Browsing by Subject "Adolescent"
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Item ADHD and Medical Correlates of Bullying of Pediatric Neurofibromatosis Patients(2016-08-25) Patel, Sarita; Holland, Alice A.; Faith, Melissa A.; Silver, Cheryl H.Neurofibromatosis Type 1 (NF1) is an autosomal dominant disorder that involves nervous system tumor growth, and it is one of the most frequently occurring genetic disorders. NF1 is a multisystem disease with a complex phenotype. Given the range in severity of presentation in NF1, research has shown that disease severity could impact children's social-emotional functioning. Physical deformities such as tumor growth often are associated with NF1, and as a result, children and adolescents with NF1 may be at greater risk for being victims of bullying by peers. Children with NF1 also tend to have higher rates of Attention-Deficit/Hyperactivity Disorder (ADHD) as compared to children without NF1 (Barton & North, 2004; Martin et al., 2012). Common issues experienced by children with ADHD, such as social immaturity and behavioral dysregulation, may put them at higher risk for both bullying and peer victimization (Wiener & Mak, 2009; Unnever & Cornell, 2003). Overall, the current study found that parentreported ADHD symptoms predicted parent-reported but not self-reported bullying. Furthermore, the current study found that parent-reported ADHD symptoms were more predictive of being bullied than provider-rated severity of physical deformity. Since the present study was the first to examine whether physical appearance and ADHD symptoms may be associated with bullying in children with NF1, the novel information gained from the study may be used to direct future research, educate parents and teachers, and inform the development of interventions specific to the NF1 population.Item Adherence as a Mediating Variable Between Depression and Health Outcomes in Adolescents with Type 1 Diabetes(2013-12-30) Wolfe, Kristin Linette; Wiebe, Deborah J.; Kennard, Beth D.; Germann, JulieAdolescence is often a time of diabetes mismanagement and poor metabolic control in adolescents with type 1 diabetes. Symptoms of depression are related to poor metabolic control, but the mechanism that links them is under debate. Because depression tends to be associated with poorer adherence and poor adherence has been shown to be related to poor metabolic control, it is possible that adherence serves as a mediator between the two. The present study tested this mediation pathway in a sample of adolescents with type 1 diabetes. Participants (N=252) were recruited from endocrinology clinics in Utah during their routine diabetes clinic visits. Participants fell between the ages of 10 and 14, were able to read and write in either English or Spanish, had a diagnosis of type 1 diabetes for at least one year, and did not have a condition that would interfere with measurement completion. Participants were drawn from a larger longitudinal observational study. This study analyzed the first three time points of data, which were obtained six months apart. Demographic and illness information was obtained from self-report and participant medical files. Questionnaires were used to assess depression and adherence. Metabolic control was measured through HbA1c levels retrieved from medical records. Data were analyzed to test the mediation hypotheses. Higher levels of depression were correlated with poorer metabolic control in cross-sectional analyses at study entry, and in longitudinal analyses measured one year later. Adherence was found to be a partial mediator in cross-sectional analyses, but did not mediate changes in metabolic control across time.Item Alchemistic Polymers for the Delivery of Therapeutic Agents in Treatment of Pediatric Tracheomalacia(2016-04-14) Goodfriend, Amy Claire; Xu, Chet; Forbess, Joseph M.; Petroll, W. Matthew; Johnson, Romaine F.; Nguyen, Kytai T.Tracheomalacia is characterized by flaccidity of the airway whereby tracheal collapse occurs during respiration. Globally, approximately 1:21 children are affected by airway malacia whether it be acquired or from congenital origins. Of the available modalities of treatment, stenting has the greatest potential for success but remains controversial in pediatrics due to limitations in biocompatibility and internal reinforcement. There is a pressing need in the design of bioresorbable devices for the treatment of this disease. Ergo, this research shows the development of a MRI-visible multi-drug release composite coating that is to be applied to a bioresorbable stent. The coating combines novel polymers synthesized using non-traditional initiators such as contrast medium and therapeutic agents. The characterization of these polymers leads to the optimization of a coating platform. Using a factorial design, a library of drug delivery particles for the delivery of an anti-inflammatory agent was generated. The novel polymer containing the contrast agent was blended with preexisting polymers to formulate theranostic nanoparticles for a three month delivery of an anti-inflammatory agent. The optimized polymer platform is synthesized using a contrast medium and an antibiotic to inhibit bacterial infection up to two weeks. Thus the combination of the polymeric theranostic nanoparticles and the antibiotic release polymer platform were combined to generate a composite coating. Each individual component of the composite coating and the combination of components was analyzed for biocompatibility and therapeutic potential in-vitro. The local multi-drug delivery and imaging capabilities in this coating design in combination with a bioresorbable stent should result in a successful intervention specifically designed for pediatric tracheomalacia. This design should mitigate long-term risks associated with current permanent devices and provide necessary theranostic agents to facilitate healing and monitor progress via non-invasive imaging techniques.Item Apolipoprotein E Isoform Influence on Outcomes after Pediatric Traumatic Brain Injury(2016-01-19) Usala, Claire; Huang, Rong; Hernandez, Ana; Miles, DarrylINTRODUCTION: The ε4 allele of the apolipoprotein E gene (APOε) is associated with poor outcomes in adults with traumatic brain injury (TBI), but its influence on recovery after pediatric TBI is uncertain. The primary aims of this study were to determine if an association exists in the outcome of children after TBI between those with at least one ε4 allele and non ε4 genotypes. Using the Glasgow outcome score (GOS), we examined three outcome variables between the two groups 1) GOS at hospital discharge, 2) GOS at long-term follow-up, and 3) the magnitude of change in GOS from discharge to > 6 month assessment (Δ GOS). METHODS: Data were prospectively collected from 220 children presenting with moderate or severe blunt head trauma between the ages of 0 and 17 years old from 2002-2013. Outcomes were assessed at hospital discharge and 12.7±8.4 months post-injury. Patients in the ε4 and non ε4 groups did not differ in injury mechanism, severity, or demographics; 23.4% had at least one ε4 allele and ε3/ ε3 was the most common genotype (67.4%). Multiple regression model analysis was conducted to determine if associations existed between the genotype combinations and outcome while controlling for age, ER GCS, ICP monitor placement, and whether CPR was performed. For ε4 genotypes analysis, we also stratified patients by admission Glasgow Coma Scale (GCS) into severe (GCS 3-8) versus non-severe (9-15), as well as moderate and severe (3-12) versus mild (13-15) groups. RESULTS: For aim 1, the GOS at discharge did not differ significantly in ε4 versus non- ε4 patients in any injury severity category before or after controlling for cofounding variables. However, after controlling for confounding variables, patients with at least one ε2 allele in the moderate or severe injury category had significantly worse GOS at discharge. For aim 2, after controlling for confounding variables, patients with the ε3/ε3 genotype had significantly better long-term GOS than patients with the genotype ε3/ε2 (p<0.05). However, we did not find a significant difference in long-term outcome between ε4 and non ε4 genotypes in the primary analysis or when stratified by injury severity groups. Finally, between ε4 and non ε4 genotypes, the Δ GOS and neuropsychological scores did not differ significantly between genotypes. DISCUSSION: Overall these results propose that unlike adults, the ε4 allele may not be associated with 12-month outcome or the rate of recovery (ΔGOS) from hospital discharge following pediatric TBI. Our results implicating worse outcomes for the ε2 genotypes suggest that this allele may be a candidate for further study to delineate its role in TBI outcome in children. Unique to this study was our analysis of neuropsychological measures, which were also not affected by the presence of ε4 in a smaller cohort of children. This study adds to current literature suggesting that unlike adults APOε4 may not exert a significant effect on pediatric TBI outcome. However, these results are limited in that any genotypic effect on neurologic repair may not be apparent for much longer time periods in pediatric brain injury as the child continues to develop and grow.Item Association Between Posttraumatic Growth, Medication Adherence, and Barriers to Adherence in Pediatric Solid Organ Transplant Patients and Their Caregivers(2020-08-01T05:00:00.000Z) Mbroh, Hayden Mensah; Triplett, Kelli; Stewart, Sunita M.; McClintock, Shawn Michael; Bonsu, Mary L.; Selders, MichaelLiving with a chronic illness can be a traumatic experience, yet there is also evidence that adverse experiences may facilitate positive psychological changes, such as posttraumatic growth (PTG). Little is known about PTG in pediatric solid organ transplant (SOT) patients and their caregivers or PTG's relationship with health behaviors. Study aims were to longitudinally evaluate 1) the role of medication nonadherence and BTA on PTG, and 2) PTG's influence on medication nonadherence and barriers to adherence (BTA). It was hypothesized that 1) Greater baseline medication nonadherence and BTA would predict greater follow-up PTG, and 2) greater baseline PTG would predict lower follow-up medication nonadherence and fewer BTA. Participants included 43 pediatric SOT patient-caregiver dyads at baseline (range: .11-17.09 years post SOT) and follow-up (range: .87-3.37 years post baseline). Baseline measures of PTG, medication nonadherence, BTA, and psychosocial factors were obtained. Follow-up measures of primary outcomes were also collected. Baseline medication nonadherence (β = -.05, SE = .87), patient-rated BTA (β = -.17, SE = .10), and caregiver-rated BTA (β = -.24, SE = .12), did not predict follow-up patient PTG. More baseline caregiver-rated BTA (β = .29, SE = .30), but not medication nonadherence (β = .07, SE = 3.02) or patient-rated BTA (β = .20, SE = .20), predicted greater follow-up caregiver PTG. Baseline patient PTG (β = -.01, SE = .04) and caregiver PTG (β = -.25, SE = .01) did not predict follow-up medication nonadherence. Higher baseline caregiver PTG (β = -.25, SE = .08), but not patient PTG (β = -.07, SE = .26), predicted fewer follow-up patient-rated BTA. Greater baseline patient PTG (β = -.01, SE = .21), but not caregiver PTG (β = -.04, SE = .06), predicted more follow-up caregiver-rated BTA. Exploratory analyses were also conducted to identify psychosocial predictors of primary outcomes. Results suggest that strengthening PTG in caregivers of pediatric SOT patients may be important for reducing BTA. Further research needed to determine whether specific domains of PTG and BTA are associated. Findings have the potential to inform strength-based interventions focused on decreasing BTA for pediatric SOT patients.Item Baseline Assessment of Adolescent Reproductive and Sexual Health in Yantaló, San Martin, Peru(2016-04-01) Murarka, Shivani; Johnson, AndreaBACKGROUND: The term “adolescent fertility rate” refers to the number of births per 1000 in girls ages 15-19. In July 2013, the adolescent fertility rate in rural Yantaló, Peru, was nearly 10%, almost double the national rate of 5.2% in 2012 (World Bank). Adolescent pregnancy remains a major contributor to maternal and child mortality and to the cycle of ill-health and poverty world-wide (WHO). In Yantaló, many young mothers are forced to terminate their schooling in order to care for their children, giving them fewer opportunities for financial independence in a society with a strong machismo culture. OBJECTIVE: To gain a better understanding of the adolescent sexual and reproductive health education and practice in Yantaló and the potential interventions that could be made to decrease the adolescent fertility rate. METHODS: This study involved numerous methods of data collection that were then evaluated and presented to the local community. We started by conducting oral interviews with 19 local authorities, who played different roles in the community, to gain a deeper understanding of the issues surrounding adolescent sexual and reproductive health in the region. We then conducted 218 written surveys with high school students ages 11-19 to investigate their baseline reproductive health knowledge, religious values, family life, and their preferences regarding avenues of receiving sexual health information and sexual health classes. We also evaluated the proposed national curriculum on sexual health. All of this data was then used to create suggestions regarding interventions to improve the adolescent fertility rate in Yantaló, and this information was presented to local authorities. RESULTS: Analysis of the study revealed that there were many components that contributed to the high adolescent fertility rate in Yantaló and many potential areas for intervention were made apparent. Data from oral interviews pointed to a strong machismo culture, rampant misconceptions regarding sexual health and contraceptive methods, insufficient outreach programs, and a general lack of coordination between local entities as reasons for the high number of adolescent pregnancies. The surveys of the adolescents revealed that they lacked basic reproductive health knowledge but were eager to learn more, especially from local clinicians and their mothers and fathers, despite admitting having difficulty communicating openly about sexual health with their parents. Although the proposed national curriculum was analyzed, the school in Yantaló admitted that it only followed the guidelines loosely, which made it an ineffective tool to evaluate sexual health education in the region. CONCLUSION: Yantaló is similar to many other rural communities in South and Central America in that it has a strong traditional, machismo culture that influences much of the adolescent sexual health practices. Like much of Peru, Yantaló also has access to trained healthcare providers and free contraceptive care, but misconceptions and a lack of education regarding sexual health limits access. This research emphasized the importance collaboration within the community to utilize the existing infrastructure of the village to increase education of adolescents and encourage communication between providers, parents, and adolescents to improve adolescent sexual health and reduce the burden of unwanted teenage pregnancy. This practice could be easily translatable to numerous other communities that struggle with the same inefficiencies.Item Behavioral Intervention for Smoking Cessation in Adolescents and Young Adults(2006-08-11) Schepis, Ty Stephen; Rao, UmaSmoking is the leading preventable cause of morbidity and mortality in the United States. The vast majority of adult smokers initiate smoking before the age of 18, and the cumulative risk for initiation does not decline until the middle 20's. Thus, early intervention programs could be of great benefit to public health. Here, we have tested such a program: a smoking cessation treatment named the Modified Brief Office Intervention (M-BOI). The M-BOI is a 10-session cognitivebehaviorally based intervention. Sixty-three participants were consented for treatment, and 38 received M-BOI treatment, in conjunction with randomized double-blind, placebo-controlled bupropion. Of treated participants, 60.5% reduced their baseline level of smoking by half at the end of treatment; overall, treated participants reduced their smoking by 49.8%. Using intent-to-treat analyses, 7.3% of participants achieved biochemically verified cessation, and treatment was associated with a significant decrease in smoking. Treatment did not seem to significantly reduce exhaled carbon monoxide (CO) levels but did reduce urine cotinine. Depression history and baseline level of depressive symptoms had no effect on change in smoking during treatment, but this may have been due to low power to detect differences. Exploratory analyses demonstrated that treatment was associated with an increase in smoking-related self-efficacy, and decreases in maladaptive cognitions related to unpleasant events, nicotine withdrawal symptoms, smoking urges and nicotine dependence symptoms. Finally, there were preliminary indications that treatment ameliorated depressive symptoms in individuals with a history of a depressive disorder. Participants rated treatment as helpful with their cessation efforts and the majority would recommend M-BOI treatment to others. One major limitation of this study is the lack of data on M-BOI treatment without pharmacotherapy. Taken together, this study provides preliminary evidence for the efficacy and acceptability of the M-BOI. Further evaluation is needed to more firmly establish its effects.Item Body Image and Age Effects in the Pediatric Cleft Population(2015-12-03) Komachi, Candice Yuki; Heppner, Celia; Faith, Melissa A.; Seaward, JamesBACKGROUND: While orofacial clefts affect the facial appearance of many children and adolescents with this birth defect, there has not been specific research examining the impact of orofacial clefts on developing body image. Body image development in the general population follows a trend in which adolescence is characterized by more negative body image than in prepubescent children. However, as children with orofacial clefts have altered appearances from birth, their body image may differ from that of the general population. This study aims to examine the relationship between orofacial clefts and body image throughout childhood and adolescence. PARTICIPANTS: Participants included children and adolescents who were seen in the multidisciplinary craniofacial clinic at Children's Health/Children's Medical Center between March 2011 and April 2015. Patients included in the sample had a diagnosis of cleft lip and/or palate (CL/P), were between the ages of 8 and 18 years of age, and had no complex medical or genetic diagnoses. METHOD: This study utilized a retrospective chart review of patients seen in the craniofacial clinic at Children's Health from March 2011 to April 2015. Data collected from the patient charts included demographic information, medical and surgical history, and history of speech intervention and recommendations. Each patient was interviewed by a clinician and filled out self-report questionnaires. Items from the self-report questionnaires relevant to body image and self-perception were used in this study along with a body image concern item asked during the clinician interview. Participants were separated into groups based on orofacial cleft diagnosis (bilateral CL/P, unilateral CL/P, cleft lip only, and cleft palate only). RESULTS: There was no significant relationship found between body image and category of orofacial cleft diagnosis. Age also did not correlate with body image scores. Body image scores that were taken from the body image-related items were also not highly correlated. DISCUSSION: There were no significant relationships found between the variables of interest in this study. However, orofacial clefts are unique conditions that may necessitate ongoing surgical and related medical intervention throughout childhood and adolescence. For patients with CL/P, body image development may not follow a typical trend and may fluctuate rapidly depending on the success of their treatment, how well treatment outcomes meet expectations, as well as patients' adaptability to their changing appearance. As a result, there may not be a clearly identifiable correlation between age and body image scores. Other factors such as the orofacial cleft diagnostic categories used for this study, the uneven group sizes, and the body image-related items used as a measure of body image may have impacted the results. As the body image-related items were not significantly correlated, another measure that has been validated to assess body image may be more efficient and necessary in future studies so that the relationship between age, orofacial cleft condition, and body image can be more precisely examined.Item Characterizing Interpersonal Perception in Adolescent Eating Disorders(August 2021) Harper, Jessica Anne; McAdams, Carrie J.; Ghannadpour, Jasmine; Palka, Jayme; Kennard, Beth D.; McDonald, WadeEating disorders (EDs) are associated with significant morbidity and mortality, and recovery is a challenging and often protracted process. Improved understanding of EDs, including identification and refinement of treatment and recovery targets, is necessary to improve intervention and treatment outcomes. Cognitive and interpersonal models of EDs propose interpersonal function as a risk and maintenance factor, and the adult ED literature documents challenges in self-concept and interpersonal function during illness that improve with recovery. Adolescence is a significant period for social development as well as ED onset and early intervention. Despite this, little research has prospectively examined interpersonal perception as a potential target in adolescents. This observational study examined baseline differences in self-referential thinking in adolescents with EDs (n = 29) compared to healthy control adolescents (n = 31) using the Internal, Personal, and Situational Attributions Questionnaire self-report and a Social Identity behavioral task. Self-attribution bias was also examined prospectively as it related to both time and clinical symptoms in 25 ED and 30 HC. When controlling for depression severity, the ED group had a more negative self-attribution bias than the HC group (p = .006). Additionally, the ED group exhibited less positive self (p < .001), social (p = .015), and socially reflected appraisals (p = .011) but no group differences for friend and friend reflected appraisals during the Social Identity task. After including depression as a covariate, however, the model was no longer significant, suggesting group differences in social appraisals may be mediated by depression. Additionally, there was no significant effect of clinical symptoms on self-attribution bias, although more severe clinical symptoms were significantly associated with lower valence indices for self, social, and socially reflected appraisals. Although significant group differences remained for self-attribution bias at follow up, there was no effect for time or group × time, nor was there a relationship between self-attribution bias change and clinical symptom change. Findings support valence in self-perception as a potential target in adolescent EDs. Future research should replicate results in larger samples and include longer follow-up duration to clarify the relationship between self-attribution bias and clinical status in adolescents.Item A Comparison of Post-Injury Symptomatology and Recovery Following Concussion Versus Orthopedic Injury(August 2021) Allen, Tahnae Tarkenton; Cullum, C. Munro; Didehbani, Nyaz; Hynan, Linda S.; Silver, Cheryl H.; Miller, ShaneOBJECTIVE: Concussion research has utilized orthopedic injury (OI) comparison groups to examine outcomes specific to concussion versus physical injury in general, due to the suggestion that preexisting, comorbid, and other injury-related factors influence post-concussion symptom reporting and recovery. The first aim of this dissertation (Study 1) was to conduct a review of the literature on post-injury symptoms and outcomes following concussion versus OI in children and adolescents, focusing on study design and synthesizing conclusions about concussion versus OI in youth populations. Incorporating findings from the review, the second objective of this dissertation (Study 2) was to collect original data from concussed youth and a carefully selected OI control group to compare symptomatology and recovery at initial presentation and 3-months post-injury to examine whether concussion outcomes are unique to a brain injury or more related to response to injury in general. METHODS: A scoping review using MEDLINE and PubMed to query databases from 2000 to 2020 was performed. Studies were included if they reported children, adolescents, or young adults with mild traumatic brain injury (mTBI)/concussion, used an orthopedic control group, and compared post-injury outcomes, which resulted in a total of 52 articles out of the 526 initially identified. For the second study, participants age 12-18 who sustained a concussion (n = 50) were matched by sex, age, and days since injury to an OI group (n = 50). Repeated measure analyses of covariance (ANCOVAs) were used to compare post-concussion symptoms, emotional symptoms, and recovery outcomes between injury groups at initial and 3 months post-injury. Binary logistic regression analyses were used to determine predictors of prolonged recovery separately in concussion and OI groups. RESULTS: Study 1: sixty-nine percent of the studies included in the scoping review reported differences between concussion and OI outcomes during at least one assessment time point during the recovery period, with higher and more persistent symptomatology in the concussion group. Study 2: the repeated measure ANCOVAs indicated that concussion participants reported significantly higher post-injury symptomatology and psychological sequelae within the first week of injury compared to OI subjects, but by 3 months, the groups showed no differences. Within the concussion group, females reported significantly higher symptoms compared to males, but this pattern was not observed in the OI group. Significant predictors for prolonged recovery also differed between injury groups. For the concussion group, previous concussion was the only significant predictor in our model for prolonged recovery. In the OI group, time since injury and functional impairment rating scores predicted prolonged recovery. CONCLUSIONS: Overall, findings suggest concussion results in a unique expression of symptoms, and recovery following concussion is influenced by a specific set of concussion-related factors that are not commonly seen in OI. Clinically, a unique presentation and recovery course following concussion versus OI supports the utility of specialized concussion treatment and clinical protocols, and may help identify individuals at greater risk of prolonged recovery.Item Components Analysis of a Cognitive Behavioral Therapy Treatment Program for Children and Adolescents with Major Depressive Disorder(2017-07-12) Owen, Victoria Jane; Kennard, Beth D.; Emslie, Graham; Hughes, Jennifer L.; Mayes, Taryn; Nakonezny, PaulThis study examined whether the receipt of specific CBT components in a CBT treatment program, parent or family involvement, and dosage across four domains (i.e., frequency, duration, length, and intensity) were associated with risk of occurrence of relapse among children and adolescents with Major Depressive Disorder (MDD). Children and adolescents aged 8 to 17 with MDD (n=75) completed a continuation phase CBT- focused treatment program after responding to an acute phase pharmacotherapy intervention. Study therapists completed session checklists following each session to document which components were introduced during session, as well as documenting parent/family involvement, and dosage variables (e.g., length of session, etc.). Depression severity was also measured through the CDRS-R, which allowed for measurement of relapse status, which was the outcome variable for the current study. Cox Proportional Hazard Regression Models were utilized to investigate whether two primary components (i.e., Wellness, Relapse-Prevention), dosage, and parent/family involvement were related to hazard of relapse. Inclusion of Wellness and Relapse-Prevention components were not significantly related to risk of relapse. Similarly, parent/family involvement was not significantly related to hazard of relapse. Regarding dosage, however, results indicate that a higher frequency of sessions, as well as a longer period of time over which treatment is delivered (e.g., length) were significantly related to a reduced risk of relapse. However, there was no statistically significant finding regarding risk of relapse based on cumulative number of minutes spent in session. Further, when length of treatment was controlled, an increase in number of weeks that elapse between each session (e.g., intensity) was related to a higher risk of relapse, suggesting that sessions that occur closer to one another are related to a reduced risk of relapse. These findings are congruent with some of the existing research on this subject, and ultimately support the idea that treatment dosage should be measured across several domains (e.g., frequency, duration, length, intensity). Additional research with a larger sample size should be conducted regarding the influence of receipt of specific CBT components as well as parent/family involvement given the lack of statistically significant findings in the current study.Item Contemporary Review of Pediatric Thyroid Surgery(2016-01-19) Spendlove, Nicholas; Rialong, Kristy; Burkhalter, Lorrie; Wang, Rong; Rice, Henry; Skinner, Michael A.; Diesen, Diana L.PURPOSE: Pediatric thyroid cancer is uncommon and, despite its relative aggressiveness, prognosis is favorable if treated appropriately. Our study is the largest contemporary review to characterize the presentation, treatment, and outcomes in all pediatric patients requiring thyroid resections from two medical centers. We examined the factors associated with complications, the accuracy of FNA, and management of follicular lesions. METHODS: After IRB approval, we reviewed all available data on pediatric patients undergoing thyroid operations at two pediatric children's centers between 2003 and 2014. We examined demographic factors, history, physical, imaging, operative course, and follow-up. RESULTS: We identified 97 patients with a median age of 13.5 years, 86% females, 75% Caucasian, 6% with a personal history of cancer and radiation, and 13% family history of thyroid cancer (12% MEN-2A) with a mean follow up of 33 months. Patients underwent total thyroidectomy (44%), near total/subtotal thyroidectomy (18%), and lobectomy (38%) with 37% having lymph node dissections and 24% having a parathyroid autotransplant. Malignancy was diagnosed in 42% of patients with 39% having malignant lymph node and 2% distant metastases. 63% percent of patients with cancer received postoperative I131. Risk factors for complications were palpable nodes, history of radiation, malignancy, and type of surgery (p<0.05). Thirteen percent of patients had complications FNA was performed on 69% of patients with a sensitivity and specificity of 95% and 100%, and a PPV and NPV of 100% and 88%, respectively. Follicular FNA was found in 32 patients. 21 patients had lobectomies after which 4 required completion thyroidectomies for malignancy. Eleven patients had total/near total thyroidectomies for goiter, bilateral lesions, or history of radiation. Patients with follicular FNA had a 34% risk of carcinoma on final pathology. CONCLUSIONS: Risk factors for complications were palpable nodes, history of radiation, malignancy, and type of surgery. FNA was a reliable tool for in evaluating thyroid nodules in children. Total thyroidectomies, subtotal thyroidectomies, and lymph node dissections were associated with an increased rate of complication as opposed to lobectomies. In the case of follicular lesions, lobectomy may be performed understanding the possible need for completion thyroidectomy.Item Cross-Sectional Differences in Brain Activity Supporting Working Memory(2011-12-12) Dewey, Laura Marie; Motes, Michael A.Cross-sectional developmental studies have shown working memory (WM) to follow monotonic developmental trajectories through childhood into adolescence. In contrast, structural neuroimaging studies have shown that several brain regions, such as the prefrontal cortex (PFC), follow nonlinear developmental trajectories from birth through late adulthood. The present study sought to explore the relationship between functional activation in brain regions supporting WM and age throughout adolescence. Forty-two healthy adolescents (aged 11 to 18) completed a delayed-response WM task while functional magnetic resonance imaging (fMRI) data were collected. Participants studied either one or six letters (3.5 seconds), remembered the items over a delay (5 seconds), and then judged whether a single probe letter was in the studied set (within 2.5 seconds). An fMRI blocked design was used: four blocks per set-size and three trials per block. Additionally, the participants completed the Digit Span subtest from the Wechsler intelligence tests in order to obtain behavioral measures of WM. Hierarchical regression analyses were used to evaluate linear and quadratic relationships between WM task-related signal-change per voxel and age while evaluating the potential mediating effects of WM indices (response time [RT], digit span forward, digit span backward). Linear relationships were found in right medial Brodmann’s Area (BA) 6, right cerebellum, and left BA34 when the linear effects of gender, handedness, response time, digit span forward, and digit span backward were controlled for statistically. Thus, activation increased with age within these regions, but the linear trends were being suppressed by the covariates. Activation on the WM task increased with age in right medial BA6 when the effects of WM indices, as measured in the present study, were removed. The separate relationship between WM capacity and right medial BA6 activation suppressed the detection of the relationship between right medial BA6 activation and age. The data support developmental, possibly maturational, changes in the role of medial PFC in WM that are independent of WM ability measures used in the present study. This finding has implications for broad theories about the development of WM and other cognitive abilities that allow for the identification of both normal and deviant developmental trajectories.Item A Cry for Tomorrow(1985-04-06) Cason, VickiItem The Development of an Animated Teaching Module Designed to Increase Understanding of the Basic Concepts of DNA, RNA, and Protein Synthesis Among Ninth Grade Biology Students(2011-12-14) Swensen, Jennie; Krumwiede, Kimberly HoggattCan a two-dimensional Flash animation be created to help teach about DNA? The goal of this thesis was to create a teaching module for DNA, RNA, and protein synthesis, designed for ninth grade students. The module contains animations created in Adobe Flash and quizzes after each section. It is to be used as a textbook and lecture supplement for high school students. Quantitative assessment showed an improvement in comprehension. Qualitative assessment showed positive feedback from both students and the teacher.Item Developmental Expectations and Adolescent Type 1 Diabetes Management in Latino and Caucasian Families(2013-12-30) Sundaram, Saranya Easwar; Wiebe, Deborah J.; Wetherington, Crista E.; Gross-Toalson, JamiBACKGROUND: Transfer of responsibility for diabetes management is important across adolescence. It may contribute to poorer adherence and family conflict if unmatched to adolescent development. Research has primarily studied Caucasian samples, which may have different expectations for autonomy compared to Latino samples. This study examined developmental expectations for independence in both general and diabetes-related tasks in age- and sex-matched samples of Caucasian and Latino youth with type 1 diabetes. SUBJECTS: Participants included 118 10- to 15-year-old Caucasian and Latino adolescents with type 1 diabetes [M (SD) = 13.24 (1.69) years; 54% female] and their mothers. METHOD: Participants independently completed questionnaires measuring expectations for independence, diabetes responsibility and conflict, and adherence to diabetes management. In addition, adolescents completed an inventory measuring depressive symptoms, and HbA1c levels were obtained through medical records. RESULTS: Mothers and adolescents held different expectations for the age at which adolescents should make independent decisions about general and diabetes-related activities. In the overall sample, adolescents expected independence at younger ages for prudential activities, but at older ages for diabetes activities than did parents. These mother-adolescent differences occurred in different domains across ethnicity; Caucasians displayed mother-adolescent differences in expectations for diabetes activities, while Latinos displayed differing expectations for prudential activities. In the overall sample, expectations were associated with mother-reported conflict, but were minimally correlated with parental diabetes responsibility. Younger age expectations for prudential items were associated with poorer diabetes outcomes, but age expectations for personal and diabetes items were generally unrelated to diabetes outcomes. In contrast to expectations, associations of developmental expectations with diabetes responsibility, conflict, and outcomes were similar across Caucasian and Latino youth. DISCUSSION: Findings support that there were differing age expectations between parents and adolescents in prudential and diabetes-related activities. Different factors may influence how these expectations were associated with parental responsibility, conflict, and diabetes outcomes.Item Effects of Surgical Intervention on Parent Reported Quality of Life in Children and Adolescents with Craniofacial Conditions(2014-12-22) Perrin, Lauren Kacey; Heppner, Celia; Wetherington, Crista E.; Kane, AlexBACKGROUND: This study compared parent-reported quality of life pre- and post-surgery in children with craniofacial conditions. Many psychosocial difficulties associated with craniofacial conditions have been identified in the literature; however, research has not yet looked specifically at parent reports of patients’ quality of life and psychosocial functioning before and after surgery. OBJECTIVE: The aim of this study was to examine changes in parent-reported quality of life over time in relation to surgical intervention in children and adolescents with craniofacial conditions. DESIGN: A retrospective chart review was conducted of patients seen in a multidisciplinary craniofacial team clinic. Data were examined for two time points: initial visit and follow-up visit to team clinic. Participants included in the chart review were patients seen twice by psychology in team clinic between March 2011 and August 2014, with PedsQL™ ratings from parents at both time points. Patients ages 0 to 23 years were eligible for inclusion in the sample. Data collected from patient charts included demographic information, medical and surgical history, and scores from the PedsQL™ TM 4.0 Generic Core Scales. RESULTS: Parenting stress reported at follow-up had a significant relationship with parent reported quality of life reported at follow-up for this sample; however, surgery was not a significant predictor of outcome quality of life. DISCUSSION: Current parenting stress and initial reports of quality of life may be important variables for clinicians to consider when working with the craniofacial population. Surgery should be investigated further in terms of its impact on quality of life in relation to other psychosocial variables.Item Emotion Dysregulation and the Interpersonal Theory of Suicide in Adolescents(2017-07-28) Eaddy, Michael E.; Stewart, Sunita M.; Kennard, Beth D.; Hughes, Jennifer L.; Schuster, Lisa; Emslie, Graham; Diederich, AndrewThe lack of progress in suicide prevention has been attributed to fractured investigations of disparate risk factors and inadequate theoretical frameworks. Adolescents are different from adults in ways that are likely to influence suicide ideation and acts. The Interpersonal Theory of Suicide (IPTS) is a promising theory that proposes three "final common pathways", perceived burdensomeness, thwarted belongingness, and acquired capability, as the most proximal risk factors to suicidal ideation and attempts. There is a growing body of literature that demonstrates that many known risk factors for suicidality are associated with these three IPTS variables, and that the IPTS variables account for the relationship between these known risk factors and suicidality. The current pair of studies was guided by two areas of interest in the current literature. First, emotional dysregulation has been consistently linked to suicide attempts, and appears to have a complex relationship with IPTS constructs in adults, but has been under-investigated in clinical adolescents when it may have particular relevance to suicidality. Second, little is known about the IPTS variables in relation to response to treatment, and whether individual characteristics interact with IPTS variables to promote or hinder changes in suicidality. This work is an examination of the relationship between emotion dysregulation and suicidality within the IPTS framework in a clinical sample of adolescents. The questions it will address are a) whether emotion dysregulation accounts for variance in suicidality independently of IPTS variables, and b) whether emotion dysregulation influences response to treatment for suicide ideation, and if so, whether this influence occurs in the context of the IPTS framework. This work will be structured as follows: An initial introductory context relevant to both studies will be provided. The measures used are the same in both studies and will be described next. These shared components will be followed by the study-specific components: abstract, introduction, aims of the study, study-specific methods, results and discussion. There is significant overlap in the references for each study and these will be condensed at the end.Item Emotional Control and Reaction Time in Children with Internalizing Disorders and Attention-Deficit Hyperactivity Disorder(2016-12-16) Turner, Melissa Dawn; Wilkinson-Smith, Alison; Brewer-Mixon, Karen; Rose, LindseyBACKGROUND: Prior literature indicates that children with slower reaction times on neurocognitive attention measures are more likely to respond more slowly to stop signals in real world situations. Taking longer to respond may also suggest a tendency to take longer to process emotional cues in real time, thus possibly resulting in vulnerability towards emotional dyscontrol. The present study examined differences between reaction time and the parental ratings of emotional control and internalizing symptomatology in three distinct pediatric populations: those with Attention-Deficit Hyperactivity Disorder (ADHD), those with internalizing disorders such as anxiety and depression, and those with comorbid ADHD and internalizing disorders. SUBJECTS: A sample of 64 children and adolescents who were patients at the Neuropsychology Service at Children's Medical Center Dallas Texas from November 2011 through July 2014 was derived. All patients received neuropsychological evaluations and were assessed for attentional and emotional disorders. METHOD: Approval for the study was obtained from the Institutional Review Board at UT Southwestern Medical Center. Data was obtained via examination of medical records. Reaction time was measured via the Conners' Continuous Performance Test II (CPT II) Overall Hit Reaction Time (RT) variable. Parent rating forms from the Behavior Rating Inventory of Executive Function (BRIEF) Emotional Control subscale (EC) and the Behavioral Assessment Scale for Children, Second Edition (BASC-2) Internalizing Problems Composite score (IP) were used as a measure of participants' emotional control capacity. A multivariate analysis of covariance (MANCOVA) was employed to assess for significant differences between all three groups for CPT II RT, BRIEF EC, and BASC-2 IP, controlling for age, education, sex, and race. RESULTS: The MANCOVA yielded a significant overall model for group [F (6, 26) = 6.89, p < .01], controlling for age (p = .08), education (p < .01), sex (p = .13), and race (p = .02). There was a significant main effect for CPT II RT [F (2) = 8.31, p < .01] and BASC-2 IP [F (2) = 3.96, p < .04], with respectable effect sizes (η2 = .56 and .35, respectively). There was a moderately significant main effect for BRIEF EC [F (2) = 3.65, p = .051] with a moderate effect size (η2 = .33). Post hoc analyses revealed significant differences between the internalizing disorder and comorbid groups (p = .048) for CPT II RT, with slower reaction times in the internalizing disorders than comorbid groups. Significant differences were also observed between the ADHD and internalizing disorders groups (p < .01) as well as between the ADHD and comorbid groups (p = .03) for BASC-2 IP, with greatest elevation in the internalizing disorders, followed by the comorbid and ADHD groups. There were significant differences between the ADHD and the internalizing disorder groups (p = .04) as well as between the ADHD and comorbid groups (p = .01) for BRIEF EC. Of note, mean CPT II RT performance was in the normal range across the groups. All other pairwise comparisons were nonsignificant. DISCUSSION: In this study we explored associations between cognitive inefficiency and emotional dysregulation in order to further our understanding of the ways in which emotional and executive functions are related. We focused on differences between groups of three specific populations (i.e., ADHD, internalizing disorders and comorbid ADHD and internalizing disorders). The co-occurrence of ADHD and internalizing disorders may have important implications for assessment and treatment. Results such as these could be useful in determining whether treating one type of internalizing symptomatology may improve the other, and can allow providers to make more informed decisions about how to better assist children with comorbid conditions.Item Endocrine problems of adolescence: the short and the tall(1967-09-21) Kaplan, Norman M.