Browsing by Subject "Child"
Now showing 1 - 20 of 99
- Results Per Page
- Sort Options
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 Association of Vitamin D Serum Concentration with Infection Outcomes for Children after Surgery(2016-01-19) Aboul-Fettouh, Nader; Williams, Timothy; Ploski, Roxana; Griffin, Allison; Szmuk, PeterVitamin D insufficiency and deficiency has been associated with various disease states and lower health outcomes. In the adult population, higher vitamin D levels correlated with decreased odds of in-hospital morbidity and mortality. However, no study examined the role of Vit D on the perioperative and post-operative outcomes in the pediatric patient population. We hypothesized that vitamin D deficient pediatric patients will have a higher incidence of composite infectious complications. As a secondary outcome we will analyze whether there is a relationship between the patient's vitamin D levels and hospital length of stay. With IRB approval we performed an EPIC search for all Children's Health patients from 2011 to 2015 where at least one 25-hydroxyvitamin D level was determined within the perioperative period (1 month pre- and post-surgery). Patients were included if they were less than 18 years of age and had underwent non-cardiac surgery. Patients were excluded if they did not receive general anesthesia, stayed less than one night in the hospital, had an American Society of Anesthesiologists Physical Status greater than 4, or underwent emergent surgery. Pertinent information including details of the surgery and relevant past medical history were collected for each patient to help analyze the data set and account for confounding factors. In order to have access to a larger number of patients, this project was performed in collaboration with Cleveland Clinic (Cleveland, OH). The EPIC search provided us with 1600 patient charts from CMC or Children's Health-Plano, and 850 were included into the study after being screened using the criteria noted previously. After analyzing the data, The incidence of infection were 5.5%, 5.8%, 4.9%, 5.8%, and 11.7% for patients with vitamin D level ≤13, 14-19, 20-25, 26-34, and ≥35 ng/ml, respectively. The odds of having infection did not differ significantly among the five vitamin D groups. Secondly, no difference was found in the length of hospital stay among the five vitamin D groups (P = 0.55). Vitamin D levels do not seem to be associated with infection or length of hospital stay in pediatric surgical patients. Other baseline and surgical factors have probably a stronger influence on in-hospital infection and length of hospital stay than vitamin D levels.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 Cancer in children part I: modern medical therapy(1981-07-29) Harrell, AnnItem Cancer in children part II: play therapy(1981-07-29) Harrell, AnnItem 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 Comparison of the Clinical Presentation of Two Age Groups in Pediatric Wilm's Tumor Patients at a Single Institution(2016-01-19) West, Lindsey; Burkhalter, Lorrie; Murphy, Joseph T.BACKGROUND: The long term survival rates for Wilm's Tumor in North America and Europe have increased to almost 85% overall. There is an emphasis on "risk based management" where children who are diagnosed with low stage tumors can achieve excellent outcomes with less intensive chemotherapy and radiation. This study aims to characterize difference of the presentation of Wilm's Tumor patients between a younger and an older age group at Children's Medical Center over 5 years from 2010 to 2015. METHODS: A retrospective review of 35 children presenting with Wilm's Tumor at Children's Medical Center of Dallas between April 2010 and April 2015 was conducted and data was collected on demographics, associated symptoms, stage of tumor, tumor histology, and outcome data. These data points were stratified between two age groups, either younger or older than 3 years old (yo). RESULTS: Ages at time of surgery ranged from ages 7 months to 15 yo, with a median age of 3 yo. Of the 16 patients younger than 3 yo, there were 10 males and 6 females, 7 white and 9 non-white, and 7 left-sided and 7 right-sided. Only 3 patients presented with abdominal pain, while 13 presented with an asymptomatic mass. Seven patients had stage 1 /2 tumors, and 9 patients had stage 3/ 4 tumors. Three of the patients had lung metastases while 12 were non metastatic tumors limited to the kidney. Of the 19 patients older than 3 yo, there were 6 males and 13 females, 14 white and 5 non-white, Sixteen patients presented with abdominal pain at the time of diagnosis while only 3 had an asymptomatic mass. There were 16 were left sided and 3 right sided tumors, 4 patients with stage 1/2 tumors and 15 patients with stage 3/4 tumors. Twelve patients had lung metastases at the time of surgery while 7 were non-metastatic tumors limited to the kidney. Compared to patients younger than 3 yo at time of surgery, patients older than 3 yo were more likely to present as female (p= 0.0946) and white (p= 0.094 ). They were also more likely to have left-sided tumor laterality (p= 0.057), have abdominal pain (p= 0.0002), and have lung metastases at time of surgery (p= 0.02). CONCLUSION: Despite a small study population from a single institution, these data demonstrate significant and critical differences in presentation, anatomy and severity of Wilm's tumor based on age at presentation.Item Comparison of Video-Assisted Thoracoscopic (VATS) Lung Biopsy vs. Bronchopulmonary Alveolar Lavage (BAL) for Diagnosis of Fungal Disease in Pediatric Oncology Patients(2015-01-26) Compton, Jeffrey; Burkhalter, Lorrie; Cohn, Shannon; Murphy, Joseph T.BACKGROUND: Pulmonary fungal infection is a known complication of the treatment of pediatric malignancy. Accurate diagnosis has relied on culture of fungi from either pulmonary lavage fluid or open biopsy of lung parenchyma. Minimally invasive lung biopsy techniques have decreased the morbidity and mortality of diagnostic lung biopsy procedures, however little data exists comparing diagnostic yields (DY) of bronchopulmonary lavage (BAL) lung washings versus video-assisted thoracoscopic surgery (VATS) tissue biopsy. METHODS: With IRB approval, the Oncology Registry and Electronic Medical Records at our institution were queried for pediatric oncology patients (age<18yrs) who have had either BAL and/or VATS for assessment of possible pulmonary fungal infection as suggested by CT imaging during treatment for various malignancies from March 2005 to May 2014 for a retrospective analysis. RESULTS: 106 pediatric oncology patients were identified to have undergone 146 procedures (116 BAL; 30 VATS) resulting in overall yield of 39 pulmonary fungal infections (30 BAL; 9 VATS). Overall DY was 27%, (BAL 26%; VATS 30%). While 25 patients had multiple procedures; 14 patients had sequential evaluations within 4 weeks to assess for persistent infection: 7 had multiple BAL; 1 had multiple VATS; 8 had BAL and VATS. Of the 8 who had sequential BAL and VATS procedures; in 50% the results were consistent (3 cases BAL/VATS both negative; 1 case BAL/VATS both positive); and 50% were discordant (2 had positive BAL / negative VATS; 2 had negative BAL / positive VATS). The combined use of both procedures within 4 weeks resulted in a 63% DY when all positive findings are considered. CONCLUSION: BAL and VATS procedures individually resulted in comparably low diagnostic yields for detection of pulmonary fungal infection in pediatric oncology patients; however when these procedures are employed sequentially within 4 weeks of each other, the diagnostic yield increased substantially.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-Cultural Comparison of Parental Perspectives of Health-Related Quality of Life in Children with Cochlear Implants(2012-11-28) Kumar, Roshini Ruth; Silver, Cheryl H.; Warner-Czyz, Andrea D.; Tobey, Emily A.BACKGROUND: Assessing health-related quality of life (HRQoL) is a useful way to quantify benefits that cochlear implants (CI) provide children with hearing loss. Since children often are too young or lack communication skills to convey their HRQoL, parents serve as a reliable proxy. This study examines parent report of HRQoL (categorized in eight domains) and demographic variables in children with CI. Lastly, this study compares parent HRQoL ratings in the United States (US) to parent ratings in the Netherlands, Finland and the United Kingdom (UK). SUBJECTS: Parents of 33 children with CIs participated in the US component of this study. METHOD: An analysis of variance was used to measure differences among HRQoL domains. Correlations between HRQoL and demographic variables, and correlations among HRQoL domains were assessed using Spearman and point bi-serial correlations. Cross-cultural differences in HRQoL domain scores were computed using one sample t-tests. RESULTS: In this US sample, education and effects of CI domains were rated least positively. Cross-culturally, US parents rated HRQoL more positively than parents in the Netherlands, generally less positively than parents in Finland and aligned most closely with parents in the UK. DISCUSSION: Limited access to CI-related accommodations and varying parent expectations likely explain the differences in low ratings of education and effects of implantation in the US, as well as the differences seen cross-culturally. Providing useful CI accommodations at school and preparing parents for realistic outcomes could greatly benefit children with CI and their families.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 Ethics large and small: moral considerations in response to childhood obesity(2022-03-08) Hester, D. MicahObesity in the U.S. has been described as an epidemic, and in response to such rhetoric, individuals, healthcare providers, public health officials, even state legislatures, and courts have proposed initiatives or enacted consequences either to encourage better eating habits, discourage poor eating habits, or even punish poor nutritional practices. All these actions raise ethical concerns for public health and individual patient care. This talk will explore a number of these issues and will suggest that certain state-based responses do not merit ethical scrutiny, but individual provider directiveness in regards to nutritional counseling, especially with parents of overweight children, is warranted.