A comparison of psychological and pharmacological treatment of pediatric migraine

A comparison was carried out of the efficacy of psychological and drug treatments for children with migraine. Forty-three children aged between 8 and 16 years (mean age: 11.3 years) who suffered from migraine received either progressive relaxation or cephalic vasomotor feedback, both with stress management training, or metoprolol, a beta-blocker. Psychological treatment was administered in ten sessions lasting six weeks and the drug treatment lasted ten weeks. Relaxation and stress management training reduced the headache index (frequency×intensity of headache episodes), more effectively than metoprolol with cephalic vasomotor feedback and stress management training in between. An overall improvement over time was found with regard to frequency and intensity of headache episodes and analgesics intake. When comparing pre- to post-treatment data, children treated with relaxation training improved significantly in headache frequency and intensity, whereas those treated with cephalic vasomotor feedback improved significantly in headache frequency and duration as well as mood. The clinical improvement was stable at an 8-months follow-up.     

The Headache Symptom Questionnaire: Discriminant classificatory ability and headache syndromes suggested by a factor analysis

A brief Headache Symptom Questionnaire was administered to 129 chronic headache Sufferers. The questionnaire accurately classified 68.42% of headache subjects in their proper diagnostic category, comparable to, but statistically less accurate than, the 86.4% agreement between expert headache diagnosticians using clinical interviews. Results of a factor analysis of the Headache Symptom Questionnaire lend support for their being two commonly accepted global headache categories—vascular/migraine and muscle contraction—and one headache dimension concerned with duration of headache pain. Combined migraine-muscle contraction headache was found to be related more to migraine than to muscle contraction headache, and cluster headaches emerged as a separate clinical entity, not loading positively on any factor and loading negatively on all three.This research was supported in part by Grant NS-15235 from the National Institute of Neurological and Communicative Disorders and Stroke.     

Visuomotor organization in the child: a neuropsychological approach

The ability of children to copy a complex figure was investigated by means of the Rey-Osterrieth complex figure and the corresponding methodology. The sample consisted of 420 children (boys and girls) aged 5 1/2 to 12 1/2 years. Responses indicate that the visuomotor ability involved in copying a complex figure increases with increasing age and that girls show significantly better performance than boys during the ages 8 1/2 to 12 1/2 years. The differences in performance can be attributed to differential neuropsychological strategies or functional differences that require further investigation.     

Risk factors of anxiety and depression in children and adolescents with headache: A cross-sectional study

IntroductionDespite numerous studies on the association between headache and psychological difficulties in children, the results remain inconclusive.ObjectiveThis cross-sectional study was conducted to clarify the links between anxiety-depression and headache in children. We evaluated the levels of anxious and depressive symptoms and the influence of risk factors: age, sex, headache diagnosis, frequency and history to identify and treat headache sufferers most at risk.MethodData were collected from a clinical sample of 368 children aged 8 to 17 years. First, a structured interview using the International Classification of Headache Disorders (ICHD-II) was used to diagnose 88 patients with migraine (M), 32 with tension-type headache (TTH), and 248 with a combination syndrome (M + TTH). Second, levels of anxiety and depressive symptoms were assessed with the Revised Children's Manifest Anxiety Scale (R-CMAS) and the Multiscore Depression Inventory for Children (MDI-C).ResultsAn ANOVA analysis showed that the mean scores for anxiety and depressive symptom levels were significantly higher among older patients and that only the M + TTH diagnosis was significantly associated with anxiety. Children with clinically significant levels of anxiety symptoms were more prevalent in our sample than in the general population (13% versus 5%). Anxiety and depression were not associated with child sex, headache frequency and history.ConclusionWe propose systematic screening for anxiety in children presenting with headache, particularly adolescents and patients with a combination diagnosis.     

Punctate transcutaneous electrical nerve stimulation in migraine therapy

Pharmacotherapy of migraine is not satisfying at present, especially in case of frequent attacks of headache. Therefore alternative methods of treatment gain increasing relevance. Based upon many years of experience with specific reflexotherapy and conventional stimulation therapy for treatment of pain we started a clinical study in migraine applying the punctual transcutaneous electrical nerve stimulation (PuTENS) performed with self-made pocket electrostimulators (TRG I-III). The study includes self-treatment of patients at home. After more than 6 months PuTENS was prophylactically effective in 225 out of 282 patients, i.e. in 80% of cases the frequency of attacks and the use of drugs were reduced to at least 50%. In 90 patients treated by the physician the rate of improvement was 86% compared to 76% in 192 patients, which performed self-treatment according to the physician's instruction and under medical supervision. 96 out of 160 patients with migraine could alleviate their acute headache by PuTENS applying the pocket electrostimulator at home. In conclusion, PuTENS is superior to drug therapy and conventioned electrotherapy in the treatment of migraine. Its effectiveness is similar to needle acupuncture. The method can therefore be regarded as a valuable alternative and help for patients with frequent headache.     

Relationships of oral stereognostic ability to age and sex of children

A battery of items testing oral stereognostic ability was individually presented to 168 children, 12 boys and 12 girls at each of seven age levels from 4-5 to 11-4. Age was significantly related to oral stereognostic scores; older subjects scored significantly higher than younger subjects. Sex was also significant; girls scored higher than boys. The interaction of age and sex was not significant.     

Diagnosis and clinical management of headaches

In this article, we will first present an overview of the epidemiology and classification of headaches, distinguishing between primary headaches (in which the headache itself is the primary disorder) and secondary headaches (ie, headaches due to an underlying condition, such as a neoplastic and/or space-occupying lesion, a cerebrovascular accident, or other type of structural brain lesion). We will use the current classification system of the International Headache Society, focusing on primary headache disorders (migraine, tension-type headache, cluster headache), which we will discuss from the practical clinical perspectives of diagnosis and clinical management. Throughout this article, we will emphasize the chronicity and periodicity of headaches as a type of chronic pain syndrome.     

Wiederkehrende,primäre Kopfschmerzen im Jugendalter

Background

Recurrent pain, especially primary headache, is a serious health problem in adolescents. Music therapy in the treatment of children with migraine has already been evaluated. The aim of this pilot study was to adopt this treatment manual for adolescent patients with recurrent primary headache in preparation for the main randomized controlled trial.

Patients and methods

In this pilot study two different modes of treatment (standard and compact treatment) were tested in an outpatient setting with 19 patients. Frequency and intensity of headache symptoms were evaluated using pain diaries for 8 weeks in a pre-post design.

Results

The pilot study showed good feasibility of both treatment conditions in outpatient practice. Patients reported a reduction of pain frequency and intensity in both groups. The evaluation of the clinical relevance of these effects remains the objective for the main trial.

Conclusions

The music therapeutic treatment plan for children with migraine is even feasible in the treatment of adolescents with recurrent, primary headache. Further evidence questioning the effectiveness of the treatment under controlled conditions is needed.

     

Gender and Age Differences in Social Skills Among Children with ADHD: Peer Problems and Prosocial Behavior

Abstract

Gender differences in peer problems and prosocial behavior among children with attention-deficit hyperactivity disorder (ADHD) were examined. Parents and teachers rated social functioning on the Strengths and Difficulties Questionnaire (SDQ) among 592 children (age 5–10?years) with ADHD and among 215 children (age 6–10?years) in a community sample. Results in the clinical group revealed significant interaction effects where older boys showed fewer peer problems than younger boys, but older girls had similar peer problems as younger girls. Teachers reported less prosocial behavior among younger girls than older girls. No gender differences in social problems emerged for the nonclinical comparison group.     

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or,the machines may be necessary some time of the time

Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.     

Hostility, aggression, and anxiety levels of divorce and nondivorce children as manifested in their responses to projective tests

The effects of parental divorce on the levels of aggression, hostility, and anxiety in children, as measured by the Rorschach test, together with the type and direction of aggression, as measured by the Rosenzweig Picture-Frustration (P-F) Study, were studied. The Rorschach and the Rosenzweig P-F study were administered to a nonclinical sample of 108 Swedish children ranging in age from 10 to 12 years old. The subjects constituted a divorce and a nondivorce group of 27 girls and 27 boys each. Children of divorced parents (hereafter referred to as divorce children, divorce boys, or divorce girls) showed significantly higher levels of hostility, aggression, and anxiety than children of married parents (hereafter referred to as nondivorce children, nondivorce boys, nondivorce girls). There were significant differences found in the type and direction of aggression between divorce girls and boys. Divorce boys showed more extraggression and ego defensive reactions, whereas divorce girls tended to evade aggression. The differences between divorce and nondivorce groups and the diversity of reactions between divorce boys and girls are discussed.     

Behavior at 10 and 13 years of age for children with low birth weight

This study was based on data from a longitudinal research program. The cohort consisted of 874 normal children in an entire school grade in a Swedish community. The aim of the study was to investigate the relation between birth weight and behavior at school, for all children and for each sex separately. The results identified specific aspects of behaviour disorder significantly related to low birth weight (LBW) for children at the age of 10 but not at the age of 13. When the sexes were separated, there were no relations between birth weight and deviant behaviour for boys of low birth weight as compared to boys of normal birth weight, while girls of low birth weight showed specific behavioural disorders at age 10 as compared to girls of normal birth weight. For girls reared in families of low parental socioeconomic status, aggressiveness and motor restlessness at age 10 but not at age 13 was also present. Further analyses showed that girls born small-for-gestational age showed lack of school motivation and concentration difficulties both at age 10 and age 13.     

Sex differences in landmark learning by children aged 5 to 12 years

Previous research has shown that men and boys learn routes faster and with fewer errors than do women and girls. Research with adults suggests that men use Euclidean cues when learning a route, whereas women use landmark-based strategies. The strategies used by children have received little study. In Exp. 1, 50 boys and girls, ages 5 to 12 years, were shown a map that contained only landmarks (no streets or roads) and were asked to learn a route consisting of 23 of the landmarks. The children used a pointer to trace the route on the map to a criterion of two successive trials without errors. The performance of boys and girls did not differ significantly on this route-learning task on three measures (number of trials to reach criterion, total time to reach criterion, and total number of errors). In Exp. 2, 52 boys and girls, ages 5 to 12 years, were shown the same map as in Exp. 1 and were asked to learn a route consisting of 12 landmarks. The children traced the route by picking pictures of landmarks in the correct order from a stack of cards with pictures of landmarks on them. Girls made significantly fewer errors than boys on this route-learning task in Exp. 2, and a significantly larger number of girls than boys completed the task. None of the boys in the 5- to 6-yr.-old age group learned the route. When Euclidean cues were minimized in Exp. 2, boys made more errors and took as much time as girls to reach the criterion of two successive correct trials.     

Hostility,Aggression, and Anxiety Levels of Divorce and Nondivorce Children as Manifested in Their Responses to Projective Tests

The effects of parental divorce on the levels of aggression, hostility, and anxiety in children, as measured by the Rorschach test, together with the type and direction of aggression, as measured by the Rosenzweig Picture-Frustration (P-F) Study, were studied. The Rorschach and the Rosenzweig P-F study were administered to a nonclinical sample of 108 Swedish children ranging in age from 10 to 12 years old. The subjects constituted a divorce and a nondivorce group of 27 gifts and 27 boys each. Children of divorced parents (hereafter referred to as divorce children, divorce boys, or divorce girls) showed significantly higher levels of hostility, aggression, and anxiety than children of married parents (hereafter referred to as nondivorce children, nondivorce boys, nondivorce girls). There were significant differences found in the type and direction of aggression between divorce girls and boys. Divorce boys showed more extraggression and ego defensive reactions, whereas divorce girls tended to evade aggression. The differences between divorce and nondivorce groups and the diversity of reactions between divorce boys and girls are discussed.     

Autogenic Feedback in the Treatment of Two Children with Migraine Headache

Autogenic feedback was used to treat two subjects, ages 12 to 14, suffering form migraine headache. A multiple baseline across subjects design was used to evaluate treatment outcome. Marked improvement was displayed on all three measures of headache activity for both subjects by the end of treatment and was maintained throughout the follow-up period. These results are comparable to those obtained when similar procedures are applied to chronic adult headache sufferers and suggest that continued investigation is warranted.     

Sex differences in oppositional defiant disorder

The goal was to analyze the sex differences in symptoms, comorbidity and functional impairment in outpatient children with Oppositional Defiant Disorder (ODD). A sample of 343 children, aged 8 to 17 years and diagnosed with ODD, were assessed with a semi-structured diagnostic interview and dimensional measures of psychopathology and functional impairment. Boys with ODD more frequently displayed the symptoms "deliberately annoys" and "blames others", presented comorbid ADHD, and had greater functional impairment in school and community contexts; girls presented higher comorbidity with internalizing symptomatology (anxiety, depression and somatic complaints). Given that some clinical differences are apparent in ODD between boys and girls, it is necessary to consider the sex of the patient in order to identify and treat this disorder efficiently and effectively in boys and in girls.     

Development of gender labeling: Effect of age of pictured children

Toddlers (27 girls and 25 boys) between 20 and 42 months of age were given three gender discrimination tasks, each consisting of 12 pairs of photographs of girls and boys at one of three age levels: 3, 8, or 13 years. The subject's task was to point to the designated target (girl or boy) on each trial. Subjects' gender discrimination improved with age, with a fairly sharp transition from chance to accurate responding occurring at approximately 29 months. The age of pictured children did not affect performance.     

A comparison of depression in children with and without mothers

The present research investigated depression in children with and without mothers. Differences in depression scores were tested by gender, socio-economic level, the cause of not having a mother, and the age of separation. The sample included 300 fourth and fifth grade elementary school children. Among them, there were 150 children (68 boys and 82 girls) who were living with their mothers and 150 (68 boys and 82 girls) who did not live with their mothers. Each group had an equal number of students (n=50) representing three different socio-economic levels (i.e., low, middle, high). Students in the sample came from 39 different public elementary schools. Children's ages varied between 10 and 12 years (M = 10.8, SD = .6). Teachers, administrators, and school counselors were asked to identify children without mothers. The children who were living with their mothers were randomly chosen. Results showed significant differences in depression between the two groups of children. Furthermore, there was a significant difference by socio-economic level. Depression of children without mothers is significantly associated with the cause of not having a mother and the age when the child was separated from the mother.     

6~10岁儿童对损人情境下行为者的道德情绪判断与归因

采用故事情境法探讨6~10岁儿童对损人情境下损人者和旁观者的道德情绪判断与归因的发展。结果发现：（1）在损人情境下,6岁儿童能理解损人行为是不对的,但直到8岁儿童才能理解旁观行为是不对的;（2）随着年龄增长,儿童判断损人者的愉悦程度逐渐降低,情绪归因从结果定向过渡到道德定向;儿童判断旁观者的愉悦程度逐渐降低,情绪归因从无法有效归因过渡到道德定向;（3）儿童对不同行为者的道德情绪判断同时受年龄和性别的影响,6岁男孩判断损人者愉悦程度显著高于女孩,6岁男孩判断旁观者愉悦程度显著低于女孩;8岁和10岁儿童对两类行为者的道德情绪判断未发现显著的性别差异。