RESUMEN
OBJECTIVE: Evidence-based guidance of clinical decision-making for the management of Autism Spectrum Disorder (ASD) is lacking, particularly for co-occurring psychiatric symptoms. This review evaluates treatment evidence for six common symptom targets in children/adolescents with ASD and provides a resource to facilitate application of the evidence to clinical practice. METHOD: A systematic search identified randomized controlled trials (RCTs) and high-quality systematic reviews published between 2007 and 2016, focused on: social interaction/communication impairment, stereotypic/repetitive behaviours, irritability/agitation, attention-deficit/hyperactivity disorder symptoms, mood or anxiety symptoms, and sleep difficulties. We then completed qualitative evaluation of high-quality systematic reviews/meta-analyses and quantitative evaluation of recently published RCTs not covered by prior comprehensive systematic reviews. RESULTS: Recently published RCTs focused on social interaction and communication impairment (trials = 32) using psychosocial interventions. Interventions for irritability/agitation (trials = 16) were mainly pharmacological. Few RCTs focused on other symptom targets (trials = 2-5/target). Integration of these results with our qualitative review indicated that few established treatment modalities exist, and available evidence is limited by small studies with high risk of bias. CONCLUSION: Given the current evidence-base, treatment targets must be clearly defined, and a systematic approach to intervention trials in children/adolescents with ASD must be undertaken with careful consideration of the limitations of safety/efficacy data.
Asunto(s)
Trastornos de Ansiedad/terapia , Trastorno por Déficit de Atención con Hiperactividad/terapia , Trastorno del Espectro Autista/terapia , Trastornos de la Comunicación/terapia , Trastornos del Humor/terapia , Guías de Práctica Clínica como Asunto , Agitación Psicomotora/terapia , Trastornos del Sueño-Vigilia/terapia , Conducta Estereotipada , Adolescente , Trastornos de Ansiedad/etiología , Trastorno por Déficit de Atención con Hiperactividad/etiología , Trastorno del Espectro Autista/complicaciones , Niño , Trastornos de la Comunicación/etiología , Humanos , Trastornos del Humor/etiología , Agitación Psicomotora/etiología , Trastornos del Sueño-Vigilia/etiologíaRESUMEN
Increasing numbers of mothers are returning to work during the first year of their infant's life. Maternal employment has been associated with decreased duration of breastfeeding. Breast milk remains the optimal source of infant nutrition, yet only 50% of families choose breastfeeding for their newborns. Clinicians in pediatrics are well positioned to promote the specific benefits to mother and baby that breastfeeding provides through advocacy, education, and support with regard to breastfeeding and employment. Anticipatory guidance specifics such as feeding patterns, guidelines for pumping and storing breast milk, and information regarding available resources are clinical knowledge areas that pediatric health care providers must have to increase breastfeeding rates and duration among women who return to the work force after the birth of their baby.
Asunto(s)
Lactancia Materna , Promoción de la Salud , Mujeres Trabajadoras , Conducta de Elección , Femenino , Humanos , Enfermería Pediátrica , Mujeres Trabajadoras/educación , Mujeres Trabajadoras/psicologíaRESUMEN
Anorexia nervosa and bulimia nervosa are complex illnesses identified with increased frequency among adolescents, particularly adolescent females. Eating disorders can have serious health consequences and school nurses can play an important role in primary, secondary, and tertiary prevention. An overview of eating disorders within a theoretical framework for school nursing practice is presented, and a case management role within an educational setting is proposed for school nurses. Etiology, classification, and signs and symptoms are highlighted for application in schools. Recommendations are made for curriculum planning and involvement of other school professionals. Treatment for eating disorders is most successful when initiated early in the illness. Schools provide a natural forum to reach adolescents, and school nurses, with their biopsychosocial emphasis, are uniquely prepared to address these disorders.