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Biomedical subjects

M L Speltz

Publications and source records attributed to M L Speltz.

At least 19 recordsLinked to original sources
PubMed1999

Preschool boys with oppositional defiant disorder: clinical presentation and diagnostic change.

OBJECTIVE: Little is known about the clinical presentation and course of oppositional defiant disorder (ODD) when first diagnosed in the preschool years. Patterns of ODD symptomatology, comorbidity, persistence of disorder, and predictors of diagnostic outcome were examined in clinic-referred preschool boys. METHOD: Boys (aged 4-5.5 years) with a DSM-III-R diagnosis of ODD were prospectively followed over a 2-year period. Multiple assessment procedures were used, including a modified version of the Diagnostic Interview Schedule for Children and parent and teacher ratings. RESULTS: Ninety-two boys (mean age 56.9 months) with ODD were followed; 42 had comorbid attention-deficit hyperactivity disorder (ADHD). Among 79 boys assessed 2 years later, 76% had ODD, ADHD, or both. Of those, 25% had other diagnoses as well, primarily anxiety and/or mood disorders. Conduct disorder was rare. Subjects with comorbid ODD/ADHD at intake were significantly more likely to have a psychiatric disorder at follow-up, especially ADHD alone. CONCLUSIONS: The findings suggest that ODD in the preschool period is a clear indicator of high risk, especially when co-occurring with ADHD. Further investigation of individual patterns of ODD symptom expression is recommended.

Anxiety Disorders↗
PubMed1999

Psychosocial adjustment in twin pairs with and without hemifacial microsomia.

OBJECTIVE: To compare the psychosocial adjustment of children with and without hemifacial microsomia (HFM). DESIGN: This cross-sectional pilot study investigated psychosocial adjustment of twin pairs in which one twin was affected with HFM and the other was unimpaired. Data were analyzed using paired t tests. SETTING: The dental medicine clinic of a large urban children's hospital, serving a multistate area. PARTICIPANTS: Participants were six twin pairs aged 9 to 15 years and their parents. Data were also collected from classroom teachers. MAIN OUTCOME MEASURES: Outcome measures included: the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Coopersmith Self-Esteem Inventory (SEI), and a structured self-concept interview (the Self-Interview). RESULTS: Children with HFM had significantly higher CBCL and TRF total behavior problem scores and lower SEI general self-esteem scores than their unimpaired twins. No differences were found in CBCL competence scores. Interview data revealed concerns among the HFM group related to appearance, negative social responses, and fear of hospital procedures. Children also reported positive aspects of coping with HFM. CONCLUSIONS: The results of this study suggest that, similar to other craniofacial conditions, HFM is associated with an elevated risk for childhood psychosocial difficulties. Replication of specific findings with a larger sample is needed. Multicenter, collaborative studies are a crucial next step for this field.

Adaptation, Psychological↗
PubMed1998

Fathers and preschool behavior problems.

Fathers have seldom been the focus of research investigating the causes and correlates of early behavior problems. Two studies examined fathers of preschool boys with and without clinic-referred behavior problems. Six domains of risk were examined: life stress, social support, psychological symptoms, parenting attitudes, positive involvement, and harsh discipline. Clinic fathers differed from fathers of matched comparison boys with respect to all of these except social support, but only harsh discipline contributed uniquely to clinic status. These domains correctly classified 81% of the boys. Within the clinic group, teacher-rated problem severity 1 year later was predicted by fathers' life stress, psychological symptoms, and positive involvement, indicating that different factors may account for initial clinic status versus stability of problems. Mothers' self-report data better predicted clinic group membership, whereas fathers' data better predicted Year 2 outcomes for clinic boys.

Adult↗
PubMed1997

Observed family interaction during clinical interviews: a comparison of families containing preschool boys with and without disruptive behavior.

The clinical intake interview is an opportunity to observe family interactions and formulate hypotheses about their influence on presenting problems. In this study family interactions were assessed during an unstructured segment of a clinical intake. Families with disruptive preschool boys were compared with those having nonproblem boys. Mother's and fathers' reports of marital satisfaction, parenting involvement, and child behavior problems were examined in relation to observed behavior during intake. Patterns of family interaction emerged which were consistent with previous research and with family systems theory. Clinic boys oriented more toward mothers than fathers and interacted more negatively with their fathers than did comparison boys. Implications for integrating the assessment of family interactions into clinical practice and research with behavior problem children are discussed.

Adult↗
PubMed1997

Face-to-face interaction between infants with orofacial clefts and their mothers.

Compared mother-infant face-to-face (en face) interaction among 3-month-old infants with cleft lip and palate (CLP), infants with isolated cleft palate (CP), or nonimpaired infants (NI). The Monadic Phase system (Tronick, Als, & Brazelton, 1980) was used to describe patterns of laboratory en face interaction in 116 mother-infant dyads. Diagnostic group comparisons of percentages of monadic phases and infant-mother monadic phase sequences revealed more similarities than differences. However, CP group mothers appeared less involved in en face interaction than mothers in the CLP group. Low maternal involvement in the combined cleft groups was predicted by concurrent measures of infant characteristics including infant negative reactivity, whereas low maternal involvement in the comparison group was predicted by maternal characteristics including low psychological distress. There was little evidence to suggest that anomalous facial appearance is a significant factor influencing the quality of early mother-infant interaction. Assessing other characteristics of the infant and the broader social context is also important.

Cleft Lip↗
PubMed1997

Presurgical and postsurgical mental and psychomotor development of infants with sagittal synostosis.

OBJECTIVE: The current study compared the mental and psychomotor development of infants with nonsyndromic sagittal synostosis (SS) with a demographically matched comparison group without congenital defects. Within the SS group, we tested the hypothesis that age of cranial release would be inversely correlated with mental development. DESIGN: The design was prospective and longitudinal. Participants were assessed at 4, 12, and 24 months of age. SETTING: The study was conducted in a craniofacial clinic at an urban children's hospital. PARTICIPANTS: Participants were 19 infants with SS (consecutive craniofacial program referrals) and 19 demographically matched comparison infants recruited from the community. One infant with SS did not attend the 24-month assessment. MAIN OUTCOME MEASURES: Mental and Psychomotor Indices from the Bayley Scales of Infant Development were the primary outcome measures. Subdomains of development were created using Kohen-Raz scoring procedures. All measures were determined a priori. RESULTS: Repeated-measures MANOVAs revealed no statistically significant differences in the developmental trajectories of the two groups. None of the SS group infants received Mental Development Index (MDI) scores in the mentally retarded or borderline range of intellectual functioning (i.e., below 78). An inverse correlation (r = -.30) was found between the age at surgery and Bayley growth curve coefficients; however, this association was not statistically significant (p = .10, one-tailed). CONCLUSIONS: Results are consistent with previous studies of the mental and psychomotor development of infants with nonsyndromic craniosynostoses in relation to normative test data. The relation between surgery age and developmental outcome merits further study in a larger sample with a greater range of surgery ages.

Age Factors↗
PubMed1997

Early predictors of attachment in infants with cleft lip and/or palate.

Previous studies have found that children with cleft lip and palate (CLP) and isolated cleft palate (CP) have elevated risk for a variety of psychosocial problems, but the origins of such problems are unclear. We expected that early medical and other stressors during infancy--including feeding problems and facial disfigurement--would have adverse effects on the infant, his or her caregivers, and the family environment, leading to a higher than expected rate of insecure attachments among infants with clefts. Twelve-month attachment classifications of CLP, CP, and comparison group infants were examined. No significant group differences in attachment status were found. When 3-month infant, maternal, and social/family characteristics were examined as potential predictors of insecure attachment, predictors interacted with diagnostic status. For the cleft group, infant and maternal characteristics, but not family characteristics, significantly predicted insecure attachment. For the comparison group, maternal and family characteristics, but not factors associated with the infant, were predictive. Infants with clefts, despite their special needs and caregiving requirements, seem not to have elevated risk for insecure attachments at the end of their first year. Contrary to social-psychological formulations, the facial appearance of infants with CLP had no adverse effect on the quality of their maternal attachment.

Case-Control Studies↗
PubMed1995

Clinic referral for oppositional defiant disorder: relative significance of attachment and behavioral variables.

Attachment classifications have been found to distinguish clinic-referred, oppositional preschool boys from controls, but there has been no previous effort to examine the relative contribution of attachment when behaviors from a social learning perspective are also considered. The present study examined the contribution of attachment and behavioral variables to the prediction of clinic referral for oppositional defiant disorder in a sample of preschool boys. We hypothesized that the attachment measures would offer better discrimination of clinic and control group boys at this age. This hypothesis was confirmed when the attachment measures were compared with the parent-child behaviors most strongly associated with social learning conceptualizations of disruptive problems (maternal commands and criticism, and child noncompliance), but rejected in a more stringent test in which the attachment measures were compared with the behavioral variables distinguishing the groups in this particular sample.

Child Behavior Disorders↗
PubMed1994

Developmental approach to the psychology of craniofacial anomalies.

This article outlines a developmental perspective on psychosocial maladjustment and its implications for the psychological study and treatment of individuals with craniofacial anomalies. A developmental theory of attachment is described and used to formulate hypotheses about the developing parent-child relationship during the first 5 years of life and its influence on the child's subsequent social and emotional growth. Preliminary research involving infants with clefts and other craniofacial anomalies is reviewed with respect to hypothesized points of vulnerability in the attachment process. Two major points are made: (1) developmental theory provides a framework for the early identification of children in this population with elevated risk of subsequent psychosocial problems, and (2) among the multiple child and family variables associated with elevated risk, a craniofacial anomaly is unlikely to produce maladjustment in the absence of one or more other risk conditions such as family adversity, insecure attachment, or compromised child characteristics.

Attitude to Health↗
PubMed1993

Physicians' practice patterns in pediatric electrodiagnosis.

The medical literature contains contradictory reports and recommendations regarding pediatric patients' pain and distress during electrodiagnosis. We surveyed 117 pediatric neurologists and physiatrists regarding their practice patterns in pediatric electrodiagnosis; 84 (72%) responded, of whom 44 (52%) regularly perform electrodiagnosis on children (mean = 85 per year, representing 3,667 examinations per year). Respondents reported extreme behavioral distress (eg, screaming, flailing, requiring additional restraint, or attempting to leave the examination table) in 35% of examinations, most often among 2- to 6-year-olds. Pain medications are never prescribed by 45%, occasionally by 48%, and always by 2%; general anesthesia is never administered by 75%, occasionally by 21%. Only 32% reported that any psychological intervention is routinely offered to enhance child coping. Wide variability was found in physicians' preferences about parental presence, order of examinations, demonstration of procedures, and other aspects of electrodiagnosis.

Adolescent↗
PubMed1993

Psychological functioning of children with craniofacial anomalies and their mothers: follow-up from late infancy to school entry.

Twenty-three mothers and their 5- to 7-year-old children with craniofacial anomalies (CFA) who were assessed during the child's infancy were followed. Three types of CFA were included: cleft lip and palate (CLP), isolated cleft palate (CP), and sagittal synostosis. Measures of child status focused on behavior-problem frequency and self-concept. Mothers completed self-report measures of emotional well-being, marital satisfaction, and social support. Results indicated that (1) a sizable minority (18%) of the children with CFA had clinically significant behavior-problem scores shown in concordant reports by parent and teacher of behavior problems; (2) individual differences in child functioning within the CFA group were predicted by observational measures of earlier mother-infant interaction during play and teaching situations; (3) mothers of children with CLP reported less favorable social support than mothers of children with CP or sagittal synostosis.

Analysis of Variance↗
PubMed1992

Exploration of variables related to children's behavioral distress during electrodiagnosis.

To investigate variables potentially related to children's distress during electromyography/nerve conduction studies (EMG/NCS), mothers of 39 children ages two to 17 years reported the child's gender, experience with EMG/NCS, previous negative medical/dental experiences, general response to painful procedures, information-seeking style prior to procedures, health care fears, and information about the mothers' own health care fears and their anxiety regarding EMG/NCS. Physicians who performed the studies completed a behavioral distress checklist for each child. Results indicated that children exhibiting more behavioral distress were younger, had been uncooperative with previous painful procedures, were more likely to have had more negative medical/dental experiences, and had mothers who themselves reported greater fear and anxiety about undergoing EMG/NCS. Regression analyses indicated that previous negative medical/dental experiences accounted for additional variance in distress beyond that attributed to the child's age. Significant positive correlations between children's distress and specific previous negative medical/dental experiences were found.

Adolescent↗
PubMed1990

Effects of craniofacial birth defects on maternal functioning postinfancy.

This study examined the relationships between children with craniofacial anomalies (cleft lip and palate, cleft palate only, and sagittal synostosis) and their mothers during late infancy and toddlerhood in an effort to identify early factors leading to the psychosocial problems that have been observed in this population of children at school age. Dyadic interaction was observed in play and teaching situations. Maternal self-reports of psychological/emotional status and the quality of relationships with spouse and others were gathered. As compared with mothers of healthy children matched for age and SES, mothers of children with craniofacial anomalies reported higher levels of stress, lower evaluations of self-competence, and a higher degree of marital conflict. The observational measures revealed no group differences in maternal response to the child or in the behavior and responsiveness of the children themselves. The implications of these findings for longitudinal research with children with craniofacial birth defects are discussed.

Adaptation, Psychological↗
PubMed1990

Assessment of injury risk in young children: a preliminary study of the injury behavior checklist.

There is a need for practical and cost-effective measures of the behavioral characteristics that predict subsequent injury in children. Previous research has focused on the predictive power of child problem behavior (e.g., hyperactivity, aggression, noncompliance) and has found reliable, but relatively weak associations with injury frequency. In an effort to improve upon this level of prediction using child behavioral measures, a care-giver report checklist of specific "risky" behaviors was developed for toddlers and preschoolers, called the Injury Behavior Checklist (IBC). A preliminary test of the reliability and validity of this instrument was undertaken in a sample of middle-class families (N = 253). Results indicated that the IBC has acceptable reliability (internal consistency = .87; 1-month test-retest correlation = .81) and is able to significantly discriminate children with two or more injuries from those with one or none (p less than .001). Multiple regression analyses indicated that the IBC was a better predictor of injury than parent-reported levels of child problem behavior using the Conners Parent Rating Scale.

Accident Proneness↗
PubMed1989

Effects of social integration on preschool children with handicaps.

This study examined the effects of (a) integrating handicapped and nonhandicapped children in preschools and (b) a condition designed to promote social integration. Fifty-six children with mild and moderate handicaps were randomly assigned to four experimental conditions: integrated/social interaction, integrated/child-directed, segregated/social interaction, and segregated/child-directed. Observation revealed a higher proportion of interactive play, as well as higher language development, in the social interaction conditions; and children in the integrated/social interaction condition received significantly higher ratings of social competence. These data suggest that structuring social interaction between higher and lower performing children can result in benefits to the lower performing students.

Child, Preschool↗