Improving social adjustment in children with attention-deficit/hyperactivity disorder.

OBJECTIVE: To determine if sending motivational letters would improve peer relations in children with social maladjustment and attention-deficit/hyperactivity disorder (ADHD). DESIGN: From a consecutive sample, a case series was followed up for 2 years. SETTING: Primary care, private physician, office-based practice. PATIENTS: Ninety-five children diagnosed as having ADHD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria made up the consecutive sample. Twenty-one children qualified with a comorbid social maladjustment disorder with baseline t scores of 1.5 SDs or greater above the mean on the asocial domain of the Conners' Teacher Rating Scale. Seventeen children completed the study. There were no significant differences between these patients and those who did not complete the study (P = .55 for baseline score differences and P = .85 for age). INTERVENTIONS: In addition to conventional therapy for ADHD when children achieved a goal, such as an improved report card or better conduct, a personal letter about their success was mailed to them. Letters averaged 5 per student per year. MAIN OUTCOME MEASURES: The asocial domain of the Conners' Teacher Rating Scale was repeated during the next 2 school years for comparison. Statistical analysis was by a repeated-measures analysis of variance and Helmert contrasts. RESULTS: Of 17 students who completed the study, 16 improved on the Conners' Teacher Rating Scale asocial domain, and the results were statistically significant (P<.001). CONCLUSIONS: Difficulties with peer relations are commonly seen in children with ADHD. Sending motivational letters correlated with improved social adjustment in these children. The data suggest that busy practitioners might consider incorporating this successful, and time-efficient, intervention into their ADHD treatment regimens.

Treatment with buspirone in a patient with autism.

This study evaluates the safety and efficacy of buspirone hydrochloride for the treatment of a patient with autism and hyperactivity disorder and determines the effect of buspirone on the number of performance tasks completed by the patient at school. A 3-week, double-blind, placebo-controlled crossover study was performed in a private physician, office-based practice. A child with autism, which was diagnosed by Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria, was studied. The child received placebo for 3 weeks and buspirone for 3 weeks; there was a 1-week interval between the 2 treatments. The outcome was measured by using Conners abbreviated parent and teacher questionnaires and by determining the number of daily performance tasks completed by the child at school. Statistical analysis was performed by linear models and standard F tests. Buspirone was found to be safe and efficacious, without side effects, for decreasing hyperactivity and increasing completed performance tasks. The beneficial effects of buspirone in helping this patient with autism in his natural daily settings suggest that buspirone may be an alternative to neuroleptic agents in the medical therapy of autism; further study in other patients is needed.

Depression in mothers of children with attention deficit hyperactivity disorder.

BACKGROUND AND OBJECTIVES: Does having a child with attention deficit hyperactivity disorder (ADHD) increase the risk of depression in the child's mother? The present study was initiated to explore this issue in a primary care setting and evaluate the need for routine screening of maternal depression in mothers of children with ADHD. METHODS: The subjects were 59 biological mothers of children with ADHD. All were patients in a rural, private, office-based family practice. Each subject was given a Zung Self-rating Depression Scale (SDS). After completion, the mothers were interviewed to confirm or exclude depression by Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. RESULTS: Thirty-nine of the 59 mothers returned a completed Zung SDS. No statistically significant differences were noted between the respondents and nonrespondents, nor between ADHD children of respondents and nonrespondents. Twenty-one respondents had Zung scores in the depressive ranges. By DSM-III-R criteria, 15 were subsequently found to be depressed. None of the 18 mothers with normal scores on the Zung were found to be currently depressed. CONCLUSIONS: The incidence of major and minor depression in primary care outpatients is 4%-6% and 6%-14%, respectively. However, the present study reveals an incidence of 17.9% for major depression and 20.5% for minor depression in mothers of children with ADHD, suggesting that routine screening for maternal depression needs to be considered when children are diagnosed with ADHD in primary care settings.

In debate: should medical staff presidents be voting members of the hospital board. Yes.

In summary, the hospital must demonstrate its willingness to create a new paradigm in physician-hospital relationships. One that is built on trust, mutual respect, and enhanced communications. Most important, the hospital needs to understand the medical staff's perspective, identify mechanisms to integrate clinical and organizational values, and recognized the medical staff's ability to contribute to the overall operations of the hospital through key decision-making roles. By establishing a new paradigm, the medical staff and the hospital++ can provide a full range of health services for the community. And, this collaborative effort will strengthen the ability of the hospital and the medical staff to better compete on the basis of quality, cost, and value.

Physiological responses of pear thrips-damaged sugar maples to light and water stress.

We assessed the effect of feeding damage by pear thrips, Taeniothrips inconsequens Uzel (Thysanoptera:Thripidae), on gas exchange and water relations of sugar maple (Acer saccharum Marsh.) seedlings. Compared to undamaged seedlings, feeding punctures in the leaf epidermis of thrips-damaged seedlings decreased water use efficiency, increased leaf conductance to water vapor, and decreased predawn water potential. Under conditions of high soil water and high light intensity, carbon dioxide exchange rate (CER) was greater for thrips-damaged than undamaged seedlings because of greater CO(2) conductance through feeding punctures. Under conditions of low soil water, CER was lower for thrips-damaged than undamaged seedlings as a result of water stress. Carbon dioxide exchange rate at low light and low soil water was limited by non-stomatal factors, but no difference in non-stomatal limitation to CER was detected between thrips-damaged and undamaged seedlings. Leaf tissue water relations differed between thrips-damaged and undamaged seedlings and under high and low soil water conditions. The results suggest that the reduction in leaf area of thrips-damaged seedlings can be partially compensated by elevated CER under conditions of high light intensity and high soil water. However, high gas exchange rates through feeding punctures predisposes thrips-damaged seedlings to water stress that can reduce CER under conditions of low soil water.