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Biomedical subjects

K L Lemanek

Publications and source records attributed to K L Lemanek.

14 recordsLinked to original sources
PubMed1999

Too little, too late: primary vs. secondary interventions for adolescents with sickle cell disease.

The cognitive, biological, and psychological characteristics of adolescents affect their adaptation to a chronic medical condition. This article reviews the literature on how sickle cell disease alters the normal developmental challenges facing adolescents. Examples of these challenges include delayed maturation, neurologic complications, sequelae of pain episodes, and prolonged financial and family dependence. These challenges are also discussed within the context of family and peer relationships, as well as cultural norms. Using the principles of anticipatory guidance, interventions into the psychological development may help to preserve normal functioning. These interventions need to be provided in a manner acceptable to the adolescent within the community context. The education, counseling, and medical services provided by the multidisciplinary team in the Comprehensive Sickle Cell Program at Children's Hospital in Columbus, Ohio are used to highlight these intervention strategies.

Adolescent↗
PubMed1998

Pain and fear ratings: clinical implications of age and gender differences.

The study investigated the relationships among children's self-report of anticipatory pain and fear, physiological measures of distress, and previous medical experience in 62 outpatients during allergy skin testing. Younger (aged 3-7 years) and older (aged 8-12 years) children reported similar amounts of pain and fear. Girls reported more pain than boys. Older children and boys provided differential pain and fear ratings compared with younger children and girls. Younger children's self-report of distress was not related to any physiological measures, but older children's report of fear was significantly related to blood pressure. In girls, positive medical experience was correlated with less pain. The implications of these findings for the clinical measurement and intervention of children's distress during painful medical procedures are discussed.

Age Distribution↗
PubMed1997

Environmental factors influencing weaning of a young child from mechanical ventilator support.

We examined the contribution of physiologic and environmental variables to the process of weaning a child with chronic respiratory failure from mechanical ventilation support. Surveillance measures, e.g., blood oxygenation, were obtained from a 6-year-old child with multiple medical and developmental disorders who received three different rates (24, 22, and 20 tidal volumes per minute) of intermittent mechanical ventilation. Direct observations were used to calculate rates of aberrant behavior, e.g., aggression toward self, for task versus play settings within the intermittent mechanical ventilation rates. Rates of aberrant behavior and adult responses were tabulated from videotaped observations for task, attention, and no attention settings. The greatest rate of aberrant behavior occurred during tasks compared with play activities, regardless of whether attention was provided while playing. Adults also responded more often to aberrant behaviors during task versus play conditions. Clinical implications are discussed concerning the inclusion of developmental and behavioral variables during weaning from mechanical ventilation.

Aggression↗
PubMed1996

Assessment as a process in pediatric psychology.

In this editorial, we have highlighted several key aspects of the assessment process. First, we consider it critical that pediatric psychologists view "assessment as a process," and not as a test or measure. Assessment begins with the formulation of a precise, answerable question--and this maxim is equally important for researchers and clinicians. It is especially critical that research questions be conceptually based, as well as of applied interest. The development of an appropriate assessment strategy should always follow directly from the question that is posed. Second, in developing an assessment strategy, we advocate selecting the "best" informants and the "best" measurement methods available, also taking into consideration the developmental level of the participants and the types of constructs being assessed. In most cases, it will be desirable to use multiple informants, rather than relying on a single source. Given the measurement constraints discussed earlier, we also advocate using multiple measures to assess a construct, and avoiding single-item measures. We also feel strongly that pediatric psychologists should consider designing focused studies of developmentally appropriate age groups, rather than evaluating children from a very broad age range (e.g., infants to teens). Third, as pediatric psychological research moves into new areas of inquiry, assessment should represent a "growth area." We need psychometrically sound measures that are appropriate for use with pediatric health populations. We also need to develop assessment strategies that capture the rich and complex process of dealing with health and disease and, therefore, we should consider gathering qualitative data, to supplement standardized questionnaires. Finally, we recognize that pediatric psychologists face many practical constraints and challenges in the assessment process, especially in today's volatile health care climate. We have seen and will continue to see radical changes in the way health care is provided; pediatric psychologists and other care providers are continually making adjustments in their activities to respond to these frequent shifts and changes. In part because of these changes, pediatric psychologists need to develop and use methods to assess the financial costs and benefits of their interventions. With the increasing emphasis on providing quality medical care at the lowest possible price, efforts to document the valuable contributions of pediatric psychologists become paramount. By sharing our ideas and strategies, as many of the contributors to this issue have done, we stand a better chance of making a better future.

Child↗
PubMed1994

A multiperspective investigation of social competence in children with sickle cell disease.

Compared the social competence and self-perceptions of 4- to 8-year-old children with sickle cell disease (SCD) to a comparison group of healthy children. Social competence ratings were obtained from multiple perspectives, including parents, teachers, and clinic staff members; children provided ratings of self-perceived acceptance and competence. Children in the SCD group were rated as socially competent as their peers in the comparison group and the normative group. Differences across raters were found, however, with parents in the SCD group giving higher ratings than clinic staff members. No differences were revealed between children in the SCD group and the comparison group in their self-perceptions of competence and acceptance. Implications for future studies addressing the situational specificity of social competence and its relevance to health care of chronically ill children are discussed.

Adaptation, Psychological↗
PubMed1990

Parental report of social behaviors in autistic preschoolers.

The aim of this study was to identify specific social behaviors that differentiate autistic preschoolers from other children at comparable developmental levels. A parent report measure, the Preschool Social Behavior Checklist (PSBC), was developed for this purpose. The PSBC consists of 22 items representing social milestones usually achieved within the first 4 to 5 years of life. Results obtained from a sample of 20 parents of children with autism and 14 parents of children with mental retardation revealed group differences in specific aspects of imaginative play, peer play, and imitation skills. The importance of examining the specific manifestations of social deficits and implications for the diagnosis of autism are discussed.

Autistic Disorder↗
PubMed1990

Pediatric appointment keeping: improving adherence in a primary care allergy clinic.

We evaluated the effects of introducing and discontinuing an intervention designed to improve adherence with scheduled appointments in a pediatric allergy clinic. Five nonadherent and three adherent patients received reminders and incentives for keeping their scheduled appointments. Adherence with appointments increased for three of the five nonadherent children, who had an average increase of 13%, and adherent patients continued to keep appointments during the intervention condition. After 10 scheduled allergy clinic appointments had been kept, incentives were discontinued while reminders continued. Improvements in adherence were not maintained after incentives were discontinued and two children showed reductions in adherence to below-baseline levels. Incentive programs increase appointment keeping, but discontinuing incentives abruptly may result in the return of nonadherence, even when reminders are provided as a maintenance strategy. Future pediatric psychology research and practice should investigate both the benefits and limitations of strategies designed to improve adherence.

Adolescent↗
PubMed1990

Play and imitation skills in the diagnosis of autism in young children.

Play behaviors and motor imitation skills of 91 children between the ages of 3 and 6 years were investigated to determine their utility in distinguishing autism from mental retardation and other communication disorders. The performance of 22 autistic children was compared with that of 15 mentally retarded, 15 hearing-impaired, 19 language-impaired, and 20 non-handicapped children. Play behaviors were assessed using structured observations of free-play activities, and imitation skills were measured using a set of 12 individually administered tasks. The autistic group spent less total time interacting with toys and using toys appropriately, engaged in fewer functional play acts, and obtained lower imitation scores compared with all other groups. Discriminant function analysis revealed that the latter three variables discriminated the autistic children from the nonautistic handicapped children, with motor imitation emerging as the most important differentiating measure. These results suggest that measuring play and imitation skills may be useful in the clinical diagnosis of autism.

Autistic Disorder↗
PubMedDate not supplied

Empirically supported treatments in pediatric psychology: regimen adherence.

OBJECTIVE: To review empirical studies of psychological interventions for nonadherence to medical regimens for three chronic illnesses: asthma, juvenile rheumatoid arthritis (JRA), and type 1 diabetes. METHODS: The Chambless criteria for "promising," "probably efficacious," or "well-established" were applied to 8 intervention studies on asthma, 4 on JRA, and 11 on type 1 diabetes. RESULTS: For asthma, organizational strategies appear probably efficacious in promoting adherence, whereas educational and behavioral strategies appear promising. For JRA, behavioral strategies appear probably efficacious in improving adherence. For type 1 diabetes, multicomponent packages and operant learning procedures appear probably efficacious, whereas cognitive-behavioral strategies appear promising. No interventions were identified as "well-established." CONCLUSIONS: Future studies will need to develop adequate definitions of adherence, accurate methods of assessing adherence, and appropriate designs to evaluate multicomponent treatment programs to advance interventions to the "well-established" category.

Adolescent↗