation on the playground for children who received PEER interventions. Changes obtained at the end of the treatment persisted to the 3‐month follow‐up. Conclusions: These data suggest that significant improvements can be made in peer social connections for children with autism spectrum disorders in general education classrooms with a brief intervention, and that these gains persist over time.     

Association of overweight with asthma symptoms in Japanese school children

Background: Most studies regarding the association of obesity with asthma have been performed in the Western countries. This study is a nationwide survey conducted in Japan. Methods: A cross‐sectional and questionnaire‐based survey was performed among children aged 6–7, 13–14, and 16–17 years, using the ISAAC questionnaire. Overweight was defined as BMI ≥ 90th according to the reference values for Japanese children obtained during 1978–1981. Results: Of a total of 179 218 children, 149 464 replied to the questionnaire (response rate 83.4%). After omitting incomplete data, 139 117 were analyzed. In all the age groups, being overweight was associated with current asthma after adjustment for confounding factors (adjusted OR: 1.24 in children 6–7 years of age, 1.31 in those 13–14 years, and 1.32 in those 16–17 years). These tendencies were observed in both genders. Overweight was a risk factor for nocturnal cough, independent of current asthma in the older age groups (adjusted OR: 1.21 in children 13–14 years, and 1.17 in those 16–17 years). Conclusions: There is a clear association between obesity and current asthma in Japanese school‐aged children. Mechanisms through which obesity related with nocturnal cough might be different from those of obesity‐associated asthma.     

An item response theory analysis of the Parenting Stress Index‐Short Form with parents of children with autism spectrum disorders

Background: The Parenting Stress Index‐Short Form (PSI‐SF) is one of the most widely used instruments for measuring parenting stress in families of children with autism spectrum disorders (ASD). However, no research to date has examined the psychometric properties of the PSI‐SF in a sample of parents of young children with ASD. In this regard, item response theory (IRT) can be used to estimate how much information or discrimination each item of a scale offers across the entire range of the latent variable being measured, by creating individual item information curves or profiles. The purpose of this study was to use IRT to examine the discriminability of PSI‐SF items in a sample of parents of young children with ASD who experience varying levels of parental stress. Methods: The study involved the parents of 141 children with autism spectrum disorders (91.4% mothers; mean age 36.2 years) who completed the PSI‐SF following diagnosis. Item characteristic curves were constructed for each of the PSI‐SF items and examined with regard to item functioning. Results: Results indicated that, for the most part, changes in parental distress severity were reflected in changes on item scores. However, several items on the subscales measuring parent–child dysfunctional interactions and child behavior difficulty functioned poorly to discriminate parents across a range of total stress severity. Conclusions: The parent–child dysfunctional interaction and difficult child subscales of the PSI‐SF scale should be used with caution with parents of young children with ASD. More research is required to examine PSI‐SF content validity, at least among parents of children with ASD and perhaps parents of children with other disabilities as well.     

Special needs of children with type 1 diabetes at primary school: perceptions from parents, children, and teachers

Objective:  To identify the special needs of children with type 1 diabetes at primary school taking into account the perceptions reported by parents, children, and teachers.
Methods:  This was a cross-sectional survey carried out at nine public hospitals with a cohort of 6- to 13-yr-old children. Parents were personally informed about the objectives of the survey and the necessity to involve their children and the teachers. The self-reporting questionnaire included demographic information as well as some questions that helped to evaluate the general situation of children with type 1 diabetes at primary school, main worries about the disease, and possible improvement measures.
Results:  A total of 430 questionnaires were completed and validated of which 39% were filled in by parents, 35% by children, and 26% by teachers. The majority of children were 10–13 yr old and came from public schools. At school, most children required glucose monitoring, but few of them (9–12%) needed insulin administration. Some parents (7%) experienced problems at their schools when they informed them about their children's disease, 2% were finally not accepted, and 1% were forced to change school. Major children's concerns included the ability to recognize hypoglycemia or to self-administer insulin. Parents, teachers, and children demanded better information at school about diabetes and about emergency management.
Conclusions:  The three population groups agreed about the necessity of having more available information on diabetes at schools. Although some discriminatory behavior was still occurring, it seemed it has been diminishing in recent years.     

Stress in mothers of young children with eczema

Objective

To assess parental stress levels of mothers of children less than 6 years old with eczema and compare these levels with those reported for other chronic childhood illnesses.

Methods

Mothers were recruited from hospital‐based out‐patient clinics (55%) or while their child was an in‐patient (45%) for management of eczema. Maternal stress was measured utilising the Parenting Stress Index‐Long Form (PSI) in 33 mothers. The severity of the eczema at the time of interview was documented by the Eczema Area and Severity Index (EASI) score and the Investigators'' Global Assessment (IGA) score.

Results

The children with eczema had a mean age of 2.8 years. Mothers of children aged 5 years or less with eczema exhibited significantly higher total stress scores (mean PSI 259.6, 95% CI 244.9 to 274.3) as compared to mothers of normal children (PSI 222.8, 95% CI 221.4 to 224.2) and children with other chronic disorders such as insulin‐dependent diabetes (PSI 218.1, 95% CI 204.7 to 231.6) and profound deafness (PSI 221.7, 95% CI 206.4 to 237.0). Stress scores in the parental domain (138.2, 95% CI 128.9 to 147.6) did not differ significantly from the scores of parents of children with severe disabilities such as those requiring home enteral feeding (135.2, 95% CI 129.3 to 141.1) and those with Rett syndrome (132.8, 95% CI 125.0 to 140.6).

Conclusions

Moderate to severe childhood eczema should be regarded as a significant illness in which maternal stress is equivalent to that associated with the care of children with severe developmental and physical problems.     

Cytokines in nasal fluids from school children with seasonal allergic rhinitis

Allergic rhinitis is a particularly good model for studies of cytokine pro-duction in vivo , in this study the occurrence of the cytokines IL-4, IL-5. IL-10 and IFN-yas well as the soluble receptor tbr IL-4 in nasal lavage flu-ids were assayed in 38 school children, with seasonal allergic rhinitis, and 19 healthy age matched, non atopic controls, using highly sensitive enzyme immunossays. IL-4 levels in patients with seasonal allergie rhinitis were markedly increased in comparison with those in non-atopic controls or in atopic pa-tients before the start of the pollen season. In controls, but not in the atopic patients, levels of IFN-yand IL-5 were significantly higher in specimens obtained during the pollen season than in those obtained outside the season. The IL-4/IFN-y ratios were significantly higher in atopic than in nonalopic subjects and further increased in atopic patients during the season. In addition to IL-4, elevated levels of IL-10 were observed in association with seasonal rhinitis. Following treatment with a topical steroid (budeso nide) there was a statistically significant increase of the levels of soluble IL-4 receptor. These findings indicate that nonatopic and atopic individuals react to pollen exposure with distinct cytokine patterns in agreement with the Thl/ Th2 concept. Topical steroids may possibly decrease inflammation by increasing the formation of soluble IL-4 receptor.     

Behavioural problems in school age children with cerebral palsy

Background

Although behavioural problems are frequent in children with Cerebral Palsy (CP), the exact nature of these difficulties and their relationship with intrinsic or extrinsic factors are just beginning to be explored.

Aim

To describe and characterize behavioural problems in children with CP and to determine the nature of any relationships with child and family characteristics.

Methods

In this cross-sectional study, children with CP between 6 and 12 years of age were recruited. Children were assessed using the Leiter Intelligence Test, the Gross Motor Function Measure, the Strengths and Difficulties Questionnaire (SDQ), the Vineland Adaptive Behavior Scales and questionnaires on demographic factors. Parents’ level of stress was measured with the Parenting Stress Index.

Results

Seventy-six parents completed the SDQ. Using the Total Difficulties Scores, 39.4% of the sample scored in the borderline to clinically abnormal range. Peer problems were the most common (55.3%). High parental stress was consistently associated with behavioural difficulties across all domains of the SDQ. Not surprisingly, better socialization skills and a lower parental stress were correlated with more positive behaviours.

Conclusion

Behavioural difficulties are common in children with CP and appear not to be associated with socio-demographic variables and physical and cognitive characteristics. These difficulties are an important correlate of parental distress. This study emphasizes the need to recognize and address behavioural difficulties that may arise so as to optimize the health and well-being of children with CP and their families.     

Fruit and vegetable exposure in children is linked to the selection of a wider variety of healthy foods at school

Schools often offer healthy fruits and vegetables (FV) and healthy entrées. However, children may resist these efforts due to a lack of familiarity with the offerings. While numerous exposures with a food increase its liking, it may be that an exposure to a variety of FV at home leads to greater willingness to select other foods – even those that are unrelated to those eaten at home. As an initial test of this possibility, this study was designed to examine how self‐reports of exposure and consumption of various FV were associated with the selection of FV and lunch entrées at school. Participants (n = 59) were a convenience sample of elementary children. A median split was used to place students into high‐ and low‐exposure groups for self‐reports of both exposure and consumption at home. The primary dependent variables were self‐reports of selecting FV at school; the children's absolute and relative ratings of eight ‘healthier’ lunch entrées; and self‐reports of selecting these entrées. These entrées were recently added to the school menu and, therefore, tended to be less familiar to children. Food ratings were collected through taste exposures conducted at school. Results indicate that children who reported more frequent exposure to FV at home consumed a wider variety of FV at school and were more likely to report selecting ‘healthier’ entrées at school lunch. These data suggest that exposure to, and the consumption of, a variety of FV may make children more willing to select a wider range of FV and other healthy entrées.     

Editorial Perspective: COVID-19 pandemic-related psychopathology in children and adolescents with mental illness

The coronavirus disease (COVID-19) pandemic is likely to have negative health consequences way beyond those caused by the virus per se – including significant psychological distress. Children and adolescents who already live with a mental illness may be particularly vulnerable to the distress associated with the pandemic – due to, for example, fear of the virus as well as the significant societal changes launched to minimize spread of the virus (social distancing and quarantine). In this editorial perspective, we (a) provide data on COVID-19 pandemic-related psychopathology in children and adolescents from a large psychiatric treatment setting in Denmark, (b) give advice on how the likely harmful effects of the COVID-19 pandemic on the mental health of children and adolescents may be minimized, and (c) propose six lines of research into pandemic-related psychopathology with emphasis on children and adolescents. Finally, we underline the necessity of politicians, health authorities, and funding bodies supporting these research initiatives here and now.     

Bullied by siblings: association with peer victimisation and behaviour problems in Israeli lower secondary school children

BACKGROUND: The association of bullying victimisation by siblings with a) involvement in bullying at school and b) behaviour problems among lower secondary school children in Israel was investigated. METHOD: Self-report questionnaires of sibling victimisation, peer bullying experiences and behaviour problems were completed by 921 pupils aged 12-15 (mean age 13.7 years). RESULTS: Of the sample, 16.2% were directly bullied by their siblings at home and 11.9% were direct victims of bullying by peers at school every week. More than half of victims of bullying by siblings (50.7%) were also involved in bullying behaviour at school compared to only 12.4% of those not victimised by siblings, indicating a strong link between intrafamilial and extrafamilial peer relationships. Children with poor sibling and peer relationships were at a highly increased risk for behaviour problems. Ethnic (Israeli Jewish vs. Arab) and sex differences were small compared to the effects of sibling relationship on behaviour problems. CONCLUSION: Intervention strategies directed at reducing bullying in school should take into account pupils' experiences of victimisation by siblings at home.     

Two children with obesity‐related glomerulopathy identified in a school urinary screening program

The incidence of obesity‐related glomerulopathy (ORG) has increased over the last decade, but there have been few reports on ORG in Japanese children. Reported herein are two children with ORG identified on school urinary screening (SUS). Patient 1 was a 12‐year‐old boy in whom proteinuria was first detected on SUS. His body mass index (BMI) was 33.8 kg/m² and he had hypertension and hyperuricemia. Patient 2, a 10‐year‐old boy, also had proteinuria identified on SUS. His BMI was 34.8 kg/m², and he had fatty liver, hyperuricemia, and hypercholesterolemia. Both were diagnosed with ORG based on obesity, proteinuria, and renal pathological findings. After treatment, including candesartan, food restriction and physical exercise, urinary protein excretion was decreased in both cases. We believe that such school urinary screening programs may be effective for the early identification and treatment of children with ORG.