SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Reanalysis of testosterone values published in 1993 gave a significantly higher mean and standard deviation for 15 learning-disabled children scoring P > V than those for 10 scoring V > P but not for a matched nonlearning-disabled group. Replication with larger samples would allow a test of hemispheric integration.
To access services for children with disabilities, the children often have been required to leave their families of origin. However, social science evidence indicates that there are substantial psychological benefits for children to remain with their families whenever possible. The U.N. Convention on the Rights of the Child (U.N. General Assembly, 1989) supports policies and programs that enable children with disabilities to receive services without leaving their family environment. This article briefly reviews the social science literature and the U.N. Convention, and it documents trends in U.S. law consistent with the implications of the scientific evidence and international consensus. The authors conclude that it is important for the federal government to maintain these progressive programs and policies even as responsibilities for social programs shift to the states.
Children and adolescents with mental retardation and developmental disabilities are thriving in their communities owing to special education programs that provide full inclusion in school and community life. Many youngsters, however, do not reach their full potential because of the limitations imposed by untreated psychiatric disorders. Although striking behavioral symptoms may be present, care providers often mistake them for typical aberrant behavior associated with developmental disabilities. When this occurs, these children do not receive proper psychiatric care and may suffer restrictive behavioral programming and exclusion from community living. On the other hand, children and adolescents with mental retardation and developmental disabilities frequently present with unusual symptoms associated with psychotic disorders, leading to misdiagnosis and inappropriate treatment with antipsychotic agents. The problems due to stress on these children and their families, long-terms costs in loss of educational and vocational opportunities, and the development of serious adult psychiatric disorders are enormous. By exploring the risk factors for psychiatric diagnosis in this population and presenting illustrative cases, awareness of the indicators for pediatric practice with this population is provided in this review.
A retrospective study was conducted to compare history of middle ear disease children with an attention deficit disorder with hyperactivity (ADD-H) and children with a learning disability. Of 138 children evaluated in a child development clinic, learning disability without ADD-H was diagnosed in 45 (29 boys, 16 girls; mean age = 9.5 years) and ADD-H without learning disability was diagnosed in 21 (17 boys, 4 girls; mean age = 8.5 years). Based on parental report, children with ADD-H had significantly more complaints of earaches during the preceding 3 months and significantly more ear infections during the preceding year. Specifically, no between-group differences were observed for total number of ear infections since birth, extended antibiotic therapy, tympanostomy tube placement, or recent hearing problems. Although middle ear disease in preschool children has repeatedly been linked to later language deficits, this study suggests that middle ear disease in school-age children may also be associated with hyperactivity and/or inattention, independently of learning disability.
A retrospective study of 60 Navajo children with developmental disabilities was conducted to evaluate the quality and comprehensiveness of health services provided. Descriptive analysis by a multidisciplinary panel included medical record reviews, family interviews, and site visits to local health, educational, and family support services. Findings included timely and appropriate management of "medical" problems but a general neglect of "developmental" issues, such as hearing, speech/language, cognitive, and behavioral functioning, and attention to family understanding and adjustment toward caring for a handicapped child. Primary prevention and screening efforts were judged generally adequate, although not utilized by the majority of mothers of disabled children. Diagnostic assessments, family counseling, and referrals for treatment were incomplete, fragmented, and poorly coordinated. These problems resulted in potentially harmful delays in making referrals to available treatment programs. The majority of families interviewed tended to focus on the "medical" problems, had a poor understanding of the "developmental" components, and rarely participated actively in treatment.
Children with congenital conditions who are nonambulatory have been observed to have pathologic fractures due to disuse osteopenia. Data support the use of intravenous bisphosphonates to treat this in children with disabilities, but there are no data to guide the use of oral bisphosphonate medication. Ten nonambulatory children with disuse osteopenia secondary to either static brain injury or spina bifida were started on alendronate. Investigators completed a chart review of each subject. There were 17 fractures before starting alendronate and 1 fracture in the follow-up period. All children with nociceptive behavior or pain complaints (5/10) had their symptoms resolve after treatment. Despite the presence of gastrointestinal comorbidities (7/10 with a history of gastroesophageal reflux disease, 5/10 taking reflux medication, and 4/10 with PEG tubes), only 1 of the 10 children discontinued the medication secondary to gastrointestinal complaints. This case series offers evidence that disabled nonambulatory children tolerate alendronate, and it may decrease fractures in those at risk from severe disuse osteopenia.
Disability of children is an urgent, little investigated and medicosocial problem. It is characterised by high level, severity, very slow dynamics and stipulates the formation of population of "invalids from childhood" among adult population. The main causes of disability are congenital and genetic diseases, mainly neuropsychic. Hereditary factors, diseases during pregnancy, the use of drugs, consumption of alcohol, complicated delivery also play a major role. The lack of watchfulness both on the part of physicians and the parents themselves also results in the birth of affected children. Prevention priorities include medico-genetic counseling, the improvement of obstetric care and increasing awareness of the importance of family planning among young people. The disability of children should be regarded as an important qualitative indicator of joint activities of obstetrician-gynaecologists, general practitioners and pediatricians.
OBJECTIVE: Although an increasing number of Medicaid children are enrolled in Medicaid managed care plans, little is known about how children with special health care needs fare under such programs. Of particular concern is the ability of such children to navigate a managed care system and gain access to specialty and other services. This study compares the managed care experiences of children with and without special care needs in the Oregon Health Plan. METHODOLOGY: Telephone surveys were conducted with a sample of parents of children enrolled in the Oregon Health Plan. Three groups of children were sampled: Supplemental Security Income (SSI) children with disabilities, children with asthma, and children without special health care needs. Descriptive and multivariate analyses were conducted to determine the impact of Medicaid managed care on access and satisfaction. RESULTS: Children with disabilities in managed care plans did not experience any more difficulty accessing needed specialty care than did those without special health care needs. Children with asthma, however, reported higher levels of unmet need. There were no differences in access between children with disabilities enrolled in managed care and those children with disabilities remaining in fee-for-service. CONCLUSIONS: Unlike SSI children with disabilities, children who were not SSI-eligible but had asthma seemed to have difficulty obtaining some services. These children were not eligible for the same consumer protections afforded SSI children by Oregon. If states want to enroll all children with special health care needs into managed care programs, they must develop mechanisms for identifying such children and ensuring that they receive medically necessary services.
Diagnostic and prognostic uncertainty is one of the major psychological stressors for patients in acute and chronic illness, as well as for parents of children with disabilities or chronic disease. Whereas the parents' feeling of uncertainty is undoubtedly very strong shortly after the birth of a child with disabilities, the long-term effects on the parents of having or not having a precise genetic diagnosis, in terms of emotional stress, remain unclear. In this study, mothers of non-disabled children are compared to mothers of children with Down syndrome, and to mothers of children with a diagnostically unassigned mental retardation with regard to the level of anxiety, feelings of guilt, and emotional burden. While the mothers of children with Down syndrome score comparably to the mothers of non-disabled children, the results show broad psychoemotional disadvantages for mothers of children with a mental retardation of unknown etiology. Consequently, the value of genetic diagnosis of infantile disabilities encompasses, beyond clinical considerations like therapy planning and assignment of the recurrence risk for siblings, significant and long-lasting emotional relief for the parents.
Data from the nation's largest household health survey indicate that the number of children with disabling chronic conditions has doubled over the last 25 years. In describing their approach to this potentially severe public health problem, the authors advance and evaluate several possible explanations for the trend. They conclude that while a portion of the trend may be explained away by artifactual causes such as changes in survey procedures, much of the increase in reporting may be reflective of a genuine change in prevalence of chronic disease among children. Future analysis of this data will focus on improving health promotion programs to target those factors identified as contributing to chronic and disabling conditions in children.
The performance of normal and learning-disabled children on a dichotic listening task using 30 paired consonant-vowel (CV) syllables was investigated in a series of studies. The effects of gender, developmental level, and prestimulus cuing on assessed auditory asymmetries were examined. In addition to providing normative data, the results of these studies are discussed as they relate to theoretical notions of cerebral asymmetries in normal and learning-disabled children and as they pertain to clinical diagnosis of childhood learning disabilities.
The effects of the participation of non-disabled children in a cooperative learning programme on their social acceptance of classmates with mild intellectual disability was examined. A sample of 24 children with mild intellectual disability in the 9-11-year-old age-range was identified from educational psychologists' case records. All of the children were receiving mainstreaming special education programmes at the time of the study. Twelve of the children had previously attended special education classes, while the remainder had always attended regular classes. Half of the children's regular classes were randomly assigned to either receive an experimental cooperative learning programme or to serve as control classrooms. The non-disabled children in the experimental classes showed significant increases in their social acceptance (sociometric ratings) of the children with mild intellectual disability, both immediately following the programme and 5 weeks later, but no such increases were evident in the children in the control classrooms. This pattern held for both the former special class pupils and the children with mild intellectual disability who had never attended special classes. The results confirm the usefulness of cooperative learning strategies for enhancing the social acceptance of children with mild intellectual disability in mainstreaming special educational programmes, regardless of the nature of their previous special educational provisions.
Each year the number of children who enter the foster care system grows because the number of children who are vulnerable to abuse, neglect and/or poverty grows. Children with disabilities are a particularly vulnerable subset of this already vulnerable population. What are the implications of conceptual and methodological issues in theories of disability for estimates of children with disabilities in foster care? To what extent do children in the foster care system have disabilities? What are implications of existing health care coverage strategies (Medicaid, managed care, etc.) for the health and well-being of foster care children with disabilities? Conceptual and operational definitions of disability are reviewed. Descriptive statistics based on a secondary analysis of 1998 administrative AFCARS data are used to summarize the extent of disabilities. In addition, existing empirical studies and public policies on national and state health care insurance strategies are analyzed.
Disability is a well known and tragic event for children. While adults are an established group for specific disability insurance cover, children were often neglected in the past. Although parents, organizations and paediatricans are aware of the risk, children specific incidence rates for disability are hardly available. The only sufficient source for some statistical data are the accident statistics because they represent a substantial group of specific cause related disability for children. Incidence rates for disease related chronic severe impairment or disability in children are either derived by single disease research or actuarial calculation of the German Social Disability Registration. Based on this statistical background, an extended accident insurance for children was introduced in Germany covering both accidents and disabling diseases. The key limitation for all variations of this insurance are exclusion clauses for congential diseases and mental disorders. This insurance requires a new approach in underwriting of the health risks. Because of the substantial number of impaired children, a simple decline of substandard cases are unacceptable. The early experience or medical underwriting shows predominantly health impairments of the following types: allergies, bronchial asthma, ectopic eczema (neurodermitis), disorders of speech and articulation, vision disorders and mental impairments. The suggested solution for underwriting of substandard risks is the predetermination of the possible future maximum degree of disability. The need for underwriting guidelines is supported by the market impact of the new disability cover with thousands of insurance policies issued in the first month after introduction.
Reading disabled and nondisabled children (13-14 years of age) were presented lists of 10 words each at different rates (one word per 1, 2, and 4 sec), and immediately after the last word of each list they recalled the words in any order. Recall of the first few words presented from each list (the primacy effect) was lower in reading-disabled than nondisabled children, and slower presentation rates increased the primacy effect in both groups. These findings suggest that reading-disabled children are not completely failing to use elaborative encoding but are using less effective elaborative encoding than nondisabled readers. With all presentation rates, recall of the last few words (the recency effect) was comparable in both groups, suggesting that older reading-disabled children encode and recognize the stimuli and that elaborative encoding is deficient in reading-disabled in spite of adequate stimulus encoding and recognition.
BACKGROUND: The possibility that reading disability in children is associated with visual problems is in dispute. We sought to test the existence of this association by using electrophysiologic techniques to measure the processing of visual information in the magnicellular and parvicellular visual pathways of the brain. METHODS: Visual evoked potentials were measured with scalp electrodes in children 8 to 11 years old who were normal readers and in those with reading disability. The potentials were measured for targets with low (0.5 cycle per degree of visual angle) and high (4.5 cycles per degree) spatial frequency, surrounded by either a steady background or a uniform-field flickering 12 times per second. A flickering field normally reduces the amplitude and increases the latency of a transient potential evoked by a low-spatial-frequency target, which preferentially excites the magnicellular visual pathway, but has little effect on the response to a high-spatial-frequency target. RESULTS: With a steady background, the latencies of the early components (N1 and P1) of the visual evoked potentials were longer in the reading-disabled children than in the normal readers when the low-spatial-frequency target was used, but not when the high-spatial-frequency target was used. In normal readers, the flickering background increased the latency and reduced the amplitude of the early components, whereas in the reading-disabled children only the amplitude was affected. No differences were observed in either group with the high-spatial-frequency target. CONCLUSIONS: The pattern of results suggests that the response of the magnicellular visual pathway is slowed in reading-disabled children, who do not, however, have a general slowing of the visual response. The possibility that there is a cause-and-effect relation between these findings and reading disability will require further study.
A displeasing dental appearance may have a significant emotional impact on an individual's well being. Although malocclusions occur more often in physically and/or mentally handicapped children than in normal children, the most severely handicapped patients are those least likely to receive orthodontic treatment. This investigation studied the modes of behaviour management used in the orthodontic treatment of disabled children, and the preferred criteria. The files of 49 disabled children were retrospectively evaluated. Two classification systems, the Frankl Behaviour Rating Scale (FBRS), and that of Owen and Graber were found to be unsuitable for determining the appropriate treatment modality. Five specific factors, frequently seen in disabled children, gag reflex, drooling, uncontrollable movements, inability to remain still, and the need for additional procedures, were graded and a scoring system was devised to include these factors within the assessment. This scoring system may be used to evaluate new patients and to assist in the choice of the appropriate behavioural management mode.
The ability to distinguish serious from playful fighting by two groups of children with learning disabilities (LD) (mean age = 9.3 and 11.8 years) and non-LD children (mean age = 10.1 years) was examined. Children with LD were generally able to make this distinction, with older children being more accurate. However, the performance of children with LD was not as high as that of non-LD children: they used a smaller range of criteria; some criteria were used significantly less; and they were much more likely not to give any reason for the judgements made. On the other hand, the order in frequency of those criteria cited was similar for both non-LD children and children with LD. Physical actions of the participants, and inference about actions and/or intent were the most frequently cited criteria. These findings indicate that although children with LD use fewer social cues, and are less accurate in making judgements about the nature of behavioural episodes, the acquisition of the meaning of particular cues may follow the same sequence as for non-LD children. Possible delays in the social cognitive development of children with LD, and their implications for the social adjustment of these children, are discussed.