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Biomedical subjects

J E Fagan

Publications and source records attributed to J E Fagan.

17 recordsLinked to original sources
PubMed1994

Attention-deficit hyperactivity disorder. Getting control of impulsive behavior.

A sizable number of school-aged children, more often boys, may have attention-deficit hyperactivity disorder (ADHD). Its cause is unknown. Some investigators implicate food additives or lead poisoning. These theories are not supported by study results, however. Physicians are dependent on reports of parents and teachers to diagnose ADHD, since the children may not show signs at an office visit. The presence of criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, third revised edition, and descriptions by parents and teachers of significant and pervasive impairment at home or school are diagnostic. Treatment is essential to minimize the academic failure, rejection, and loss of self-esteem that can result from the behaviors that typify ADHD. Use of stimulant medication is the most effective intervention and should be continued as long as it provides benefits without adverse effects. Concomitant behavioral therapy may be useful, and the entire family may benefit from psychotherapy.

Attention Deficit Disorder with Hyperactivity↗
PubMed1993

Assessment of the child with failure to thrive.

Failure to thrive is a presenting symptom, rather than a diagnosis. Organic failure to thrive may be caused by defects in food assimilation, excessive loss of ingested calories, increased energy requirements or prenatal insults. Nonorganic failure to thrive may occur accidentally, or it may be related to economic or emotional deprivation, as well as to child abuse or neglect. Assessment of a child with failure to thrive includes a comprehensive history and a thorough physical examination. Some basic laboratory screening tests may be helpful in the evaluation. More extensive investigation may be required, based on the clinical findings and the results of the initial screening tests. Early intervention is essential, because children may develop significant long-term sequelae from nutritional deficiency.

Body Height↗
PubMed1991

Nondairy-creamer-induced kwashiorkor: 5-year follow-up.

Failure to thrive may not be a result of organ disease, physical abuse, or intentional neglect. We describe an infant who developed kwashiorkor with a high-fat, low-protein, nondairy coffee creamer diet. The elimination diet was administered on the advice of a family friend for a facial rash. The child presented at 10 months of age with decreased weight for height, rash, hepatomegaly, edema, hypoproteinemia, hypoalbuminemia, anemia, hypoglycemia, and evidence of hepatic sequestration of lipids. A rapid recovery of biochemical abnormalities was evident on reinstitution of a full diet. An intellectual assessment at age 5 years showed normal results.

Female↗
PubMed1991

Temper tantrums.

Temper tantrums are a normal response to anger and occur commonly in the child between one and four years of age. They arise from the child's thwarted efforts to exercise mastery and autonomy. Tantrums occur more frequently in the active, determined child who has abundant energy. Parenting practices that may encourage tantrums include inconsistency, unreasonable expectations, excessive strictness, overprotectiveness and overindulgence. Boredom, fatigue, hunger or illness may reduce the child's tolerance for frustration. Management consists of teaching the parents to understand the underlying meaning of tantrums and to modify parental behaviors that may perpetuate or accentuate the problem. Temper tantrums are best handled by ignoring the outburst, offering nurturance to the child after the tantrum has subsided and helping the child learn to express negative feelings in more acceptable ways.

Adaptation, Psychological↗
PubMed1989

Tic disorders in childhood (and beyond).

Tic disorders are classified into three main categories: transient (duration more than 1 month but less than 1 year), chronic (duration more than 1 year), and Tourette's syndrome (multiple motor and vocal tics lasting more than 1 year to life). Typically, symptoms increase with emotional stress, diminish with distraction or concentration, and disappear during sleep. Because of the risks involved and the lack of any truly curative value, drug therapy should be used only when tics are seriously disabling. Haloperidol (Haldol), the most widely prescribed medication, is efficacious in about 80% of patients with Tourette's syndrome. Psychotherapy is not effective as a primary therapeutic strategy; it may, however, be indicated in selected cases to relieve the grief and frustration of parents and to help affected children deal with the disorder.

Adolescent↗
PubMed1988

Fixational instability and saccadic eye movements of dyslexic children with subtle cerebellar dysfunction.

Fixational stability and saccadic eye movements were measured in 9- to 13-year-old dyslexics with signs of subtle cerebellar dysfunction and in a group of age-matched normal readers. This group of dyslexics was specifically chosen because cerebellar disorders are often associated with ocular motor dysfunction. Dyslexic children were found to exhibit significantly greater fixational instability than controls while viewing a simple, stationary stimulus. Although both groups of children showed disruption of fixational stability when viewing stationary targets against optokinetic backgrounds, gaze stability of dyslexics was more degraded than that of controls. However, latency and accuracy of saccadic eye movements of dyslexic children were not different from those of normal readers. The results suggest that poor maintenance of gaze stability, rather than inadequate control over saccadic eye movements, characterizes the ocular motor problems that may contribute to reading difficulties in this subgroup of dyslexics.

Cerebellar Diseases↗
PubMed1988

The failure of antimotion sickness medication to improve reading in developmental dyslexia: results of a randomized trial.

Although there have been no randomized clinical trials of the efficacy of antimotion sickness medication treatment of developmental dyslexia, some children are treated in this way. We have performed two evaluations of such treatments. In Experiment 1, 12 children participated in a double-blind within-subject crossover design to test the acute (2-day) administration of four preparations: 10 mg methylphenidate, 12.5 mg meclizine, both methylphenidate and meclizine, or placebo. Improvements obtained with each drug were scattered across measures of reading fluency, balance and coordination, and eye movements, suggesting that a chronic trial would be justified. In Experiment 2, six children from Experiment 1 received 12.5 mg meclizine b.i.d. for 3 months and placebo for 3 months in a double-blind within-subject crossover design. Meclizine had no effect on reading, but it significantly improved ocular motor stability during steady fixation. This study thus failed to support the hypothesis that meclizine is of benefit in developmental dyslexia.

Child↗
PubMed1987

Palatopharyngeal incompetence in association with esophageal dysmotility, acquired glucocorticoid deficiency, and deficient tear production.

An 8 1/2-year-old male is described with the rare triad of acquired adrenal insufficiency, esophageal dysfunction, and alacrima. In addition, he had velopharyngeal insufficiency, which is a previously unreported feature of this syndrome. Although the pathophysiology of this disorder remains to be demonstrated, a defect may be present, linking hormone-receptor cyclic AMP-mediated processes with abnormalities in parasympathetic and voluntary neuronal innervation or transmission.

Child↗
PubMed1986

Effects of video display character size, clarity, and color on P-300 latency.

The P-300 is a positive polarity electroencephalographic (EEG) signal occurring about 300 ms after a surprising, novel, or unique stimulus. The amplitude of the P-300 is dependent on the degree of attention and importance the subject has assigned to the stimulus and on its relative novelty. P-300 latency is dependent on the time it takes the subject to mentally process the stimulus and determine if the information it carries is novel. In Experiment I, the latencies of P-300's for 40 and 80 column size video display characters were compared. The effect of dioptric blur (mean add power +2.44 D) on latency was also determined. It was found that 40 column size characters could be interpreted more quickly than 80 column size characters and that blur increased the processing time equally for both character sizes. In Experiment II, P-300 latencies for green and amber display screens were compared. Display screen color did not significantly affect latency, neither did the addition of lens powers ranging from a mean of -1.15 D to a mean of +1.15 D over the subjects' habitual lenses. However, it was found that latencies significantly increased when a mean add of +2.29 D for the green display or a mean add of +2.57 D for the amber display were used. (Chromatic aberration accounted for the difference in lens power for the green vs. amber display.) These results demonstrate that character size and clarity are significant factors in determining the time required to mentally process a stimulus. They also demonstrate that there is no clear advantage to using an amber vs. a green screen when speed of mental processing (as measured by P-300 latency) is used as a criterion.

Adult↗
PubMed1985

Theoretical reliability of visual evoked response-based acuity determinations.

The process of determining acuities from visual evoked responses (VER's) was computer modeled. Based on amplitude variability data from earlier studies, the reliability and validity of the acuity determinations for normal subjects were assessed. For subjects who had poor quality VER data [low signal-to-noise (S/N) ratios], considerable variability and an artifactual shift toward elevated (better) acuity determinations were found.

Evaluation Studies as Topic↗
PubMed1985

Steady-state visual evoked response amplitudes and concurrent electroencephalographic activity.

Among the possible causes of steady-state visual evoked response (VER) amplitude variability are: concurrent electroencephalographic (EEG) activity occurring at frequencies other than that of the VER (alpha rhythms, etc.), and EEG activity occurring at the same frequency as the VER (Noise). To evaluate these two factors, 10 steady-state VER's (7.8 Hz pattern reversal rate) and 10 samples of resting EEG activity were obtained from each of 20 normal subjects. The correlations between VER and concurrent EEG activity at other frequencies were calculated from simultaneous determinations of Fourier-derived VER and EEG amplitudes. No significant correlations were found. Because EEG Noise occurring at the same frequency and time as the VER cannot easily be separated from the VER by Fourier transformation, two indirect techniques for assessing the amplitude of this Noise were evaluated: measurement of simultaneously recorded activity at frequencies directly adjacent to the 15.6 Hz VER frequency and measurement of EEG activity at 15.6 Hz obtained just before the VER measurements. Neither of these procedures could predict trial-by-trial variations in the amplitude of the Noise at 15.6 Hz. However, across subjects both procedures provided good estimates of the mean EEG Noise underlying the VER.

Alpha Rhythm↗
PubMed1984

Factors contributing to amplitude variability of the steady-state visual evoked response.

Ten steady-state visual evoked responses (VER's) were recorded from each of 47 normal, adult subjects. For each subject, the mean and SD for the 10 VER amplitudes were calculated and used to determine amplitude variability. Although some subjects produced extremely reliable VER's, data from the majority showed a considerable degree of variability. A number of factors including trend (the tendency of the VER amplitudes to increase or decrease with repeated measurements), noise, attention, binocularity, accommodation, eye movements, artifacts, and electrode placement were evaluated to determine their relative contributions to this variability. Noise and trend factors produced a large proportion of the variability (75%) whereas the other factors were found to be relatively insignificant.

Accommodation, Ocular↗
PubMed1977

An approach to solving problems of growth retardation in the child and teenager.

The physician who looks after children and teenagers is often confronted with the problem of short stature or growth failure. Common causes of growth failure include genetic background, intrauterine disease, malnutrition, chronic illness and hormonal disorders; some cases are attributed to mental retardation or primary central nervous system disease. A major concern in the evaluation of these patients is when, and how extensively, to investigate the problem. From a practical standpoint assessment can be related to height percentiles. The aims of treatment are a) to identify and treat appropriately the patients in whom there is an organic cause and b) to provide psychologic counselling and support.

Adolescent↗