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Biomedical subjects

D V Cicchetti

Publications and source records attributed to D V Cicchetti.

At least 37 records · Page 2Linked to original sources
PubMed1996

Improving participation and interrater agreement in scoring Ambulatory Pediatric Association abstracts. How well have we succeeded?

OBJECTIVE: To determine whether increasing the number and types of raters affected interrater agreement in scoring abstracts submitted to the Ambulatory Pediatric Association. METHODS: In 1990, all abstracts were rated by each of the 11 members of the board of directors of the Ambulatory Pediatric Association. In 1995, abstracts were reviewed by four to five raters, including eight members of the board of directors, two chairpersons of special interest groups, and 10 regional chairpersons, for a total of 20 potential reviewers. Submissions were divided into the following three categories for review: emergency medicine, behavioral pediatrics, and general pediatrics. Weighted percentage agreement and weighted kappa scores were computed for 1990 and 1995 abstract scores. RESULTS: Between 1990 and 1995, the number of abstracts submitted to the Ambulatory Pediatric Association increased from 246 to 407, the number of reviewers increased from 11 to 20, the weighted percentage agreement between raters remained approximately 79%, and weighted kappa scores remained less than 0.25. Agreement was not significantly better for the emergency medicine and behavioral pediatrics abstracts than for general pediatrics, nor was it better for the raters who reviewed fewer abstracts than those who reviewed many. CONCLUSIONS: The number and expertise of those rating abstracts increased from 1990 to 1995. However, interrater agreement did not change and remained low. Further efforts are needed to improve the interrater agreement.

Abstracting and Indexing↗
PubMed1996

Preoperative anxiety in children. Predictors and outcomes.

OBJECTIVE: To determine predictors and behavioral outcomes of preoperative anxiety in children undergoing surgery. DESIGN: A prospective, longitudinal study. SETTING: A university children's hospital. PARTICIPANTS: One hundred sixty-three children, 2 to 10 years of age (and their parents), who underwent general anesthesia and elective surgery. MAIN OUTCOME MEASURES: In the preoperative holding area, anxiety level of the child and parents was determined using self-reported and independent observational measures. At separation to the operating room, the anxiety level of the child and parents was rated again. Postoperative behavioral responses were evaluated 3 times (at 2 weeks, 6 months, and 1 year). RESULTS: A multiple regression model (R2 = 0.58, F = 6.4, P = .007) revealed that older children and children of anxious parents, who received low Emotionality, Activity, Sociability, and Impulsivity (EASI) ratings for activity, and with a history of poor-quality medical encounters demonstrated higher levels of anxiety in the preoperative holding area. A similar model (R2 = 0.42, F = 8.6, P = .001) revealed that children who received low EASI ratings for activity, with a previous hospitalization, who were not enrolled in day care, and who did not undergo premedication were more anxious at separation to the operating room. Overall, 54% of children exhibited some negative behavioral responses at the 2-week follow-up. Twenty percent of the children continued to demonstrate negative behavior changes at 6-month follow-up, and, in 7.3% of the children, these behaviors persisted at 1-year follow-up. Nightmares, separation anxiety, eating problems, and increased fear of physicians were the most common problems at 2-week follow-up. Multivariate analysis demonstrated that child's age, number of siblings, and immediate preoperative anxiety of the child and mother predicted later behavioral problems. CONCLUSIONS: Variables such as situational anxiety of the mother, temperament of the child, age of the child, and quality of previous medical encounters predict a child's preoperative anxiety. Although immediate negative behavioral responses develop in a relatively large number of young children following surgery, the magnitude of these changes is limited, and long-term maladaptive behavioral responses develop in only a small minority.

Age Distribution↗
PubMed1996

Test-retest reliability for false-belief tasks.

Despite notable variations in children's rate of success on theory of mind tasks and the presumed theoretical implications drawn from a child's success or failure on such tasks, there have been no studies of the test-retest reliability of children's performance on these tasks. Twenty-three children (mean age 49.6 months, SD 8.6) watched three videotaped stories illustrating a false-belief situation: the standard experimenter narrated false-belief task, a minor variant replacing the narration of the story with a dialogue among the characters, and a third version involving a humorous situation. The time elapsed between test and retest was 2-3 weeks and the order of presentation was counterbalanced. Results corroborated previous findings of a developmental trend in the understanding of false-belief questions but, despite a general improvement in children's comprehension of the stories, the test-retest reliability for the false belief questions was poor. Although changes recorded between test-retest sessions frequently occurred in the direction of children answering correctly questions they had previously failed, a subset of children incorrectly answered questions they had initially passed. These findings underscore the need for validation assessments of techniques for studying children's developing theories of mind.

Child↗
PubMed1996

Children's understanding of the symptoms of AIDS.

Symptoms are the outward manifestations that allow children to identify and recognize illness; children's understanding of the symptoms of an illness may be directly related to their understanding of its cause or means of transmission. This study is the first empirical investigation of children's conceptual understanding and factual knowledge of the symptoms of AIDS. Children (N = 361; grades K to 6; 57% black, 24% Hispanic, 19% white; 52% female) attending four public schools in New Haven, Connecticut, were interviewed using a standardized semistructured interview (ASK, AIDS Survey for Kids) that included open-ended questions about the symptoms of AIDS and, for comparison, cancer and colds. Responses were scored for level of conceptual understanding and coded for factual content. For each illness, grade level was the variable most strongly correlated with symptomatology concept score (R = .42-.48, p < .0001) and contributed significantly (p < .0001) to the variance observed in concept score even after controlling for race, gender, verbal fluency, and socioeconomic status. The mean concept score was lower (p < .01) for symptomatology of AIDS (2.8 of possible 5) than for cancer (3.1) or colds (3.9). In addition, far more symptoms were named for colds than for either cancer or AIDS. Children who believed that HIV is spread via each of five potential means of transmission by casual contact were more likely (p < 01) to cite cold symptoms as symptoms of AIDS. We conclude that there exists a developmental progression in children's understanding of the symptomatology of AIDS. Children have a less sophisticated conceptual understanding and narrower factual knowledge base for AIDS than for colds and therefore have the capability to increase their understanding and knowledge about AIDS. Furthermore, improving children's understanding of the symptoms of AIDS may diminish misconceptions about transmission of HIV via casual contact.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Screening for lead poisoning by fingerstick in suburban pediatric practices.

OBJECTIVE: To assess the false-positive rate of blood lead determinations on samples obtained by fingerstick from children screened in private suburban and rural practices. METHODS: Screening capillary lead samples were obtained by fingerstick; children with capillary lead levels of 0.7 mumol/L (15 micrograms/dL) or greater were recalled for a confirmatory venous lead test that served as the criterion standard. Parents completed a five-question risk assessment questionnaire at the time of initial screening. SETTING: Four private suburban to rural practices that serve predominantly white, middle-class populations. PARTICIPANTS: Children seen for routine care between August 1992 and February 1993 (N = 1085; 98% between 6 months and 6 years of age). RESULTS: Capillary lead level was 0.7 mumol/L (15 micrograms/dL) or greater in 35 children (3% of total sample); venous lead samples were obtained in 30 patients. Nine of the elevated capillary lead results were true-positives (venous lead = 0.7, 0.8, 0.8, 0.9, 0.9, 0.9, 1.1, 1.1, and 1.7 mumol/L [15, 17, 17, 18, 18, 18, 22, 22, and 35 micrograms/dL]); parents of only two of these children answered yes to any question on the risk assessment questionnaire. Although the false-positive rate of the capillary lead screening test was 70% (21/30) in this setting, only 2% of the total sample had a false-positive screening test (an average of fewer than one false-positive per month per practice). Screening by fingerstick allowed phlebotomy to be avoided for 97% of the children. CONCLUSION: Fingerstick screening for lead poisoning is a reasonable alternative to direct venous testing within private suburban and rural practices, provided that care is taken to avoid specimen contamination, that appropriate caution is used in the interpretation of screening test results, and that medical and environmental interventions are based on the results of confirmatory venous testing.

Blood Specimen Collection↗
PubMed1995

Validity and neuropsychological characterization of Asperger syndrome: convergence with nonverbal learning disabilities syndrome.

The authors investigated the validity of Asperger Syndrome (AS) by comparing the neuropsychological profiles in this condition and Higher-Functioning Autism (HFA). Diagnostic assignment followed a stringent procedure based on ICD-10 research criteria for the two disorders. The groups had comparable age and Full Scale IQ distributions. The groups differed significantly in 11 neuropsychological areas. The profile obtained for individuals with AS coincided closely with a cluster of neuropsychological assets and deficits captured by the term nonverbal learning disabilities, suggesting an empirical distinction from HFA.

Adolescent↗
PubMed1995

A randomized, controlled trial of a school-based, multi-faceted AIDS education program in the elementary grades: the impact on comprehension, knowledge and fears.

OBJECTIVE: Several educational theorists have suggested that young children are unlikely to benefit from detailed instruction regarding AIDS prevention because of inherent developmental cognitive limitations. This study aims to determine whether AIDS education in the elementary grades can advance young children's understanding of this illness. METHODS: A randomized, controlled trial was used to measure the impact of a 3-week, multifaceted AIDS education program on conceptual understanding, factual knowledge, and fears about AIDS in 189 students in grades kindergarten through 6th. The ASK (AIDS Survey for Kids), a standardized, semistructured interview that measures conceptual understanding, factual information, and fears about AIDS, was administered before and after the intervention. RESULTS: Children in the intervention group, as compared to those in the control group, showed significant (P < .0001) gains in their level of understanding of the concepts of causality and prevention of AIDS. These results were unaffected by controlling for grade, gender, race, socioeconomic status, and verbal fluency. The gains in children's understanding of causality of AIDS represented at least 2 years' growth in the level of conceptual sophistication and persisted at a follow-up evaluation several months later. After the intervention, more children (P < .001) in the intervention group than in the control group accurately identified causes of AIDS in response to open-ended questions: germ/germ theory (41% vs 13%), mother-to-infant transmission (54% vs 15%), blood transmission (83% vs 40%), and sexual transmission (56% vs 30%). Fewer than half as many children in the intervention group responded incorrectly to each of five direct questions about transmission of HIV through casual contact. The intervention did not increase children's fears about the illness. CONCLUSIONS: A short, developmentally based, multifaceted AIDS education program in the elementary grades can advance children's conceptual understanding and factual knowledge about AIDS and decrease their misconceptions about casual contact as a means of acquiring the illness, without increasing their fears. Significant advances in conceptual understanding about AIDS can be achieved through direct educational interventions.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The accuracy of children's reports with anatomically correct dolls.

The accuracy of children's reports of alleged sexual abuse during interviews with anatomically correct dolls is the focus of considerable controversy. This study used an analog experience to measure empirically the accuracy of reports in a relevant, but controlled setting: the forensic medical examination for suspected sexual abuse. Twenty-one 3- to 7-year-old children were interviewed about what occurred during previous examinations with open-ended questions, open-ended questions with anatomically correct dolls, and direct questions with the dolls. Children provided significantly more accurate reports and fewer omissions with direct questions using the dolls compared with either of the two open-ended sections, but there was no significant difference in the number of false reports across the three sections of the interview. These results suggest that anatomically correct dolls may bolster the recall of children's memory in the setting of direct questions without prompting false reports.

Anatomy↗
PubMed1994

Multiple comparison methods: establishing guidelines for their valid application in neuropsychological research.

This comment serves to provide a rationale for research clinical neuropsychologists to decide: (1) under what conditions multiple comparison methods are required; and (2) what specific guidelines can be used to distinguish conditions favoring a given multiple comparison technique over its competitors. The topic is discussed both for the parametric and nonparametric case, as well as for post hoc tests following both statistically significant main effects and interactions.

Analysis of Variance↗
PubMed1994

Re-examining threats to the reliability and validity of putative brain-behavior relationships: new guidelines for assessing the effect of patients lost to follow-up.

It often happens in behavioral and biomedical research that subjects in prospective, multiple assessment investigations, including clinical trials, are lost to follow-up evaluations. The purpose of this report is to outline a model that will enable the investigators to determine the extent to which results based upon the maintained cohort can be generalized to the attrited cohort, or those subjects lost to follow-up. While our proposed model derives from a specific application pertaining to changes in personality and affect behaviors following left and right hemisphere stroke, it should apply, with appropriate study-specific modifications, to a wide range of follow-up research designs in neuropsychology, behavioral science more generally, and other areas of biomedical research.

Bias↗
PubMed1994

Field trial for autistic disorder in DSM-IV.

OBJECTIVE: This project focused on the development of the definition of autism for DSM-IV. METHOD: Multiple sites were involved in obtaining information regarding 977 patients with the following clinician-assigned diagnoses: autism (N = 454), other pervasive developmental disorders (N = 240), and other disorders (N = 283). A standard coding system was used, and the raters (N = 125) had a range of experience in the diagnosis of autism. Patterns of agreement among existing diagnostic systems were examined, as was the rationale for inclusion of other disorders within the class of pervasive developmental disorders. RESULTS: The DSM-III-R definition of autism was found to be overly broad. The proposed ICD-10 definition most closely approximated the clinicians' diagnoses. Inclusion of other disorders within pervasive developmental disorders appeared justified. Partly on the basis of these data, modifications in the ICD-10 definition were made; this and the DSM-IV definition are conceptually identical. CONCLUSIONS: The resulting convergence of the DSM-IV and ICD-10 systems should facilitate both research and clinical service.

Age of Onset↗
PubMed1994

Screening for lead poisoning in an urban pediatric clinic using samples obtained by fingerstick.

OBJECTIVE: To assess the false positive rate of blood lead (BPb) determinations on samples obtained by fingerstick from children screened in an urban clinic. METHOD: From a single fingerstick (N = 1573), blood was collected in a capillary tube for determining lead concentration (CPb) by graphite furnace and an additional sample was absorbed onto a filter paper for determining lead concentration (FPb) by atomic absorption spectrophotometry with Delves cup. Zinc protoporphyrin (ZPP) was measured immediately and a confirmatory venous lead (VPb) specimen was obtained at the same visit if the ZPP was > or = 35 micrograms/dL (0.6 mumol/L); children with either a CPb or FPb > or = 15 micrograms/dL (0.7 mumol/L) were later recalled for determining VPb. RESULTS: For the 172 children who had a VPb on the same day as the screening tests, the false positive rates (95% confidence intervals) at a lead threshold of 15 micrograms/dL (0.7 mumol/L) were: CPb, 13.5% (6.7-20.3); FPb, 19.1% (11.8-26.4). Analyses using all 679 screens with a paired venous specimen (mean delay between screen and venous testing = 30 days) yielded much higher false positive rates (CPb, 31.3%; FPb, 46.0%). CONCLUSIONS: Screening for lead poisoning is feasible within an urban pediatric clinic by direct measurement of lead concentration in blood samples obtained by fingerstick. The false positive rate that can be obtained is acceptable given the precision of measuring BPb concentration. Practitioners using a staged screening protocol may incorrectly attribute a higher false positive rate to the screening tests, when much of the error may be due to the temporal variability of BPb resulting from both biologic variability in BPb concentration and intermittent exposures.

Child↗
PubMed1993

Quantifying social development in autism.

OBJECTIVE: This study was concerned with the development of quantitative measures of social development in autism. METHOD: Multiple regression equations predicting social, communicative, and daily living skills on the Vineland Adaptive Behavior Scales were derived from a large, normative sample and applied to groups of autistic and nonautistic, developmentally disordered children. Predictive models included either mental or chronological age and other relevant variables. RESULTS: Social skills in the autistic group were more than two standard deviations below those predicted by their mental age; an index derived from the ratio of actual to predicted social skills correctly classified 94% of the autistic and 92% of the nonautistic, developmentally disordered cases. CONCLUSIONS: The findings are consistent with the idea that social disturbance is central in the definition of autism. The approach used in this study has potential advantages for providing more precise measures of social development in autism.

Adolescent↗
PubMed1993

Understanding of acquired immunodeficiency syndrome by elementary school children--a developmental survey.

OBJECTIVES: The developmental process by which young children acquire an understanding of the concepts of causality, treatment, and prevention of illness as related to acquired immunodeficiency syndrome (AIDS) is poorly understood. Previous studies have focused on adolescent populations and have measured the facts that children seem to know rather than their understanding of relevant concepts. Such approaches are likely to overestimate the child's true level of understanding and obscure significant misconceptions. The aims of this project are to measure directly the level of understanding of the concepts of causality, treatment, and prevention of AIDS in healthy, elementary school children and to assess the sociodemographic variables associated with their conceptual understanding. METHODS: Using a new, developmentally based, semistructured interview protocol (ASK, AIDS Survey for Kids), 361 children (57% black, 24% Hispanic, 19% white) in kindergarten through sixth grade at four public schools in New Haven, CT were interviewed. Responses to questions about causality, treatment, and prevention were scored for each of three illnesses (AIDS, and for comparison, colds and cancer) based on the level of conceptual sophistication of the response, irrespective of its factual accuracy. RESULTS: Scores for each of the concepts were highly intercorrelated and were correlated most strongly with grade level (R = .31 to .50, P < .0001 for each of these correlations, with the exception of the treatment of AIDS). Gender, race, and socioeconomic status did not contribute significantly to the variance observed for any of the concept scores in a linear regression model. Over-all, children's level of understanding of causality was significantly less sophisticated for AIDS than for colds (P < .0001); their level of conceptual understanding for the causality of AIDS was not significantly different from that of cancer (P = .9). CONCLUSIONS: Children's understanding of causality, treatment, and prevention of AIDS, as measured by the ASK, follows the same developmental sequence reported for children's understanding of general physical illness. Sociodemographic variables, such as race, gender, and socioeconomic status do not affect children's level of sophistication of these developmental concepts. These results have implications for the creation of developmentally appropriate and effective AIDS education curricula for primary and elementary grades. They also offer guidance to health care providers in their efforts to educate parents and young children about this important topic.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Three diagnostic systems for autism: DSM-III, DSM-III-R, and ICD-10.

ICD-10 draft research criteria for childhood autism were applied to a previously published data set comparing DSM-III and DSM-III-R to clinicians' diagnoses of autism. The ICD-10 approach paralleled clinicians' patterns of diagnosis and, to a lesser extent, the DSM-III system. Relative to either clinicians, DSM-III, or ICD-10 the DSM-III-R system overdiagnosed the presence of autism. Implications for research and for future revision of diagnostic criteria are discussed.

Adolescent↗
PubMed1992

Assessing the reliability of clinical scales when the data have both nominal and ordinal features: proposed guidelines for neuropsychological assessments.

The purpose of this article is to present, for the first time, a comprehensive methodology for assessing the reliability of a clinical scale that is frequently utilized in neuropsychological research and in biomedical studies, more generally. The dichotomous-ordinal scale is characterized by a single category of "absence" and two or more ordinalized categories of "presence" of a symptom trait, state, or behavior, and it also has special properties that need to be understood in order for its reliability to be appropriately assessed. Using the Brief Psychiatric Rating Scale (BPRS) as a clinical example, we cover the principles of expressing scale reliability in terms of a dichotomy ("absence" - "presence" of a given BPRS symptom); as a trichotomy ("none"; "mild to moderate" symptomatology; and "severe" symptomatology); and as the full 7-category dichotomous-ordinal scale: "none," "very mild," "mild," "moderate," "moderately severe," "severe," and "extremely severe." Criteria are presented that can be used to evaluate which of these three formats produces the most reliable results. Finally, we address, with a second sample, the important issue of replication, or whether the original reliability findings generalize to other independent populations.

Adult↗