Use of Dietary Fiber and Stimulus Control to Treat Retentive Encopresis: A Multiple Baseline Investigation

Diet modification and stimulus control training for retentiveencopresis was evaluated in a multiple baseline across subjectsdesign. Three encopretic boys were assessed for 6, 10, and 14weeks of baseline. Diet modification comprised increasing dietaryfiber and water intake through a point contingency, and stimuluscontrol comprised scheduled toileting with limited, contingentuse of suppositories. Diet changes were associated with increasesin appropriate toileting and decreases in accidents. All subjectsattained four consecutive accident-free weeks, and gains weremaintained for 1 year. Only one subject required limited useof suppositories. Results suggest diet change is one alternativeto purgatives in treatment for retentive encopretics. Qualificationsof the approach are noted, and recommendations are made forfuture research.     

Additive Benefits of Laxative, Toilet Training, and Biofeedback Therapies in the Treatment of Pediatric Encopresis

Compared the additive benefits of laxative, behavior, and biofeedbacktreatments for encopresis, while attempting to identify treatmentmechanisms and predictors of treatment outcome. 44 encopreticchildren, ages 6–15 years, were randomly assigned to eitherlaxative therapy (LAX), LAX plus enhanced toilet training (ETT),or LAX + ETT + anal sphincter biofeedback (BF). Daily symptomdiaries were completed 14 days before, upon initiation of, and3 months following treatment initiation. ETT and BF were superiorto LAX in reducing encopresis. Outcome was significantly predictedby improvement during the initial 14 days of treatment. Reductionof soiling was associated with an increase in bowel movementfrequency, and reductions in defecation pain and parental promptingto use the toilet. Because of its efficacy and minimal relianceon technology, ETT should be the initial treatment of choice.     

Treatment of A Retentive Encopretic Child Using Contingency Management and Diet Modification with Stimulus Control

This clinical case study utilized a new method of systematicdiet modification in combination with stimulus control trainingand contingency management to treat a 7-year-old retentive encopreticmale. Diet modification comprised increasing the child's intakeof dietary fiber through a point system. Diet change (increasesin "fiber points") was associated with increases in appropriatebowel movements and decreases in soiling accidents. The combinationof diet modification, stimulus control, and contingency managementeliminated soiling accidents, and treatment gains were maintainedat 1-year follow-up. The findings provide preliminary supportfor diet change as a possible alternative to use of purgativesin behavioral treatment for retentive encopresis. Limitationsof the study are discussed, and recommendations for furtherresearch on diet modification are made.     

Group behavioral treatment of retentive encopresis

Investigated the efficacy of behavioral group treatment for children with retentive encopresis who had previously failed medical management. Eighteen children between the ages of 4 and 11 years and their parents were seen in small treatment groups of 3 to 5 families over 6 sessions. The sessions focused on education about retentive encopresis, and the integration of behavioral parenting procedures with medical management. Parents and children were taught to deliver an enema clean-out, increase the children's dietary fiber, and appropriate toileting techniques. The results indicated that children significantly increased their fiber consumption by 40%, increased appropriate toileting by 116%, and decreased their soiling accidents by 83% pre- to posttreatment. Further, these treatment gains maintained or improved at the 6-month follow-up. The results are discussed in terms of cost-effective interventions and the interface between psychology and medicine in pediatric psychology.     

Assessment of behavioral mechanisms maintaining encopresis: Virginia Encopresis-Constipation Apperception Test

OBJECTIVE: To develop and test a scale for parent and child, evaluating theoretical and clinical parameters relevant to children with encopresis. Encopretic children were hypothesized to have more bowel-specific, but not more generic, psychological problems, as compared with nonsymptomatic control children. In addition, mothers were also believed to be more discerning than children. METHODS: The Virginia Encopresis-Constipation Apperception Test (VECAT) consists of 9 pairs of bowel-specific and 9 parallel generic drawings. Respondents selected the picture in each pair that best described them/their child. It was administered to encopretic children (N = 87), nonsymptomatic siblings (N = 27), and nonsymptomatic nonsiblings (N = 35). The mothers of all the participants also completed the VECAT. Encopretic children were retested 6 and 12 months posttreatment with Enhanced Toilet Training. RESULTS: The VECAT demonstrated good test-retest reliability and internal consistency. Encopretic children and their mothers reported more bowel-specific, but not more generic, problems. Bowel-specific scores improved significantly posttreatment only for those patients who demonstrated significant symptom improvement. Mothers were significantly more discerning than children. CONCLUSION: The VECAT is a reliable, valid, discriminating, and sensitive test. Bowel-specific problems appear to best differentiate children with and without encopresis.     

Internalizing and externalizing problem behavior in children with nocturnal and diurnal enuresis: a five-factor model perspective

OBJECTIVES: To describe personality traits, internalizing, and externalizing problems of 6- to 12-year-old children with nocturnal and diurnal enuresis, examining differences from healthy referents, and investigating the association between personality traits and problem behavior. METHODS: Eighty-five children with combined nocturnal and diurnal enuresis were compared with 56 children with nocturnal enuresis and 155 healthy children on personality characteristics and problem behavior. RESULTS: Post hoc analyses of multivariate analyses indicated that parents of children with combined nocturnal and diurnal enuresis reported on average lower conscientiousness and higher neuroticism scores in their children than parents of healthy children, although the magnitude of these differences was moderate. Considerable differences in mean scores were found for the Child Behavior Checklist (CBCL) total problem scale and moderate differences for internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) problems in children with nocturnal and diurnal enuresis compared with healthy referents. Regression analyses across enuretic and healthy groups demonstrated that personality trait and problem behavior scales share substantial variance. CONCLUSION: Moderate to substantially higher levels of problem behavior is demonstrated in children with nocturnal and diurnal enuresis, who also display slightly higher neuroticism and lower conscientiousness scores.     

Adjustment of siblings of handicapped children: a comparison

Compared 55 older siblings (ages 7 1/2 to 15 years) of young handicapped children (ages 1-7 years) with 55 matched siblings of nonhandicapped children. Results of standardized children's assessment scales show that siblings of handicapped children are comparable to siblings of nonhandicapped children in self-concept, behavior problems, and social competence. Differences, however, appear along certain psychological dimensions and great variations exist within each group of siblings. Further, demographic and personal attributes are differentially related to measures of adjustment in different groups of siblings. Implications for research and intervention are drawn.     

儿童肥胖症的综合干预研究

本文以３３例１２－１４岁的青春前期单纯性肥胖儿童为治疗组，另设同性别、同年龄的肥胖对照组２９例和正常体重对照组３２例作对比研究。治疗前对三组儿童均进行体格测量及生化检测，只对肥胖治疗组儿童进行综合性干预，包括家庭行为疗法、饮食指导和运动训练，为肥胖儿童制定减肥计划，内含中介行为、目标行为、奖惩手段、制约方法等，由专业人员定期家访指导，学校老师监督执行。经过二年的治疗观察，肥胖治疗组儿童肥胖度明显下降，身高的增长与正常对照组儿童一致，接受治疗的肥胖儿童血压、总胆固醇、甘油三酯、体脂含量均有不同程度的降低，不良饮食、运动行为得到不同程度的矫正，体育成绩提高，热卡摄入量比治疗前有所减少，而肥胖对照组儿童上述各指标无明显变化。     

Characterization of a comprehensive type a measure for children in a biracial community: The Bogalusa heart study

To evaluate the development of Type A-like behavior in children, responses to the Hunter-Wolf Instrument were studied in 2128 children in Bogalusa, Louisiana, a biracial community. Test-retest reliability measures were generated by retesting a random subsample of 387 children 2 weeks after the initial testing. Norms were tabulated for each of the age, race, and sex groups. Increases in total and subscale scores with age were noted except for the Hostility subscale, which decreased dramatically in the older groups. White males had higher average scores during the entire period than other groups and scored significantly higher than other groups on subscales, created from principal-components analysis, measuring Eagerness and Hostility. Low test-retest correlations were observed in children younger than 13 years of age. Of the four race-sex groups studied, white males appear to accrue the highest risk for coronary heart disease from type A-like behavior.This research is supported by funds from the National Heart, Lung, and Blood Institute of the United States Public Health Service (USPHS), National Research and Demonstration Center-Arteriosclerosis (NRDC-A), Grant HL15103.     

The children's eating behavior inventory: reliability and validity results.

Eating and mealtime problems are common in childhood. They occur across a broad age span, in normally developing children and in a wide variety of developmental and medical disorders. There is no currently available standard instrument by which to assess these problems. The Children's Eating Behavior Inventory (CEBI) was developed according to a conceptual framework based upon a transactional/systemic understanding of parent-child relationships. It was completed by 206 mothers of nonclinic children and 110 mothers of clinic children. Results of test-retest and internal reliability testing indicate that the CEBI meets criteria for instrument reliability. Construct validity is demonstrated by the significant difference between the clinic and nonclinic groups in the mean total eating problem score and in the mean number of items perceived to be a problem.     

Candida Colonization as a Risk Marker for Invasive Candidiasis in Mixed Medical-Surgical Intensive Care Units: Development and Evaluation of a Simple,Standard Protocol

Colonization with Candida species is an independent risk factor for invasive candidiasis (IC), but the minimum and most practicable parameters for prediction of IC have not been optimized. We evaluated Candida colonization in a prospective cohort of 6,015 nonneutropenic, critically ill patients. Throat, perineum, and urine were sampled 72 h post-intensive care unit (ICU) admission and twice weekly until discharge or death. Specimens were cultured onto chromogenic agar, and a subset underwent molecular characterization. Sixty-three (86%) patients who developed IC were colonized prior to infection; 61 (97%) tested positive within the first two time points. The median time from colonization to IC was 7 days (range, 0 to 35). Colonization at any site was predictive of IC, with the risk of infection highest for urine colonization (relative risk [RR] = 2.25) but with the sensitivity highest (98%) for throat and/or perineum colonization. Colonization of ≥2 sites and heavy colonization of ≥1 site were significant independent risk factors for IC (RR = 2.25 and RR = 3.7, respectively), increasing specificity to 71% to 74% but decreasing sensitivity to 48% to 58%. Molecular testing would have prompted a resistance-driven decision to switch from fluconazole treatment in only 11% of patients infected with C. glabrata, based upon species-level identification alone. Positive predictive values (PPVs) were low (2% to 4%) and negative predictive values (NPVs) high (99% to 100%) regardless of which parameters were applied. In the Australian ICU setting, culture of throat and perineum within the first two time points after ICU admission captures 84% (61/73 patients) of subsequent IC cases. These optimized parameters, in combination with clinical risk factors, should strengthen development of a setting-specific risk-predictive model for IC.     

Evaluation of a Web-Based Food Record for Children Using Direct Unobtrusive Lunch Observations: A Validation Study

Background

High-quality, Web-based dietary assessment tools for children are needed to reduce cost and improve user-friendliness when studying children’s dietary practices.

Objective

To evaluate the first Web-based dietary assessment tool for children in Norway, the Web-based Food Record (WebFR), by comparing children’s true school lunch intake with recordings in the WebFR, using direct unobtrusive observation as the reference method.

Methods

A total of 117 children, 8-9 years, from Bærum, Norway, were recruited from September to December 2013. Children completed 4 days of recordings in the WebFR, with parental assistance, and were observed during school lunch in the same period by 3 observers. Interobserver reliability assessments were satisfactory. Match, omission, and intrusion rates were calculated to assess the quality of the recordings in the WebFR for different food categories, and for all foods combined. Logistic regression analyses were used to investigate whether body mass index (BMI), parental educational level, parental ethnicity or family structure were associated with having a “low match rate” (≤70%).

Results

Bread and milk were recorded with less bias than spreads, fruits, and vegetables. Mean (SD) for match, omission, and intrusion rates for all foods combined were 73% (27%), 27% (27%), and 19% (26%), respectively. Match rates were statistically significantly associated with parental educational level (low education 52% [32%] versus high 77% [24%], P=.008) and parental ethnicity (non-Norwegian 57% [28%] versus others 75% [26%], P=.04). Only parental ethnicity remained statistically significant in the logistic regression model, showing an adjusted odds ratio of 6.9 and a 95% confidence interval between 1.3 and 36.4.

Conclusions

Compared with other similar studies, our results indicate that the WebFR is in line with, or better than most of other similar tools, yet enhancements could further improve the WebFR.     

Effects of Gender on Type A Assessment with the Matthews Youth Test for Health (MYTH)

Abstract

This study investigated the influence of childrens' and teachers' sex on Type A assessment using the Matthews Youth Test for Health (MYTH). Two hundred and ten teachers and student teachers read vignettes describing the behavior of children reacting to challenges in a school environment. Teachers were randomly assigned to one of four vignettes: (1) male Type A child; (2) female Type A child; (3) male Type B child; (4) female Type B child. Higher MYTH scores were assigned to Type A compared with Type B children. However, among Type A children, male teachers assigned significantly lower MYTH scores to girls than to boys; the MYTH ratings made by female teachers for Type A children were equivalent for boys and girls. These results suggest that the sex of the child and the teacher interact significantly to influence aspects of Type A assessment, but that classification overall reflects observed behavior.     

A reexamination of a childhood cancer stereotype

OBJECTIVE: To examine whether young adults have stereotypical beliefs toward children who have been treated for cancer. METHODS: Undergraduate participants read a vignette describing a child labeled either healthy (HL), in remission from cancer and no longer undergoing treatment (RCL), or in remission and still undergoing treatment (RCTL) and rated the child on the Ratings of the Child Questionnaire (ROCQ). Univariate and multivariate analyses of variance were conducted. RESULTS: Participants rated the HL child more positively than the RCL or RCTL child; the RCL and RCTL child ratings did not differ. Females evaluated the child more positively than did males. CONCLUSIONS: These results support previous findings of a childhood cancer stereotype. However, effect sizes were small, which may indicate a weak stereotype with these specific participants.     

Risk for minor childhood injury: an investigation of maternal and child factors

OBJECTIVE: To examine how maternal and child characteristics interact to moderate injury rate and injury severity for young children. METHODS: In this study, 149 mothers reported their toddlers' injuries over a 6-month period during biweekly interviews. Mothers completed questionnaires assessing parenting behaviors, psychological characteristics, and their children's injury-relevant behaviors. RESULTS: Maternal locus of control was found to moderate the association between children's risky behavior and child injury rate. Specifically, an external locus of control was associated with increased child injury rate for high-risk but not for low-risk children. CONCLUSION: These findings illuminate the potential importance of parental locus of control in moderating high-risk injury-relevant behavior.     

The use of focus group interviews in pediatric health care research.

OBJECTIVE: To review and synethize the research material on focus groups with children and adolescents and to provide guidelines for future development. METHODS: Psychlit, Medline, and Cinahl electronic databases, as well as the reference lists of those articles consulted, were reviewed for information regarding focus groups with participants under the age of 18 years. Both empirical and methodological articles were part of this review. RESULTS: We review the utility of focus groups for exploratory research, program evaluation, program development, and questionnaire construction or adaptation. Based on previous research, we provide guidelines for focus groups with children and adolescents and outline suggestions for future development. CONCLUSIONS: There is evidence to suggest that focus groups are a valuable means of eliciting children's views on health-related matters, given an appropriate research question. However, empirical research is required in order to investigate systematically the effect of different processes and variables on the final outcome of focus group interviews.     

Problem Solving and Diabetes Regiman Adherence by Children and Adolescents with IDDM in Social Pressure Situations: A Reflection of Normal Development

Investigated problem-solving ability and reported regimen adherenceamong children, early adolescents, and middle adolescents withIDDM in response to hypothetical social situations where a choicebetween diabetes regimen adherence and peer desires must bemade. Sixty–seven 8–to 17–year-olds with IDDMfrom two distinct U.S. geographical areas participated. Resultsindicated that compared to children with IDDM, adolescents withIDDM had better problem-solving abilities in response to socialpressure situations, possibly reflecting their greater cognitivematurity. However, adolescents were also more likely to choosebehaviors that are regimen adherent. Differences in levels ofproblem-solving ability and adherence between the two regionalsubsamples were also found. Similar developmental petterns weerfounde in both groups, showing the robust nature of the observedage-related trent of decreasing adherence in the contxt of normaladolescent development. Result are conceptually important forthose interested in the transaction between peer and socialinfluences and adherence for children and adolescents with IDDM,as other health behavoirs