Helen D. Pratt

Pediatric neurodevelopment and sports participation ☆: When are children ready to play sports?

A fundamental knowledge of normal child and adolescent development is essential to providing a developmentally appropriate sports experience for the child, and to providing guidance to parents regarding their childs sport participation. This article reviews neurodevelopment, normal child and adolescent development relevant to sport participation, and developmental readiness to participate in sports. Neurodevelopmental maturation is a complex, continuous process. The sense of social comparison is not achieved until after 6 years of age, and the ability to understand the competitive nature of sports is generally not achieved until 9 years of age. By about 12 years of age, most children are mature enough to comprehend the complex tasks of sports and are physically and cognitively ready to participate in competitive sports with appropriate supervision.

Eating Disorders in the Adolescent Population: An Overview.

Although eating disorders often begin during adolescence, characteristics of this population can complicate early detection by clinicians. The purpose of this article is to selectively review the literature on the diagnostic criteria for eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder) as described in Diagnostic and Statistical Manual of Mental Disorders (4th ed.) and International Classification of Diseases (10th ed.). The prevalence and course of eating disorders, theories regarding their etiology, and issues of comorbidity and differential diagnosis are also discussed.

Corporal punishment in schools

Corporal punishment refers to intentional application of physical pain as a method of changing behavior [1]. It includes a wide variety of methods such as hitting, slapping, spanking, punching, kicking, pinching, shaking, shoving, choking, use of various objects (wooden paddles, belts, sticks, pins, or others), painful body postures (as placing in closed spaces), use of electric shock, use of excessive exercise drills, or prevention of urine or stool elimination [2,3]. Corporal punishment in schools does not refer to the occasional need of a school official to restrain a dangerous student or use physical force as a means of protecting members of the school community subject to imminent danger.

Eating Disorders in Adolescent Athletes.

Adolescent athletes are especially vulnerable to developing disordered eating behaviors. Risk factors include participation in sports where weight and lean body type are important, high-intensity training, pressure from coaches, and training and dieting beginning at an early age. Medical complications associated with these unhealthy dietary and weight-control practices and eating disorders can be potentially dangerous. Prevention strategies include minimizing the importance of weight, increased sensitivity on the part of those working with athletes for issues around weight and dieting, and appropriate education on proper weight-control methods and nutrition. The long-term prognosis is not known.

Suicide risk in adolescents with chronic illness: implications for primary care and specialty pediatric practice: a review.

Suicide in adolescents is a global tragedy. Research‐identified correlates of suicide in youth include depression, academic failure, loss of friends, social isolation, and substance abuse, among others. This review focuses on the potential link between chronic illness in adolescents and increased suicide risk. Research suggests that chronic illness is a risk factor for depression in adolescents that may induce suicide ideation and attempts; however, this risk may be increased even more in young adulthood if the underlying causes of depression are not resolved. This risk needs to be considered against the research data noting an increase in suicide attempts and completions, in each decade of life from adolescence into adulthood. Although more research is clearly needed, it can be concluded that suicide risks are seen in adolescents with chronic illness and all of these young people should be screened for depression and other risk factors for suicide on a regular basis.

Syndromes and disorders associated with mental retardation

This article reviews selective comments on the concept of Mental Retardation (MR) in adolescents. Issues covered include the definition, prevalence, and differential diagnosis of MR. Some of the syndromes and disorders associated with MR in the adolescents are also considered with emphasis on the behavioral concerns that may be present in this age group. Finally, concepts of management by the clinician are reviewed. It is recommended that health care professionals caring for adolescents with MR should help these youths maximize their potential as human beings, helping them achieve meaningful functioning in adulthood.

The Adolescent Female Athlete: Current Concepts and Conundrums

The adolescent female athlete has become a common part of the sports environment at all levels from childhood play to professional adult sports. This article considers various issues common to this athlete to help clinicians care for their patients. Basic sports physiology is reviewed and then specific conditions are considered, including iron deficiency anemia, stress urinary incontinence, breast issues (ie, pain, asymmetry, galactorrhea, injury), the female athlete triad (ie, menstrual dysfunction, abnormal eating patterns, and osteopenia or osteoporosis), and injuries. Clinical conundrums are considered including the difficulty in caring for a dedicated athlete whose intense love of her sport may lead to menstrual and bone loss complications. The knowledgeable clinician in the twenty-first century can be of considerable help to the female athlete who is at and beyond puberty.

The rebellious adolescent. Evaluation and management of oppositional and conduct disorders

A wide variety of management options are available to the primary care physician who is presented with a rebellious adolescent. After a careful assessment, the clinician and other health care professionals can choose a diverse combination of interventions: individual therapy, family therapy, youth-centered programs, community-centered programs, psychopharmacology, and others. Rebellious adolescents need access to comprehensive medical and mental health care, academic education (including sexuality education), and full employment opportunities. Primary care physicians can play a vital and sometimes pivotal role coordinating services and helping parents, school personnel, and therapists work with these youth. Even when dealing with the very difficult and resistant group of youth with CD and ODD, optimism for improvement should always be maintained by the clinician.

Attention-deficit/hyperactivity disorder in children and adolescents: interventions for a complex costly clinical conundrum

Management of a child or adolescent with attention-deficit/hyperactivity disorder (ADHD) is reviewed, including psychological and pharmacologic approaches. Psychological treatment includes psychotherapy, cognitive-behavior therapy, support groups, parent training, educator/teacher training, biofeedback, meditation, and social skills training. Medications are reviewed that research has revealed can improve the core symptomatology of a child or adolescent with ADHD. These medications include stimulants, antidepressants, alpha-2 agonists, and a norepinephrine reuptake inhibitor. Management of ADHD should include a multi-modal approach, involving appropriate educational interventions, appropriate psychological management of the patient (child or adolescent), and judicious use of medications. Parents, school officials, and clinicians must work together to help all children and adolescents with ADHD achieve their maximum potential.

Treatment of Adolescents with Anorexia Nervosa

Research on the treatment of adolescents with anorexia nervosa is limited but shows that effective strategies employ a multidisciplinary team approach. Most patients receive medical attention when there is an acute medical or psychiatric emergency after losing a significant amount of weight and there is a need for nutritional and metabolic stabilization. Medical and nutritional stabilization are the first courses of treatment, followed by psychological stabilization. Initial treatment settings are dependent on the severity of symptoms and can range from inpatient to partial hospitalization or from day treatment to outpatient clinics. Physical activity and weight gain must be gradually accomplished. Effective treatment includes a variety of psychotherapeutic approaches (individuals and family therapy). Psychopharmacotherapy is generally unreliable in the treatment of anorexia nervosa and should be targeted to specific symptoms or complications. Prevention programs have been shown to have limited success.