John T. Goodman

The role of parent training in treatment of preschoolers with ADDH

The efficacy of group parent training was assessed in improving compliance and time on task in preschoolers with attention-deficit disorder with hyperactivity. Positive effects were obtained on measures of child compliance, but not on measures of attention. Parental compliance-management skills and overall style of interaction were also positively affected. The use of parent training for early intervention with ADDH children is discussed.

The efficacy and efficiency of a self-administered treatment for adolescent migraine☆

&NA; Migraine headaches are frequent in adolescents. Although many adolescents are adequately treated palliatively with analgesics, an important subgroup requires prophylactic treatment. Medical treatments for adolescents with frequent severe headaches is often problematic. Prophylactic pharmacological treatments are often shunned by adolescents and their parents because of concern over drug usage. Moreover, propranolol, the most widely used prophylactic drug with adults, is frequently not effective. Psychological interventions are effective but are costly and often not available. A randomized controlled trial was undertaken to evaluate the efficacy and efficiency of a predominantly self‐administered treatment that could be delivered in a very cost‐efficient format. Eighty seven adolescents (63 females and 24 males) ranging in age from 11 to 18 years were randomly assigned to receive a self‐administered treatment, the same treatment delivered by a therapist or a control treatment. Self‐administered and clinic treatment were equally effective and superior to the control treatment. However, the self‐administered treatment was substantially more efficient. Both active treatments were durable at 1‐year follow‐up.

Cognitive and relaxation treatment of paediatric migraine

&NA; The present study compared the efficacy of two active treatments, relaxation training and cognitive coping, with a non‐specific placebo control in the treatment of 42 children and adolescents with migraine. The first treatment is a simplified version of progressive deep muscle relaxation; the second, a form of cognitive restructuring involving the alteration of dysfunctional thought processes. The results demonstrated that each active treatment was superior to the non‐specific intervention in reducing overall headache activity and frequency but not duration or intensity. There were no differences between the experimental groups, and both continued to improve through a 16‐week follow‐up period, but the control group did not. Initial level of headache severity was an important factor in treatment outcome, with children with severe headaches responding better than those with milder headaches. Possible reasons for the differential treatment effects are discussed, and the implications for future research are considered.

ATTENTION AND IMPULSIVITY CHARACTERISTICS OF THE BIOLOGICAL AND ADOPTIVE PARENTS OF HYPERACTIVE AND NORMAL CONTROL CHILDREN

On tests comparing 176 biological and adoptive parents of hyperactive and normal control children, biological parents of hyperactives evidenced more attentional difficulties, slower mean reaction times, and fewer correct recognitions than did the other parents. They showed no significant differences in impulsivity. A familial association between childhood hyperactivity and attentional deficits in the biological parents was suggested, as was the persistence of attentional difficulties as compared to impulse control problems.

Pain in hospitalized pediatric patients: how are we doing?

ObjectiveThe purpose of this study was to provide a baseline description of the prevalence of pain and pain management strategies in a pediatric hospital and to compare the prevalence of pain in this hospital to that in published reports in the literature. MethodsTwo hundred thirty-seven children ranging in age from 10 days to 17 years and 223 parents participated in an 8-hour survey on 5 inpatient units. Information about pain intensity and pain affect was collected from the children older than 6 years of age and from parents of those who were younger at 4 2-hour intervals. Information about procedural pain was collected from children, parents, and health care professionals over this 8-hour period. The type and amount of analgesia were also noted. ResultsMore than 20% of the children had clinically significant pain at each of the 2-hour intervals, and 7 had pain scores of 5/10 or greater for the majority of the study day. At least 50% of the children were found to be pain-free during the 4 intervals, and there was a high level of agreement between parents and childrens pain-intensity ratings. One hundred fifty-seven children had medication ordered and 80 children had no analgesia ordered. There was no significant correlation between characteristics of the patients and amounts or types of medication given. No analgesia was administered via intramuscular or subcutaneous injection. DiscussionAlthough these results are encouraging in that a significant portion of the children were pain-free during the study day, the number of children who had clinically significant pain was too high. The results of this study compare with others in that a significant number of children were inadequately treated for pain. Clinical implications are discussed.

RELAXATION PROPHYLAXIS FOR CHILDHOOD MIGRAINE: A RANDOMIZED PLACEBO-CONTROLLED TRIAL

A randomized controlled trial was used to evaluate the effectiveness of relaxation training in the treatment of paediatric migraine. Relaxation training was compared with two control groups (psychological placebo and ‘own best efforts’) in a total of 99 children and adolescents with frequent migraine. Daily recording of the headaches following treatment, three months after treatment and at the one‐year follow‐up indicated that all three treatments were equally effective. The importance of the use of adequate control conditions which generate equivalent expectancies in pain treatment research was confirmed.

The Clinical Measurement of Pain in Children: A Review

The accurate measurement of pain in children is difficult. This article reviews research on methods that have been used to tap different aspects of pain and highlights the advantages and limitations of each method.

Differential Effects of Parent Training and Stimulant Medication with Hyperactives: A Progress Report.

Abstract During a 3-month intervention program, 43 hyperactive children and their families were assessed and followed. Families were randomly assigned to one of three groups: parent training in behavior modification while the child was administered a placebo; parent training plus methylphenidate; and methylphenidate only. All groups showed improved home and school behavior. However, only with medication were there also gains on measures of attention and impulse control. The results also revealed greater improvement in the area of academic achievement and classroom behavior in the medication groups as compared with children on placebo. There was no evidence of significant benefit from the addition of parent training to the administration of medication.

Prognostic validity of brainstem electric response audiometry in infants of a neonatal intensive care unit.

This study compared the results of brainstem electric response audiometry (BERA) in infants of a neonatal intensive care unit to those obtained on the same children with pure-tone audiometry at 3 years of age. Six hundred children were initially tested in infancy, and complete follow-up information was obtained on 333. In 297 (89%) the BERA results accurately predicted the hearing status at the age of 3 years. Twenty-nine (9%) of the discrepancies were related to conductive hearing losses: 17 patients with a conductive hearing loss in the first few months of life had normal hearing at 3 years, and 12 patients normal in infancy had a conductive loss at 3 years. Two patients evaluated as a sensorineural hearing loss by BERA had normal hearing. These may have been due to a conductive loss. Six patients assessed as normal by BERA had significant hearing losses at the age of 3 years. Five of these had normal hearing at one frequency between 1,000 and 4,000 Hz. The sixth may have developed a sensorineural hearing loss after birth.

VICISSITUDES OF FOLLOW‐UP STUDIES: Differential Effects of Parent Training and Stimulant Medication with Hyperactives

A two-year outcome study of 73 hyperactive children supports both previous short-term studies which suggested that stimulant medication is superior to parent training and long-term studies which found no differences between the two interventions. The discrepancy is discussed in light of complications that inevitably arise in outcome studies and that tend to preclude meaningful outcomes in long-term studies. The development of new research strategies is called for.