The Implications of Childhood Bacterial Meningitis for Language Development

Bacterial meningitis is a life threatening infection of the central nervous system. This illness is most prevalent early in life when the healthy child is rapidly acquiring language. This study investigated whether children with a history of bacterial meningitis were at risk for language difficulties post illness. Thirty post-meningitic children, aged between 9 years 0 months and 11 years 0 months, participated in this study. Each subject was administered a measure of non-verbal cognitive ability and a range of language tasks. These children performed poorly on applied language tasks, which tap skills used in effective discourse. These deficits occurred despite age appropriate performances on measures of linguistic/grammatical knowledge. These findings clearly illustrate that bacterial meningitis has implications for ongoing language development, which emphasises the importance of long term follow up. In developmental terms, this discrepancy between verbal knowledge and problem solving represents a dissociation between language skills which develop early in life and those which emerge later. This pattern of results suggests that bacterial meningitis may result in a delay in language development. A young age at illness was identified as an additional risk factor for adverse outcome. This study highlights the need to inform parents/guardians that post-meningitic children are at risk for experiencing language difficulties throughout childhood.     

Executive functions and social skills in survivors of pediatric brain tumor

Medical advances have resulted in increased survival rates for children with brain tumors. Consequently, issues related to survivorship have become more critical. The use of multimodal treatment, in particular cranial radiation therapy, has been associated with subsequent cognitive decline. Specifically, deficits in executive functions have been reported in survivors of various types of pediatric brain tumor. Survivors are left with difficulties, particularly in self-monitoring, initiation, inhibition, and planning, to name a few. Another domain in which survivors of pediatric brain tumor have been reported to show difficulty is that of social skills. Parents, teachers, and survivors themselves have reported decreased social functioning following treatment. Deficits in executive functions and social skills are likely interrelated in this population, as executive skills are needed to navigate various aspects of social interaction; however, this has yet to be studied empirically. Twenty-four survivors of pediatric brain tumor were assessed using a computerized task of executive functions, as well as paper-and-pencil measures of social skills and real-world executive skills. Social functioning was related to a specific aspect of executive functions, that is, the survivors' variability in response time, such that inconsistent responding was associated with better parent-reported and survivor-reported social skills, independent of intellectual abilities. Additionally, parent-reported real-world global executive abilities predicted parent-reported social skills. The implications of these findings for social skills interventions and future research are discussed.     

The mythic significance of risk-taking,dangerous behaviour

Clinical research using grounded theory methodology was undertaken to discover the origin, structure and meaning of risk-taking, dangerous behaviour in childhood. Three different situations were identified in which risk-taking, dangerous behaviour occurred. These were named illusory-haven, no-haven and perilous-haven: 'haven' describing different object relationships which occurred both inter-psychically and intra-psychically, each of which was dangerous for the child. These configurations of relationships were found to be meaningfully linked to different situations in the Oedipal drama. The 'havens' were also found to be important in linking patterns of family relationships to gang formation. By using the havens in this broader context the insights gained from the Oedipus Complex are seen to be more widely applicable. Es wurde klinische Forschung , die sich auf theoretische Methodik beruft, benutzt, um den Ursprung, die Struktur und die Bedeutung von risikohaftem, gefährlichem Verhalten in der Kindheit zu entdecken. Es wurden drei verschiedene Situationen identifiziert, in denen risikohaftes, gefährliches Verhalten auftrat. Diese wurden illusorische Oase, keine Oase und gefähliche Oase genannt: 'Oase' beschreibt verschiedene Objektbeziehungen, die sowohl interpsychisch als auch intrapsychisch auftreten und jeweils gefährlich für das Kind sind. Diese Beziehungskonfigurationen konnten bedeutungsvoll mit verschiedenen Situationen des ödipalen Dramas verbunden werden. Die 'Oasen ' wurden auch als bedeutend dafür gesehen, Muster von Familienbeziehungen mit Gangformationen in Verbindung zu setzen. Indem man die Oasen in diesem weiteren Zusammenhang benutzt, werden die Einsichten, die aus dem ödipuskomplex gewonnen werden, als weitreichender anwendbar gesehen. Des recherches cliniques utilisant la méthodologie dite de la théorisation ancrée (analyse qualitative et catégorielle) ont été entreprises afin de déceler, chez l'enfant, l'origine, la structure et la signification de la prise de risques et du comportement dangereux. Trois situations différentes, dans lesquelles ce type de comportement se produit, ont été identifiées. Elles sont appelées «havre illusoire», «absence de havre» et «havre périlleux»; le mot «havre» est ici employé pour désigner les différentes relations objectales, inter-psychiques comme intra-psychiques, qui s'avèrent dangereuses pour l'enfant concerné. Ces configurations relationnelles sont liées de façon significative à certains avatars du drame ?dipien. L'idée du «havre» est une représentation qui permet de relier certaines configurations relationnelles familiales à la formation de «gangs» ou de bandes. La notion de «havre» utilisée dans ce contexte élargi permet de conclure que les insights acquis grâce au complexe d'?dipe sont d'application plus générale. Sono state fatte delle ricerche cliniche utilizzando una metodologia teorica fondata per scoprire l'origine, la struttura e il significato del comportamento di correre rischi e di quello pericoloso nell'infanzia. Si identificarono tre diverse situazioni in cui si presentava tale comportamento. Queste furono denominate rifugio-illusorio, non rifugio e rifugio pericoloso: 'il rifugio' descrive diverse relazioni d'oggetto sia a livello inter-psichico che intra-psichico, ciascuna delle quali e' stata pericolosa per il bambino. Risulto' che queste configurazioni di relazioni erano significativamente correlate a diverse situazioni nel dramma edipico. I 'rifugi' erano anche importanti nel correlare modelli di relazioni familiari alla formazione della gang. Usando i rifugi in questo contesto piu' ampio le insights ricavate dal complesso edipico possono essere piu' largamente applicabili.     

Effects of emotion regulation on concurrent attentional performance

We explored the attentional demands of unpleasant picture viewing and emotion regulation strategies. Participants received instructions to view, reappraise, or suppress their emotional experience to unpleasant and neutral pictures, while performing a concurrent auditory discrimination task, both during and after the picture presentation period. Reaction times (RTs) were slower during unpleasant than neutral pictures, which persisted into the post-picture period. RTs were also slower during reappraisal and suppression than viewing and for earlier than later tones following picture onset. An enduring effect of negative emotion was found in the picture and post picture period for suppression but not reappraisal. Findings suggest that both viewing emotional stimuli and regulating one’s emotions using either reappraisal or suppression draw upon common attentional resources, but with suppression resulting in the distinct cost of maintaining the effects of negative emotion.     

Managing Physical and Sexual Assault Risk in Urban Nightlife: Individual- and Environmental-Level Influences

In this article we use interview and direct observation data to examine the experiences of young people in two Philadelphia nightlife scenes, and the ways in which they manage risk of physical and sexual assault. Our analysis reveals several environmental-level factors that shape risk exposure, as well as a number of individual-level tactics used to manage risk. Our observations are discussed in terms of their implications for developing a risk management framework that accounts for the role of individual- and environmental-level factors in shaping victimization.     

Quality adjusted survival analysis: A neglected application of the quality of well-being scale

Abstract

Background In survival analysis, those who are alive are statistically coded as 1.0 while those who are dead are coded as 0.0. Since everyone who remains alive is given the same score, a person confined to bed with an irreversible coma is alive and is counted the same as someone who is active and asymtomatic. The Quality of Well-being (QWB) scale defines levels of wellness on the continuum between death and optimum function and integrates morbidity and mortality into the same number. This paper demonstrates the effect of including mortality in QWB estimates for male adults with HIV infection.

Method This study involves follow-up of a cohort of 386 male adults participating in the San Diego HIV Neurobehavioral Research Center (HNRC). Patients were evaluated using the QWB at enrollment and at six month intervals. All patients were classified into three stages of HIV disease according to the Center for Disease Control (CDC) classification: CDC IV (symptomatic HIV disease), CDC II or III (asymptomatic infection) and uninfected male controls.

Results QWB scores were calculated with and without mortality included for men in each CDC class who completed a one year (N = 148) or two year follow-up (N = 60). At each evaluation, there were significant differences among CDC classes and inclusion of deaths increased the variance accounted for by CDC class at each evaluation.

Conclusions HIV infection has significant impacts upon both morbidity and mortality. Survival analysis captures only the mortality dimension, while quality adjusted survival analysis using the QWB includes both dimensions. We propose quality adjusted survival analysis as a more sensitive method for assessing outcome in HIV disease and other health conditions.     

Development of decisional balance and self-efficacy measures for adolescent sedentary behaviors

Writing about traumatic events can produce health benefits, yet emotionally non-expressive or cognitively avoidant individuals may be unwilling or unable to express their emotions. This study examined non-expression, cognitive avoidance, response to writing, and subsequent health. As part of a larger study, participants ( N = 71) with asthma or rheumatoid arthritis (RA) wrote about traumatic experiences for 20 min on three consecutive days. Alexithymia, denial, behavioral disengagement, mental disengagement, focus on/venting of emotions, avoidant thoughts, and health status were assessed at baseline, health status again 4 months after writing. Essays were coded for how personal and how emotional they were, and for narrative structure. Non-expression and cognitive avoidance were neither related to how personal or emotional essays were, nor to affective response to writing. High levels of denial or avoidant thoughts predicted less narrative structure. Avoidant thinking marginally predicted health improvements in RA patients. Results suggest that non-expression and cognitive avoidance do not interfere with writing in terms of emotional engagement, but may influence narrative use.     

Assessment and Development of Executive Function (EF) During Childhood

This review paper outlines the issues associated with the assessment of executive function (EF) in children and adolescents, and describes the developmental profile of executive processes across childhood. At the outset, EF is defined, and cognitive and behavioral impairments associated with executive dysfunction (EDF) are described. A developmental model of EF is proposed incorporating four discrete but inter-related executive domains (attentional control, cognitive flexibility, goal setting, and information processing) which operate in an integrative manner to enable “executive control”. Characteristics that constitute traditional EF measures are discussed, as are the problems associated with test interpretation. The ecological validity of EF tests and neuropsychological assessment procedures are examined, and adjunct methods of measurement are presented to enable a more comprehensive and valid assessment of EF. Based on developmental and normative studies, the maturation of executive domains is mapped. Attentional control appears to emerge in infancy and develop rapidly in early childhood. In contrast, cognitive flexibility, goal setting, and information processing experience a critical period of development between 7 and 9 years of age, and are relatively mature by 12 years of age. A transitional period is thought to occur at the beginning of adolescence, and shortly after “executive control” is likely to emerge. In order to confirm our current understanding of EF development and further enhance our understanding of brain-behavior relationships, longitudinal studies incorporating structural and functional neuroimaging are required.