The impact of adverse childhood experiences on obesity and unhealthy weight control behaviors among adolescents

BackgroundChildhood abuse and other early-life stressors associate with being overweight or obese later in life. In addition to being overweight, unhealthy weight control behaviors (e.g., vomiting, using diet pills, fasting, and skipping meals) have been shown to be common among adolescents. To our knowledge, the association between these behaviors and adverse childhood experiences (ACEs) remains unexamined.MethodsWe examined the association of ACEs to body mass index (BMI) and unhealthy weight control behaviors among 449 Finnish adolescents aged 12 to 17 years admitted to an acute psychiatric hospital unit between April 2001 and March 2006. We used the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) and the European Addiction Severity Index (EuropASI) to obtain information about ACEs, psychiatric diagnoses and weight control behaviors. BMI was calculated using the weight and height measured for each adolescent upon admission.ResultsGirls who experienced sexual abuse were more likely to be obese (OR: 2.6; 95% CI: 1.1–6.4) and demonstrate extreme weight loss behaviors (EWLB) (OR: 2.2; 95% CI: 1.0–4.7). Among girls, parental unemployment is associated with an increased likelihood of obesity (OR: 3.5; 95% CI: 1.2–9.6) and of being underweight (OR: 3.6; 95% CI: 1.1–11.6). A proneness for excessively exercising was found among girls who had witnessed domestic violence (OR: 3.5; 95% CI: 1.4–9.2) and whose parent(s) had died (OR: 5.4; 95% CI: 1.1–27.7).ConclusionThis study showed that female adolescents with a history of traumatic experiences or difficult family circumstances exhibited an elevated likelihood of being obese and engaging in unhealthy weight control behaviors.     

The relationship between atypical visual processing and social skills in young children with autism

The present study examined whether atypical visual processing is related to the level of social skills in children with autism spectrum disorder (ASD). Thirty-eight young children with ASD (29 boys, 9 girls) were included. Atypical visual processing was assessed by coding the number of lateral glances and the amount of object grouping behavior on videotaped observations of the ADOS (aged 35 ± 9 months). The level of social skills was measured using the subscale interpersonal relationships of the Vineland SEEC (32 ± 7 months). A negative relationship with a medium effect size was found between lateral glances and interpersonal relationships. Object grouping behavior and interpersonal relationships were not related. This study suggests that visual perception may be a mechanism in the development of interpersonal relationships in ASD, which is in accordance with an embodied approach to social cognition.     

Epilepsy-related clinical factors and psychosocial functions in pediatric epilepsy

PurposeThe aim of this study was to identify the different influencing patterns of demographic and epilepsy-related variables on various aspects of psychosocial function in pediatric epilepsy.MethodFive hundred ninety-eight patients with pediatric epilepsy between the ages of 4 and 18 years (boys = 360, 60% and girls = 238, 40%) and their parents participated in the study. Parents completed the Social Maturity Scale (SMS), the Korean version of the Child Behavior Checklist (K-CBCL), and the Korean version of the Quality of Life in Childhood Epilepsy Questionnaire (K-QOLCE) to assess daily living function, behavior, and quality of life. The Children's Global Assessment Scale (CGAS) was completed by clinicians to assess general adaptive function. Demographic variables, such as age and sex of child, and epilepsy-related clinical variables, including seizure type, seizure frequency, duration of epilepsy, and number of medications, were obtained from medical records.ResultsDemographic and epilepsy-related clinical variables had a strong influence (22–32%) on the cognition-related domain such as general adaptive function, school/total competence, and quality of life for cognitive function while a comparatively smaller effect (2–16%) on the more psychological domain including behavioral, emotional, and social variables. Younger age, shorter duration of illness, and smaller number of medications showed a strong positive impact on psychosocial function in pediatric epilepsy, particularly for adaptive function, competence, and quality-of-life aspects.ConclusionGiven the wide range of impact of demographic and clinical variables on various facets of psychosocial functions, more specific understanding of the various aspects of factors and their particular pattern of influence may enable more effective therapeutic approaches that address both the medical and psychological needs in pediatric epilepsy.     

“They silently live in terror…” why sleep problems and night-time related quality-of-life are missed in children with a fetal alcohol spectrum disorder

Children and adolescents with a Fetal Alcohol Spectrum Disorder (FASD) are at high-risk for developing sleep problems (SPs) triggering daytime behavioral co-morbidities such as inattention, hyperactivity, and cognitive and emotional impairments. However, symptoms of sleep deprivation are solely associated with typical daytime diagnosis, such as attention deficit hyperactivity disorder (ADHD) and treated with psychotropic medications. To understand how and why SPs are missed, we conducted qualitative interviews (QIs) with six parents and seven health care professionals (HCPs), and performed comprehensive clinical sleep assessments (CCSAs) in 27 patients together with their caregivers referred to our clinic for unresolved SPs. We used narrative schema and therapeutic emplotment in conjunction with analyzes of medical records to appropriately diagnose SPs and develop treatment strategies. The research was conducted at British Columbia Children's Hospital in Vancouver (Canada) between 2008 and 2011. In the QIs, parents and HCPs exhibited awareness of the significance of SPs and the effects of an SP on the daytime behaviors of the child and the associated burdens on the parents. HCPs' systemic inattention to the sequelae of SPs and the affected family's wellbeing appears due to an insufficient understanding of the various factors that contribute to nighttime SPs and their daytime sequelae. In the CCSAs, we found that the diagnostic recognition of chronic SPs in children and adolescents was impaired by the exclusive focus on daytime presentations. Daytime behavioral and emotional problems were targets of pharmacological treatment rather than the underlying SP. Consequently, SPs were also targeted with medications, without investigating the underlying problem. Our study highlights deficits in the diagnostic recognition of chronic SPs among children with chronic neurodevelopmental disorders/disabilities and proposes a clinical practice strategy, based on therapeutic emplotment that incorporates patients and parents' contributions in recognizing SPs and related sequelae in designing appropriate treatment and care.     

Individual and family factors associated with self-esteem in young people with epilepsy: A multiple mediation analysis

ObjectiveAs young people experience added demands from living with epilepsy, which may lead to poor psychosocial adjustment, it is essential to examine mechanisms of change to provide practitioners with knowledge to develop effective interventions. The aim of this study was to examine individual and family-level factors – stress and illness perceptions, coping behaviors and family resilience – that promote or maintain young people's self-esteem.MethodsFrom November 2013 to August 2014, young people attending a neurology clinic in KK Women's and Children's Hospital, Singapore, participated in a cross-sectional survey (n = 152; 13–16 years old). Multiple mediation analyses were conducted to evaluate whether these variables mediated the relationship between illness severity (i.e., low, moderate, high) and self-esteem.ResultsMultiple mediation analyses demonstrated that illness severity had a direct effect on young people's self-esteem. Compared to those with moderate illness severity (reference group), young people with low severity had significantly higher self-esteem (c = 3.42, p < 0.05); while those with high severity had a more negative view of themselves (c = − 3.93, p < 0.001). Illness severity also had an indirect influence on self-esteem through its effects on mediators, such as perceived stress, illness perceptions and family resilience (D₁: Total ab = 3.46, 95% CI 1.13, 5.71; D₂: Total ab = − 2.80, 95% CI − 4.35, − 1.30). However, young people's coping levels did not predict their self-esteem, when accounting for the effects of other variables.SignificanceThe continued presence of seizure occurrences is likely to place greater demands on young people and their families: in turn, increased stress and negative illness perceptions negatively affected family processes that promote resilience. As the mediating effect of these modifiable factors were above and beyond the contributions of illness characteristics and young people's levels of coping, this has implications for developing individual and family interventions aimed to support young people living with epilepsy.     

Tone as a health concept: An analysis

Study designConcept analysis.IntroductionThis paper is a report on the analysis of the concept of tone in chiropractic.PurposeThe purpose of this paper is to clarify the concept of tone as originally understood by Daniel David Palmer from 1895 to 1914 and to monitor its evolution over time.MethodsData was sourced from Palmer's original work, published between 1895 and 1914. A literature search from 1980 to 2016 was also performed on the online databases CINHAL, PubMed and Scopus with key terms including ‘tone’, ‘chiropractic’, ‘Palmer’, ‘vitalism’, ‘health’, ‘homeostasis’, ‘holism’ and ‘wellness’. Finally hand-searches were conducted through chiropractic books and professional literature from 1906 to 1980 for any references to ‘tone’. Rodgers' evolutionary method of analysis was used to categorise the data in relation to the surrogates, attributes, references, antecedents and consequences of tone.ResultsA total of 49 references were found: five from publications by Palmer; three from the database searches, and; the remaining 41 from professional books, trade journals and websites.Major conclusionsThere is no clear interpretation of tone in the contemporary chiropractic literature. Tone is closely aligned with functional neurology and can be understood as an interface between the metaphysical and the biomedical. Using the concept of tone as a foundation for practice could strengthen the identity of the chiropractic profession.