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PubMed1989

Communicative performance of adolescents with severe speech impairment: influence of context.

The communicative performance of 4 preoperational-level adolescents, using limited speech, gestures, and communication board techniques, was examined in a two-part investigation. In Part 1, each subject participated in an academic interaction with a teacher in a therapy room. Data were transcribed and coded for communication mode, function, and role. Two subjects were found to predominantly use the speech mode, while the remaining 2 predominantly used board and one other mode. The majority of productions consisted of responses to requests, and the initiator role was infrequently occupied. These findings were similar to those reported in previous investigations conducted in classroom settings. In Part 2, another examination of the communicative performance of these subjects was conducted in spontaneous interactions involving speaking and nonspeaking peers in a therapy room. Using the same data analysis procedures, gesture and speech modes predominated for 3 of the subjects in the nonspeaking peer interactions. The remaining subject exhibited minimal interaction. No consistent pattern of mode usage was exhibited across the speaking peer interactions. In the nonspeaking peer interactions, request predominated. In contrast, a variety of communication functions was exhibited in the speaking peer interactions. Both the initiator and the maintainer roles were occupied in the majority of interactions. Pertinent variables and clinical implications are discussed.

Adolescent↗

PubMed1989

Social competence and behavioral adjustment of children who are long-term survivors of cancer.

Relatively little is known about the special needs of long-term survivors of childhood cancer or the factors that make this growing population vulnerable to chronic psychologic disorders. We therefore surveyed 183 children who had been treated for cancer at St Jude Children's Research Hospital and were free of the disease for greater than or equal to 2 years after completing therapy. Parental responses to the Child Behavior Checklist, a standardized inventory of social competence and behavioral problems, were analyzed in relation to demographic and medical variables, as well as the children's appearance and functional status. School-related problems and somatic complaints of undetermined origin were increased fourfold relative to age- and gender-adjusted rates for peer groups in the general population. The presence of functional but not cosmetic impairments increased the risk of academic and adjustment problems. An older age at evaluation, treatment with cranial irradiation, and residence in a single-parent household were also associated with an increased risk of psychologic problems. General pediatricians must eventually assume responsibility for the extended follow-up care of children who have survived a malignancy. Their awareness of the high-risk groups described in this report should facilitate more timely identification of problems and referral of the children to appropriate services.

Achievement↗

PubMed1995

[Light therapy can restore a disturbed sleep/wake rhythm in dementia: but what is the basis of its efficacy?].

In dementia short nocturnal sleep length, agitation and naps in the day-time suggest a chronobiological disturbance. Bright light therapy seems indicated because of its chronobiological activity. However, dementia is accompanied by a decrease in volume and number of active cells of the suprachiasmatical nuclei, the internal clock. Is the circadian system still functioning then or is it irrevocably damaged? The findings concerning the circadian rhythm of several physiological functions are not consistent but do not show a weakened rhythm. Rest/activity and sleep/wake rhythms, however, are weaker in demented elderly than in their peers. All things considered the internal clock is still functioning and the Zeitgeber maintain their chronobiological activity. Research shows that bright light therapy can restore the sleep/wake rhythm in dementia but research does not uncover the working mechanism. Further studies can give clues for alternative treatments. If the effect of light therapy is based on its Zeitgeber function, other Zeitgeber may be considered as treatments. There is some evidence that an increase in social contacts is effective. The efficiency of light therapy can also be caused by stimulation in a situation of sensory deprivation. There are only anecdotical indications that this stimulus role can also be fulfilled by music.

Aged↗

PubMed1995

Effects of paternal absence on male adolescents' peer relations and self-image.

This study explores the extent to which adolescent males experience different peer adjustment and masculine self-image as a function of father deprivation. A sample of 40 middle school boys (20 father-present and 20 father-absent) rated each other on peer adjustment and masculine self-image. Results indicate that father-absent boys evidence a poorer sense of masculinity as well as poorer interpersonal relationships than do father-present boys.

Absenteeism↗

PubMed1977

Peer sex education training and evaluation.

Human sexuality has been recognized as an important developmental, emotional, and medical concern on the college campus. The Peer Sex Education Program at the University of Massachusetts/Amherst has been developed as a model for the use of trained students in an educational, referral, and counseling role. This paper describes the program and outlines the methodology used in the documentation and evaluation of various program aspects. Aspects described include the program's rationale and background, the recruiting process, roles and responsibilities, training and supervision models, community development, and delivery of service. Categories of documentation and evaluation considered include effort, performance, adequacy of performance, efficiency, and process. These are related to consumer acceptance and satisfaction, outcome measures of knowledge, attitude, and behavior, effectiveness of referral and other functions, and effect of program on the peer educators' growth and development. The allocation of energy and resources between program development, service delivery and evaluation needs is highlighted.

Humans↗

PubMed1992

The relationship between attitude to disabled siblings and ratings of behavioural competency.

The impact of maturation factors and functioning level on the relationship between disabled and non-disabled siblings was examined. Two groups of adults, distinguished by level of functioning of their mentally retarded sibling, completed a Schaefer Sibling Behavior Inventory (SBI) and participated in a semi-structured interview. The latter explored a number of dimensions of the relationship including degree of warmth, contact and involvement. Judgements about involvement and comfort as remembered from the past and judgements about the present were obtained to derive hypotheses about possible changes with time. Data from the SBI indicated that significantly more competent siblings tended to be involved in relationships with a higher degree of reciprocity. In contrast, measures of attitude derived from interview data did not appear to relate to the functioning level of the sibling in any systematic manner. The results suggest that level of discomfort with peers may decrease significantly over the years with neither level of functioning nor gender being important variables. The extent to which non-disabled individuals expressed a preparedness to participate in the life of their disabled sibling may relate to the life-stage of the two. Males in particular anticipated increased future involvement. Although higher-functioning siblings were described as more active in the relationship, this did not appear to influence perceived positiveness of regard. The implications of these results are discussed briefly.

Activities of Daily Living↗

PubMed1994

Limits to a left hemisphere explanation for specific language impairment.

The hypothesis of unilateral left hemisphere damage as an explanatory model for the neurological basis of specific language impairment (SLI) does not appear to be sufficient for most children with SLI. Children with unilateral brain lesions have been shown to function significantly lower than their neurologically intact peers on a variety of language measures, yet few of the deficits noted are as persistent or severe as those seen in SLI. In at least two instances, however, language symptomatology following unilateral lesions in children does parallel some types of SLI. The first occurs following subcortical damage to anterior grey and white matter structures that typically results in pronounced language and learning disorders. The second parallel lies in the similar developmental course shared by children with "delayed" language and children with known unilateral lesions, whereby language onset and development is slow in the preschool years but normalizes by school age, with minimal long-term language-learning deficits.

Brain↗

PubMed1998

Attachment and adolescent psychosocial functioning.

To explore the meaning and function of attachment organization during adolescence, its relation to multiple domains of psychosocial functioning was examined in a sample of 131 moderately at-risk adolescents. Attachment organization was assessed using the Adult Attachment Interview; multiple measures of functioning were obtained from parents, adolescents, and their peers. Security displayed in adolescents' organization of discourse about attachment experiences was related to competence with peers (as reported by peers), lower levels of internalizing behaviors (as reported by adolescents), and lower levels of deviant behavior (as reported by peers and by mothers). Preoccupation with attachment experiences, seen in angry or diffuse and unfocused discussion of attachment experiences, was linked to higher levels of both internalizing and deviant behaviors. These relations generally remained even when other attachment-related constructs that had been previously related to adolescent functioning were covaried in analysis. Results are interpreted as suggesting an important role for attachment organization in a wide array of aspects of adolescent psychosocial development.

Adolescent↗

PubMed1996

The relations of children's dispositional prosocial behavior to emotionality, regulation, and social functioning.

The purpose of this study was to examine the relations of a measure of children's dispositional prosocial behavior (i.e., peer nominations) to individual differences in children's negative emotionality, regulation, and social functioning. Children with prosocial reputations tended to be high in constructive social skills (i.e., socially appropriate behavior and constructive coping) and attentional regulation, and low in negative emotionality. The relations of children's negative emotionality to prosocial reputation were moderated by level of dispositional attentional regulation. In addition, the relations of prosocial reputation to constructive social skills and parent-reported negative emotionality (for girls) increased with age. Vagal tone, a marker of physiological regulation, was negatively related to girls' prosocial reputation.

Adaptation, Psychological↗

PubMed1997

Posttraumatic stress, family functioning, and social support in survivors of childhood leukemia and their mothers and fathers.

Psychological sequelae are examined in 130 former childhood leukemia patients and 155 comparison participants and their parents. The major dependent variables are symptoms of anxiety and posttraumatic stress, family functioning, and social support. Multivariate analyses of covariance indicated significantly more posttraumatic stress symptoms in mothers and fathers of childhood leukemia survivors (p < .001) and no differences between survivors and peers. There were no significant group differences for family functioning or social support, although they were associated with anxiety and posttraumatic stress outcomes. Current child age, age at diagnosis, and months off treatment were not significantly correlated with outcome. These findings document the long-term impact of childhood cancer treatment on parents. The lack of significant differences for survivors argues for further attention to the relevance of posttraumatic stress disorder for childhood cancer survivors. The clinical implications are that psychological interventions are needed during and after cancer treatment.

Adolescent↗

PubMedDate not supplied

The development of the Comprehensive Addiction Severity Index for Adolescents (CASI-A). An interview for assessing multiple problems of adolescents.

The Comprehensive Addiction Severity Index for Adolescents (CASI-A) is a 45 to 90-minute comprehensive, semi-structured clinical interview for evaluating adolescents who present for treatment at various provider agencies. CASI-A modules and their individual items were selected and revised based on theory, clinical wisdom, and adolescent experiences obtained during pilot interviews and focus groups. The CASI-A assesses known risk factors, concomitant symptomatology, and consequences of adolescent alcohol/drug use within seven primary areas of functioning: education status, alcohol/drug use, family relationships, peer relationships, legal status, psychiatric distress, and use of free time. The CASI-A is not a diagnostic or screening instrument, but rather a clinical assessment tool that obtains clinically pertinent information designed to guide treatment planning and to evaluate treatment outcome. The CASI-A's design makes it suitable for administration in a variety of settings, for repeat administration at posttreatment follow-up evaluations, and for assessment of virtually all adolescents in treatment regardless of their admission problem. Overall, the CASI-A has encouraging but preliminary evidence of validity and internal consistency. Information collected soon after admission during administration of the CASI-A by nonclinical interviewers corresponded quite well with that obtained over the course of the adolescent's treatment stay by the entire treatment team. Revisions to the instrument are being made in those areas where correspondence between information on the CASI-A and that extracted from clinical records dropped below 75%, or in those early subscales, where alpha coefficients dropped below .6. As a result of the encouraging results reported in this paper, we are beginning additional psychometric testing, refining the proposed scoring system, and developing a computerized data entry, scoring, and report system.

Adolescent↗

PubMed1975

Relation between quality assessment and utilization review in a functioning PSRO.

The Utah State Medical Association, through its peer-review foundation, the Utah Professional Review Organization, has implemented an integrated system of utilization reveiw and quality assessment linked to a program of continuing education. Nurse co-ordinators, employed by the Organization, screen all hospitalized patients covered by Titles XVIII, XIX and V as well as by subscribing private insurers. Approximately 10 per cent of hospitalized patients do not meet peer-generated criteria for admission review or length of stay and are screened out for peer review, The nurse co-ordinators collect data for retrospective quality assessment, identifying targets for continuing medical education. Preliminary data support the cost effectiveness of such a review program. Continuing qualtiy audit will test the effectiveness of education programs.

Education, Medical, Continuing↗

PubMed1992

Breast and cervical cancer screening in minority populations: a model for using lay health educators.

Although mammography and the Pap smear have significantly reduced US deaths related to breast and cervical cancers, screening prevalence and survival rates for both diseases are disproportionately lower among minority women. This model program outlines techniques for recruiting and training minority women to serve as lay health educators who can effectively deliver preventive health care information to their peers. Lay health educators have three primary functions: to serve as mediators between minority women and health agencies, to establish a social network, and to offer social support. When properly recruited and trained, these educators can bridge the gap between health professionals and the community as well as help health professionals to better understand community and individual concerns about cancer. The goal is to increase the detection, prevention, and treatment of breast and cervical cancers in minority communities and thus decrease related deaths. An ongoing intervention by the Arizona Disease Prevention Center, targeting Yaqui Indian and Mexican-American women aged 35 and older, illustrates specific elements of the model.

Arizona↗

PubMed1985

Parent interview findings regarding the impact of cystic fibrosis on families.

An assessment of the impact of cystic fibrosis (CF) was conducted with 43 families. Semistructured parental interviews on family functioning, parent-child interactions, sibling and peer relationships, and medical issues were coded by two independent raters to identify "major," "minor", or "no" problems. Of the 62 questions presented, only 8 were viewed by more than 10% of parents as "major problems." The impact of hospitalization upon parents was the most prevalent "major problem." Parental communication was a "major problem" for 28% of the mothers but for only one father. Ten to 15% of the parents described "major problems" related to: their marital relationship, accepting the illness, feeling they should do more for their child with CF, feeling their other children had been deprived or complained about inattention, or their relationship with the ill child's grandparents. While most families were generally coping successfully, health care professionals should be alert to specific areas of potential problems.

Adaptation, Psychological↗

PubMed1998

Use of peer ratings to assess sociability among inpatients with severe psychiatric disorders.

OBJECTIVE: A critical component of inpatient treatment for persons with severe psychiatric disorders is an evaluation of their social impairments. Most existing methods for such evaluations involve staff input and can be both time-consuming and expensive. This paper reports on the use of peer ratings as a method for assessing sociability, an aspect of social functioning in this clinical population. METHODS: Thirty-two inpatients with severe psychiatric disorders who had spent an average of 18 months on an inpatient unit in a state facility rated the popularity of their inpatient peers by completing a 7-point scale measuring how much they enjoyed visiting with each patient. The reliability of peer ratings and their association with staff ratings of patients' behavior on the unit were assessed. RESULTS AND CONCLUSIONS: The peer ratings had excellent test-retest reliability and were highly associated with staff members' independent evaluations of patients' behavior. Peer ratings appear to have promise as a measure of social functioning among inpatients with severe psychiatric disorders.

Adult↗

PubMed1992

Functional status as an overall measure of health in adults with cystic fibrosis: further validation of a generic health measure.

We studied the validity of a generic health measure in a population with a chronic, life-shortening illness. Thirty-seven adults with cystic fibrosis (CF) and 46 of their healthy peers completed a questionnaire which included 12 questions on functional status from the RAND Health Insurance Study. For the CF group, the questionnaire and a medical chart review yielded data on 7 additional health variables, including pulmonary function. After data collection, members of the CF group were followed for 5 years, by which time 11 had died. The functional status of the CF group was significantly lower than that of the comparison group. Within the CF group, functional status correlated significantly with 6 of the 7 other health variables. Analysis using the Cox proportional hazards model showed that functional status alone was a significant (p less than 0.001) predictor of a CF subject's survival time; in a multivariate model a non-significant trend suggested that lowered functional status may be associated with an increased risk of early death even after adjustment for pulmonary function and percent ideal body weight. These results extend previous findings and suggest that functional status can be used as an overall measure of health in a wide variety of studies.

Activities of Daily Living↗

PubMed1989

Behavioral and autonomic responses to peer separation in pigtail macaque monkey infants.

Brief maternal separations of young nonhuman primates have been used extensively to study the behavior and physiology of attachment, loss, and bereavement. The physiological responses to the loss of alternative attachment figures, such as peers, is less well documented in nonhuman primates. This study examined both autonomic and behavioral responses of peer-reared pigtail macaque infants to separation. Eight infants were removed from their mothers at birth and reared in four peer pairs. At 6 months of age, each monkey was implanted with a multichannel biotelemetry device which transmitted heartrate, body temperature, EEG, EMG, and EOG. Blood was collected twice weekly for immunological assessment. Behavioral and physiological data, including sleep, were collected for 1 week of baseline, 2 weeks of separation, and 1 week of reunion. Behavioral and physiological results indicated agitation but not depression following separation from their peer attachment figures. We found reduced mitogenic responses to pokeweed consequent to peer separation, suggestive of altered B-cell function. REM variables were the only sleep measures affected by the separation, and were suggestive of agitation but not depression.

Animals↗

PubMed1993

New morbidity-problems and peer relations in a sample of Swedish primary school children: a follow-up from the first to the third grade.

The stability in the new morbidity-problem domains motor skills, reading/writing ability, behavioral-psychological-social function and concentration ability in school, and the stability of peer status and peer preferences as well as relationships between peer status and problems among boys and girls was studied in a sample of 81 Swedish primary school children. The children were rated by teachers and made peer nominations six months after school start, and in the third grade. There was considerable stability in problems, while the stability in peer status was modest. There were marked gender differences. Boys in contrast to girls improved in motor skills from the first to the third grade, and boys had more concentration problems and multiple problems than girls in both grades 1 and 3. In the first grade low peer acceptance in boys was accompanied by low motor skills. In the third grade, low peer acceptance in boys was accompanied by deficient concentration ability and externalizing problems. For girls, few relationships between low peer acceptance and problems emerged Various explanations for these findings are discussed.

Child↗