Event-related brain potentials (ERPs) were used
to investigate how and when a semantic factor (animacy)
affects the early analysis of a difficult syntactic structure,
namely, object relative ...sentences. We contrasted electrophysiological
and behavioral responses to two object relative types that
were syntactically and lexically identical and varied only
in the order of the component animate and inanimate nouns
Inanimate (Animate) vs. Animate (Inanimate).
ERPs were recorded from 40 subjects to each word of 30
I(A) and 30 A(I) sentences that occurred randomly among
a set of various other sentence types read for comprehension.
ERP effects to the early noun animacy manipulation were
observed beginning with the initial noun and extending
past the main clause verbs. We interpret the timing and
multitude of electrophysiological effects, including the
N400, P600, and left-anterior negativity, as evidence that
both semantic and syntactic, and perhaps other types of
information, are used early during structural analysis
and message-level computations as needed for comprehension.
To evaluate the feasibility of the San Diego Attention-Deficit/Hyperactivity Disorder Project (SANDAP) protocol, a pediatric community-initiated quality improvement effort to foster implementation of ...the American Academy of Pediatrics (AAP) attention-deficit/hyperactivity disorder (ADHD) diagnostic guidelines, and to identify any additional barriers to providing evidence-based ADHD evaluative care.
Seven research-naïve primary care offices in the San Diego area were recruited to participate. Offices were trained in the SANDAP protocol, which included 1) physician education, 2) a standardized assessment packet for parents and teachers, 3) an ADHD coordinator to assist in collection and collation of the assessment packet components, 4) educational materials for clinicians, parents, and teachers, in the form of handouts and a website, and 5) flowcharts delineating local paths for referral to medical subspecialists, mental health practitioners, and school-based professionals. The assessment packet included the parent and teacher versions of the Vanderbilt ADHD Diagnostic Rating Scales. In this study, we chose a conservative interpretation of the AAP ADHD guidelines for diagnosing ADHD, requiring that a child met criteria for ADHD on both the parent and teacher rating scales. A mixed-method analytic strategy was used to address feasibility and barriers, including quantitative surveys with parents and teachers and qualitative debriefing sessions conducted an average of 3 times per year with pediatricians and office staff members.
Between December 2000 and April 2003, 159 children were consecutively enrolled for evaluation of school and/or behavioral problems. Clinically, only 44% of the children met criteria for ADHD on both the parent and teacher scales, and 73.5% of those children were categorized as having the combined subtype. More than 40% of the subjects demonstrated discrepant results on the Vanderbilt scales, with only the parent or teacher endorsing sufficient symptoms to meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Other mental health and learning problems were common in the sample; 58.5% of subjects met screening criteria for oppositional defiant disorder/conduct disorder, 32.7% met screening criteria for anxiety/depression, and approximately one-third had an active individualized education program in place or had received an individualized education program in the past. On evaluation, the SANDAP protocol was acceptable and feasible for all stakeholders. However, additional barriers to implementing the AAP ADHD guidelines were identified, including 1) limited information in the guidelines regarding the use of specific ADHD rating scales, the evaluation and treatment of children with discrepant and/or negative results, and the indications for psychologic evaluation of learning problems, 2) families' need for education regarding ADHD and support, 3) characteristics of physical health and mental health plans that limited care for children with ADHD, and 4) limited knowledge and use of potential community resources.
Our results indicate that children presenting for evaluation of possible ADHD in primary care offices have complex clinical characteristics. Providers need mechanisms for implementing the ADHD diagnostic guidelines that address the physician education and delivery system design aspects of care that were developed in the SANDAP protocol. Additional barriers were also identified. Careful attention to these factors will be necessary to ensure the sustained provision of quality care for children with ADHD in primary care settings.
Pediatric bipolar mood disorder Weckerly, Jill
Journal of developmental and behavioral pediatrics,
02/2002, Letnik:
23, Številka:
1
Journal Article
Recenzirano
The diagnosis of bipolar mood disorder (BP) in preadolescents (pediatric mania) has generated considerable controversy in terms of its estimated prevalence and validity as a diagnostic category. The ...relative paucity of systematic studies and the current diagnostic confusion related to the disorder are often attributed to the apparent discontinuities in the childhood versus adult presentation of the illness, namely, irritability as the predominant "mood" of mania and a continuous course of symptoms. The goal of this article is to review the current literature and identify sources of confusion relating to pediatric mania by considering results to date within a larger context that include findings from studies on (1) BP illness in adults, (2) mood disorders across the lifespan, (3) the role of development in symptom expression, and (4) patterns of heritability in psychiatric disorders. Whereas much remains to be investigated in the validation of the diagnosis for children, integrating results across studies may provide a framework for understanding the differences in the presentation of severe mood disorders in children and adults.
To investigate rates of psychotropic medication use by youths served in public service sectors as a function of race/ethnicity.
Logistic regression models were used to examine racial/ethnic ...differences in caregiver report of psychotropic medication use for a random stratified sample of 1,342 children who were served in public service sectors during the second half of fiscal year 1996-97.
Race/ethnicity predicted caregiver report of past-year and lifetime psychotropic medication use when all other factors were held constant. Specifically, caregivers of African-American and Latino children were less likely to report past-year use compared to white children; caregivers of Latino children and "others" were less likely to report lifetime use. Additional factors predictive of medication use in regression models included younger age, male gender, higher household income, insurance type, active to mental health sector at time of enumeration into the study, impairment and diagnosis of mood, and anxiety or attentional disorder.
Racial/ethnic differences in use of psychotropic medication occur in children served in public service sectors and need to be considered in clinical diagnosis and treatment.
We examined the development of some features of morphosyntactic ability, specifically the acquisition of auxiliaries and use of agreement marking, along with sentence processing capacity. We used a ...conceptually simple task called the Tags Question Task, which is a method for evaluating a number of language processes in the production of a commonly used, familiar linguistic device. We compared the performance of children with early focal lesions (
N=21), children with specific-language impairment (
N=24), and typically developing children (
N=24) matched in age and nonverbal ability; additional analyses involved comparisons of children matched on performance level. The data converge to support a “delayed” development of language behavior in our clinical groups, as overall patterns of performance and age-related changes on individual tag features and tag questions were strikingly similar in all three groups across a number of methods of comparison. Implications for theories of the development of brain–language relationships as they pertain to early focal brain damage, specific-language impairment, and the language acquisition process in typically developing children are discussed.
This study examined aspects of verbal fluency performance of children with Specific Language Impairment (SLI) and typically developing children matched on age and Block Design scores. While children ...with SLI showed deficits in verbal fluency compared to their peers, they showed the same pattern of performance on phonemic compared to semantic fluency trials. Children with SLI and normally developing children also demonstrated equivalent rates of clustering and switching, measures hypothesized to reflect aspects of frontal lobe functioning, when the overall number of exemplars was taken into account. The absence of a condition by group effect supports general processing limitation accounts of SLI, while the absence of group differences on cluster size and switches supports language-based processing accounts of SLI.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To determine if the American Academy of Pediatrics Attention-Deficit/Hyperactivity Disorder (ADHD) guidelines require tailoring for different settings, the researchers used a mixed-method research ...design to review an ADHD quality improvement effort in community clinics and private offices in San Diego County. Clinically, no differences were noted in rates of ADHD in the two settings. Children in community clinics (58.3%) were more likely to report public insurance (p<.001), diverse ethnic backgrounds (p=.003), low household incomes (p<.001), single parent households (p=.009), and to screen positive for Oppositional Defiant Disorder/Conduct Disorder (p=.027). They were also more likely to have experienced socio-environmental stressors (p<.001) including foster care, homelessness, parental drug use, and domestic violence. No differences were noted by treatment received at 12 months post-evaluation by office type. Open-ended interviews with clinicians confirmed these findings and revealed a need for tailoring of implementation strategies to more closely fit the needs of children and families cared for in public sector settings.
Semantically associated and unassociated word pairs were embedded in normal meaningful sentences and in sentences that were semantically anomalous throughout. The influence of lexical context was ...isolated via comparison of responses to the second words of the associated and unassociated pairs. The influence of sentence-level context was isolated by comparing responses to the same words in the two sentence types. Subjects of high, medium, and low working memory capacity (as evaluated by the reading span test) showed modulations of event-related brain potentials in response to lexical context. In contrast, only the high- and medium-capacity groups were responsive to purely sentence-level semantic context. The results demonstrate that sentential context influences the processing of words in intermediate sentence positions at normal reading speeds, but that the on-line utilization of this context is more demanding of working memory than single-word contexts.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, FSPLJ, IZUM, KILJ, NMLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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