A violence-prevention program helps teach medical students and pediatric residents about childhood aggression

There were 65 third-year medical students and 59 pediatric residents who participated. The intervention was a 40-minute multimedia program that teaches how to counsel parents about childhood aggression. Comparing pre- and 2-month postintervention data, there was an increase in the proportion of medical students (11% pre vs 92% post; P < .001) and residents (3% pre vs 95% post; P < .001) who felt that their ability to counsel parents about hurtful behavior was high or very high. Compared with baseline, a higher proportion of trainees at the 2-month follow-up recommended redirecting (11% pre vs 69% post; P < .001), promoting empathy (13% pre vs 42% post; P < .001), and not using physical punishment (25% pre vs 50% post; P < .001). A brief, independently viewed curriculum addition expanded the repertoire of health care trainees related to counseling parents about childhood aggression. These findings have implications for violence prevention.     

A multimedia violence prevention program increases pediatric residents' and childcare providers' knowledge about responding to childhood aggression

A pre-post knowledge test using alternate forms was used to determine if a multimedia violence prevention program can increase knowledge about management of childhood aggression. The participants were pediatric residents and childcare workers who attended lectures about aggression management in young children. The intervention was a presentation of a 30 minute CD-ROM program, Play Nicely, which teaches how to manage aggression in young children ages 1 to 7 years. A pretest and posttest multiple-choice knowledge assessment that focused on the program's most important recommendations was administered. Childcare workers and pediatric residents had significantly increased knowledge scores after viewing the CD-ROM demonstration (F=6.8, p = 0.01). Childcare workers' scores improved by 2.6 points (p< 0.001) and residents' scores by 3.8 points (p< 0.001). A relatively short CD-ROM can improve knowledge about how to manage aggression in young children, indicating its usefulness as a violence prevention resource.     

Gaps in pediatricians' advice to parents regarding early childhood aggression

Persistent early childhood aggression is a strong predictor of violence later in life. To determine how well general pediatricians counsel parents regarding aggression management strategies, responses to open-ended questions and endorsements of specific aggression management strategies, among 27 pediatricians were evaluated. Sixteen (59%) screened regularly for aggression and 23 (85%) counseled (rather than referred) if there were parental concerns. Pediatricians were most likely to spontaneously recommend time-outs (85%) and verbal reprimands (78%) and much less likely to recommend other strategies such as redirecting (26%, p < 0.01) and promoting empathy (22%, p < 0.001). Pediatricians did endorse other aggression management strategies, however, when specifically asked about them. Pediatricians appear to take a limited approach to counseling parents of children with hurtful behavior. To increase health care providers' role in violence prevention, more systematic efforts are needed to increase rates of screening for early childhood aggression and to broaden the scope of how pediatricians counsel parents.     

Feedback on a multimedia violence prevention program

The objective of this study is to describe feedback on a multimedia violence prevention program. Professionals and laypersons provided feedback regarding a multimedia CD program by completing an anonymous form. Feedback was obtained from 66% of participants (314). In general, participants felt more comfortable managing childhood aggression after the program (p<0.001). Pediatric residents felt more comfortable counseling parents (p<0.001). Approximately 90% of participants would either strongly or very strongly recommend the program to others. Multimedia programs can increase comfort level with managing childhood aggression, suggesting that they hold promise for use as adjunctive violence prevention tools.     

Abusive early child rearing and early childhood aggression

Childhood aggression is significant for children, their families, and the society because aggressive children often become violent adolescents. This article examines the relationship between maltreatment and early childhood aggression. Data are from a longitudinal study of maltreated and nonmaltreated children assessed as preschoolers and again at school age. The dependent variable is the child's teacher's rating of aggression at school age. The independent variables are from preschool and school age observations of the mother-child interaction and the mother's report of physical discipline practices. Using structural equation modeling, harshness of interaction at preschool age but not school age and severity of physical discipline at school age but not preschool age, relate to aggression at school age. Results suggest a difference in the developmental stage at which different features of harsh child rearing exert their influence. Strategies for intervening to prevent the development of childhood aggression are suggested.     

The role of parents in preventing childhood obesity

As researchers continue to analyze the role of parenting both in the development of childhood overweight and in obesity prevention, studies of child nutrition and growth are detailing the ways in which parents affect their children's development of food- and activity-related behaviors. Ana Lindsay, Katarina Sussner, Juhee Kim, and Steven Gortmaker argue that interventions aimed at preventing childhood overweight and obesity should involve parents as important forces for change in their children's behaviors. The authors begin by reviewing evidence on how parents can help their children develop and maintain healthful eating and physical activity habits, thereby ultimately helping prevent childhood overweight and obesity. They show how important it is for parents to understand how their roles in preventing obesity change as their children move through critical developmental periods, from before birth and through adolescence. They point out that researchers, policymakers, and practitioners should also make use of such information to develop more effective interventions and educational programs that address childhood obesity right where it starts-at home. The authors review research evaluating school-based obesity-prevention interventions that include components targeted at parents. Although much research has been done on how parents shape their children's eating and physical activity habits, surprisingly few high-quality data exist on the effectiveness of such programs. The authors call for more programs and cost-effectiveness studies aimed at improving parents' ability to shape healthful eating and physical activity behaviors in their children. The authors conclude that preventing and controlling childhood obesity will require multifaceted and community-wide programs and policies, with parents having a critical role to play. Successful intervention efforts, they argue, must involve and work directly with parents from the earliest stages of child development to support healthful practices both in and outside of the home.     

Importance of patient/parents education in childhood asthma

Asthma is fairly common in pediatric age group and the suffering due to asthma continues to increase despite excellent treatments available. One of the four major components of asthma management is patient education and is critical to the success of asthma management. Reasons for continued suffering include that our management strategies are not easily understood by the patient/parents without a simple and careful approach towards this step. Eliciting common concerns and fears is the single and foremost strategy to develop a relationship of trust with the patients/parents. Making them understand about the chronic nature of asthma, need for a long-term care approach, what happens during acute attacks and where medications act are some of the important areas you should be educating about in the beginning. Then comes the skill transfer, i.e. giving them skills to monitor asthma including use of peakflowmeter and use of inhalation devices effectively. Joint development of written plans for medications is essential. Development of plans to control of asthma; jointly with them; including learning about warning signs and a plan to manage acute attack at home is also very important and patient/parents should be having an active participation. Finally, educating them how to identify asthma triggers helps as a long-term strategy to keep control over asthma with or without medications. Reminding patient/parents when to come for follow-up and what would be discussed next time are some important tricks of the trade.     

Different neurocognitive functions regulating physical aggression and hyperactivity in early childhood

Background:  There are strong parallels between early childhood and adolescent behavior problems. However, we do not know if behavioral symptoms associate with neurocognitive processes in very young children as they do in older children.
Methods:  We studied a population-based birth cohort of children ( N  =   1,950) whose developmental trajectories of physical aggression and hyperactivity were assessed between the ages of 17 and 41 months. We measured the following neurocognitive abilities at 41 months of age: Receptive vocabulary, visuospatial organization, and short-term memory.
Results:  After controlling for other neurocognitive abilities, frequent physical aggression was related specifically to receptive vocabulary deficits ( p  < .0001) while frequent hyperactivity was related specifically to deficits of visuospatial organization ( p  < .0001). The pattern of associations was robust despite controls for socioeconomic and perinatal status.
Conclusions:  The different neurocognitive correlates of physical aggression and hyperactivity problems observed during adolescence are apparent in early childhood. Whereas physical aggression problems are associated with language deficits, hyperactivity problems are related to non-verbal deficits.     

Clinician practice patterns: linking to community resources for childhood aggression

Creating links to community resources for childhood aggression is one component of office-based violence prevention. Evidence is lacking regarding the effect of training clinicians to make these referrals and families' responses to them. Clinicians who received training (n=47) and parents (1093) were queried on the provision of referrals immediately after the visit. Fewer than half of clinicians (45%) reported making a community referral. A third of providers (37%) noted difficulty in identifying local resources. Training clinicians to utilize community resources for childhood aggression does not often result in creating community links for this purpose.     

Impact of childhood cancer on the mental health of parents

BACKGROUND: When a child is diagnosed with cancer, the family experiences great stress and disruption to daily life. As part of a national study in New Zealand, we evaluated the mental health of mothers and fathers of children with cancer, making comparisons to parents of children from the general population. PROCEDURE: This was a cross-sectional study. All children diagnosed with cancer at ages 0-14 years in New Zealand during a defined period were ascertained from the national cancer registry and other databases. The population-based comparison children were selected using national birth records. Parents from both groups completed self-administered questionnaires containing the General Health Questionnaire (GHQ-12) and other measures. The analyses included 218 mothers and 179 fathers of children with cancer, and 266 mothers and 224 fathers of children in the comparison group. Multivariate regression was used to adjust for demographic and socioeconomic characteristics, life events, and social support. RESULTS: Mothers and fathers of children with cancer had poorer GHQ-12 and mood rating scores than those of controls. The adjusted difference in the mean total GHQ-12 score (comparing mothers of children with cancer to mothers of controls) was 2.2 (95% confidence interval 1.3-3.2). The 12 items of the GHQ were each scored 0-3, and the total score was the sum, so 2 points is a small difference. For fathers the difference was 1.5 (95% confidence interval 0.6-2.4). Some subgroups of cancer group parents had poorer emotional health scores than others, including those with poor social support and no paid employment and also those who were bereaved. CONCLUSIONS: We found statistically significant but small differences between the mental health of parents of children with cancer and controls. The small differences suggest that as a group the parents of children with cancer are relatively resilient.     

Psychosocial functioning in parents of adult survivors of childhood cancer

BACKGROUND: Although significant progress has been made in identifying long-term sequelae for adult survivors of childhood cancer, comparatively little attention has been paid to the functioning of their parents. In a previous study, we observed that a majority of adult survivors are accompanied to clinic visits by at least 1 parent, suggesting ongoing concern for their children's health. In the current study, we explore psychologic stressors that characterize this population and might account for this finding. PROCEDURE: Responses to measures of psychosocial functioning (ie, Brief Symptom Inventory, Impact on Family Scale, Impact of Events Scale, Parent Experience of Child Illness Scale) were compared between 27 parents of adult survivors (mean age=25.6 y) of pediatric cancer and 28 parents of current pediatric cancer patients (mean age=10.2 y) on, or within 1 year of, active treatment. RESULTS: Compared with parents of pediatric cancer patients on treatment, parents of adult survivors demonstrated few significant differences in overall psychologic functioning, posttraumatic stress symptoms, and adjustment to the disease experience. Indeed, the 2 groups differed only in their report of objective and family burden (eg, financial cost, time off from work, less time with family members), and in their levels of anger associated with the illness experience. CONCLUSIONS: Results suggest that parents who continue to accompany their adult child to clinic may remain psychologically vulnerable many years after the end of treatment, and that the impact of having a child with a life-threatening illness may not diminish even years into the child's survivorship.     

Host factors and childhood injury: the influence of hyperactivity and aggression

OBJECTIVE: This study examined the association between hyperactivity, aggression, and unintentional childhood injury among a cohort of children aged 5-12 years. Participants were recruited utilizing a two-tier randomization process from primary schools in Brisbane, the capital city of Queensland, Australia. Information on hyperactivity and aggression was collected by trained interviewers using a semi structured questionnaire and episodes of injury were reported by parents using an injury event report form. Eight hundred and seventy-one children were recruited into the study of which 811 (93%) completed the full 12 months of follow-up. All subsequent analysis was limited to the children who were retained for the full study period. METHODS: One hundred and twenty-one children were categorized as hyperactive and 48 as aggressive. Boys were nearly twice as likely as girls to be categorized as hyperactive or aggressive, although this difference was not statistically significant for aggression. Lower socioeconomic status (SES) as measured by household income was also associated with aggression while more children from middle SES households as measured by both household income and maternal education were hyperactive compared with children from either low or high SES households. RESULTS: After adjusting for key confounding factors, children with high hyperactivity scores had an increased risk of all injuries (OR 1.98, 95% CI 1.48-2.64) and medically treated injuries (OR 1.56, 95% CI 1.01-2.43). Male gender was also a significant predictor of injury. Initiatives to prevent childhood injuries should take into account that child temperament may act as a mediating factor in the injury pathway. CONCLUSION: Further research is necessary to determine the success of preventive efforts in higher risk children who may react to their environment in a substantially different manner compared with less hyperactive children.