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Biomedical subjects

M Wolraich

Publications and source records attributed to M Wolraich.

16 recordsLinked to original sources
PubMed1998

Attention deficit hyperactivity disorder.

In summary, ADHD is a mental disorder whose diagnosis is based on a child manifesting the symptoms of inattention, hyperactivity and impulsivity to the extent that the symptoms impair the child's ability to function. The main beneficial treatments are two nonspecific treatments, stimulant medication and behavioural interventions, preferably in combination. Dietary interventions have included diets that restrict allergenic foods, starting with a generally restricted diet and adding those foods that do not worsen the child's behaviour; a diet that restricts food additives and preservatives, referred to as the Feingold diet; and diets that restrict sugar. These dietary interventions either have not been proved to be efficacious or still require more study to determine their effects.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

Quantitative EEG differences in a nonclinical sample of children with ADHD and undifferentiated ADD.

OBJECTIVE: To use quantitative electroencephalographic (EEG) techniques to identify electrophysiological differences between children with distinct disorders of attention and/or hyperactivity. METHOD: Forty children from a prescreened community sample were evaluated by means of both spectral EEG and evoked response potential (ERP) techniques. The children were 7 to 13 years of age and were selected on the basis of membership in one of the following DSM-III-R categories: attention-deficit hyperactivity disorder (ADHD) (n = 16), undifferentiated attention deficit disorder (UADD) (n = 12), or no disruptive disorder diagnosis (n = 12). RESULTS: Spectral EEG revealed that UADD subjects had less delta band relative percent power (RPP) (p < .01), more beta band RPP (p < .01), and ERP findings of a decreased rare tone P300 amplitude (p < .02) compared with the control group. ADHD subjects had spectral EEG findings of increased beta band RPP (p < .05) and ERP findings of an increased common tone N100 latency (p < .02) and a decreased rare tone P300 amplitude (p < .02). Interhemispheric asymmetries appeared to distinguish the groups: the UADD group had spectral EEG asymmetries; the ADHD group had only ERP asymmetries; and the control group had no asymmetries. CONCLUSION: Quantitative EEG techniques may prove useful in differentiating specific subtypes of ADHD.

Adolescent↗
PubMed1995

Abnormalities in control of ventilation in newborn infants with myelomeningocele.

OBJECTIVE: The objective of this study was to assess respiratory responses of newborn infants with myelomeningocele through pneumograms and carbon dioxide challenge, and to evaluate the possibility of predicting which patients with myelomeningocele acquired respiratory symptoms related to the Arnold-Chiari deformity and brain-stem dysfunction. METHODS: All surviving infants with spina bifida who were born at the University of Iowa Hospitals and Clinics (UIHC) or were transferred there on the first day of life between January 1987 and January 1991 were assessed with a pneumogram and CO2 challenge once they were medically stable, and were followed for a mean of 30 months (10 to 53 months). RESULTS: Thirty patients met the inclusion criteria for this study; four died before being studied. Of the 26 remaining patients, 12 were born at the UIHC and 14 were transferred to the UIHC on the first day of life. Of the 26 infants studied, 12 (46%) had abnormalities on the pneumogram, including 2 with significant periodic breathing and 10 with episodes of desaturation below 87%. Of the 26 infants studied, 4 had no detectable response to an increasing fraction of CO2 in inspired air on the CO2 challenge and 12 had an increase in exhaled minute ventilation per increase in the alveolar fraction of CO2 in exhaled air more than 2 SD below the mean. Only 10 patients (38.5%) had normal ventilatory responses to the increasing fraction of CO2 in inspired air. On follow-up, only one study patient had symptoms related to Arnold-Chiari deformity and brain-stem dysfunction (bilateral vocal cord paralysis). His neonatal CO2 challenge results and his pneumogram were normal. CONCLUSION: We conclude that these two tests are not useful in predicting which patients will have symptoms related to Arnold-Chiari deformity. Specificity for the pneumogram and the CO2 challenge was 0.52 and 0.36, respectively. Sensitivity was zero for both tests, although this result is limited by the low incidence of symptomatic Arnold-Chiari deformity in this sample. As previous investigators have found, a significant number of patients with meningomyelocele had abnormal ventilatory patterns. These ventilatory abnormalities indicate that even in the absence of severe symptoms, the control of the ventilatory response is somewhat impaired in many patients with meningomyelocele. This alteration in ventilatory control is probably related to abnormalities in the development of the brain stem.

Arnold-Chiari Malformation↗
PubMed1995

Effect of sugar on behavior and mental performance.

Sugar is one of the major dietary components and any relation between sugar and behavior is of major interest. We review the scientific evidence supporting or refuting the relation between sugar and behavior or cognitive function. Little evidence supports the claim that refined sugar intake significantly influences behavior or cognitive performance in children. A few children may have idiosyncratic reactions or rare allergic syndromes and may therefore respond adversely, but this has yet to be substantiated by carefully controlled research. A role for glucose in the potentiation of memory processing appears clear. Further research is required to define the clinical relevance of this role and to elucidate the mechanisms involved. Sucrose may have a sedative effect, at least in infants, but there are no substantial data suggesting that any sugar has analgesic properties.

Behavior↗
PubMed1993

Society of Pediatric Psychology Task Force Report: pediatric psychology and injury control.

Injuries are the major causes of death for children. Pediatric psychology offers significant contributions to the multidisciplinary efforts necessary to prevent injuries and reduce harm to children. This Task Force Report reviews epidemiological data, characteristics of children's injuries, passive and active interventions for reducing injuries, and research, policy, and evaluation issues for individual and community injury control efforts. Directions for future pediatric psychology efforts are identified and placed in a context of collaborative efforts required to advance the control of children's injuries.

Adolescent↗
PubMed1988

Biofeedback training for patients with myelomeningocele and fecal incontinence.

This study evaluated the efficacy of biofeedback training for fecal in continence in patients with myelomeningocele. 12 patients were randomized to receive conventional treatment alone, or in conjunction with biofeedback. Anorectal manometric functions were evaluated before and after treatment, six and 12 months later. 16 control children were also studied. Three of eight patients in the biofeedback group and three of the four given conventional treatment alone reported greater than or equal to 75 per cent improvement in frequency of soiling 12 months later. Biofeedback training did not improve anal squeeze, rectal sensation or continence of rectal infused saline. The number of patients who improved in both treatment groups was not different.

Adolescent↗
PubMed1987

Pediatricians' reported practices in the assessment and treatment of attention deficit disorders.

This study examined, in a national survey, the assessment and treatment practices of pediatricians who care for children with attention deficit disorders (ADD). A questionnaire was sent to randomly selected members of the American Academy of Pediatrics (AAP), stratified by state. Of 417 (52%) responses returned, there were 290 (38%) completed questionnaires. It was found that most pediatricians did not utilize specific DSM-III criteria for ADD; however, they do rely on symptoms of distractibility, overactivity, and impulsivity, which are the behaviors central to the DSM-III diagnosis. In addition, learning difficulties were felt to be contributory. Parents were the most frequently reported sources of information about a child's behavior, but the histories provided by teachers, and psychoeducational reports, also were sought frequently. Many pediatricians still use diagnostic procedures that have recently come under question, such as soft neurologic signs, activity level in the office, and response to stimulant medication. Methylphenidate and behavior modification were the most frequent therapies employed. Over half of the respondents use periodic reevaluation with rating scales to determine medication efficacy, but very few use placebo trials. More recently trained pediatricians tended to rely more on behavioral treatments than did earlier trained physicians.

Attention Deficit Disorder with Hyperactivity↗
PubMed1986

Verbal and non-verbal behaviour of doctors while conveying distressing information.

This study was an attempt to gather information on doctors' verbal and non-verbal hand- and speech-related behaviours during interactions involving the conveyance of distressing information. Similarities and differences in verbal/non-verbal communication were identified and described between doctors rated high, medium or low in communication skills. Gender differences were also explored. Statistically significant differences were found among doctors rated high in communication skills on the use of 'Information/advice' and 'Emotional probes'. Differences were also found on the frequency of speech disruptions and hand behaviour patterns. Doctors rated high were less anxious during the interactions as inferred from their hand- and speech-related behaviours. Gender differences on verbal behaviours indicate that 'Emotional probing' and 'Reflection of feelings' were exhibited more frequently by females. On the other hand, no statistically significant differences were found in non-verbal hand- and speech-related behaviours.

Female↗
PubMed1985

Effects of sucrose ingestion on the behavior of hyperactive boys.

A challenge design was used in two separate studies to investigate the effects of sucrose ingestion on the behavior and learning of hyperactive boys. In both studies, 16 boys were admitted to a clinical research center for 3 successive days, on each of which they were given a sucrose-free diet. On day 1, baseline levels on the learning tasks were established; on days 2 and 3 a challenge drink of either sucrose 1.75 gm/kg or a placebo (aspartame in equivalent sweetness) was presented, in a counterbalanced order. In the first study the challenge drink was administered 1 hour after lunch; in the second study it was given in the morning after an overnight fast. On days 2 and 3 of both studies, 37 behavioral (playroom observation and examiner ratings) and cognitive (learning and memory tasks) measures were collected, starting 1/2 hour after ingestion of the drink. The results of both studies revealed no differences between the boys' performance on the two challenge days. These findings undermine the hypothesis that sucrose plays a major role in accounting for the inappropriate behavior of hyperactive boys.

Aspartame↗
PubMed1978

Effects of methylphenidate alone and in combination with behavior modification procedures on the behavior and academic performance of hyperactive children.

Twenty hyperactive 6- to 9-year-old children of normal intelligence were studied in a half-day laboratory classroom in a 2-week period baseline-treatment-reversal design for behavior modification. Under double-blind conditions half the children were placed on .3 mg/kg of Ritalin and half on placebo for the entire program. The classroom program consisted of a group period with immediate reinforcement possible, and an individual time period without immediate reinforcement possible. Behavior modification caused a significant decrease in nonattending, out-of-seat, inappropriate vocalizing and inappropriate peer interaction behavior in the group period. Fidgeting, a nontargeted behavior, was not significantly decreased during this period but did significantly decrease as a result of medication. No other drug effects occurred during this period. During the individual period, the results were essentially reversed. There were no significant behavior modification effects observed. Significant reductions resulted from medication in all behaviors except out-of-seat and fidgeting. Behavior modification alone significantly affected the two academic measures. No signigicant effects were seen on the Conners Abbreviated Teacher Rating Scale. No significant interactions were noted between medication and behavior modification.

Achievement↗