Melvin D. Levine

Recurrent Abdominal Pain of Childhood Due to Lactose Intolerance

The role of lactose malabsorption was studied prospectively in 80 schoolchildren with recurrent abdominal pain. Malabsorption was documented in 40 per cent (16 of 59 whites, 12 of 16 blacks and four of five Hispanic children) on the basis of elevated levels of hydrogen in their breath. Those with lactose malabsorption, however, were not clinically distinguishable on the basis of past milk ingestion (P greater than 0.05), weekly pain frequency (median, five vs. six times), presence of diarrhea (40 vs. 27 per cent) or symptom response to lactose load. In children with malabsorption who completed a six-week diet trial, 70 per cent reported increased frequency of pain (P less than 0.002) when placed on their usual lactose-containing diet. Lactose malabsorption has a substantial role in the symptoms of children with recurrent abdominal pain, and it should be considered before performing invasive procedures or assuming a psychogenic origin.

The emergence of attention deficits in early childhood: A prospective study.

To study the emergence of attention deficits in early childhood, the diagnostic team of an early education program documented the occurrence of poor concentration, distractibility, behavioral disorganization, poor self-monitoring, and overactivity in a group of 174 children followed prospectively from birth to school entry. Persistent attentional problems were identified in 5% of the children; 8% had problems which abated before kindergarten. Over the period from birth to kindergarten, 40% of the preschool youngsters were found to have some attentional indicator, but many of the findings were minor or transient. This study points to (1) the clustering of persistent attentional concerns with other developmental and environmental concerns, (2) the substantial long-term consequences of early attentional problems and (3) the feasibility of early detection of some children with attentional disorders.

An Analysis of the Learning Styles of Adolescent Delinquents

The association between school failure and antisocial behavior has been the focus of much discussion but little consensus. In the present study, 53 delinquent adolescents and 51 junior high school students were compared on the basis of their learning profiles. An educational battery was devised to evaluate quality of learning style and error clusters in addition to traditional grade-equivalents. Significant differences were found in the type and prevalence of multiple error clusters within each of the eight educational skill areas and across the eight combined skills. In a second part of the study early school records and parent questionnaires were reviewed. Results indicated a significantly higher prevalence of school problems among the delinquents as early as kindergarten. By second grade, 45% of the delinquents were already delayed in reading and 36% in handwriting, in contrast to only 14% of the comparison group (p < .001). Finally, the prevalence of special education services recommended or provided over the years was surveyed. It is concluded that the learning styles of delinquents may be qualitatively different and that early learning difficulties may provide a sensitive indicator of risk for later delinquency.

A study of neurodevelopmental findings in early adolescent delinquents

Subtle deficits or delays in the development of the central nervous system in young children are associated with problems affecting learning, behavior, and social adjustment. Less is known about the impact of such neurodevelopmental dysfunction in adolescents. This study assesses the possible association between neurodevelopmental delays and juvenile delinquency. An adolescent neurodevelopment examination was devised and administered to 54 delinquents and 51 secondary school students. Six areas were assessed. There were no significant differences in the prevalence of minor neurologic signs (P = 0.37) or in gross motor function (P = 0.02) and temporal sequential organization (P = 0.04). The greatest differences were in visual processing (P = 0.0002) and auditory-language function (P = 0.0001). Eighteen percent of delinquents and 4% of the comparison group were deficient in two or more neurodevelopmental areas. Nine percent of the delinquents and none of the comparison group had three or more dysfunctions. A neurodevelopmental examination may be a useful diagnostic tool for identifying endogenous factors in behavior, learning, and adjustment problems of this age group. Such findings have implications for the formulation of individualized management strategies.

The wrath of math : deficiencies of mathematical mastery in the school child

Mastery of mathematics involves the interactions of multiple developmental pathways. Children with mathematics disabilities often experience profound feelings of intellectual inadequacy that can erode self-esteem and academic motivation. This article delineates 16 interactive subcomponents that students who underachieve in mathematics can encounter. The article also discusses assessment and management issues for children with mathematics disabilities.

Locus of control as predictor of compliance and outcome in treatment of encopresis

We examined the effectiveness of instruments that describe a childs locus of control and perceived self-competence as predictors of outcome in the treatment of encopresis. Fifty children 9 to 12 years of age completed such instruments prior to clinical interview. Clinicians were blind as to the results of these questionnaires and administered a standard encopresis protocol to all patients. Six to 17 months later, 45 (90%) of the patients parents were interviewed to assess compliance and treatment outcome. Children who significantly improved had a more internal locus of control (P less than 0.05) and better compliance (P less than 0.05) as determined by two separate outcome variables. Locus of control and compliance were not, however, significantly correlated with each other; each appeared to have an independent association with outcome. There was no association between perceived self-competence and outcome. The positive association between locus of control and outcome was not mediated by socioeconomic status, age, duration of encopresis, severity of encopresis, gender, or time between initiation of treatment and follow-up. Measurement of locus of control in children with encopresis appears to be helpful in identifing a group at high risk for resistance of treatment.

Public knowledge of ipecac syrup in themanagement of accidental poisonings

Information given during a Poison Prevention Week increased the knowledge of and the willingness to use ipecac syrup but not the actual possession of the drug. Distribution by physicians significantly increased possession. There is need for the development of programs which will secure the interest and participation of the practicing physician.

A Follow-up Study of Preschool Children Evaluated for Developmental and Behavioral Problems

Parents and teachers of preschool children evaluated for developmental and behavioral problems in a tertiary pediatric clinic were surveyed an average of 15 months after the initial visit to determine whether they thought the original presenting problem(s) were still present. In 46 percent of cases in which there was an initial concern about behavior, parents continued to be concerned. In contrast, only 24 percent of responding parents continued to be concerned about developmental problems. In more than half of the cases in which parents were no longer concerned, especially about behavior, teachers indicated that there continued to be problems. Age and sex of children were not related to outcome. The higher the socioeconomic status of parents, the more likely the parents were to report persistent developmental problems. Children with persistent problems tended to have difficult temperament characteristics. This study suggests that it is difficult to predict which problems will persist and that there are varying viewpoints as to the nature and existence of these problems.

395 RECURRENT ABDOMINAL PAIN (RAP) OF CHILDHOOD DUE TO LACTOSE INTOLERANCE: A PROSPECTIVE STUDY

The role of lactose intolerance was assessed prospectively in 47 consecutive children (4.2-15 yrs: mean 9.5)presenting as outpatients with RAP. Milk ingestion and pain frequency (documented by diary) and symptom production following lactose ingestion (2gm/kg; max. 50 gm) were correlated with lactose malabsorption determined by breath hydrogen excretion (> 10 parts per million above baseline)- an accurate technique for demonstrating disaccharide malabsorption in children(Perman,JA et al, Ped. Res. 11:488, 1977). Lactose malabsorbers underwent a 3-stage elimination diet including a regular diet control period. There were no differences between lactose malabsorbers and absorbers with regard to amount of milk ingested (1.6 vs 1.7 glasses/day; p>0.5)or pain frequency (11.7 vs 8.4 episodes/week; p>0.5). Lactose malabsorption occurred in 20 children(43%), 9/34 were Caucasian, 8/11 Black and 2/2 Hispanic. Cramps or diarrhea were reported in 82% of malabsorbers and 41% of absorbers. 11 of 20 malabsorbers have completed the diet trial; in 10 of 11 pts., pain frequency was reduced (paired t test; n=8; p<0.05): 3 patients refused to continue the control diet due to symptoms.Conclusion: In RAP, lactose malabsorption is present and significantly contributes to symptoms in at least 1 in 4 pts, regardless of ethnic background-Milk ingestion, pain frequency and symptom response to lactose are unreliable indicators of lactose malabsorption. Thus, documentation of lactose malabsorption is indicated in children with recurrent abdominal pain.

The Learning Disorders of Adolescence: Organic and Nonorganic Failure to Strive

As students proceed through late elementary and junior high school, academic demands change drastically. The altered requirements may give rise to seemingly new learning disorders or may aggravate or modify a preexisting recognized dysfunction. This article discusses common areas of disability in this age group, developmental complications, and academic performance delays, and presents guidelines for assessment and management.