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Biomedical subjects

F Earls

Publications and source records attributed to F Earls.

At least 19 recordsLinked to original sources

Child abuse and performance task assessments of executive functions in boys.

We examined executive functions using performance tasks in 126 boys aged 6 to 16 years. who attended public schools and therapeutic schools for children with emotional and behavioral problems. Children were further grouped based on the presence or absence of substantiated abuse histories. Based on their abuse histories and schools of origin, children were classified as Therapeutic, Abused (TA, N = 25). Therapeutic, Nonabused (TN, N = 52), and Public School (PS, N = 48). Controlling IQ and medication status, we compared children in the three groups on teacher ratings of behavior, on experimenter observations of behavior during testing, and on performance tasks challenging the capacities to inhibit an act in progress, and to passively avoid responses associated with adverse consequences. We examined mean group differences in symptoms, behaviors, and task performance, as well as differential age-dependent changes in these dimensions. Independent of abuse history, therapeutic school children demonstrated comparable levels of internalizing and externalizing symptoms, and comparable levels of redirections to task during testing-sessions, that were significantly higher than those of the public school children. Both groups of therapeutic school children also showed comparable overall performance on the capacities to inhibit an act in progress, and to passively avoid responses associated with adverse consequences that were poorer than the performance of children from the public school. Children with histories of substantiated abuse showed diminished improvement with increasing age in the capacity to passively avoid responses associated with adverse consequences when compared not only to the public school children, but also to the children from the therapeutic schools without histories of abuse. Our findings complement reports of behavioral observations of abused children, and reports associating child abuse with altered cognitive development in other areas of competence. They suggest that child abuse may negatively influence the expected developmental progression of competence in certain executive functions. This in turn could have implications for the nature and the persistence of certain forms of psychopathology associated with abuse and poor self-control. Given the cross-sectional nature of our data, however, longitudinal developmental studies of the relations between child abuse and executive functions are needed to elucidate the influence of abuse on the growth and development of such organizing principles of behavioral self-regulation.

Adolescent↗

The social ecology of child health and well-being.

The term social ecology refers to the nested arrangement of family, school, neighborhood, and community contexts in which children grow up. In this chapter, new directions in public health science as reflected in the theoretical and methodological implications of the concept are explored. The contributions of this ecologically oriented approach to child health practice, designed as it is from a health promotions perspective, are considered. A critique of the term social capital is also presented because of its growing popularity in matters of child health. The point is made that application of this vague term carries the serious risk of misspecifying social phenomena. Future trends in the promotion of child well-being are in a position to flourish given the confluence of advances in theory, methods, and analytical capacity. The capacity to benefit children is also enhanced as public health science aims to translate the principles of child rights into health practice and policy.

Child↗

Trends in adolescent suicide: misclassification bias?

OBJECTIVES: This study investigated the effect of misclassification of accidental deaths and undetermined deaths on age-, sex-, and race/ethnicity-specific adolescent suicide rates from 1979 through 1994. METHODS: Official mortality data were used to present suicide mortality trends. Two estimates of misclassified suicides in other death categories were applied to calculate "corrected" trends of adolescent suicide. RESULTS: The corrected trends showed a downward adjustment for Black adolescent males and young adolescents. This result does not, however, substantially alter the trend toward a recent increase in suicide in these groups. CONCLUSIONS: Despite misclassification, the true direction of trends in adolescent suicide is reflected in recent official data. However, suicide rates should continuously be tested for misclassification, mainly in populations with proportionately high accidental and undetermined death rates.

Adolescent↗

Community factors supporting child mental Health.

A principal purpose of this article has been to examine the gap between research and practice in relation to community factors in child mental health. Two caveats were introduced in preparation for this assessment. First, it was pointed out that the definition of communities has been expanded by considering the organizing properties of social aggregates that are not simply a function of the race, ethnicity, or social class of individuals who compose them. Having these definitions grounded in theory substantially advances the needs of research and the design and goals of community-level interventions. The second caveat relates to the boundaries of the disciplines that cater to the needs of children. During the same era when child psychiatry is largely occupied with placing psychotropic medications at the center of clinical approaches, there is an important effort in child psychology and sociology to cut across their disciplinary confines to form more comprehensive designs that are sensitive to experiences and circumstances that emerge from specific aspects of community context. Research from the PHDCN was used as an example of this new interdisciplinary approach. Several community-based research projects were selected for review based on their clear implications to improve context-sensitive assessment of child mental health and design effective community-based interventions to improve child mental health. The Healthy Start and CATCH programs indicate that involving child professionals at the grassroots of community life requires skill and patience but that the effort is satisfying and potentially effective. Other examples, exemplified by North Carolina's Smart Start initiative and the program of developmental assets from the Search Institute, demonstrate coherent approaches that provide a foundation for long-term capacity building in assessment, local decision making, and the design and evaluation of interventions. Three conclusions are warranted from this discussion. The first conclusion suggests that research in child development generally, and child mental health specifically, does not incorporate the social ecology of the child is seriously flawed. There is a broad recognition within most sectors of society that the quality of civic engagement is of critical importance to community efforts to improve the health and well-being of children. This is true for all communities and families, regardless of their levels of material wealth and educational achievement. It is also well understood that poverty undermines the well-being and life chances of children. For this reason, the third conclusion requires that intensive, sustained efforts be made to eradicate poverty and reverse the current economic trend toward growing economic disparity. The implications of this knowledge for the practice of child psychiatry are not new ones. In many ways, they advocate for a re-examination of the historical roots of the field as it defined approaches to juvenile justice, school counseling, and early intellectual enrichment for economically disadvantaged preschool children. All these efforts were sensitive to children's social environment, and child psychiatrists viewed their success in taking on the challenges of changing schools, courts, and community and family environments. These challenges hardly have been overcome. The requirements of understanding and evaluating community supports for children are a fundamental component in the training and practice of child psychiatry. To quote the U.S. Surgeon General in a preamble to the recent Report on Child Mental Health: One way to ensure that our health system meets children's mental health needs is to move toward a community based health system that balances health promotion, disease prevention, early detection and universal access.

Adolescent↗

Relations of age to cognitive and motivational elements of impulse control in boys with and without externalizing behavior problems.

In a cross-sectional study of 83 unmedicated boys, 6 to 16 years of age (M = 10.6, SD = 2.1), attending public (N = 48) and therapeutic schools for behaviorally disturbed children (N = 35), we examined relations of externalizing psychopathology to age-dependent change in performance on cognitive and motivational dimensions of impulse control assessed by laboratory tasks. When we controlled for internalizing symptoms and IQ or school achievement, all children showed improving competence with increasing age on both dimensions over the age range of the sample. Children with externalizing problems performed more poorly on both dimensions at all ages than children without such problems. Comparing age-dependent competence for the two groups, a model of convergent maturation in cognitive aspects of impulse control, and a model depicting a stable deficit in motivational aspects of impulse control in those children with externalizing behavior problems, relative to those without such problems, emerged. Studies of individual growth in impulse control, together with correlates of growth, are needed to validate these observations.

Adolescent↗

Tricyclic antidepressants and cardiac autonomic control in children and adolescents.

OBJECTIVE: To elucidate the effects of tricyclic antidepressants on sympathetic and vagal modulation of heart rate variability. METHOD: Seventy-five children and adolescents (mean age 10.5 years, SD 2.0) from therapeutic and regular schools underwent challenges of paced breathing and orthostatic postural change, while heart rate was continuously recorded. Teachers completed dimensional ratings of behavior to quantity anxiety and conduct disorder. Spectral analysis of heart rate variability was utilized to decompose the postural (sympathetic) and respiratory (vagal) contributions to beat-to-beat variations in heart rate. RESULTS: Under conditions in which cardiac vagal effects were expected to predominate, subjects medicated with tricyclic antidepressants (n = 13) showed significantly reduced vagal modulation of heart rate variability (F[5,69] = 5.23, p < .003), higher heart rates (F[5,69] = 5.54, p < .002), and higher relative sympathovagal balance (F[5,69] = 5.51, p < .002) than nonmedicated (n = 42) and medicated comparison groups (n = 20), even after controlling for the effects of age and psychopathology. CONCLUSIONS: The relative loss of cardiac vagal control in young subjects medicated with tricyclic antidepressants, considered in the context of factors known to be associated with the development of tachyarrhythmias, presents as yet another risk, especially when coupled with factors such as maturational effects and psychopathology.

Adolescent↗

The adolescent with conduct disorder.

Conduct disturbances are some of the most prevalent, enduring, impairing, and costly problems of childhood and adolescence. Despite many advances in our understanding of these disorders, they still remain a problem for the individuals, families, and society alike. Large-scale, multifaceted efforts are needed within our schools and communities if we are to have an impact on the prevalence and progression of these very problematic disturbances.

Adolescent↗

Executive and motivational control of performance task behavior, and autonomic heart-rate regulation in children: physiologic validation of two-factor solution inhibitory control.

Forty-two (42) children (mean age 10.6 years) from mainstream public (N = 22) and therapeutic schools (N = 20) completed performance tasks assessing executive and motivational influences on motor responses. In a separate protocol, children underwent physiologic challenges of paced breathing and supine to standing postural change, while heart rate was continuously monitored. Executive control was associated with vagal modulation of respiratory driven, high-frequency heart-rate variability (t = 2.20, p < .03), whereas motivational control was associated with sympathetic modulation of posturally driven, low-frequency heart-rate variability (t = -2.22, p < .03). These findings supported a two-factor solution of inhibitory control derived in a previous study.

Adolescent↗

Neighborhoods and violent crime: a multilevel study of collective efficacy.

It is hypothesized that collective efficacy, defined as social cohesion among neighbors combined with their willingness to intervene on behalf of the common good, is linked to reduced violence. This hypothesis was tested on a 1995 survey of 8782 residents of 343 neighborhoods in Chicago, Illinois. Multilevel analyses showed that a measure of collective efficacy yields a high between-neighborhood reliability and is negatively associated with variations in violence, when individual-level characteristics, measurement error, and prior violence are controlled. Associations of concentrated disadvantage and residential instability with violence are largely mediated by collective efficacy.

Chicago↗

Anxiety, antisocial behavior, and heart rate regulation in adolescent males.

We explored relationships between anxiety and antisocial behavior and autonomic heart rate regulation in a homogenous sample (N = 175) of 15-year-old males. Measures of anxiety and antisocial behavior were obtained at yearly intervals over a period of 4-6 years. Components of heart rate variability associated with postural (sympathetic) and respiratory (vagal) change and transfer of respiratory to heart rate variability were estimated at age 15 using spectral analytic techniques. Anxiety and antisocial behavior were predictably related to enhanced and diminished levels of mean heart rate, respectively. Anxiety was also predictably related to enhanced sympathetic mediation of phasic postural effects on heart rate. Antisocial behavior was unexpectedly related to disruption of vagally mediated, phasic respiratory effects on heart rate. Anxiety and antisocial behavior showed distinct relationships to heart rate, and to the autonomically mediated components of heart rate variability from postural and respiratory sources. Spectral analytic techniques helped elucidate these unique regulatory patterns, suggesting utility for future research in this area.

Adolescent↗

Infants and young children in orphanages: one view from pediatrics and child psychiatry.

A large body of medical knowledge exists that can inform the public policy debate as to whether the current needs and future life prospects of poor children could better be served in orphanages than by continuing safety net programs, such as Aid to Families with Dependent Children, Medicaid, and Supplemental Social Security Income, which maintain children in families. This special article explores a century of pediatric and child psychiatry research covering five areas of potential biologic and social risk to infants and young children in orphanage care: (1) infectious morbidity, (2) nutrition and growth, (3) cognitive development, (4) socioaffective development, and (5) physical and sexual abuse. These data demonstrate that infants and young children are uniquely vulnerable to the medical and psychosocial hazards of institutional care, negative effects that cannot be reduced to a tolerable level even with massive expenditure. Scientific experience consistently shows that, in the short term, orphanage placement puts young children at increased risk of serious infectious illness and delayed language development. In the long term, institutionalization in early childhood increases the likelihood that impoverished children will grow into psychiatrically impaired and economically unproductive adults.

Child↗

Father involvement and cognitive/behavioral outcomes of preterm infants.

OBJECTIVE: To assess the independent effect of father involvement on intellectual and behavioral outcome of 985 low birth weight preterm infants followed longitudinally from birth to age 3 years as part of the Infant Health and Development Program. METHOD: The sample for this study is drawn from eight urban sites, composed largely of ethnically diverse and relatively disadvantaged families. On the basis of a combined score for father's stable presence in the home and amount of play with the infant, we defined extreme groups of high-involvement fathers (33%, n = 305) and low-involvement fathers (16%, n = 148), with the remainder as a middle group (51%). RESULTS: Most fathers played a meaningful role as play partner with their high-risk infants. Approximately 75% of fathers were reported to play with the baby every day at 12 (peak), 24, and 36 months. Fathers who were black, younger, had teenage mothers as companions, or were from low-income families were less involved with their infants. For black fathers, low family income was significantly associated with low father involvement. Within the black ethnic subgroup only, higher father involvement was associated with improved cognitive outcome. Mean IQ for the high-involvement subgroup was 6.00 points higher than for the low-involvement group even after adjusting for family income, neonatal health, treatment group status, and paternal age. CONCLUSION: Father involvement enhances cognitive outcome in black families and may have implications for intervention.

Black or African American↗

Longitudinal patterns of heart rate and fighting behavior in 9- through 12-year-old boys.

OBJECTIVE: To assess the temporal stability of heart rate and to examine its relationship with fighting behavior. METHOD: Heart rate at ages 9 through 12 was compared to a composite measure of fighting behavior in three cohorts of low socioeconomic status boys (n = 138; two cohorts of boys who had been rated as having disruptive behavior problems in kindergarten and one normative cohort) while controlling for body size, pubertal status, and level of family adversity. RESULTS: Heart rate showed moderate stability at 1- and 2-year intervals in two of the three cohorts. The composite fighting score was related to heart rate for 11-year-old boys in the normative cohort and 12-year-old boys in one of the disruptive cohorts. CONCLUSION: These data support the conclusion that there is a relationship between heart rate and aggression even within a low socioeconomic status sample.

Aggression↗