RESUMEN
OBJECTIVE: The recently validated Cornell Assessment for Pediatric Delirium (CAPD) is a new rapid bedside nursing screen for delirium in hospitalized children of all ages. The present manuscript provides a "developmental anchor points" reference chart, which helps ground clinicians' assessment of CAPD symptom domains in a developmental understanding of the presentation of delirium. METHOD: During the development of this CAPD screening tool, it became clear that clinicians need specific guidance and training to help them draw on their expertise in child development and pediatrics to improve the interpretative reliability of the tool and its accuracy in diagnosing delirium. The developmental anchor points chart was formulated and reviewed by a multidisciplinary panel of experts to evaluate content validity and include consideration of sick behaviors within a hospital setting. RESULTS: The CAPD developmental anchor points for the key ages of newborn, 4 weeks, 6 weeks, 8 weeks, 28 weeks, 1 year, and 2 years served as the basis for training bedside nurses in scoring the CAPD for the validation trial and as a multifaceted bedside reference chart to be implemented within a clinical setting. In the current paper, we discuss the lessons learned during implementation, with particular emphasis on the importance of collaboration with the bedside nurse, the challenges of establishing a developmental baseline, and further questions about delirium diagnosis in children. SIGNIFICANCE OF RESULTS: The CAPD with developmental anchor points provides a validated, structured, and developmentally informed approach to screening and assessment of delirium in children. With minimal training on the use of the tool, bedside nurses and other pediatric practitioners can reliably identify children at risk for delirium.
Asunto(s)
Desarrollo Infantil , Cuidados Críticos/métodos , Delirio/diagnóstico , Tamizaje Masivo/métodos , Preescolar , Cuidados Críticos/psicología , Humanos , Lactante , Recién Nacido , Tamizaje Masivo/psicología , Reproducibilidad de los ResultadosRESUMEN
Autism spectrum disorders (ASD) are often associated with impairments in judgment of facial expressions. This impairment is often accompanied by diminished eye contact and atypical amygdala responses to face stimuli. The current study used a within-subjects design to examine the effects of natural viewing and an experimental eye-gaze manipulation on amygdala responses to faces. Individuals with ASD showed less gaze toward the eye region of faces relative to a control group. Among individuals with ASD, reduced eye gaze was associated with higher threat ratings of neutral faces. Amygdala signal was elevated in the ASD group relative to controls. This elevated response was further potentiated by experimentally manipulating gaze to the eye region. Potentiation by the gaze manipulation was largest for those individuals who exhibited the least amount of naturally occurring gaze toward the eye region and was associated with their subjective threat ratings. Effects were largest for neutral faces, highlighting the importance of examining neutral faces in the pathophysiology of autism and questioning their use as control stimuli with this population. Overall, our findings provide support for the notion that gaze direction modulates affective response to faces in ASD.
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Amígdala del Cerebelo/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/etiología , Trastornos Generalizados del Desarrollo Infantil/complicaciones , Trastornos Generalizados del Desarrollo Infantil/patología , Reacción de Fuga/fisiología , Cara , Fijación Ocular/fisiología , Adolescente , Adulto , Amígdala del Cerebelo/irrigación sanguínea , Niño , Expresión Facial , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Reconocimiento Visual de Modelos , Estimulación Luminosa , Tiempo de Reacción , Adulto JovenRESUMEN
One of many publications emanating from the New York Longitudinal Study (NYLS), the prospective study of Stella Chess, Alexander Thomas, and Mahin Hassibi of six cases of depression during childhood and adolescence, which appeared in the Journal of Nervous and Mental Disease in 1983, provides an opportunity to reflect on the climate in which the NYLS was conceived and conducted. Its methodology is reviewed, and principle findings are summarized. In the more than 50 years since the inception of the NYLS, the attention of temperament investigators has shifted from a focus on definition and measurement to the examination of relations between temperament and psychopathology, including the exploration of the neurocircuitry underlying different dimensions of temperament and their contributions to the etiology, pathogenesis, and treatment of axis I disorders in developing children.
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Trastorno Depresivo/historia , HumanosRESUMEN
Possible explanations for the well-replicated platelet hyperserotonemia of autism include an alteration in the platelet's handling of serotonin (5-hydroxyserotonin, 5-HT) or an increased exposure of the platelet to 5-HT. Measurement of platelet-poor plasma (PPP) levels of 5-HT appears to provide the best available index of in vivo exposure of the platelet to 5-HT. Mean (± SD) concentrations of PPP 5-HT observed in the autism (N = 18), hyperserotonemic subgroup (N = 5) and control (N = 24) groups were 0.86 ± 0.53, 0.87 ± 0.43 and 0.86 ± 0.36 nM, respectively. The results suggest that the hyperserotonemia of autism is not due to increased exposure of the platelet to 5-HT and make it more likely that the factor(s) contributing to the hyperserotonemia of autism have to do with the platelet's handling of 5-HT.
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Plaquetas/metabolismo , Trastornos Generalizados del Desarrollo Infantil/sangre , Recuento de Plaquetas , Serotonina/sangre , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Valores de Referencia , Adulto JovenRESUMEN
Intellectual functioning at school age was studied in boys who had been severely malnourished during the first 2 years of life (index cases). IQ in these index cases was compared with that of male siblings closest in age and unrelated class mates or neighbors matched for sex and age (comparisons). Full scale, verbal and performance IQs were lowest for the index cases. All IQ measures were significantly lower in the index cases than in the comparisons. full scale and verbal IQ were significantly lower in the index cases than in the siblings. Siblings differed from comparison children only in performance IQ. No association was found between the intellectual level of index cases and the ages at which they had been hospitalized for the treatment of severe malnutrition during the first 2 years of life. (AU)