Identifying depressed and suicidal adolescents in a teen health clinic.

PURPOSE: This study examined the 6-month prevalence of depression and suicidal probability among new referrals to an adolescent health clinic. METHODS: All subjects (n = 104) completed the Beck Depression Inventory (BDI) and the Suicide Probability Scale (SPS) prior to being seen by a physician and were categorized according to presenting problem (physical complaints only, psychological complaints only, and physical and psychological complaints combined). RESULTS: Fifty-nine percent of the sample was depressed with 21% falling in the moderate range and 21% falling within the severe range of depression. Almost 23% of the sample demonstrated significant suicidal probability. The BDI and SPS were highly correlated (r = .73, p < .001) and 22% of the sample met criteria for both moderate to severe depression and suicidal probability. A significantly greater proportion of patients presenting with physical and psychological complaints combined (60%) met BDI criteria for depression than was found for the other two groups. Suicidal probability was most prevalent in patients presenting with psychological complaints only (26%) and moderate to severe depression and significant suicidal probability also coexisted to a greater extent within this group (26%). CONCLUSIONS: Results suggest that depression and suicidal probability represent significant mental health problems within the adolescent clinic and the identification of high-risk individuals can be achieved through comprehensive screening practices.

Is childhood sexual abuse really increasing in prevalence? An analysis of the evidence.

One controversy regarding childhood sexual abuse is whether the increased rate of reported cases reflects a true increase in prevalence. In this report, data obtained in the 1970s and 1980s were compared with those of the 1940s. Using predetermined criteria for quality of information, commonality of definitions of childhood sexual abuse, and research design, the authors reviewed the Kinsey report published in 1953 and 19 prevalence studies reported in the last 10 years. Interrater reliability was .97 for each paper. In spite of differences in study designs and populations surveyed, where definitions of childhood sexual abuse were similar, the more recent studies with the strongest methodology reported prevalence figures similar to those of Kinsey in the 1940s, ie, 10% to 12% of girls younger than 14 years of age. Thus it would appear that increased reporting is due to changes in legislation and social climate rather than a true increase in prevalence. The absence of an increase in prevalence of childhood sexual abuse should not deter those interested in pursuing solid research in prevention and treatment because any childhood sexual abuse is too much.

Prognostic validity of brainstem electric response audiometry in infants of a neonatal intensive care unit.

This study compared the results of brainstem electric response audiometry (BERA) in infants of a neonatal intensive care unit to those obtained on the same children with pure-tone audiometry at 3 years of age. Six hundred children were initially tested in infancy, and complete follow-up information was obtained on 333. In 297 (89%) the BERA results accurately predicted the hearing status at the age of 3 years. Twenty-nine (9%) of the discrepancies were related to conductive hearing losses: 17 patients with a conductive hearing loss in the first few months of life had normal hearing at 3 years, and 12 patients normal in infancy had a conductive loss at 3 years. Two patients evaluated as a sensorineural hearing loss by BERA had normal hearing. These may have been due to a conductive loss. Six patients assessed as normal by BERA had significant hearing losses at the age of 3 years. Five of these had normal hearing at one frequency between 1,000 and 4,000 Hz. The sixth may have developed a sensorineural hearing loss after birth.

Bayley developmental performance at two years of age of neonates at risk for hearing loss.

Of 306 infants in a neonatal intensive care unit (NICU) screened for hearing-loss before discharge with both the 'Crib-O-Gram' (COG) and brainstem auditory evoked responses (BAER), 122 failed either or both tests. These infants were then tested on the Bayley Scales at approximately 24 months corrected age, together with 25 infants who had passed both tests and 25 non-NICU infants from a general medical follow-up clinic. Compared with BAERs, the COG was found to be inadequate in detecting mild hearing loss, but its sensitivity increased with more severe loss. On the Bayley Scales, infants who had failed the BAER had lower scores than those who had passed, but for those who had passed the BAER, there was no difference in development between those who had failed and passed the COG.

Relaxation prophylaxis for childhood migraine: a randomized placebo-controlled trial.

A randomized controlled trial was used to evaluate the effectiveness of relaxation training in the treatment of paediatric migraine. Relaxation training was compared with-two control groups (psychological placebo and 'own best efforts') in a total of 99 children and adolescents with frequent migraine. Daily recording of the headaches following treatment, three months after treatment and at the one-year follow-up indicated that all three treatments were equally effective. The importance of the use of adequate control conditions which generate equivalent expectancies in pain treatment research was confirmed.

Culture versus biology: children's attitudes toward thinness and fatness.

Many of the studies regarding children's acquisition of prevailing cultural concepts of physical attractiveness are flawed by small and unrepresentative samples, measurement instruments of questionable reliability and validity, and experimental designs that do not protect against bias. Additional studies in which these methodologic flaws are overcome must be carried out if we are to understand truly when and how cultural concepts of beauty are acquired. Nevertheless, the majority of the studies already done find that children acquire prevailing cultural values of beauty before adolescence and that thinness is desirable to girls considerably before puberty. It is suggested that the etiology of eating disorders and the reasons for their increasing prevalence will not be discovered by studying only clinical cases. We propose that those interested in this important health problem study children before adolescence in an attempt to learn how preoccupation with weight begins and why thinness is believed to be attractive. Once these are understood, a greater challenge will be the development and testing of interventions--be they in the schools or using the media--which can effectively prevent this public health problem. When culture and biology clash, people may suffer.

Brainstem electric-response audiometry in infants of a neonatal intensive care unit.

Brainstem electric-response audiometry was used to assess the auditory function of 600 infants from a neonatal intensive care unit. Two groups of children were tested, one group as inpatients prior to discharge with a mean age at test of 39.4 weeks and one group as outpatients with a mean age at test of 55.4 weeks. Our results indicate that testing infants when they are older will reduce the incidence of failure on the initial evaluation and will reduce the identification of transient hearing losses which resolve spontaneously. Our results also indicate that a threshold of 30 dB nHL or less is probably normal and that some infants with a threshold of 40 dB nHL at first test require otological or audiological management.

Evaluation of child life intervention in emergency department suturing.

The effects of stress-reducing intervention in emergency department suturing were evaluated by comparing children receiving intervention from child life staff, with two control groups who did not receive intervention, control A at a pediatric hospital and control B at a general hospital. The following measures were obtained: observable anxiety during the procedure; the child's self-report of anxiety, self-report of pain, postemergency visit behavior, and anxiety about a return visit; the parent's overall rating of satisfaction with care given and the parent's feelings of anxiety. Children and parents in the intervention group received emotional support and information concerning the medical procedure, and were taught appropriate coping strategies. Measures were obtained across three age groups (four to six years, seven to 10 years, 11 to 14 years) divided by sex; site of cut (face or body), and extent of injury (five or fewer sutures, six or more sutures). Intervention had its greatest influence on 11- to 14-year-olds with a facial injury requiring six or more sutures. Children in the intervention group expressed fewer fears than children in the general hospital control group. Parents of children who received intervention reported a significantly higher degree of satisfaction with the overall care given in the emergency department.

Assistive devices: utilization by children.

The use of assistive devices by children has become widespread and has been supported financially by insurance carriers and governments. However, there has been little evaluation of the utilization of these devices. To determine utilization of, satisfaction with, and perceived value of the aid, an independent evaluator contacted 502 families who had used a provincial government funding program to obtain an assistive device. High levels of use, satisfaction, and perceived value were reported, indicating that a decentralized funding program can provide aids effectively.

The Crib-O-Gram in the NICU: an evaluation based on brain stem electric response audiometry.

This study evaluated the Crib-O-Gram as a screening test for hearing loss in NICU infants using Brain Stem Electric Response Audiometry (BERA) as the standard. Two Crib-O-Gram tests were administered to 280 babies within 48 hours of BERA testing. An additional 26 babies received BERA and one Crib-O-Gram test. Correlation coefficients for the two Crib-O-Gram scalar scores were calculated separately for a group of preterm (31 to 37 weeks) and a group of full term and older (38 to 54 weeks) infants, with values of 0.36 and 0.52, respectively. This indicates that the Crib-O-Gram has poor reliability for a screening test, particularly for preterm babies. Approximately one-third of babies with normal BERA thresholds failed Crib-O-Gram screening. The identification of hearing loss by Crib-O-Gram increased with the severity of the loss. Crib-O-Gram was able to identify moderately severe hearing losses in full term and older babies.

Recurrent abdominal pain: a psychogenic disorder?

A controlled study of 30 children with recurrent abdominal pain and 30 pain free children failed to show any statistically significant differences between the groups on a variety of psychological variables thought to be associated with psychogenicity. A psychogenic basis has often been assumed as the cause in diagnosis of recurrent abdominal pain when clinical examination and laboratory tests show no organic or medical reason. We emphasise that establishing a psychogenic cause is only indicated where there is positive evidence for psychological factors such as family or school stress, extreme personality characteristics, or modelling of family pain behaviour.

Client, treatment, and therapist variables related to outcome in brief, systems-oriented family therapy.

Client, therapist, and treatment characteristics were examined with respect to how much of the variance they could account for in a variety of outcome measures. Multiple regression analyses were used to examine relationships among each of the client, therapist, and treatment characteristics studied and the various outcome measures. For the 219 families that were treated with brief family therapy, only a relatively low amount of variance in any of the outcome measures could be accounted for. The amount of explained variance, however, varied considerably from one outcome measure to the other. When the more homogeneous groups of clients (single parents or adolescent identified patients) were considered, the amount of explained variance generally showed an increase. Different sets of client, therapist, and treatment variables accounted for the variance in these outcome measures across client groups, demonstrating both the complexities of the relationships and the relative independence of various outcome measures. New variables are suggested for future research.

The intelligibility of whitened and amplitude compressed speech in a multitalker background.

This experiment determined the effects of amplitude compression on speech intelligibility when both a target speech signal and a competing message were whitened and amplitude compressed. The target CNC discrimination words were electrically mixed with a competing message composed of five talkers. This composite signal was presented to normal hearing subjects in four ways: unmodified, whitened, whitened pplus 3:1 amplitude compression and whitened plus 10:1 amplitude compression. Discrimination functions were obtained for the CNC material by varying the signal-to-competition ratio. The unmodified and whitened speech yielded comparable discrimination functions, but reduced discrimination scores were obtained with the whitened lus compressed speech. However, the reduction in speech discrimination for the whitened plus compressed speech was slight and was most evident when the target signal and the competing background were at the same intensity.

Effects of whitening and peak-clipping on speech intelligibility in the presence of a competing message.

The purpose of this experiment was to determine the effects of peak clipping on speech intelligibility when both a target speech and a competing message were simultaneously peak-clipped. A competing message composed of 5 talkers was electrically mixed with CNC discrimination words. This composite signal was presented to normally hearing subjects in three ways: unmodified, whitened, and whitened and peak-clipped. Discrimination functions were obtained for the CNC material by varying the signal-to-competition ratio. Under these conditions, essentially identical discrimination functions were yielded by the unmodified and whitened speech, whereas substantially reduced discrimination scores were obtained with the whitened/clipped speech. These results would suggest that speech intelligibility is reduced by whitening and peak clipping when more than one talker is present. This is true even though earlier studies have shown that whitening and peak clipping do not reduce speech intelligibility when only a single talker is present. Such a finding has implications for wearable amplification.

The intelligibility of whitened and peak clipped speech.

Consonant-nucleus-consonant monosyllabic words were filltered such that each spectral component had equal energy (i.e., "whitened") and peak clipped in one of four ways: minimal, 20, 30, and 40 dB of clipping. In addition, unmodified consonant-nucleus-consonant words were used as stimuli. These different types of sppech were presented to 20 persons with normal hearing at various sensation levels. The results indicate that whitening and peak clipping do not substantially degrade speech intelligibility. In fact, under some conditions whitening and peak clipping may slightly enhance intelligibility.