Jack Gladstein

A comparison of inner-city and upper-middle class youths' exposure to violence

Exposure to violence in healthy adolescents has not been explored. We questioned 838 youths (ages 11-24 years; 620 females) from two medical clinics. The Exposure to Violence Questionnaire was completed by 403 inner-city adolescents (inner-city group), and 435 middle-to-upper class youths (resort group). Inner-city participants were more often victims, knew of victims, and witnessed more assaults, rapes, knifings, life-threatening events, and murders than their resort group counterparts. In both groups, males were more likely to have been victims, witnesses, and to have known victims personally than were females, except for sexually related crimes. In both settings, youths often did not seek medical or psychological help after victimization. Adolescents are exposed to a startling amount of violence. Violence prevention should be targeted to the inner-city male population.

Diagnoses and symptom patterns in children presenting to a pediatric headache clinic

SYNOPSIS

Chronic Daily Headache in Children and Adolescents

Recurrent headache is a relatively frequent problem in children and adolescents, with the majority of the research attention focused on pediatric migraine. This study assessed differences in consequences to headaches, coping with headaches, and associated disability in children and adolescents attending a headache clinic who were diagnosed with migraine, chronic daily headache, or carried both diagnoses. Results, generally indicated higher levels of impairment for patients with chronic daily headaches. These patients were also more likely to use blaming others and wishful thinking as coping mechanisms. Gender and racial status interacted with headache diagnosis to predict parent response patterns and disability outcomes. The results provide initial support for the applicability of Martins functional model of chronic headaches to a pediatric population.

Substance use among adolescents with diabetes mellitus: Preliminary findings

Alcohol and drug use frequency was assessed by means of an anonymous, self-administered questionnaire in 79 diabetic adolescents who attended a diabetic sleep away camp. More than half of the participants reported using tobacco or alcohol at least once and 12%-25% reported greater that five times use in their lifetime. The overall frequency of drug and alcohol use was less than the general adolescent population. A modified Michigan Alcohol Screening Test (MAST) was used to evaluate abnormal drinking patterns, and 40%-50% of 12- and 16-year-old campers had an abnormal score, indicating that almost one-quarter of diabetic teens drink dangerously. There was a high correlation between campers who use drugs or alcohol and a positive family history of alcohol or substance abuse. Few campers perceived alcohol or drug use to affect their diabetic control, and the majority believed their control to be good to excellent, thus demonstrating the impact of denial in diabetic adolescent substance use. Adolescent diabetic assessments should include a psychosocial history, with emphasis on patterns of substance use, family substance abuse, and use of the MAST to identify high-risk individuals.

Chronic Daily Headache in Children and Adolescents:Current Status and Recommendations for the Future

The Pediatric Committee of the American Association for the Study of Headache was created in 1994 to develop a plan for comprehensively addressing global issues of headache in childhood. It was the impression of clinicians and researchers with an interest in childhood headaches that a clearer focus was needed to facilitate progress in the study and management of pediatric headache. It was further felt that approaches to treatment and outcomes, as well as assessment and classification schema for pediatric patients needed to be examined separately. The goal of the committee is to integrate anecdotal, clinical, and research expertise into a plan for addressing headaches in the pediatric population in the future. During the last 5 years, substantial attention has been devoted to chronic daily headache, primarily in adult populations. It is the purpose of this paper to review the literature of chronic daily headache in children, and propose areas for further exploration, given the recent emergence of interest in this diagnostic entity.

Use of the modified Atkins diet for adolescents with chronic daily headache

Chronic daily headache is a difficult problem to treat for many adolescents, with a natural tendency for parents to look into ‘alternative’ treatments such as acupuncture, herbal remedies, biofeedback and relaxation techniques (1). Data on food trigger avoidance are controversial and not universally recommended even as an adjunctive treatment (2–4). Obesity may be a factor in frequent migraines (5) and therefore weight loss through exercise and diets may be theoretically beneficial (6). The modified Atkins diet (MAD) is a high-fat, very low carbohydrate diet used in the treatment of children and adults with intractable epilepsy (7). This diet creates a ketotic state similar to the traditional ketogenic diet, but is started as an out-patient without a fast, or calorie, fluid or protein restriction (7). Weight loss can occur as well. Similar to anticonvulsant drugs, there has been recent interest in the potential benefits of ketogenic diets for the treatment of neurological conditions other than epilepsy, including Alzheimer disease, amyotrophic lateral sclerosis, brain tumours and autism (8). In 2006, a single case report was published regarding a 43-year-old woman with daily migraines who completely responded to a ketosis-inducing diet containing several high-protein and low-carbohydrate shakes per day (9).

Parent Responses to Pediatric Headache

Evaluated child and parent report versions of a 16‐item parent response to childrens recurrent pain episodes scale (PR‐PAIN) on a sample of 153 pediatric headache patients. Factor analyses yielded three factors—Solicitous, Affiliative/Distracting, and Negative responses—for each report form. Correlations among factor scores provided evidence for convergent and discriminant validity. Factor scores from the parent and child report scales were differentially related to levels of episode‐specific disability and overall behavior problems, supporting the criterion‐related validity of both the child and parent measures, The PR‐PAIN scale may assist in performing a thorough functional analysis of pediatric headache and other pain‐related problems.

Headaches and hormones.

It is clear that hormones play an important role in modulating and exacerbating headaches. From an epidemiologic standpoint, we know that before puberty, incidence of new headache is similar for boys and girls. By age 18, however, most new cases of migraine occur in young women. The role of sex hormones in headache is described in the context of pubertal development. Obesity and Pseudotumor also impact headache through hormonal influences. Menstrual migraine will often present in the teenage years. Oral contraceptives may worsen or ameliorate headache. This article will introduce these concepts and help the reader become familiar with the role of hormones in headache.

Children's Coping with Recurrent Headache

We investigated the relationships among perceptions of control over pain, gender, and coping responses in 57 school-aged children receiving services at a specialized pediatric headache clinic. Perceptions of control and gender interacted to predict frequency of active and negative coping responses. A wide range of coping strategies was reported, but only minimal gender or perceived control differences were found in the frequency and helpfulness of individual coping strategies. Results are discussed within the context of recent stress and coping models within the pediatric chronic illness literature.

Pediatric Headache: Where Have We Been and Where Do We Need to Be

In this article, we hope to summarize current understanding of pediatric headache. We discuss epidemiology, genetics, classification, diagnosis, outpatient, emergency and inpatient treatment options, prevention strategies, and behavioral approaches. For each section, we end with a series of questions for future research and consideration.