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Biomedical subjects

M D Levine

Publications and source records attributed to M D Levine.

At least 73 records · Page 4Linked to original sources
PubMed1981

An analysis of observed attention and activity patterns in preschool children.

An activity-attention scale was incorporated into the Pediatric Examination of Educational Readiness to determine whether performance of age-appropriate tasks would elicit or provoke attentional weakness or activity level modulation in a sample of prekindergarten children. Thirty-three (9.8%) of the 338 children met the criteria of weak attention and/or increased activity at one time during the assessment, and 18 (5.3%) met the criteria at two or more times. The "flagged" children were more likely to be boys and to have other developmental findings, lower McCarthy scores, and teacher concerns. Significant fluctuation of attention was noted commonly during the sessions. Furthermore, difficulty in interrater scoring of severity was demonstrated. This study underscores the variability and complexity of attention and activity findings, and confirms the need for direct observation as well as integration of information from all available sources.

Attention↗
PubMed1981

Developmental output failure: a study of low productivity in school-aged children.

Children with low academic productivity in late elementary and junior high school present a vexing problem to parents and schools. A subgroup of these youngsters may have underlying subtle handicaps that result in reduced productivity and chronic underachievement. Such children may be clinically characterized as exhibiting "developmental output failure." Using parent and teacher questionnaires, educational achievement tests, and pediatric neurodevelopmental assessments, a group of 26 children was selected according to predetermined criteria from among the clinic population seen in The School Function Program at The Children's Hospital Medical Center. Common findings among the group included problems with expressive language, fine motor tasks, finger agnosia, attention, and retrieval memory. It is suggested that clinicians be aware of the possibility that a child in this age group with low academic work output may have underlying developmental dysfunctions, whose manifestations may not have been evident earlier in life.

Achievement↗
PubMed1981

Evaluation of a multidimensional assessment procedure for preschool children.

The Pediatric Examination of Educational Readiness was administered to 386 preschool children to determine whether the predictive value of this instrument could be enhanced by the inclusion of systematic measures of processing efficiency, selective attention, behavioral adaptation, and neuromaturation. Findings on these dimensions, as well as the traditional developmental attainment measure, were consistent with McCarthy cognitive scores. Concerns regarding developmental attainment, processing efficiency, and selective attention were more common in children later found to have weak kindergarten mastery skills. Data analysis revealed minimal redundancy and specific additive effects in this multidimensional assessment. It is concluded that such instruments can contribute to a broader, more integrated diagnostic procedure for behavioral and developmental problems.

Attention↗
PubMed1980

Behavioral symptom substitution in children cured of encopresis.

Follow-up data were obtained on 47 children who had been treated for encopresis with an initial catharsis, maintenance laxative therapy, demystification, symptom-related counseling, and close follow-up. Behavioral inventories were used at the beginning of treatment and three years later to determine whether any significant symptom substitution occurred in children cured of encopresis. Little evidence of this was uncovered. There was a comparison of cured and uncured children with respect to behavioral profiles at the start of treatment and three years later. The uncured group showed more aggressive behaviors initially, and also were more socially withdrawn at the start of treatment, although this was not evident three years later. Monitoring of associated behaviors should be an important part of the management of encopresis.

Aggression↗
PubMed1980

Hyperactivity. Symptom complex or complex symptom?

The phenomenon of "hyperactivity" is well recognized. Results of long-term follow-up studies show that children diagnosed as "hyperactive" are at risk for severe problems during adolescence and adulthood. However, no common diagnostic criteria exist for "hyperactivity." The term can refer to a number of very different behaviors, and children diagnosed as "hyperactive" may also exhibit one or more concomitant difficulties. A "hyperactive" child should be carefully assessed to determine the nature of the behavioral problem and its source, and the term "hyperactivity" itself should be used with caution.

Attention↗
PubMed1980

Selective hearing screening for young children.

A "selective" hearing screening program was instituted in an early education project. Three-year-old children were deemed "at risk" for mild-to-moderate hearing loss if they met one of the risk criteria established by the Joint Committee on Infant Hearing Screening, if they had recurrent ear infections, or if there was parent or staff concern about the child's hearing. Based on these criteria, 31 per cent of the 228 children in the project were eligible for full audiologic evaluation at a speech and hearing center. The parents of 45 children took advantage of this special evaluation. Twenty-nine per cent of these selected children had some hearing loss documented. The highest yields of abnormal hearing were for children "at risk" because of recurrent ear infections (42%), and parent for educational staff concern (71%).

Child↗
PubMed1980

The Pediatric Examination of Educational Readiness: validation of an extended observation procedure.

The Pediatric Examination of Educational Readiness (PEER) is a standardized observation system for use by health care professionals. It combines a prekindergarten physical examination with a neurodevelopmental and behavioral assessment. The PEER was field tested on 386 children, of whom 22% revealed a "definite concern" in one area of development or behavior, 8% in two, and 14% in three or more areas. (A concern was a finding that required direct intervention, continuing surveillance or further evaluation.) Children with multiple areas of concern were found to have lower teacher rating scores at the end of kindergarten than those with isolated or no concerns. An observation procedure, such as the PEER, can be a productive part of the pediatric assessment of children entering kindergarten.

Child↗
PubMed1979

Recurrent abdominal pain of childhood due to lactose intolerance.

The role of lactose malabsorption was studied prospectively in 80 schoolchildren with recurrent abdominal pain. Malabsorption was documented in 40 per cent (16 of 59 whites, 12 of 16 blacks and four of five Hispanic children) on the basis of elevated levels of hydrogen in their breath. Those with lactose malabsorption, however, were not clinically distinguishable on the basis of past milk ingestion (P greater than 0.05), weekly pain frequency (median, five vs. six times), presence of diarrhea (40 vs. 27 per cent) or symptom response to lactose load. In children with malabsorption who completed a six-week diet trial, 70 per cent reported increased frequency of pain (P less than 0.002) when placed on their usual lactose-containing diet. Lactose malabsorption has a substantial role in the symptoms of children with recurrent abdominal pain, and it should be considered before performing invasive procedures or assuming a psychogenic origin.

Abdomen↗
PubMed1979

Training in developmental pediatrics. How practitioners perceive the gap.

Ninety-seven randomly selected, board-certified pediatricians in five New England states were interviewed by two physicians to explore attitudes toward previous training and current sources of knowledge in developmental pediatrics. Formal training in development was rated as inadequate by 79%, of residency experience was viewed as highly valuable by only 30%, and 47% rated medical school as having no value. Although clinical experience was reported as a valuable source of knowledge by 99% of the sample, almost two thirds did not regard it as an adequate substitute for formal training. Frequent interdisciplinary communication was reported, and professional contacts were described as a highly valuable ongoing source of knowledge. Social class and size of practice did not correlate with differences in consultation patterns. A part-time longitudinal clinical experience for further education was preferred by 97%. Improved training with greater interdisciplinary content is needed.

Child↗
PubMed1979

Developmental-behavioral dysfunction in preschool children. Descriptive analysis of a pediatric consultative model.

A study of 79 preschool children referred to an interdisciplinary clinic because of behavioral problems and developmental concerns was done. Historical data and information regarding present functioning were collected using standard questionnaires. In addition to medical, neurological, and psychiatric examinations, every child received a neurodevelopmental assessment. When compared with a matched cohort of children from the community, the clinic population had a higher incidence of developmental concerns. Of 37 children referred because of "hyperactivity" or other behavioral concerns, 13 had previously undetected developmental concerns requiring specific interventions. Dysfunction in preschool children may be the result of an ongoing reciprocal interaction between constitutional predispositions and social and environmental factors. A comprehensive, developmentally oriented approach seems to be indicated in the assessment of these children. This may have implications for pediatric practice.

Affective Symptoms↗
PubMed1979

Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children.

A scoring method was developed to assess severity of stool retention using plain abdominal radiographs. To determine whether the technique was clinically valid in identifying chronic stool retention, the method was used to evaluate films taken of children with known stool retention before and after therapy. The method showed significant statistical differences between symptomatic pre-therapy films and controls and between pre- and post-therapy films of treatment "successes." No significant differences were found between pre- and post-therapy "failures." Use of radiographs is not a substitute for careful history taking and examination, but this scoring method for evaluating stool retention can be recommended prior to more extensive, invasive investigations in children presenting with functional abdominal complaints.

Abdomen↗
PubMed1979

Primary care approaches to developmental disabilities.

Ninety-seven board certified pediatricians who spend at least 75% of their professional working hours involved in the delivery of primary care in New England were interviewed to explore their attitudes and current clinical approaches to developmental disabilities. The majority of the pediatricians relied exclusively on clinical judgment and general observations for assessing developmental problems in their offices. Responsibility for preschool screening for potential learning problems and the assessment of school failure were considered appropriate pediatric concerns. Reported customary approaches to a variety of developmental problems were not affected by the size of the practice nor by the socio-economic status of the patient population. Patterns of referral for consultation appeared to be more dependent on the nature of the suspected disorder than on the characteristics of the physicians or their practices. The need for more rigorous training in the developmental aspects of child health has been emphasized. In order to meet this challenge, more precise techniques for pediatric developmental assessment and more conclusive evaluations of specific interventions will have to be produced.

Attitude of Health Personnel↗