Seeking urgent pediatric treatment: factors contributing to frequency, delay, and appropriateness

The present study explored the factors that contribute to mothers' decisions to seek urgent medical attention for their children when symptoms are not of a traumatic nature. One hundred mothers seeking treatment for their children at a prepaid clinic completed a questionnaire eliciting their expectations regarding the course of their children's problems, seriousness of the problems, perceived responsibility for the symptoms, and extent to which a variety of factors contributed to their decisions to seek treatment. Demographic data and information about each child's symptoms and medical history were also obtained. Four major "reasons for seeking treatment" factors were identified: family history of the presenting complaint, worry regarding the symptoms, situational variables, and the extent of the child's illness behavior. The appropriateness of the visit, delay in seeking treatment, and frequency of mothers' use of the pediatric clinic were predicted by the nature of the presenting symptoms (particularly the presence of fever), the ages of the mother and child, and two of the reasons for seeking treatment factors (i.e., family history and child's illness behavior). The present study suggests that mothers pay more attention to presenting symptoms and to the children's behavior than to psychosocial stressors in deciding to seek urgent care.     

Appetitive differential conditioning of the rabbit’s jaw movement response

Two experiments examined appetitive differential conditioning of the rabbit’s jaw movement response (JMR) in a two-phase procedure. The first phase entailed reinforced training with one conditioned stimulus (CS+), and the second phase involved intermixed presentations of CS+ and an unreinforced stimulus (CS?). In Experiment 1, CS+ was a 600-Hz tone, and CS-was either a 660-,1,000-, or 2,100-Hz tone. In Experiment 2, the magnitude of the water unconditioned stimulus (US) paired with CS+ was either 1, 3, or 9 ml. The experiments revealed that 1) the level of responding to CS-rose for several days and then declined over the remainder of training; 2) the physical similarity between CS+ and CS?directly affected the level of responding to CS?but had no discernable effect on the level of responding to CS+ ; and 3) US magnitude positively affected the level of responding to CS + and, to a lesser extent, CS?. The results are discussed in terms of their implications for Spence’s gradient interaction theory and Pavlov’s external inhibition hypothesis.     

An “outside-in” processing strategy in the perception of form

The discriminability of line segments in a number of different geometric forms was examined. The procedure used was to have one of the lines within a given form drawn thinner than the other lines. The location of the thin line varied randomly within the form, and subjects were required to detect its location. Three observations were made. First, outer line elements were discriminated more accurately than inner line elements. Second, the outer line advantage appeared to reflect an attentional strategy: By presenting inner and outer lines independently, and informing subjects in advance as to whether target lines would be in the inner or outer area of the form, the outer line advantage could be eliminated. Third, consonant with a global attentional strategy, and in opposition to any retinally tied, peripheral-to-central scanning process, an outer-line advantage was evident regardless of whether the fixation point was positioned within or outside the forms, or whether outer lines were more peripheral than inner lines.     

Accommodation to increased accuracy demands by the right and left hands

This study was designed to identify the phase of rapid aimed movements responsible for hand differences in motor skill, and to evaluate potential differences between the hands in accommodating to greater accuracy demands. In both experiments, an accelerometer mounted on a stylus allowed key changes in acceleration to be used to partition the movement into phases. In Experiment 1, slower left hand movement times were attributable primarily to a terminal homing-in phase, especially as target size decreased. Since error rates varied as a function of hand and target size, speed-accuracy trade-offs may have occurred. Experiment 2 rigidly controlled error rate and confirmed the major hand difference to occur in the latter phase of the movement where error correction is presumed. Although less pronounced, adjustments were made in the earlier movement phases as well. Accommodation to greater accuracy demands involved moving the stylus closer to the target before decelerating to engage in error correction. This adjustment to gain enhanced precision was more pronounced in the left hand.     

Antidepressant treatment of children: clinical relapse is unrelated to tricyclic plasma concentrations

Plasma concentrations of imipramine and amitriptyline and their desmethylated metabolites were measured in 20 children being treated for major depressive illness 2 wk. and 5 to 10 wk. after achieving drug dosages of 2.25 mg/kg body weight. At 2 wk. all children had exhibited clinical improvement, but by 10 wk. 4 of the 10 children treated with imipramine and 5 of the 10 children treated with amitriptyline had experienced clinical relapse of depressive symptoms. Tricyclic antidepressant plasma concentrations and ratios were comparable in the subgroups of children who maintained their clinical improvement and those who relapsed. There was no evidence of a systematic decline in plasma tricyclic antidepressant concentrations in those children who relapsed.     

Infant hypotonia, obesity, hypogenitalism and oligophrenia--new viewpoints on the etiology and symptoms of Prader-Willi syndrome

We present four cases of Prader-Willi syndrome. Two of them have an abnormality of a chromosome 15, the other both show different chromosomal abnormalities. Translocations or deletions were found recently in the bands 15q11/12 in about 60% of the cases of Prader-Willi syndrome. The consequences for diagnosis, symptomatology and genetic counselling of the syndrome are discussed.     

Changes in self-stimulatory behaviors with treatment

For four of six autistic children who underwent intensive behavioral treatment, the nature of their self-stimulatory behavior changed from initial lowlevel motor behaviors (such as rocking, spinning, twirling) to differing kinds of higher-level behaviors (such as lining of objects, echolalic speech, and preoccupation with spelling and numerical values). The children who changed to the highest levels of self-stimulatory behavior also showed the largest gains in treatment (as determined by IQ scores, school placement, etc.). The changes in self-stimulatory behaviors were attributed to the intense teaching of appropriate social behaviors and the explicit therapeutic suppression of low-level, self-stimulatory behaviors. The long-term therapeutic effects of changing from lower-to higher-level forms of self-stimulatory behavior were discussed.This study was supported by a grant from the National Institute of Mental Health (grant MH 11440). We want to express our thanks to the parents who allowed us to study their children. We gratefully acknowledge the assistance of Maria Audero with the design of the weighted measure, and Tracee Parker with the collection of the data.