(BQ) Part 2 book Developmental behavioral pediatrics presents the following contents: Outcomes—school function and other task performance, outcomes—physical functioning, outcomes—developmental, assessment, management and treatment, legal, administrative, and ethical issues.
Part VI oUTCOMES—SCHOOL FUNCTION AND OTHER TASK PERFORMANCE 51 SCHOOL ACHIEVEMENT AND UNDERACHIEVEMENT Lynn Mowbray Wegner Vignette Alice, an 8-year-old third-grade student in an upper middle class public school, gets along very well with all the other children in her class and her teacher Alice’s parents are concerned about her classroom achievement Her teacher had Alice’s older sister as a student and she also wonders at the difference in the two girls with respect to their academic attainment Alice’s sister consistently mastered every classroom task with little effort and good humor Alice has a similar sunny disposition, but her performance usually falls in the lower range of mid-average Alice’s parents, both attorneys, requested a conference, and the three adults could not find a logical reason for this discrepancy between the two siblings “Why don’t you discuss this with Alice’s pediatrician and see if there might be a medical reason for Alice’s apparent underachievement?” suggested the teacher On the first day of kindergarten, all children are poten- tial Rhodes scholars! Even if the child has been attend- ing daycare and preschool for several years, the first day of “real school” is a milestone in every family The fam- ily anticipates sharing the child’s care and nurture with teachers and other school personnel This care becomes a combined responsibility The child must navigate the transition between the primary influence of the home and a larger world with different expectations, and each set- ting contributes uniquely and importantly to the child’s educational experience Educating children is important at many levels: to the child, the family, and society In the medical home, pediatricians providing health maintenance for children are often consulted before school entry to help parents decide the “best” school setting or “when” it is best for the child to enter formal schooling Later, if children not perform at levels ex- pected by their families or teachers, pediatricians again often are consulted for recommendations about further formal assessment and school placement Sometimes, chil- dren perform below parental expectations, and sometimes their achievement clearly exceeds stated thresholds Pedia- tricians who provide medical care for children are expected to be child development experts Moreover, parents ex- pect the pediatrician to be able to apply this knowledge to the acquisition of academic skills from the early primary through the secondary school years School achievement is not merely “being smart enough.” Achievement is very dependent on a complex and interwoven system reflecting societal, familial, and child elements (e.g., cognition, tem- perament, language, memory, attention, visual-spatial, fine and gross motor) These factors contribute to the child’s ability to acquire information and new skills in the school setting The proficient pediatrician will consider the matrix of societal, familial, and individual elements when trying to discern the factors affecting a particular child’s academic achievement profile The three areas (Fig 51-1) are discussed individually and then considered as elements in “school achieve- ment.” This discussion examines the factors affecting children to attain academic achievement commensurate with their cognitive level or those affecting children who 497 498 Part VI OUTCOMES—SCHOOL FUNCTION AND OTHER TASK PERFORMANCE Society Family Economic Political Achievement Societal Factors Child Cultural Religious Figure 51-1. Academic achievement: Interplay of individual profile, family factors, and community characteristics not “make the grade.” Finally, suggestions are offered to help direct the pediatrician’s surveillance efforts to avoid unexpected academic struggles SOCIETAL FACTORS Within each community, there are economic, political, cultural, and even religious influences on the educational system offered (Fig 51-2) Whereas there are national federal mandates, control of local schools often is left to local officials with state oversight This can create pock- ets of inequality as more affluent communities may be able to provide, and expect, more diversity of resources and experiences for their children Communities with larger tax bases can support larger school budgets Teacher salaries may be greater, schools may be bet- ter maintained, and “perishable goods” such as books, computers and software, and CD-ROMS may be more easily updated Innovative programs may be explored as school personnel are able to attend professional trainings to learn about these offerings Conversely, communities with fewer economic resources may not be able to attract teachers with advanced skills, more experience, or pro- fessional choices There may be inadequate or outdated textbooks, fewer supplemental classes, and less ability to address individual student differences as completely Often interwoven with the economic forces are politi- cal agendas Although a community may need a larger budget for school use, local politicians may be reluctant to promote tax increases Their personal professional agen- das may directly compete with school needs Overarching local concerns may be a higher influence on curriculum because certain topics may be considered inappropriate Restricting books in the school libraries is one example of this Curriculum control is sometimes used as a means of inserting political influence in school policies Cultural and frequently associated religious influ- ences can be subtle when the school is located in a geo- graphic region populated by a preponderance of families from a particular ethnic group with specific cultural heritage and religious beliefs If the majority believe a certain way, there is an assumption the schools will fol- low suit If, however, there are many religions repre- sented in the families, more strident and vocal groups may exert undue influence, and dissention from the oth- ers may follow The dictum “separation of church and state” is sometimes difficult to follow when community Figure 51-2. Societal factors that influence educational systems political leaders represent a majority religious group in the community School administrators reflect these larger societal fac- tors as well as their personal values and beliefs Whereas school system administrators must follow federal and state mandates, most district systems are given signifi- cant leeway to permit local mores to set local standards (e.g., sex education, traditional man-woman marriage versus same-gender marriage/union, evolution versus creationism) These local school officials may respond to influential local groups and individuals with strong opin- ions about curriculum, policy, and procedures These administrators also have their individual perspectives about how things should be run, and they often have the ability to make school policies fit their perspectives Teachers also bring their professional training and in- dividual values to the classroom The variability of teacher preparation is staggering Some teachers have master’s degrees from extremely strong education programs; other teachers may have only a few education courses taken while they receive on-the-job training The length of the teaching career is variable also The teacher’s personal be- liefs are brought to the classroom every day It is clear that the educational experience being of- fered to each child is complex and reflects many factors beyond the control of the child and family Some of these factors are readily apparent: an aging school facility can be seen from the curb Other equally important factors are much more subtle and may not be discerned until a problem arises For example, a child who refuses to pray or to say the Pledge of Allegiance because of religious reasons may uncover pervasive community values Both apparent and subtle factors are important FAMILY FACTORS Families are the first communities of which children are members It is safe to say that at this time (early 21st century), there are no “typical” families (see Chapter 9) Children may live with birth parents, adoptive parents, grandparents, other relatives, single parents, parents who are married but not live together, same-sex parents, or foster parents, or they may be truly raised by paid caretakers while their actual parents are fre- quently absent These arrangements may be variably Chapter 51 School Achievement and Underachievement Community acceptance Performance expectation Family Factors Family culture Parental academic abilities Figure 51-3. Family factors that influence student educational achievement accepted by the community, and this acceptance may affect the child’s functioning in the family Community acceptance also may affect the child’s ability to func- tion as an “equal” citizen in the school community (Fig 51-3) Families also have culture The family culture some- times is consistent with the larger community, and some- times there is lack of congruity If the family values are at odds with the larger community, conflicts can arise, and these may interfere with the child’s successful academic achievement For example, a family with strict religious adherence (e.g., Passover, Yom Kippur, Ramadan) may require school absences not synchronous with the es- tablished attendance schedule The child may miss tests, field trips, or special opportunities Depending on the school and community acceptance, these absences may be excused and the child allowed to make up the missed time, or the child may be penalized There are laws pro- hibiting discrimination on the basis of religion, but dis- crimination can be subtle This “subtle” discrimination may also occur when the family does not meet community expectations Biracial children may experience this Children whose parents have unpredictable work schedules may not consistently come for school open houses or teacher conferences This may be perceived by school personnel or other par- ents as “lack of interest” in school matters Parents who have legitimate but out of the ordinary occupations (e.g., bartenders, entertainment industry) may have their par- enting skills regarded more severely than those of more “traditional” parents Children who live with relatives and are not cared for by a parent whose career precludes daily contact with the child may overhear adults make assumptions about the parents’ affection and concern for the child Children with parents in prison are often in- nocent victims of hostility directed at their absent parent with secondary judgments of the child’s character Sometimes, the culture of the family excludes the community If the family perceives the larger commu- nity as being “hostile” or alien to its values, the child may receive the message that only the family, or those of whom the family approves, are “safe” and acceptable In this manner, the child may reject acceptance from the school community Reinforcement is accepted only 499 from the family The family standards of achievement are those only accepted Family standards as the sole reference point for the child’s academic performance may create false impres- sions If the child is perceived as having more capabil- ity than he or she is able to demonstrate, the child may receive the message “You are lazy You are not work- ing hard enough You could better work if you tried harder You are capable of better performance in your school work.” Conversely, if the family has diminished expectations (e.g., “Girls in this family are not good at math.”), a child with weak academic performance may not be offered a careful assessment of why his or her performance is weak The child’s parents or primary caretakers can have a tremendous impact on successful daily school function- ing Parental disorganization and problems with time management and scheduling can upset the most consci- entious student If the child has a primary developmen- tal condition, such as attention deficit disorder, weak parental organizational skills compound problems with getting to school on time, completing homework assign- ments and returning them to school, locating materials for extra projects, and even getting to bed on time so the child has adequate rest A parent with substance abuse habits can undermine the child’s sense of security and regularity Not only can parental mental illness make the child genetically vulnerable to similar conditions, but poor emotional regulation clearly can affect daily routines and habits supporting successful school participation Parental learning disabilities can have a significant impact on the child’s ability to master academic tasks Not only is there an inherited pattern to some learning disabilities (Williams and O’Donovan, 2006), but many children rely on their parents to provide additional ex- planation and help in the evenings with homework as- signments The child whose parent struggles with basic reading, math, and written expression skills will not have the advantage of this additional home support Many adults have significant shame about their weak basic ac- ademic skills and may try to hide this information from their children by “being too busy” to help them or telling them “You are just being lazy by asking for my help.” Finally, much has been written about socioeconomic status and the impact on child health and development Magnetic resonance imaging studies of normal brain development in children between and 18 years of age and neuropsychological testing of children in lowincome families ( standard score 85) stand a better chance of being able to acquire the academic skills requisite to fluid reading speed and acceptable comprehension, math calculation and understanding, and expression of their ideas in written form If “intelligence” is closely examined, there are de- velopmental skills clearly identifiable as contributing to this measured intelligence Receptive and expres- sive language, selective attention, immediate and longterm recall, working memory, visual-spatial skills, and fluid processing all are potential domains of individual strength on which to build (see Chapter 55) These areas also can be individual weaknesses that may be addressed for either remediation or bypass What is important is that intelligence is perceived not as a com- posite but rather as a synergistic amalgam Every child has an individual strength:weakness profile, and those chil- dren who are successful in school are taught to recognize their individual areas of strength to use when their weaker areas are emphasized during the school day Another important characteristic of academically successful children is resilience (see Chapter 50) Strongly resilient children not buckle when they fail, either absolutely or relatively This resilience may reflect their basal level of academic skills or their personal motiva- tion to succeed in school Some children are extremely motivated to learn and are not dissuaded by “failure.” These children persevere in the face of academic strug- gles They may possess a strong self-concept as part of their inherent temperament (see Chapter 7), or they have had their resilience “shaped” by the parenting style in their homes The classroom is a laboratory for social skills and in- teraction abilities One of the most important skills a child needs to learn is how to be a “good citizen” in the classroom The child must have needs met and respect the needs of the other students and the teacher Children vary in their abilities to share, to take turns, to start and to maintain conversations, to control their bodies, and to request assistance They have to know when to listen and when to talk Children enter school with potentially very different abilities to be successful group members Some children have successfully attended daycare or preschool and have demonstrated this ability Other children have had home training that has made them ready to adapt to the classroom setting Another important characteristic of children who succeed in school is their personal belief that educa- tion is important to their present and future well-being Young children have these feelings imparted to them by their families, who articulate the importance of educa- tion to them As they become older, the personal ac- ceptance of these beliefs is essential to help maintain the motivation to attend school and to give the best effort to assignments This personal “ownership” of education’s value becomes an integral part of the child’s resilience to school struggles If the child does not receive ongoing support from the family with respect to the value of education, even a mild setback can lead the child to re- ject school as important to him or her THE PEDIATRICIAN’S ROLE IN ANTICIPATORY CARE The pediatrician can play a central role and be a signifi- cant agent in helping children to achieve school success from early childhood experiences in daycare or pre- school through post-secondary education (Levine, 2002) Table 51-1 shows the various points for medical moni- toring and intervention Genetic Elements Certain genetic disorders have identified cognitive pat- terns clearly affecting a child’s ability to master new information Many of these conditions (e.g., trisomy 21, fragile X and other “expansion disorders”) have variable expression in the child, and early intervention can fre- quently be associated with relatively optimal school per- formance Careful family history can alert the clinician to assess the infant for any physical features suggesting par- ticular inheritance or supplemental newborn screening Prompt referral as soon as physical signs are identified can result in appropriate referral for supportive developmen- tal interventions and family advocacy Malformations may suggest syndromes with subsequent developmental and cognitive effects (e.g., velocardiofacial syndrome) Prenatal Factors Maternal and paternal age at conception, maternal hab- its such as alcohol use and cigarette smoking, maternal hypertension during pregnancy, and other indicators Chapter 51 School Achievement and Underachievement 501 Table 51-1. Topics Related to School Achievement: What May Be Discussed at Anticipatory Care Visits Age Considerations Infant Genetic elements Cognitive Fragile X Trisomy 21 Malformations Velocardiofacial Prenatal factors Parent age at conception Alcohol or tobacco use Hypertension during pregnancy Birth and perinatal events Intraventricular hemorrhage Secondary visual impairments Central nervous system infections Child Formal developmental screening Months 9, 18, and 30 or 36 New concerns by family or physician Regular developmental surveillance Parent Maternal postpartum depression Referral to mental health programs Surveillance of family “wellness” Parental literacy Referral to adult literacy groups Child Continue formal developmental screening Continue developmental surveillance Interaction with same-age children Independent play Sustained interest Interactive conversations with adults Variety of activities Parent Discussion about early education Family ambitions Community pressures Mistaken ideas Parent Community expectations Family history Child’s characteristics Parents’ personal school experiences Child Factors affecting standardized test ������������� performance ������������������������ Personal characteristics Physical Sensory deficits Medical conditions Motor skills Neuropsychological Attention Memory Reasoning Language Comprehension Temperament Stress and frustration ���������������������� management Emotional Previously diagnosed mental health conditions Birth–3 years years–kindergarten entry Kindergarten entry Early elementary years (grades 1-3) Age Later elementary years Middle school High school Post-secondary edu- cation/vocational training Considerations School Resources Facility conditions Student-teacher temperament synchrony Home Learning atmosphere Educational support Daily routine Parent and child expectations Peers Acceptance in social group Peer attitudes toward achievement Parent Review and explain testing reports Child—continue developmental surveillance Independence Initiates parental involvement Turns in assignments Asks specific questions to facilitate learning Cognitive changes Reading at appropriate grade level Understanding peer humor Peer influence Social hierarchies Attitudes toward academic achievement Differences in physical development Strengths and weaknesses identification Observation in the examination room Noting examples of stronger functioning by parents Parent Encouragement toward independence Child and school Chronic illness Educational and cognitive aspects Current research Effects of treatment Use of offered accommodations School personnel support Peer acceptance Parent Emphasize need for autonomy and individuation Contact school Suggest classroom modifications Adolescent Identification of personal areas of strength Facilitate communication between child and parent Parent Unresolved need for success Young adult If previously received supplemental ������������������������� services: apprenticeships 502 Part VI OUTCOMES—SCHOOL FUNCTION AND OTHER TASK PERFORMANCE of possible fetal hypoxemia (including maternal iron deficiency anemia) and suboptimal fetal growth have been associated with developmental conditions later associated with school and behavior struggles Birth and Perinatal Events Significant adverse events during delivery and prolonged neonatal complications, such as intraventricular hem- orrhage with subsequent hydrocephalus, secondary visual and hearing impairments, central nervous system infections, and other significant congenital abnormali- ties, potentially may affect cognition and educational attainment in later childhood Birth Through Three Years Between birth and years of age, expert opinion recommends regular developmental surveillance as well as formal developmental screening with standardized in- struments at months, 18 months, and 30 or 36 months of age Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening Formal screening also may properly be offered at any other time if the child’s family or the pediatrician has new concerns All U.S states have early intervention services for young children, and pediatricians may make referral for formal developmental testing at any time before 36 months of age (www.cdc.gov/ncbddd/child/ devtool.htm) During these early years, formal screening for maternal postpartum depression, surveillance for indicators of family “wellness,” and careful but clear addressing of parental literacy are important to help develop a strong and supportive family home in which the child can grow and be nurtured Referral to local mental health pro- grams and adult literacy groups can begin interventions benefiting everyone in the family Three Years Through Kindergarten Entry Developmental support for children in this age range is usually provided through the public school sys- tems Whereas referrals certainly can be made after 36 months of age, it can be more difficult to obtain formal standardized assessment of the child’s cognitive, lan- guage, and motor skills if the family’s economic re- sources are limited It is for this reason that referral for formal assessment before years is emphasized None- theless, children with identified developmental delays may enter the school system–sponsored structured preschool programs For this reason, continued devel- opmental surveillance and screening with a standard- ized instrument is optimal care for children in this age group As part of the developmental surveillance, asking the parent how the child interacts with other same-age children in paired situations as well as in larger group settings is important As the child becomes older, there should be more independent play, more sustained interest in a preferred activity, and increasing length of interactive conversations with adults Asking the parents if the child freely participates in many different types of activities—coloring, assembling puzzles, imaginative play, riding a scooter or tricycle, listening to books being read aloud, and reciting nursery rhymes—can point to areas of further discussion if the child routinely avoids certain areas Pediatricians are often asked about the “best” preschools for their patients Many parents mistakenly believe that young children need to be taught to read and to count before they enter kindergarten The wise pediatrician will ask the parents what they think is im- portant about attending preschool That query can open a discussion about family ambitions, community pres- sures, and possibly mistaken ideas about early education A thoughtful conversation often can help the parents decide for themselves the best preschool setting for their child Kindergarten Entry The kindergarten physical examination appointment is often a well-attended visit because many school sys- tems demand a school form completed by a physician The pediatrician can be very helpful in providing some common-sense anticipatory suggestions Regular bed- times, breakfast in the morning, time for exercise after school, and time and place for homework completion should be emphasized With respect to parenting, maybe the most important suggestion is to develop the habit of praising the child’s efforts and not the outcome This is very important as reading and written expression of- ten require repeated attempts to master a subskill, and children may become tired and want to give up their at- tempts They need to know that their parents appreciate and value the hard work they are showing as they work to master these skills Parents may quickly perceive that the kindergarten their child is attending is much different from the experience they had as 5-year-olds Adults inspecting kindergarten curriculum may have the sense “We aren’t in Kansas anymore, Toto!” As elementary curricula seem to move more quickly and encourage the acquisition of more complex skills at a younger and younger level, skills that were once the purview of first grade are now expected by the end of the kindergarten year Some par- ents, sensing the intensity of the kindergarten curriculum, want the pediatrician’s advice about not having the child enter kindergarten when the fifth birthday is reached Other parents may allow matriculation but then want to retain the child for a second year of kindergarten for “maturing” purposes Again, the community expecta- tions, the family’s history, and the child’s characteristics all must be considered This is another excellent time for a thoughtful explication of the parents’ personal school experiences and an emphasis on their decision making rather than taking the pediatrician’s expert opinion Early Elementary Years Grades through are the foundation for skills used throughout the remainder of the child’s school years Learning to read, to arithmetic functions, and to express ideas in written form may be the first tasks in Chapter 51 School Achievement and Underachievement which a child shows struggles Parents want to know if early problems with classroom learning suggest more se- rious cognitive or processing problems, and this can be difficult to discern Teachers are loathe to separate chil- dren in these early grades as being “deficient” and may try a variety of informal interventions before requesting formal psychoeducational testing either to identify or to describe a “learning disability.” If the teacher does not communicate concerns about the child’s progress to the parents, many parents assume the child is meeting expectations The news that the child is being referred to the school’s student support team for further assess- ment either can come as a shock to the family or can be welcomed that “finally something is being done.” Many parents not understand the testing process, the results from standardized testing, and what appropriate inter- ventions should be offered if the child is found to meet criteria for a learning disability The pediatrician can be helpful by offering to review the test report and ex- plaining the standard scores in the context of a normally distributed curve Seeing the information displayed in this graphic manner sometimes makes the numbers more understandable There also are books explaining psy- chological tests to nonpsychologists (Wodrich, 1997) For the typical nonstruggling student, the third grade is usually the first formal testing experienced, when children are given the high-stakes educational achievement testing mandated by No Child Left Be- hind legislation Learning disabilities aside, Table 51-2 illustrates many factors potentially affecting the child’s ability to learn classroom material and also to dem- onstrate this acceptable mastery on these tests These factors should be considered throughout the academic course through college entry When children not pass these examinations, additional testing will identify neuropsychological fac- tors; however, the environmental and temperamental contributors are best assessed through interviews, obser- vations, and checklists By reviewing the medical record, the pediatrician can find much of this other information and can be a valuable member of the assessment team Later Elementary School Years As the child progresses in school, the demands increase Not only does the complexity of the material increase, with resulting emphasis on more adept integration of all the neuropsychological elements described in Table 51-2, but there is an expectation the student will function more independently This can create problems for the child in several ways First, if the parents are not also emphasizing more independent management of school homework and proj- ects, the student is not practicing independence out of the classroom This can be seen in children not remembering to have parents sign forms brought home, not turning in completed homework although the parent made sure it was in the book-bag, or needing the parent’s pres- ence as they their assignments Second, teachers in later grades may function more as “consultant” rather than as teacher That is, they may present the content in a lecture but then expect the students to ask specific questions about what they not understand There 503 Table 51-2. Factors Affecting Standardized Test Performance Personal Characteristics Physical Sensory deficits affecting acquisition of tested material (vision, hearing) Medical conditions, acute and chronic (Brown, 1999) Fine motor and gross motor: precision, strength, and speed Neuropsychological factors Attention Memory: short-term, working, and long-term retrieval Reasoning ability, possibly reflecting fluid processing, working memory, and processing speed (WISC Book) Visual-spatial skills Language Comprehension (both aural and reading) affected by receptive skills and prior exposure to the “language” of the test (Leonard, 1998) Personal experience Past exposure to material covered on the test Temperament Perceived stress of the testing and internal coping style Past temperamental factors affecting learning Persistence Frustration management Coping with both failure and success Emotional factors Previously diagnosed mental health conditions: attention deficit disorder; depression Anxiety-related disorders Bipolar disorder Environmental Factors School Resources available for teaching and learning content: teacher qualifications; current resources for content (books, computers, consultants) Physical building conditions Temperament synchrony between the student and teacher Home Availability for supplemental learning opportunities provided in the home Support for consistent and complete homework mastery Predictable daily routine, including meals, physical exercise, and adequate sleep “Good fit” between parents’ and child’s expectations for school performance Peers Child’s acceptance by peers in the social group Peer attitudes toward school and academic achievement certainly are independent learners who can proceed and handle assignments with only minimal questioning of the teacher Some children, however, cannot articulate what it is they not understand; they need for the content to be presented in a slightly different manner This may be misperceived as being overly dependent on the teacher for help, and the teacher may refuse to help them Asking if the child shows independence at home can help resolve this confusion Older elementary children are expected to be transi- tioning into more conceptual and higher order language use and understanding Their reading material is less about concrete and tangible topics This change in lan- guage use and understanding is developmental and may begin as early as years and yet in other students may not be mastered until later middle school An informal 504 Part VI OUTCOMES—SCHOOL FUNCTION AND OTHER TASK PERFORMANCE sign that the child is not understanding more conceptual language is the complaint that appropriate grade-level books are “boring.” When they are reading for plea- sure, they may choose books at a lower level than they are capable of reading Similarly, they may not under- stand the humor of same-age peers, although they used to easily tell jokes and understand them Peer relations also become increasingly more im- portant as children approach the middle school years (see Chapter 15) The complex social hierarchies can take a significant amount of emotional energy, and some students will become internally distracted in the class- room as they mull over an unkind remark casually made in the lunchroom by a former close friend Peer attitudes toward academic achievement also can be a significant factor in a student’s willingness to actively participate in classroom discussions or enrichment after-school programs Concerns about their physical development in comparison with peers also can significantly affect a child’s social interactions in the classroom As more stu- dents are retained because of failure to pass high-stakes testing, there will be more “old for grade” students, and the discrepancies between physical size and development will likely increase Finally, identification of the gifted student should not be forgotten (see Chapter 52) As everyone has a personal profile of strengths and weaknesses, there may be students who clearly excel and are identified early in their school years as intellectually bright There are other students, however, who quietly their work and may show one area of significant talent These chil- dren should not be ignored as just showing a “splinter strength.” It is possible they may fall in the designation of “academically gifted and learning disabled.” That is, they will show superior scores on standardized in- telligence testing, but their academic achievement test- ing falls in the average range of standard scores If no one probes for more careful and formal scrutiny, the child will be passed along as average This is a situation in which the pediatrician can make a significant con- tribution by noting examples of stronger functioning described by the parents or observed in the examina- tion room The pediatrician then can be the professional requesting further assessment by the school Middle School The middle-school years can be a maelstrom for children, parents, and school personnel All the issues described for the late elementary school-age child are present and made even more dramatic by the physical and cognitive changes experienced by young adolescents Puberty en- compasses the physical and sexual changes; adolescence demonstrates the enduring psychosocial and learning/ cognitive transitions between childhood and adult life The content demands of middle-school subjects increase also, and concomitantly supports offered in the elemen- tary schools seem to fade More is expected in the abil- ity to organize their assignments, to maintain prolonged focused attention, to understand increasingly more con- ceptual and higher order language, and quickly to shift topics as they transition between classes and people with whom they interact This appears to be true for both those students who have identification as “specifically learning disabled” and those who receive support through “other health impaired” identification At the same time sup- port is changed, the typical young and mid-adolescent does not want to appear different from peers and may refuse any offered supplemental services The needs not abate, but the intervention certainly changes Par- ents may seek help from the pediatrician to advocate for the school to continue to honor accommodations offered in elementary school as they are clearly needed for the student to make academic progress When contact is made with the school for this purpose, a successful strat- egy is to focus on the eventual goal of school attendance through the twelfth grade and high-school graduation Asking how this student will successfully manage the content of middle-school courses and develop the skills requisite for successful mastery of high-school demands can help focus the discussion more on strengths of the middle-school teachers to enhance development and less on what will or will not be offered If the pediatrician makes suggestions about classroom modifications (pref- erential seating, copies of class notes, after-school as- sistance in how to stage long-term projects), the process may be viewed as less adversarial Another manner in which the pediatrician can be helpful to both school personnel and the child is to act as a resource for information about the educational and cognitive aspects of chronic illnesses Although most lay- people understand that central nervous system disorders (e.g., seizure disorders, past history of meningitis or head trauma with prolonged loss of consciousness, congeni- tal brain malformations) could have a clear impact on learning, they may not understand other conditions and the relationship to cognition This might include mid- line heart defects, sickle cell anemia, insulin-dependent diabetes, and asthma Discussions about chronic health conditions might include review of current research about cognition and the condition, effects of treatment, need for hospitalization, and reduced endurance once the child is in the classroom Pediatricians also may be drawn into a discussion with the student to encourage the use of offered accom- modations Whereas parents may have many directives about what they want their child to do, the pediatrician may be viewed as more neutral, and thus recommen- dations made may be taken more seriously by the stu- dent An especially important aspect to this discussion is to acknowledge humiliation protection and how the student may accept the support and avoid as much as possible teasing by peers High School High school may begin in either the ninth or tenth grade, but high school is clearly different from all other school experiences, as parents and teachers remind the students that high-school grades “count.” These are the courses and grades the colleges, technical schools, and special- ized vocational programs will use to determine eligibility after the senior year If you ask middle-class ninth-grade students what they plan to after high school, most will give an answer including further education It is important to try to ensure that all students leaving high Chapter 51 School Achievement and Underachievement school have solid reading and reading comprehension, practical math skills, and the ability to express their ideas clearly in written form If a student’s parents did not have a strong educational background, they may not have an accurate understanding of their child’s ability level rela- tive to that expected by a graduating senior The pedia- trician may have to be the strong advocate for ensuring that the student is offered assistance to graduate with as much of the basic skills as possible Adults concerned with adolescents must remember that this age also in- cludes first work experiences, social distractions and pre- occupations, excessive media consumption, and risks of tobacco or alcohol and other substances for abuse On the other end of the spectrum are those students whose parents bought infant clothing for them with the logo of an Ivy League college and who are determined their child will matriculate into a “top” college This can be a very difficult situation if the student does not have the academic or personal profile consistent with this de- manding institution or if the student does not follow his or her parents’ wishes Sometimes, the decision about college can uncover the parents’ unresolved needs for success and how these needs are being channeled through the child The pediatrician can be helpful here by empha- sizing in the child’s early adolescent years the need for au- tonomy and individuation from the parents Encouraging the adolescent to identify personal areas of strength and to pursue these for a sense of mastery and accomplish- ment will provide a buffer for any academic setbacks It is a rare child who completely ignores his or her parents’ suggestions, as the family messages can be incredibly powerful, but emotionally healthy children may choose a path in which they know they can find success rather than temporarily appease the parent In this situation, the pediatrician can use skills as both a child and parent advocate to help facilitate communication between the child and parent and meaningfully contribute to an ac- ceptable resolution to the differing needs of each Planning for Post-Secondary Education or Vocational Training Ideally, these plans were being developed at the begin- ning of high school Certain factors can prevent the best plan’s being followed An intervening serious health con- dition may change the student’s plans from going to col- lege in another state to attending a local and less stressful community college Family disruption through the death of a parent or divorce may change the financial support available to the student, and the student may realistically have to defer formal training or education to be selfsupporting Emotional and mental health conditions can change the academic trajectory of a promising student Most high schools have guidance counselors to advise students, but the services that these overextended pro- fessionals can offer are usually limited to developing the letters of recommendation for the student If a student is not planning to attend a post-secondary technical or academic program, and if the student ever received supplemental school services as either learning dis- abled or “other health impaired,” it is very important to see if that student would be eligible for vocational rehabilitation consultation Whereas these resources 505 can be variable in the completeness of services offered, they should know about training centers and other community programs for individuals who not have the educational background to enter a more advanced technical school Apprenticeships can be another avenue for more specialized training, and this can be invaluable for students who are not reading at a high-school level and who learn best through on-the-job training For all students, the pediatrician can be a strong ally in communicating with teachers and other school person- nel, making suggestions about improving time manage- ment and organizational skills, developing appropriate medication plans when indicated, facilitating family dialogue, and making evidence-based suggestions about diet, sleep, and exercise The final years of secondary school can be tumultuous for students and parents The pediatrician can be the voice of calm for them all SUMMARY School performance is a multifaceted marker of a child’s development, and pediatricians can make significant con- tributions to helping the child be as successful as he or she is capable Knowledge of the community characteristics, the family background, and the child’s individual physical, developmental, and emotional strengths and weaknesses places the pediatrician in a position to help guide the child through preschool programs all the way to high-school graduation Actively soliciting informa- tion at all appointments about school performance and showing a genuine interest in mastery of educational tasks demonstrate the pediatrician’s desire to be a part- ner with the child and family in their common goal of helping the child manage the academic challenges as the child develops physically, emotionally, and socially REFERENCES American Academy of Pediatrics: Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening Pediatrics 118:405420, 2006 Brown RT (ed): Cognitive Aspects of Chronic Illness in Children New York, Guilford, 1999 Leonard LB: Children with Specific Language Impairment Cambridge, Mass, MIT Press, 1998 Levine MD: Educational Care Cambridge, MA, Educator Publishing Service, 2002 Lezak MD, Howieson DB, Loring DW, Hannay HJ: Neuropsycho- logical Assessment, 4th ed New York, Oxford University Press, 2004 Sattler JM: Assessment of Children, Revised and Updated, 3d ed San Diego���������������������������������������������������������������������������� , Jerome M.����������������������������������������������������������� Sattler����������������������������������������������� , Publisher, 1992 Waber DP, De Moor C, Forbes PW, et al: The NIH MRI study of normal brain development: Performance of a population based sample of healthy children aged to 18 years on a neuropsycho- logical battery J Int Neuropsychol Soc 13:729, 2007 Wehman P: Life Beyond the Classroom: Transition Strategies for Young People with Disabilities, 3rd ed Baltimore, MD, Paul Brookes, 2001 Williams J, O’Donovan MC: The genetics of developmental dyslexia Eur J Hum Genet 14:681, 2006 Wodrich DL: Children’s Psychological Testing: A Guide for Nonpsy- chologists Baltimore, MD, Paul Brookes, 1997 52 THE GIFTED CHILD Mary C Kral Children who are gifted compose 5% to 20% of the general school-age population, depending on how “gifted” is defined or the criteria used to identify students who are gifted (Pfeiffer and Stocking, 2000) Primary care physicians may be the first line of professionals consulted by parents of gifted children Is my preschooler gifted? How can I nurture my child’s talents? What is the best educational setting for my gifted child? Why is my child not achieving at a level consistent with his or her high ability? Primary care physicians are frequently placed in the position of assisting parents with answers to these questions and directing them to appropriate resources and educational opportunities The following summary of the current research on identification of, appropriate educational programming for, and special challenges faced by children who are gifted is provided as a resource for the primary care provider DEFINITIONS OF GIFTEDNESS “Gifted” means different things to different people in different contexts and cultures Some equate gifted with high intelligence, others with high academic achievement Still others highlight the domain-specific mastery characteristic, for example, of musically or artistically gifted individuals What constitutes giftedness in terms of cognitive abilities, talents, personality traits, or environmental contributions is the source of ongoing investigation and public debate Researchers and educators alike differ in how they define giftedness, and the empiric literature is characterized by the absence of a common vocabulary or universally defined terms, making comparisons across studies difficult Within the realm of education, there is no federal definition recognized by all states—a child who qualifies for gifted programs in one state may not be eligible for similar programs in a different state Historically, gifted has been equated with high intellectual functioning In the early 20th century, Lewis Terman defined gifted as an intelligence quotient (IQ) at or above 150 on the Stanford-Binet Intelligence Scale (Terman et al, 1926) Subsequently, the 98th percentile (IQ = 130) has commonly been used as the cutoff for giftedness More recently, some school districts recognize students with IQs of 120 or above as eligible to receive gifted programming 506 The problem with viewing exceptionally high IQ as synonymous with giftedness is that a fixed proportion of the population is always selected (e.g., top 3% to 5%; Renzulli, 2005) Research suggests that heritability accounts for most of the variance in IQ among children in middle and upper socioeconomic classes However, for children from low-resource backgrounds or minority groups, environment—not genes—makes a bigger difference (Turkheimer et al, 2003) As such, use of an IQ cutoff as the criterion for gifted will underidentify children from low-resource backgrounds An additional problem with use of intelligence test scores to define giftedness is the limited predictive utility of these scores IQ correlates only modestly with academic achievement, and noncognitive factors also account for a significant proportion of variance in academic attainment, including but not limited to motivation, interest, self-efficacy, and self-regulation skills In addition, intelligence test scores are poor predictors of real-world functioning, such as job performance (Neisser et al, 1996) Finally, IQ scores not capture the range of cognitive abilities Therefore, classifications that emphasize IQ for placement will miss those children with “uneven giftedness” (e.g., nonverbal intelligence > verbal intelligence) For all of these reasons, IQ cutoff criteria frequently result in underidentification of gifted children Modern-day conceptualizations of giftedness recognize that general intellectual ability is an important component of giftedness but reject the notion that intelligence is a unitary construct For example, Howard Gardner’s (1999) “multiple intelligences” highlights the multifactorial nature of giftedness by defining eight domain-specific intelligences: linguistic, logicalmathematical, musical, bodily-kinesthetic, spatial, interpersonal, intrapersonal, and naturalistic Similarly, Robert Sternberg suggests that intelligence is not a fixed entity but a flexible and dynamic one, a form of developing expertise involving noncognitive and cognitive components Specifically, Sternberg’s WICS model (2005) asserts that gifted individuals possess a synthesis of wisdom (balancing intrapersonal, interpersonal, shortand long-term goals), intelligence (ability to adapt to one’s environment and to learn from experience), and creativity (applying and balancing innovative, analytical, 1028 INDEX Prenatal screening, for Down syndrome, 236 Prenatal strokes, 217 Prenatal toxin(s), 315-317 alcohol as, 316, 316f cigarettes as, 316-317 cocaine as, 317 marijuana as, 317 opiates as, 317 neonatal withdrawal from, 318 polychlorinated biphenyls as, 317-318 specific hazards of, 315 Preoperational stage, 42 in middle childhood, 52 Preparedness, for disasters, 203, 204t Preschool, 44-45 Preschool years, 39-49 ADHD in, 48, 49t advising on kindergarten readiness in, 47-48 anxiety in, 48-49 autism spectrum disorders in, 48, 48t biophysical maturation in, 40, 40t clinical issues for, 45-48 cognitive development in, 42 cultural context of development in, 185 developmental and behavioral pathology in, 48-49 developmental and behavioral screening in, 45-46, 46t developmental assessment during, 788-796 Flynn effect in, 789 frequently used standardized tests for, 789-796, 794t vs measures of cognition and intelligence, 789 parent resources on, 796 predictive validity of, 789 quality control in, 788-789 selection and administration of, 788 , 788f written report of, 788 developmental domains in, 40-44 divorce of parents during, 128 Down syndrome in, 241t eating and diet in, 47 environmental risk factors in, 40, 40t family systems in, 44 feeding in, 565t language development in, 43, 44t evaluation of, 728t major tasks of, 39-40 moral development in, 43-44 motor development in, 40-41, 648-649 fine, 648 gross, 648 milestones in, 41t palliative and end of life care in, 356-358 parent support and guidance in, 46 play development in, 42-43, 43f preschool and daycare in, 44-45 psychosocial context of development in, 44-45 psychosocial stressors in, 45 regulatory issues in, 47 response to disaster in, 203 self-control in, 454 sexuality in, 416-417, 416t sleep in, 47, 620-621 social and emotional development in, 41-42, 42f social cognition in, 375 social difficulties in, 377t social withdrawal and isolation in, 399, 399t, 403 treatment of, 404t toileting in, 47 Preschool years (Continued) understanding of death in, 149 vignette on, 39b Prescription drug abuse, epidemiology of, 438 Prescription drug advertising, 196, 197-198 President’s Panel on Mental Retardation, Presurgery programs, 332 Pre-teens sexual intercourse in, 420-421 sexuality in, 416t, 418 Preterm birth, 259-268 See also Premature infant(s) and academic achievement, 265 ADHD with, 266 and adolescent and adult functioning, 266 and antenatal brain development, 263 cerebral palsy with, 264 concerns with, 259 defined, 259-260 epidemiology of, 259, 259-262 etiologies of, 260-261 executive dysfunction with, 265-266 gestational age and, 260 health outcomes of, 262-263 hearing impairment with, 263 intellectual disability and borderline intelligence with, 265 intellectual disability due to, 668 low birth weight and, 260 and lung disease, 741 with multiple gestation, 262 neurodevelopmental outcomes of, 263-266 neurodevelopmental support and follow-up for, 266-267 after discharge from NICU, 266-267 in NICU, 266 neuromotor abnormality with, 264-265 perinatal and neonatal brain injury with, 263-264 prevention and treatment of, 261-262 racial and ethnic disparities in, 261 risk factors for, 260 trends in, 261 visual impairment with, 262-263 Preventive counseling, 848 Preventive guidance, for adjustment disorders, 412 Previsualization dyspraxia, 540 Primary care, access to consistent source of, 981 Primary circular reaction, 33 Primary prevention services, poverty and, 177 Primidone, for seizures, 216t Principlism, 987-988 Printed materials, for patient education, 849 Prioritizing for learning differences, 826t for neurodevelopmental dysfunctions, 544t Problem behaviors, 437 Problem clarification, counseling for, 850 Problem Oriented Screening Instrument for Teenagers (POSIT), 440 Problem solving abilities, screening for, 393-394, 393t Problem solving skills training (PSST), 495-496, 495f Problem solving, strategies for promoting, 394t, 395 Problem solving strategies, in behavioral adjustment, 84, 84t Problematic use, 439f, 446f, 440 Procedural memory dyspraxias, 540 Procedural pain, acute, self-regulation techniques for, 919, 919-920b Procedures, in memory consolidation, 537 Process, of interview, 749-750 Process praise, 428-429, 430t Processing speed, 795 Professional support, during pregnancy, 14, 15 Proficiency assessment, problems related to current practices of, 817-818 Progressive HIV encephalopathy (PHE), 271-272 Progressive infantile poliodystrophy, 307-308 Progressive muscle relaxation, as selfregulation technique, 912t, 914 Project Head Start, 8, 45, 185 Project PRISM, 711 Projective tests, 768-769 Proofreading, assessment parameters for, 822-823t Propionicacidemia, 290f, 298 Propranolol, for recurrent and chronic pain, 553t Prosocial behavior, in middle childhood, 54-55, 54f, 58-59 Protease inhibitor drugs, for HIV infection, 273t Protection, family dysfunction related to, 104t, 105-109 parental overprotection and overanxiety as, 108-109 physical abuse as, 105-108 Protective custody, 970 Protective response, 31 Protein booster, for tube feeding, 285t Protein requirements, 278-279 Protein-sparing modified fasts, 599 Proteus syndrome, 250 Protodeclarative pointing, 28 Protoimperative pointing, 28 Prune belly syndrome, home care for, 351f Pseudobulbar palsy, with cerebral palsy, 659 Pseudo-diseases, 327 Pseudomotor dysfunction, 540 Pseudotumor cerebri, 217-218 Psilocybin, intoxication with and withdrawal from, 442-495t PSST (problem solving skills training), 495-496, 495f Psychiatric disorders See Mental health disorder(s) Psychiatric symptoms, of inborn errors of metabolism, 293-295t, 292-295 Psychiatrist, communication between pediatrician and, 882-883 Psychoactive medications See Psychopharmacotherapy Psychoanalytic psychotherapy, 880-881 Psychobiologic theories, of aggression, 391 Psychodynamic Diagnostic Manual (PDM), 777 Psychodynamic psychotherapy, individual, 880-881 Psychoeducation for ADHD, 531 on depression, 463 Psychoeducational assessment, in developmental assessment, 798 Psychogenic cough, 636-637 Psychological abuse, 111-112 Psychological assessment, for obesity, 597 Psychological counseling See Pediatric counseling Psychological disorders See Mental health disorder(s) Psychological interventions See Psychotherapy INDEX 1029 Psychological issue(s) with chronic health conditions, 346t, 348 prevention and management of, 352-353 in eating disorders, 569-570 in palliative care, 358-360 loss of control as, 359-360, 359b pain management as, 359, 359b separation as, 358-359 trust and honest communication as, 360, 360b Psychological tests and testing, 763-769 psychometric considerations for, 763-765 positive and negative predictive value as, 765-769 reliability as, 765 sensitivity and specificity as, 765 standardization and sampling as, 764 types of scores as, 764-765, 764f validity as, 765 reasons for, 763 relevance of, 763 structured interviews or dimensional ratings in, 769 types of, 765-769 measures of academic achievement as, 768 measures of adaptive behavior as, 766-767 measures of attention as, 768 measures of infant development as, 767 measures of intellectual ability as, 766 in special populations, 767 neuropsychologic, 767-768 norm-reference and criterion-referenced, 766 projective, 768-769 Psychological therapy See Psychotherapy Psychology, historical background of, 4-5 Psychometric assessment in developmental screening, 785 Flynn effect in, 789 Psychometric considerations, 763-765 positive and negative predictive value as, 765-769 reliability as, 765 sensitivity and specificity as, 765 standardization and sampling as, 764 types of scores as, 764-765, 764f validity as, 765 Psychometric models, of intelligence, 804-805, 804t Psychoneuroimmunology, as self-regulation technique, 915 Psychopathology categorization method, for behavioral adjustment assessment, 774-776 Psychopathy, autistic, 675 Psychopharmacotherapy, 885-909 for ADHD, 886-892 α2-adrenergic agonists as, 888t, 889t, 891 antiepileptic drugs as, 891-892 antipsychotics as, 891 atomoxetine as, 888t, 889t, 889-890 bupropion as, 888t, 889t, 890-891 complementary and alternative medicine as, 892 historical background of, 885, 886t non-benzodiazepine hypnotics as, 892 psychosocial treatments and sequencing of, 892 psychostimulants as, 887-889 adverse effects of, 887-889, 889t delivery systems for, 887, 888t dosage of, 887-888, 888t improving clinical usefulness of, 887 Psychopharmacotherapy (Continued) marketed preparations of, 887, 888t mechanism of action of, 887 monitoring of, 889, 890t tricyclic antidepressants as, 888t, 889t, 890-891 for adolescents, 72 for anxiety, 896-899 antihistamines as, 898 benzodiazepines as, 898 buspirone as, 898 glutamate antagonists as, 898 with psychosocial and combination treatment, 898-899 serotonin and norepinephrine reuptake inhibitor antidepressants as, 898 SSRIs as, 897-898, 897t tricyclic antidepressants as, 896-897 for autistic spectrum disorders, 904-905 for bipolar disorder, 901-902, 901t for depression, 893-896 black boxes and risk of suicidality with, 896 complementary and alternative medicine as, 895 MAO inhibitors as, 894 norepinephrine and dopamine reuptake inhibitors as, 895 norepinephrine and specific serotonin antagonists as, 895 with psychosocial and combination treatment, 895-896 serotonin and norepinephrine reuptake inhibitors as, 894 serotonin S2 antagonist and reuptake inhibitors as, 895 SSRIs as, 893-894, 893t, 894t tricyclic antidepressants as, 893 for disruptive behavior, 892-893 for eating disorders, 905-906 future of, 885 historical background of, 7, 885 media coverage of, 885 NIMH-sponsored trials of, 885, 886t before prescribing, 885-886 for psychosis, 899-901 atypical antipsychotics as, 900-901, 900t typical antipsychotics as, 899-900, 899t and psychotherapy, 882 for tics and Tourette disorder, 903-904 Psychosexual development, Psychosis(es) See also Psychotic disorder(s); Schizophrenia childhood, 475 disintegrative, 675 pharmacotherapy for, 899-901 with atypical antipsychotics, 900-901, 900t with typical antipsychotics, 899-900, 899t Psychosocial assessment, for recurrent and chronic pain, 550-551 Psychosocial context, of preschool development, 44-45 Psychosocial development, in preschool years, 41-42, 42f Psychosocial environment, and growth and development, 88 Psychosocial factors, affecting chronic health conditions, 345-346 Psychosocial growth tasks, of adolescence, 63-65, 63t Psychosocial issues, with HIV infection, 270-271 Psychosocial stressors adjustment disorder and, 411 in preschool years, 45 Psychosocial variation, and middle childhood development, 57-58 Psychosomatic counseling, 853, 853t Psychosomatic symptoms, psychotherapy for, 877, 877b, 882 Psychostimulants abuse of, 438, 889 management of, 442-445t for ADHD, 532, 887-889 dosage of, 887-888, 888t improving clinical usefulness of, 887 marketed preparations of, 887, 888t mechanism of action of, 887 monitoring of, 889, 890t adverse effects of, 888-889, 889t for autism spectrum disorders, 905 for disruptive behavior, 892 interactions with nutrients of, 282t for neurodevelopmental dysfunctions, 545 Psychotherapist, communication between pediatrician and, 882-883 Psychotherapy, 876-884 for ADHD, 877, 877b, 880 for anorexia nervosa, 576 for bruxism, 635 for bulimia nervosa, 579 challenges in, 883-884 for challenging behaviors with intellectual disability, 487 cognitive-behavioral therapy as, 881 for depression, 463-464, 463t dialectical behavior therapy as, 881 for divorce, 877, 877b efficacy of, 883 family therapy as, 882 individual psychodynamic (psychoanalytic), 880-881 for obsessive-compulsive disorder, 481 parent guidance as, 882 pediatrician’s repertoire for, 877 psychopharmacologic interventions in, 882 for psychosomatic symptoms, 877, 877b, 882 for recurrent and chronic pain, 553-554 referral for, 878 attributes of successful, 878t resistance to, 878-879 for self-control issues, 458-459 after separation, divorce, or remarriage, 132 varieties of experience in, 879-882, 880t vignettes on, 877b Psychotic disorder(s) See also Psychosis(es); Schizophrenia brief, 475t, 477 due to general medical condition, 475t, 477 with intellectual disability, 486 not otherwise specified, 475t, 477 shared, 477 substance-induced, 475t, 477 Psychotropic agents See Psychopharmacotherapy PTEN gene, 210 Ptosis, 762t PTSD See Post-traumatic stress disorder (PTSD) Puberty and eating disorders, 569-570 hormonal changes of, 66 onset of, 417-418 1030 INDEX Puberty (Continued) precocious, with spina bifida, 744 signs of, 66 timing of, 66 Pubescence, 63, 64, 66 Public buildings, accessibility to, Public school movement, Punishment(s), 858t and academic performance, 167 corporal, 859-860t, 862 in preschool years, 46 Pupil asymmetry, 762t Pupil Evaluation Inventory, 157t Pupil-to-teacher ratio, 166 Purging in anorexia nervosa, 570 in bulimia nervosa, 577 Purine disorders, 303 PW syndrome See Prader-Willi (PW) syndrome Pyrimidine disorders, 303 Pyruvate carboxylase, defects in, 307 Pyruvate dehydrogenase complex, defects in, 307 Q Quality of life, with chronic health conditions, 347 Quantitative assays, for CNS disorders, 840 Quantitative electroencephalography, 838-839 Quantitative trait loci, for intelligence, 807 Quasi-adoption, 135 Question(s) for history taking, 753-754 leading, 754 open-ended, 753 Questionnaires, for behavioral style assessment, 782-783, 782t Quetiapine (Seroquel) adverse effects of, 900 for agitation or violence, 871t for bipolar disorder, 901t, 902 for psychosis, 900, 900t for recurrent and chronic pain, 553t Quickening, 644 Quiet sleep state, of newborn, 18t R Racial disparities, in preterm birth, 261 Racial segregation, and school connectedness, 517-518 Racoon sign, 216 Rapid eye movement (REM) sleep, in infants and toddlers, 29 Rate adjustment for learning differences, 826t for neurodevelopmental dysfunctions, 544t Raven’s Progressive Matrices and Vocabulary Scales, 804-805, 807 Reaction intensity, in temperament, 19t Reactive behavior problem, annoying temperament vs., 79 Reactive effect, 860 Reactivity of affect, 463 Reading assessment of, 800t, 812-813t parameters for, 821, 822-823t oral, 821, 822-823t silent, 821, 822-823t in Stage 1, 821 in Stage 2, 821 in Stage 3, 821 Reading (Continued) demographics on, 193f with infants and toddlers, 35 neurodevelopmental dysfunction and, 542 Reading disability, 800, 800b attentional problems due to, 528 Reading skills, in middle childhood, 52-53, 53t Reagan, Ronald, Re-alerting stage, of hypnosis, 914t Rearrangement, chromosomal, 228-229f Reasonable care, duty of, 968 Reassurance counseling to provide, 849-850 examples of, 849-850 nonverbal, 849 Recall memory, in infants and toddlers, 34 Receptive language defined, 717 development of in infants and children, 32t, 35 milestones in, 719, 719t in preschool years, 43 dysfunctions of, 538, 538t norm-referenced assessment of, 722t Receptive vocabulary, assessment of, 800t Reciprocal friendships, 157t Reciprocal language, in infants and toddlers, 34 Reciprocal translocation, 228-229f, 229-230 Recognition memory, in infants and children, 33 Recommended Dietary Allowance, for vitamins and minerals, 279 Rectal examination, for constipation or encopresis, 614 Recurrent pain See Pain, recurrent and chronic Redirecting, 859-860t Reduplicated babbling, 718t Refeeding syndrome, 574-575 Referral(s) access to, 982 for adoption, 136 for behavior management, 868 for early intervention services, 924, 929 for grief and bereavement, 369, 369t for psychotherapy, 878 attributes of successful, 878t resistance to, 878-879 after separation, divorce, or remarriage, 132 for recurrent and chronic pain, 552-554 for special education services, 937-939, 939t Reflex(es) in infancy, 645-646 in intrauterine period, 644 in preterm infant, 644 Reflex sympathetic dystrophy, 552 Reflexive vocalizations, 718t Reflux gastroesophageal, 566 in Down syndrome, 237-238 with multiple disabilities, 740 infantile, 340 Refsum disease, infantile, 303-304, 304f Regional anesthesia during labor, effect on newborn behavior of, 16 toxicity of, 317-318 Regularity, in temperament, 19t, 82t Regulatory issues, in preschool years, 47 Regurgitation, 566 Rehabilitation for intellectual disability, 670 after stroke, 90, 91 Rehabilitation Act, 7, 935f, 936 vs Individuals with Disabilities Education Act, 936t Reinforcement(s) differential, of incompatible behavior, 859-860t fading, 862-863 natural and logical, 861-862 negative, 858t and oppositional behavior/ noncompliance, 383, 383f, 385 positive, 858t example of, 864 Reiss Screen, 485 Reitan-Indiana Neuropsychological Test Battery for Children, 767-768 Rejection, 112-113 Relapse, in stages of change model, 446, 447f Related services, with special education, 974 Relationships in adolescence, 63t, 64 in behavioral adjustment, 84, 84t in neighborhood, 170 Relaxation for hyperventilation, 874 for recurrent and chronic pain, 554 as self-regulation technique, 912t, 914 Reliability, 765 Religion after death of child, 369 and school achievement, 498 Relocation, adjustment disorder due to, 407b, 411 REM (rapid eye movement) sleep, in infants and toddlers, 29 Remarriage, 121 consequences of, 129 after death of spouse, 148 demographics of, 126 developmental-behavioral problems due to, 131 as family process, 126 Remedial intervention for learning differences, 824-825 principles of, 824-825 Remediation of skills and subskills, for neurodevelopmental dysfunctions, 544-545 Remeron (mirtazapine) for depression, 895 for recurrent and chronic pain, 553t Remethylation defects, 300 Renal abnormalities, due to inborn errors of metabolism, 292, 293-295t Renal complications, of anorexia nervosa, 573t Renal Fanconi syndrome, due to inborn errors of metabolism, 292, 293-295t Renzulli, Joseph, 506-507 Repetition, during interview, 749 Repetitive behavior(s), 629-641 See also Tics with autism, 676-677, 677t body rocking as, 632 breath-holding spells as, 633 bruxism as, 634-635 classification of, 630, 631t with developmental disorders, 640 etiology of, 629-630 habit cough as, 636-637 habit reversal for, 639, 639t head banging as, 631-632 with intellectual disability, 484t, 485-486, 486-487 nail biting as, 633-634 INDEX 1031 Repetitive behavior(s) (Continued) nose or skin picking as, 635 rumination as, 634 thumb sucking as, 630-631, 632t trichotillomania as, 635-636, 636f vignettes on, 629 with visual impairment, 712-713 Replacement therapy, for substance abuse, 448 Reporting, mandatory, to law enforcement authorities, 970 Reproductive services, poverty and, 176-177 Research Units on Pediatric Psychopharmacology (RUPP), 886t Research Units on Pediatric Psychopharmacology Autism Network (RUPPAN), 904 Residencies, 11 Residential instability, 180 Residential options, in transition to adulthood, 962 Residential transition, 962 Residential treatment programs for anorexia nervosa, 573 for substance abuse, 448 Resiliency and adjustment, 408-409 and coping, 493 and school achievement, 500 vs vulnerability, 341 Resonance, 718t Resonance disorders, 727-728 Resource Benefiber, for tube feeding, 285t Resource Beneprotein, for tube feeding, 285t Resource(s), for grief and bereavement, 369, 369t Respiratory complications, of cerebral palsy, 659-660 Respiratory issues, with multiple disabilities, 740-742 Respondent conditioning, 857t example of, 864 Response, conditioned, 857t Response inhibition, in attention, 526 Response to intervention (RTI), 535, 816-817, 819-820 Responsibility, cultural context of, 186 Responsiveness, threshold of, in temperament, 19t Resting tremors, 222 Restless legs syndrome (RLS), 623 Restraint(s) chemical, 871, 871t legal issues with, 969-970 physical, 871 Restrictive lung disease, with cerebral palsy, 659, 659t Reticent patient, 753 Retinal disorders, 700-709t Retinal hemorrhages, due to child abuse, 107f Retinitis pigmentosa, 700-709t due to inborn errors of metabolism, 293-295t Retinopathy of prematurity (ROP), 262, 698, 700-709t Rett syndrome, 253 diagnostic features of, 676t, 678 historical background of, 675 music therapy for, 946, 947f outcome and prognosis for, 682 Reunification, after disasters, 204-205 Reversibility, concept of, 52 Review, during interview, 749 Rewards and academic performance, 167 in behavior plan, 861-862 for desirable behavior, in preschool years, 46 social, 861-862 Rhizomelic chondrodysplasia punctata, 303-304 Rhizotomy, selective dorsal, for cerebral palsy, 657-658 Rhythmic movement disorders, during sleep-wake transition, 623 Rhythmic movement(s), repetitive See Repetitive behavior(s) Rhythmicity in behavioral style assessment, 780t in temperament, 19t, 76t Riboflavin deficiency, 282t Richmond, Dale K., 366 Richmond, Julius, 8, 8f, 9t Richmond, Julius Benjamin, 366b Right brain dysfunction, 800-801, 800b Right-left discrimination, 758 Riluzole, for obsessive-compulsive disorder, 898 Ring chromosome, 228-229f, 229 Risedronate, for osteopenia due to anorexia nervosa, 575 Risky behaviors, in adolescence, 65, 70-71, 437 clinical signs and symptoms of, 71, 71t epidemiology of, 71 treatment for, 71-72 Risperidone (Risperdal) for ADHD, 891 adverse effects of, 900 for agitation or violence, 871t for autism, 681t, 904 for bipolar disorder, 466, 466t, 901t, 902 clinical trials of, 886t for disruptive behavior, 892-893 for recurrent and chronic pain, 553t for schizophrenia, 474b, 900, 900-901, 900t for tics, 638, 638t, 903 Ritalin See Methylphenidate RLS (restless legs syndrome), 623 RNA toxicity, 233 Robertsonian translocation, 228-229f, 229-230 Rocking behavior, 632 Rolling, 645-646 Roosevelt, Eleanor, Roosevelt, Franklin, 206 Roosevelt, Theodore, Rooting reflex, 35 ROP (retinopathy of prematurity), 262, 698, 700-709t Rorschach inkblot technique, 768-769 Rotary nystagmus, 762t Rousseau, Jean-Jacques, Roux-en-Y gastric bypass, 592b, 599, 600t RTI (response to intervention), 535, 816-817, 819-820 Rule usage, 541-542 in memory consolidation, 537 Rumination, 634 “Runaways,” 174-175 RUPP (Research Units on Pediatric Psychopharmacology), 886t RUPPAN (Research Units on Pediatric Psychopharmacology Autism Network), 904 Rush, Benjamin, 3-4 Russell-Silver syndrome, 231, 232 S SAD (separation anxiety disorder), 467, 467t management of, 469 Safety planning for depression, 463 for suicidality, 470-471, 470t Saliency, of behavior plan, 862 Salla disease, 308-309 Same-sex parents, 98, 98f, 99t Same-sex partner, addition to family of, 148-149 Sampling, 764 Sanfilippo syndrome, 309t, 310, 311f Savants, autistic, 677 SB5 (Stanford-Binet Intelligence Scale, Fifth Edition), 794t, 795, 806 Scheduled awakenings, 623 Scheie syndrome, 309t, 311f Schemas, 31 SCHIP (State Children’s Health Insurance Program), 176, 980-981 Schizencephaly, 218-219, 219f Schizoaffective disorder, 476, 475t, 477 Schizoid disorder of childhood, 478 Schizophrenia, 475-477 autism vs., 476, 675 clinical features of, 475 defined, 475 developmental aspects of, 475 differential diagnosis of, 475-476, 475t epidemiology of, 476 etiology of, 476 with intellectual disability, 486 neurobiology of, 476 prognosis and course of, 476-477 risk factors for, 476 treatment of, 476 pharmacotherapy for, 899-901 with atypical antipsychotics, 900-901, 900t with typical antipsychotics, 899-900, 899t vignette on, 474b Schizophreniform disorder, 475t, 477 Schizotypal personality disorder, 476 Scholastic Achievement Test for Adults, 812-813t School(s) See also under Academic; Education health-related services provided by, 974 impact of, 164-169 for disadvantaged students, 168 historical considerations on, 165, 166t and No Child Left Behind Act, 164 pediatrician advocacy on, 168 physical and administrative feature(s) in, 165-166 administrative arrangements as, 166 age and condition of buildings as, 166 internal organization as, 166 size and space as, 166 staff provision as, 166 school process(es) in, 167-168 academic emphasis as, 167 pupil conditions as, 167 responsibilities and participation as, 167 rewards and punishments as, 167 stability of teaching and friendship groups as, 167 staff organization as, 167-168 teachers’ actions in lessons as, 167 1032 INDEX School(s) (Continued) vignette on, 164b oppositional behavior/noncompliance at, 386 positive orientation to, 516-517 individual characteristics influencing, 517t, 518 system variables influencing, 517-518, 517t School accountability, 815-817 problems related to current practices of, 817-818 School achievement, 497-505 anticipatory care on, 500-505, 501t from birth to three years, 501t, 502 in early elementary years, 501t, 502-503 in high school, 501t, 504-505 in infancy, 501t , 500-502 at kindergarten entry, 501t, 502 in later elementary years, 501t, 503-504, 503t in middle school, 501t, 504 for post-secondary education/vocational training, 501t, 505 from three years to kindergarten entry, 501t, 502 assessment of, 800t (See also Educational assessment) factors influencing, 497-498, 498f child, 499-500, 500f family, 498-499, 499f genetic, 500 perinatal, 502 prenatal, 500-502 societal, 498, 498f importance of, 515 measures of, 768 poverty and, 173 preterm birth and, 265 vignette on, 497b of vulnerable children, 339 School assessment See Educational assessment School attachment, 516-517 individual characteristics influencing, 517t, 518 system variables influencing, 517-518, 517t School attendance, with chronic health condition, 348-349, 353 School avoidance, 518-520 school refusal as, 519-520 management of, 519-520 truancy as, 520 management of, 520 vignette on, 518b School bonding, 516-517 individual characteristics influencing, 517t, 518 system variables influencing, 517-518, 517t School connectedness, 516-517 individual characteristics influencing, 517t, 518 system variables influencing, 517-518, 517t School disengagement, 516-518 individual characteristics influencing, 517t, 518 management of, 518 system variables influencing, 517-518, 517t vignette on, 516b School dropout, 521-522 management of, 521-522, 522t vignette on, 521b School functioning, assessment of, 797-798 School maladaptation, 515-523 defined, 515 evaluation of, 515-516, 516t school avoidance as, 518-520 school refusal as, 519-520 management of, 519-520 truancy as, 520 management of, 520 vignette on, 518b school disengagement as, 516-518 individual characteristics influencing, 517t, 518 management of, 518 system variables influencing, 517-518, 517t vignette on, 516b school dropout as, 521-522 management of, 521-522, 522t vignette on, 521b School phobia, 478, 519-520 management of, 519-520 vs truancy, 519 School problems with ADHD, 532 in adopted children, 138-139 School readiness assessment of, 800t cultural context of, 185 poverty and, 173 School Readiness programs, 185 School recommendations, counseling on, 852 School refusal, 478, 519-520 management of, 519-520 vs truancy, 519 School segregation, and school connectedness, 517-518 School size, and school connectedness, 517-518 School underachievement, by vulnerable children, 339 School-age children See also Middle childhood anticipatory guidance on school achievement in, 501t, 502-504, 503t chronic health conditions in, 347 cultural context of development in, 185-186 developmental assessment of, 797-802 ancillary testing in, 801 behavioral and developmental history in, 798-799 family history in, 799 getting ready for, 797-799, 798t with left brain (language and auditory processing) dysfunction, 800, 800b medical issues in, 798 neurodevelopmental testing in, 799, 800t with right brain (visual processing) dysfunction, 800-801, 800-801b school functioning in, 797-798 feeding of, 565t oppositional behavior/noncompliance in, 383, 384f palliative and end of life care in, 357, 357-358, 359 self-control in, 454 problems of, 455t sexuality in, 416t, 417-418 social cognition in, 375-376 social difficulties in, 377t, 378 social withdrawal and isolation in, 399, 399t, 403 treatment of, 404t visual impairment in, 713 Schoolwork, for hospitalized child, 334 Scoliosis due to inborn errors of metabolism, 293-295t with spina bifida, 744 Scores, types of, 764-765, 764f Scoring of standardized achievement tests, 815 of state-based proficiency tests, 817 Screening tests, false-positive results on, 339-340 Screening Tool for Autism in Two-year-olds (STAT), 683t SDB (sleep disordered breathing), 622 Seafood, mercury in, 321-322 Search and seizure, 970 Seclusion, legal issues with, 969-970 Second opinion, legislation on, 974 Secondary circular reaction, 33 Secondary prevention services, poverty and, 177 Section on Children with Disabilities, 10 Secure attachment, 26 Security attachment and, 25 parents’ sense of, 14, 15 Sedatives, abuse of, 438 Sedentary behavior, and obesity, 594-595 Séguin, Eduard, Seizure(s), 213-216 See also Epilepsy absence, 214 with cerebral palsy, 658 defined, 213 in Down syndrome, 240 in Draver syndrome, 214 evaluation of, 213, 215 generalized, 213, 214t tonic-clonic, 213 infantile spasms as, 214 in Landau-Kleffner syndrome, 215 in Lennox-Gastaut syndrome, 214 nocturnal, 623 partial (focal), 213, 214t complex, 213 simple, 213 prevalence of, 213 treatment of, 215-216, 216t types of, 213-216, 214t Selective dorsal rhizotomy, for cerebral palsy, 657-658 Selective mutism, 48-49, 478 Selective serotonin reuptake inhibitors (SSRIs) for anorexia nervosa, 576 for anxiety disorders, 469, 897-898, 897t for autism, 681, 681t for binge-eating disorder, 580 for bipolar disorder, 466 for bulimia nervosa, 579 for depression, 464, 464t, 893-894, 893t adverse effects of, 893-894, 894t for eating disorders, 569 for obsessive-compulsive disorder, 481 during pregnancy, and newborn behavior, 17 for recurrent and chronic pain, 553t for social phobia, 479 and suicide, 464, 471-472, 471t Self, emergence of, in adolescence, 63, 63t, 68-69 Self-advocacy, historical background of, Self-assertion, 381 Self-care skills, during physical examination, 760, 760t Self-care system, 979 INDEX 1033 Self-concept, 427-435 beliefs and, 428, 430-431 of brilliant but unmotivated child, 427, 433 clinical implications of, 432-433 criticism and, 429 cultural diversity and, 433 defined, 428 effort vs ability in, 428-429, 430 fixed vs growth mindset in, 430-431 with physical deformities and disabilities, 433-434 praise and backfiring of, 428-429 process vs person, 428-429, 430t of promising child who failed, 428, 433 recommendations for, 434, 434t and self-esteem, 431-434, 431t setbacks and, 430-431 of talented but low-confidence child, 427, 433 vignettes on, 427, 428 Self-confidence, false, 432 Self-consoling behavior, in infants and toddlers, 28 Self-control, 453-459 in behavioral adjustment, 85 cultural factors in, 455-456 and executive functions, 453 of healthy lifestyle, 453b, 455, 458 important additional contributions to, 455-456 limited capacity for, 459 normal development of, 454 problems of, 455, 455t biofeedback for, 457, 457t training in, 457, 457t, 920, 921t vignette on, 458b biologic basis for, 456 causes of, 454-455, 455t diagnostic evaluations of, 455t, 456 hypnotherapy for, 456-457, 457t guidelines for teaching, 457-458 training in, 457, 457t, 920, 921t vignette on, 458b due to learning disability, 456 psychotherapy for, 458-459 self-efficacy and, 453-454 vignettes on, 453b, 458 Self-determination, in transition to adulthood, 962-963, 959t Self-efficacy, and self-control, 453-454 Self-esteem, 68 with ADHD, 532 defined, 428 evaluation of, 428 fixed vs growth mindset in, 431-434, 431t repair of injured, 431-432 and school connectedness, 518 Self-handicapping, 432 Self-harm See Self-injurious behaviors Self-help skills, with Down syndrome, 242t Self-hypnosis, 914 applications of, 456-457, 457t, 914 defined, 912t, 914 goal of, 914 guidelines for teaching, 457-458 myths and misperceptions about, 914 process of, 457 for self-control issues, 456-457, 457t training in, 457, 457t, 920, 921t vignette on, 458b Self-injurious behaviors, 470 in developmental disorders, 640 dialectical behavioral therapy for, 881 with intellectual disability, 484t, 486-487 Self-monitoring for obesity, 598t as self-regulation technique, 912t Self-mutilating behaviors See Self-injurious behaviors Self-ratings, in educational assessment, 820 Self-regulation, 453 areas of, 911 cultural factors in, 455-456 defined, 911 and executive functions, 453 of healthy lifestyle, 453b, 455, 458 important additional contributions to, 455-456 limited capacity for, 459 normal development of, 454 problem(s) of, 455, 455t biologic basis for, 456 causes of, 454-455, 455t diagnostic evaluations of, 455t, 456 due to learning disability, 456 psychotherapy for, 458-459 self-efficacy and, 453-454 vignettes on, 453b, 458 Self-regulation technique(s), 911-922 advantages of, 911 autogenics as, 912t, 914-915 biofeedback as, 912-913 applications of, 457t defined, 912-913, 912t equipment for, 913, 913f goal of, 912-913 modalities of, 912-913, 913t, 916 training in, 457, 457t, 920, 921t vignette on, 458b cognitive-behavioral therapy as, 912t, 914 diaphragmatic breathing as, 912t, 914 future of, 921 hypnosis as, 914 applications of, 456-457, 457t, 914 defined, 912t, 914 goal of, 914 guidelines for teaching, 457-458 myths and misperceptions about, 914 process of, 457 stages of, 914t training in, 457, 457t, 920, 921t vignette on, 458b important considerations with, 911-915 indications for, 911, 912t acute procedural pain and distress as, 919, 919-920b nocturnal enuresis as, 915, 916b, 917f for pediatrician in busy practice, 920, 920b recurrent pain as, 917, 918b sleep disorders as, 916, 916b tic disorder as, 918, 918b meditation as, 912t, 915 mind-body education as, 912t progressive muscle relaxation as, 912t, 914 psychoneuroimmunology as, 915 relaxation as, 912t, 914 self-monitoring as, 912t training and certification in, 920, 921t yoga as, 912t, 915 Self-relations assessment of, 774, 778, 775t in behavioral adjustment, 84, 84t in comprehensive formulation of assessment, 842t, 843 Self-report, of peer difficulties, 157t Self-stimulation behavior, 419-420, 419b, 419t Selye, Hans, 491 Semantics, 718t problems with, 538, 538t Senn, Milton, 9t Senna, for constipation or encopresis, 615, 616t, 617 Sensitive differential responding, for colic, 560 Sensitivity, 765 in behavioral style assessment, 780-781t in temperament, 76t, 82t Sensorineural hearing loss, 687 due to inborn errors of metabolism, 293-295t Sensory assessment, 800t Sensory diet, for sensory processing disorders, 734 Sensory Integration and Praxis Tests, 733 Sensory integration disorders See Sensory processing disorder(s) (SPDs) Sensory integration intervention, 734, 735t, 952 Sensory maturation, of infants and toddlers, 29-31 clinical implications of, 30 Sensory modulation disorder (SMD), 731-732, 732b, 733t Sensory processing disorder(s) (SPDs), 730 assessment of, 732-733 examination in, 733, 734t history in, 732-733, 734t behavioral characteristics of, 730 dyspraxia as, 731, 731t epidemiology of, 730 intervention for, 734, 735t outcomes of, 735 sensory modulation disorder as, 731-732, 732b, 733t sensory-based motor disorders as, 730-731 types of, 730 vestibular-based postural disorder as, 730-731, 731b, 731t vignettes on, 731b, 732b Sensory threshold in behavioral style assessment, 780-781t in temperament, 76t, 82t Sensory-based motor disorder(s), 730-731 dyspraxia as, 731, 731t vestibular-based postural disorder as, 730, 731b, 731t Sensory-perceptual functions, in newborn, 18 Sentence dictation, assessment parameters for, 822-823t Separated parent, return of, 148 Separation of child from parents in adolescence, 63, 63t, 68-69 in infants and toddlers, 26 clinical implications of, 26-27 cultural variations in, 26-27 in palliative and end of life care, 358-359 with vulnerable children, 338 of parents, 125-133 of children with special health care needs, 131 clinical implications of, 129-132 for developmental-behavioral pediatricians, 131 for primary pediatric care, 129-130 for subspecialty pediatric care, 131 consequences of, 126-129 age-related behavior changes as, 128-129 associated with gender, 129 for children, 127-129 1034 INDEX Separation (Continued) developmental-behavioral problems as, 131 influence of cultural factors on, 129 for parents, 126-127 variability of, 127-128 custody arrangements after, 130, 131t demographics of, 126 as family process, 126 general clinical guideposts for, 132 risk assessment with, 130, 131t, 132 telling child about, 130, 130t vignette on, 125 Separation anxiety disorder (SAD), 467, 467t management of, 469 Separation protest, 25 Septo-optic dysplasia, 218 Sequential Assessment of Mathematics Inventories, 812-813t Serial casting, for cerebral palsy, 656 Serious illness, of sibling, 122 Seroquel See Quetiapine Serotonergic function, in eating disorders, 569 Serotonin and aggression, 391 in autism, 904-905 Serotonin and norepinephrine reuptake inhibitors for anxiety, 898 for depression, 894 Serotonin antagonist, for anorexia nervosa, 905 Serotonin S2 antagonist and reuptake inhibitors, for depression, 895 Serotonin transporter gene (5HTT), 92 Sertraline for anxiety disorders, 897, 897t for depression, 464, 464t, 893t, 894 SES See Socioeconomic status Setbacks, and self-concept, 430-431 Sex chromosome anomalies, 225f Sex education abstinence-only, 196 for pre-teens, 418 Sex, in media, 196-197, 197f Sex play, in preschoolers, 417 Sexual abuse, 107f, 113-114 arts therapies for, 947 and bulimia nervosa, 577 with developmental disabilities, 960 masturbation and, 419 and oppositional behavior/noncompliance, 382 and sexual behaviors in preschoolers, 417 Sexual activity confidentiality on, 966 decision making on, 967 Sexual consent, capacity for, 960 Sexual development, 416-419, 416t in adolescence, 416t, 418 counseling about, 418-419 in infancy, 416, 416t in middle childhood, 50-51 in pre-teens, 416t, 418 in school-age children, 416t, 417-418 in toddlers and preschoolers, 416-417, 416t Sexual drives, in adolescence, 63t, 64 clinical approach to, 69 cultural context of, 188-189 early, 65-66 mid, 66 Sexual identity in adolescence, 418 defined, 415-416, 421 Sexual intercourse in adolescence, 420-421 epidemiology of, 418, 420 issues related to, 418, 421 sexual activities preceding, 420 vignette on, 420b, 421 initiation prior to age 13 of, 420-421 Sexual misuse, 113 Sexual orientation, 421-424 in adolescence, 418 biologic basis for, 422 birth order and, 120 defined, 415-416 vignette on, 421b Sexual pressure, 421 Sexuality, 415-425 defined, 421 with disabilities and chronic disease, 347, 422-424, 422-423b, 423t with Down syndrome, 242-243 gratification behaviors and masturbation in, 419-420, 419b, 419t with HIV infection, 270-271 influences on, 415 normal development of, 416-419, 416t in adolescence, 416t, 418 counseling about, 418-419 in infancy, 416, 416t in middle childhood, 50-51 in pre-teens, 416t, 418 in school-age children, 416t, 417-418 in toddlers and preschoolers, 416-417, 416t poverty and, 173 sexual intercourse and related practices in, 418, 420-421, 420b sexual orientation and homosexuality in, 421-424, 421b, 422t with spina bifida, 744 terminology for, 415-416 in transition to adulthood, 960-961, 960t vignette on, 415b, 418-419 Sexualization, traumatic, 114 SHADSS Assessment, 83 Shaping, 859-860t example of, 864 after stroke, 90 Shared psychotic disorder, 477 SHCN See Special health care needs (SHCN) Shelter in place, during disasters, 204 Sheppard-Towner Act, SHH (Sonic Hedgehog) gene, 209, 218 Short arm, of chromosome, 225 Short stature, 761t Short-term memory, difficulties in, 536-537, 536t Shprintzen syndrome, 249-250 Shriver, Eunice, Shyness, 398 Sialadenosis, due to bulimia nervosa, 577, 579 Sialic acid metabolism, disorders of, 308-309 Sialorrhea, with cerebral palsy, 659 Sibling(s), 119-124 with acute medical problem or developmental disability, 144b, 146-147 adult relationships between, 122 birth of, 44 as critical family event, 146 with acute medical problem or developmental disability, 144b, 146-147 birth order of, 119-120 in blended families, 121 with chronic health condition, 350 intellectually disabled, 669-670 Sibling(s) (Continued) labeling and typing of, 122 number of, 121 during palliative or end of life care, 361 serious illness or death of, 122, 149 spacing between, 120 with special needs, 121-122 through childhood, 122 twin and other multiple-birth, 120-121 vignette on, 119b Sibling issues, coping with, 122-123, 123t Sibling rivalry, 121, 122-123 Sibutramine (Meridia), for obesity, 599-600 SIDS (sudden infant death) syndrome, poverty and, 172 Sign language, 695 Simon, Theodore, Simultaneous-recall deficits, 537 Singer, Peter A D., 986 Single parent families, 97-98, 97t, 126 Single-photon emission computed tomography (SPECT), 839 Sister(s) See Sibling(s) Sister chromatid exchanges, 225 Sitting, 31, 646-647 Situational reaction style, in comprehensive formulation of assessment, 842t Skeletal abnormalities, due to inborn errors of metabolism, 289f, 293-295t Skeletal complications, of anorexia nervosa, 573t, 575-576 Skeletal dysplasias, as difference vs disability, 991 Skills, in memory consolidation, 537 Skin abnormalities, due to inborn errors of metabolism, 293-295t Skin biopsy, 840 Skin conductance, biofeedback on, 913t Skin fold measurements, 281-282 Skin, in nutrition assessment, 281-282 Skin injuries, due to child abuse, 108t Skin picking, 635 Skinner, B F., Skull fracture, 216 Sleep fragmented or disrupted, 621-622 insufficient, 621-622 normal, 622-623 in adolescents, 621 in infants, 30, 620, 620f in middle childhood, 621 in newborns, 619-620 in preschoolers, 47, 620-621 in toddlers, 30, 620 Sleep apnea, obstructive, 622 in cerebral palsy, 660 crisis management of, 874-875 in Down syndrome, 238 Sleep attacks, 623-624 Sleep consolidation, 620 Sleep disorder(s) attentional problems due to, 528 behavioral insomnia of childhood as, 624-625 with cerebral palsy, 660 circadian rhythm, 621-622 crisis management for, 874-875 cultural context of in infants, 187-188 in toddlers, 186-187 delayed sleep phase syndrome as, 624 in Down syndrome, 238 due to drugs, 625 epidemiology of, 874 etiology of, 621-622 INDEX 1035 Sleep disorder(s) (Continued) evaluation of, 626-627 identification of, 874-875 implications for clinical care and research of, 626-627 media violence and, 195 due to medical conditions, 625 melatonin for, 952-953 narcolepsy as, 623-624 neurobehavioral and neurocognitive impact of, 621 with neurodevelopmental disorders, 625-626 obstructive sleep apnea as, 622 parasomnias as, 622-623 with psychiatric disorders, 625 due to recurrent and chronic pain, 551 restless legs syndrome and periodic limb movement disorder as, 623 self-regulation techniques for, 916, 916b sleep disordered breathing as, 622 in special populations, 625-626 treatment of, 625, 626t vignettes on, 619b with visual impairment, 712 Sleep disordered breathing (SDB), 622 Sleep drive, 619 Sleep hygiene, 625, 626t Sleep initiation insomnia, 624 Sleep medications, for recurrent and chronic pain, 553t Sleep paralysis, 623-624 Sleep regulation, 619, 620 Sleep states in infants and toddlers, 29 clinical implications of, 30 in newborn, 17-18, 18t Sleep terrors, 622, 623, 874 Sleepiness, excessive daytime, 621-622 Sleep-wake cycle(s), 619 in newborns, 17-18, 18t phase shift in, 624 Sleepwalking, 622, 623 SLI (specific language impairment), 725 Slosson Oral Reading Test, 812-813t “Slow-to-warm-up” child, 76 Sly syndrome, 309t Small-for-gestational-age infants, 20 and failure-to-thrive, 585 growth of, 36 SMD (sensory modulation disorder), 731-732, 732b, 733t Smell hypersensitivity to, 733t in infants and toddlers, 29 Smiling, social, 375 Smith-Lemli-Opitz syndrome, 296f, 312 metabolic testing for, 665 Smith-Magenis syndrome, 250 Smoking See Cigarette smoking Snoring, 622 in cerebral palsy, 659 Social adaptation problems, with intellectual disability, 484t Social anxiety disorder See Social phobia (SP) Social Anxiety Scale for Children–Revised, 403 Social behavior, childcare and, 161 Social change, in history of developmentalbehavioral pediatrics, 5-8 Social cognition, 373-380, 542 components of, 374 defined, 374 developmental course of, 375-376 Social cognition (Continued) in adolescence, 376 in infancy, 375 in school age, 375-376 in toddler/preschool age, 375 intellectual cognition and, 374 neural basis of, 374-375 problems with assessment and intervention for, 376-379 in adolescence, 377t, 379 in infancy, 377-378, 377t in school age, 377t, 378 screening tool in, 377t in toddler/preschool, 377t, 378 diagnostic considerations for, 376 vignette on, 373b, 373 Social cognitive theory, of substance abuse, 437 Social competence, assessment of, 774, 775t, 778 Social conditions, in history of developmentalbehavioral pediatrics, 2-3, 5-6 Social cues, 375 Social development in adolescence, 68 with hearing impairment, 690-691 in middle childhood, 54-55, 54f, 55t in preschool years, 41-42, 42f Social difficulties assessment and intervention for, 376-379 in adolescence, 377t, 379 in infancy, 377-378, 377t in school age, 377t, 378 screening tool in, 377t in toddler/preschool, 377t, 378 diagnostic considerations for, 376 temperament and, 78-79 vignette on, 373b, 373 Social disadvantage, concept of, historical background of, Social Effectiveness Training for Children, 404 Social environment in developmental niche, 183 unresponsive, language disorders due to, 723 Social history, for failure-to-thrive, 588 Social information processing models, of aggression, 391 Social interactions with autism, 676, 677t during physical examination, 760, 760t Social learning, 857t Social learning theories, of aggression, 391 Social learning theory approaches, for social withdrawal and isolation, 404 Social mirroring, 375-376 Social phobia (SP), 466-467, 478-479 clinical features of, 461-462, 478 comorbidity with, 478 developmental considerations with, 478 diagnosis of, 466-467, 467t, 478 differential diagnosis of, 478 epidemiology of, 398, 466-467, 478 etiology of, 479 management of, 469 prognosis for, 479 treatment of, 479 Social Phobia and Anxiety Inventory for Children, 403 Social reciprocity, 374, 376 Social referencing, 375 in infants and toddlers, 27-28 Social rewards, 861-862 Social scripts, 378 Social significance, of newborn behavior, 21 Social skills, and school achievement, 500 Social skills functioning, screening for, 392-393, 393t Social skills groups, 378, 379 Social Skills Rating System, 393 Social skills training, 404 as coping strategy, 496 for school disengagement, 518 Social smiling, 375 Social support during pregnancy, 14, 15 and stress response, 492 Social withdrawal, 397-406 in adolescents, 399, 399t, 403 treatment of, 404t assessment of, 402-403, 402t formal, 403 informal, 402-403 child maltreatment and, 401 culture and, 401-402 defined, 397-398 developmental psychopathology approach to, 397 differential diagnosis of, 397, 398t epidemiology of, 398-399 etiology of, 399-401, 399t parent-child relationships and attachment in, 400-401 peer relationships in, 401 temperament in, 400 in infancy, 399, 399t, 402 treatment of, 404t and peer rejection, 153 in preschool years, 399, 399t, 403 treatment of, 404t prevention of, 404-405 in school-age children, 399, 399t, 403 treatment of, 404t theory of, 399 in toddlers, 399, 399t, 403 treatment of, 404t treatment of, 403-404, 404t vignette on, 397b Social-emotional development and giftedness, 507 in infants and toddlers, 24-29 poverty and, 173 Social-environmental influences, on intelligence, 807 Socialization in comprehensive formulation of assessment, 842t family dysfunction related to, 104t, 114-116 extrafamilial, 104t, 115-116 intrafamilial, 104t, 114-115 Socially isolated gifted child, 509-510 Societal factors, in school achievement, 498, 498f Societal influences, on eating disorders, 570 Society, and middle childhood development, 57-58 Society for Developmental and Behavioral Pediatrics, 10 Society for Developmental Pediatrics, 10 Society of Behavioral Pediatrics, 10 Society of Behavioral Pediatrics Executive Council, 10 Sociocultural milieu, in comprehensive formulation of assessment, 842t, 844 Socioeconomic status (SES) See also Poverty and academic skills, 53-54, 54f, 69 and cognitive and language development, 57-58 1036 INDEX Socioeconomic status (SES) (Continued) and growth and development, 88 and language development, 720 and obesity, 592 and oppositional behavior/noncompliance, 382 and school achievement, 498, 499 and school milieu, 168 SOFT (Support Organization for Trisomy 18, 13, and Related Disorders), 226 Soiling See Encopresis Solid foods, introduction of, 281, 563 Solnit, Albert, 9t Solvents, abuse of, 323 Sonic Hedgehog (SHH) gene, 209, 218 Soranus of Ephesus, 2t, 2f SP See Social phobia Spanking, 46, 859-860t, 862 Spasticity, due to cerebral palsy, 655-658 defined, 655 evaluation of, 655, 655t treatment of, 656 botulinum toxin and phenol injections for, 657 intrathecal baclofen for, 657 oral medications for, 656-657 orthopedic surgery for, 658 physical therapy and equipment use for, 656 selective dorsal rhizotomy for, 657-658 Spatial concepts, with visual impairment, 712 Spatial intelligence, 806t Spatial ordering abilities, 539 in middle childhood, 53 Spatial ordering dysfunctions, 538-539 SPDs See Sensory processing disorder(s) Special education services, 933-943 advocacy for, 939 assessment for, 937, 939t child find for, 937, 938-939, 939t collaborative teaming in, 941 cultural issues for, 941-942 demographics of, 934 with Down syndrome, 241-242 early childhood, 935 early intervening for, 942 eligibility for, 811-813, 814, 937, 939t essential features of, 934, 935 evidence-based practices in, 942 with HIV infection, 272-273 and inclusion, 935, 940-941 individualized education program for development of, 937-938, 939t implementation of, 938, 939t legislation on, 934, 973 review and re-evaluation of, 938, 939t for intellectual disability, 669 issues and trends in, 940-942 least restrictive environment for, 934, 937-938 legislation on, 934-937, 936t, 973-974 family-professional partnership in, 972 future directions for, 975 Individuals with Disabilities Education Act as, 972-974, 973t ongoing challenges with, 974-975 process of, 937-938 referral for, 937, 938-939, 939t related services with, 974 role of families in, 940 role of pediatrician in, 938-939, 939t, 973 screening for, 938 in specialized classrooms or programs, 991 Special education services (Continued) time line of changes in, 935f transitioning with, 940 vignettes on, 933b, 934f Special health care needs (SHCN), 737 approach to, 739-742 with cerebral palsy, 737, 738t comorbid diagnoses in, 738t complexity of diagnosis and management of, 737-738, 738t defined, 737 divorce of parents of child with, 131 energy and nutrient requirements with, 278-280, 278t epidemiology of, 737 etiology of, 738-739 feeding problems with, 739-740 gastrointestinal complications with, 740 growth assessment with, 277-278 with intellectual disability, 737, 738t with myelomeningocele, 742-744 general developmental and medical concerns and needs with, 744 orthopedic procedures for, 744 urologic procedures for, 743-744 ventriculoperitoneal shunts for, 743 vignette on, 742b respiratory issues with, 740-742 sibling issues with, 121-122 specialized equipment with, 742 web resources on, 745 Special service programs, for poor children and their families, 176t Special time, 859-860t, 865 Specialist services, for chronic health condition, 351 Specific language impairment (SLI), 725 Specific phobia, 478 Specificity, 765 SPECT (single-photon emission computed tomography), 839 Speech assessment of, 722 childhood apraxia of, 727 components of, 717, 718t criterion-referenced measured of, 721-722 defined, 717 in infants and toddlers, 34-35 norm-referenced formal measures of, 721, 721t, 722t in preschool years, 43, 44t Speech delays causes of, 722t evaluation of preschool child with, 728, 728t Speech pathologists, for neurodevelopmental dysfunctions, 545 Speech sounds audiometric characteristics of, 688f development of, 718-719, 718t disorders of, 726-728 due to anatomic disorders, 726-727 articulation disorders as, 726 due to inborn errors of metabolism, 293-295t management of, 728 due to neurologic disorders, 727 phonologic disorders as, 726 stuttering as, 727 vignette on, 717b voice and resonance, 727-728 inventory of, 718t Speech therapy, 728 Speech-language therapy, 723 Spelling assessment of, 812-813t parameters for, 821, 822-823 neurodevelopmental dysfunction and, 512 Sphingolipidoses, 310 Spina bifida, 742-744 energy needs with, 278, 278t general developmental and medical concerns and needs with, 744 language disorders with, 724-725 orthopedic procedures for, 744 urologic procedures for, 743-744 ventriculoperitoneal shunts for, 743 vignette on, 742b Spinal cord compression, in Down syndrome, 239-240 Spinal cord lesions, urinary incontinence due to, 602, 606 Spinal muscular atrophy, 220 Spirituality, after death of child, 369 Spitting up, 566 Split-half reliability, 765 Spock, Benjamin, “Spoiling,” 112 Sports participation, in middle childhood, 51 Sports-related injuries, in middle childhood, 51 SSI (Supplemental Security Income), 958-959 SSRIs See Selective serotonin reuptake inhibitors St John’s wort, for depression, 895 STAART (Studies to Advance Autism Research and Treatment), 904 Stages of change, in brief office intervention for substance abuse, 446, 447, 447f Staging for learning differences, 826t for neurodevelopmental dysfunctions, 544t Stair climbing, 648 Standard deviations, 764 Standard error, 765 Standard scores, 764-765, 764f Standardization, 764 Standardized achievement testing, 811-814, 812t informal assessment inventories with, 814 scoring for, 815 weaknesses of, 814-815 Standardized test performance, factors affecting, 503, 503t Standards-based education, 817 Standing, 647 Stanford Achievement Tests, 768, 811, 812-813t Stanford Diagnostic Mathematics Test–3, 812-813t Stanford-Binet Intelligence Scale, Fifth Edition (SB5), 794t, 795, 806 Stanford-Binet test of intelligence, Stanford-Binet–4, 813-814 Stanines, 764-765 Starvation, 109 STAT (Screening Tool for Autism in Two-year-olds), 683t State Children’s Health Insurance Program (SCHIP), 176, 980-981 State control, in infants and toddlers, 29-30 clinical implications of, 30 State intervention, legal issues on, 970 State variations, in early intervention services, 924-925 State-based educational standards, 816 problems related to, 817-818 State-generated achievement tests, 811 INDEX 1037 Statistical significance, 764 Stature, assessment of, 761t Status completion rate, 521 Status dropout rate, 521 Status epilepticus, language disorders due to, 725 Status groups, 157t Statutes, 965 Stavudine, for HIV infection, 273t Step-families, 121 demographics of, 126 effect on children of, 129 Step-parent, addition to family of, 147, 148 Stereotypic movement disorder See Repetitive behavior(s) Sterilization, 961, 990 Sternberg, Robert, 506-507 Steroids, interactions with nutrients of, 282t Still, George F., 527t, 886 Stimulability, 718t Stimulant(s) abuse of, 438, 889 management of, 442-445t for ADHD, 532, 887-889 dosage of, 887-888, 888t improving clinical usefulness of, 887 marketed preparations of, 887, 888t mechanism of action of, 887 monitoring of, 889, 890t adverse effects of, 888-889, 889t for autism spectrum disorders, 905 interactions with nutrients of, 282t for neurodevelopmental dysfunctions, 545 Stimulant-response learning, 857t, 858t Stimulation in comprehensive formulation of assessment, 842t family dysfunction related to, 104t, 110-111 Stimulus conditioned, 857t unconditioned, 857t Stimulus control, 859-860t, 861 Stimulus-stimulus learning, 857t Stool softeners, for constipation or encopresis, 615 Stool withholding See Constipation; Encopresis Stoplight diet, 598-599 Strabismus, 89 Strange situation, 25-26 Stranger anxiety, 25 Stranger awareness, 25, 34 Strategic activities, for poor children and their families, 176t, 178 Strengths and Difficulties Questionnaire, 403 Streptococcal infections, pediatric autoimmune neuropsychiatric disorders associated with, 480, 637-638, 903-904 Streptococcus pneumoniae, meningitis due to, 221-222 Stress(es) due to acute minor illness, 325-326 effects of, 326, 326f adaptation to, 491, 492 attentional problems due to, 528 defined, 407 ecologic and cultural perspectives on, 409 due to hospitalization, surgery, and medical and dental procedures, 329-336 effects on children of, 330-331, 331t effects on clinicians of, 331-332 factors affecting consequences of, 333, 333t minimization of, 333-335, 333t, 334f Stress(es) (Continued) prevention and intervention for, 332-333, 332t, 334f sources of, 329-330, 330t and illness, 491 long-term effects of, 408 perinatal intellectual disability due to, 666 and newborn behavior, 16-17 post-traumatic, 468-469, 469t psychological consequences of, 492 and self-control, 454 sources of, 407, 408 unhealthy, 491 Stress incontinence, 603 Stress management techniques, for hospitalization, surgery, and medical and dental procedures, 331, 333-335 Stress response, 491-492 acute, 492 chronic, 492 factors that influence, 492 learning and cognition and, 492 modulation of, 492 Stress response systems, 407-408 Stressors, 407, 408 adjustment disorder and, 411 and temperament, 80-81 Stroke(s), 217 metabolic, 289-291, 290f neural reorganization after, 90 rehabilitation after, 90, 91 Strokelike episodes, due to inborn errors of metabolism, 289-291, 290f Stroop paradigm, 526 Structured interviews, 769 Student-teacher ratio, 166 Studies to Advance Autism Research and Treatment (STAART), 904 Study skills, assessment parameters for, 822-823t, 823 Stuttering, 727 Subdural effusions, due to inborn errors of metabolism, 293-295t Subdural hemorrhage, 216 Submetacentric chromosome, 225 Substance abuse, 437-451 See also Toxin(s) with ADHD, 532 in adolescence, 72, 437 associated problems with, 439 brief office intervention for, 446-447 Change Plan Worksheet in, 447, 448f FRAMES mnemonic for, 447, 447f stages of change model in, 446, 447, 447f confidentiality about, 966 defined, 440 developmental view of, 439-440, 439f differential diagnosis of, 873, 873t early intervention plans for, 925 epidemiology of, 438, 873 in families, 116 identification of, 873 intervention pyramid for, 441-446, 446f by parents, 449-450, 449f, 450f during pregnancy, 315-316 and failure-to-thrive, 586-587 and newborn behavior, 16-17 psychotic disorder due to, 475t, 477 referral for, 441-446 risk and problem behaviors and, 437 risk factors for, 438-439 screening and assessment for, 440-446 assessment interview in, 441 confidential history in, 440 CRAFFT screen in, 440-441, 441f Substance abuse (Continued) drug screens in, 441 physical examination in, 441 POSIT questionnaire in, 440 signs and symptoms in, 441, 442-445t social cognitive theory of, 437 stages of, 439-440, 439f treatment of, 442t, 447-449 crisis management for, 873, 873t detoxification programs for, 447 family participation in, 449 follow-up visits for, 449 outpatient, 448 replacement therapy for, 448 residential treatment programs for, 448 support groups for, 449 withdrawal from, 439-440, 442-445t Substance dependence, 439-440, 439f, 446f Subtelomeric FISH, 664-665 Succimer, for lead poisoning, 320-321 Succinic semialdehyde dehydrogenase deficiency, 302-303 Sucking as repetitive behavior, 630-637, 632t as self-consoling behavior, 28-29 Sudden death, psychostimulants and, 889 Sudden infant death (SIDS) syndrome, poverty and, 172 Suicide, 469-472 antidepressants and, 471-472, 471t, 896 contagion effect for, 472 depression and, 462 epidemiology of, 469-470 with intellectual disability, 486 management of, 470-472 crisis, 871-872 diagnosis and treatment of underlying disorder in, 471, 471t dialectical behavioral therapy in, 471 hospitalization in, 470, 470t safety planning in, 470-471, 470t in media, 196 methods of, 470 prevention of, 471, 472t risk factors for, 472, 472t, 872 vs self-harm, 470 Sulfite oxidase metabolism, defects of, 302 Sulpiride, for tics, 903 Superior mesenteric artery syndrome, due to anorexia nervosa, 575 Super-peer theory, of media influence, 194 Superstitious thinking, 479 Supplemental Food Program for Women, Infants, and Children (WIC), 177 Supplemental Security Income (SSI), 958-959 Support groups, for substance abuse, 449 Support Organization for Trisomy 18, 13, and Related Disorders (SOFT), 226 Support systems counseling on mobilization of, 852-853 during pregnancy, 14, 15 Surgery, stress due to, 329-336 effects on children of, 330-331, 331t effects on clinicians of, 331-332 minimization of, 333-335 prevention and intervention for, 332-333 sources of, 329, 330 Sympathetic-adrenal-medullary system, in stress response, 407-408 Symptom(s) in behavioral adjustment, 84, 84t medicalization of, 340 Symptom checklists, 769 Synaptic sculpting, 90 1038 INDEX Syntax, 718t norm-referenced assessment of, 722t problems with, 538, 538t Systematic decision making, 541 Systematic desensitization, 859-860t Systemic insults, neuropsychological deficits due to, 831-832 Systems models, of intelligence, 805-806, 806t Systems-based practice, 982 T T score, 764 Tactile hypersensitivity, 733t Tactile sensory processing problems, 733t, 734t TADS (Treatment for Adolescents with Depression Study), 464, 886t, 895-896 Tall stature, 761t TANF (Temporary Assistance for Needy Families), 171 Tantrums, 29 Tardive dyskinesia, 899 Target behavior(s) defining, 856-857 measuring and monitoring, 857-860, 861f “Task orientation” cluster, 79 Task performance assessment of, 774, 775t, 778 in behavioral adjustment, 84, 84t Taste hypersensitivity to, 733t in infants and toddlers, 29 TCAs See Tricyclic antidepressants (TCAs) Teacher(s), and school connectedness, 517-518 Teacher behavior, and academic performance, 167 Teacher continuity, and academic performance, 167 Teacher of students with visual impairment (TVI), 710-711, 713 Teacher Report Form, 392-393, 403 Teacher report, of peer difficulties, 157t Teacher-Child Rating Scale, 157t Teacher-student ratio, 166 Teacher-student relationship, assessment of, 797 Teaching to the test, 817 Teased fiber analysis, 840 Teasing, of siblings, 123 Teenage years See Adolescence Teeth grinding, nocturnal, 623, 634-635 Tegaserod (Zelnorm), for recurrent and chronic pain, 552 Television viewing demographics on, 192-194, 193f and obesity, 594-595 recommendations on, 199 Temper tantrums, 29 Temperament, 74-86 and ADHD, 80 and adjustment, 79, 81, 408-409 assessment of, 77, 779-783 indications for, 779 techniques for, 779-783 interviews as, 779, 780-781t observations as, 779-782 questionnaires as, 782-783, 782t attentional problems due to, 528 clinical importance of, 77-81 for caregivers, 77-78, 78f for children, 78-81 clusters of, 76 and colic, 559, 561 Temperament (Continued) in comprehensive formulation of assessment, 842t, 843-844 and critical family events, 144 cultural context of, 185-186 defined, 75, 400 and development, 78 in developmental assessment, 799 dimensions of, 400 and environment, 77 and environmental stressors and crises, 80-81 gender differences in, 76 goodness or poorness of fit of, 76-77 historical background of, 75 and intelligence, 78 management of differences in, 81-83, 82t of newborn, 18-19, 19t and obesity, 594 and oppositional behavior/noncompliance, 382 origins of, 77 and physical problems, 78 risk factors based on, 76 and school performance, 79-80 and self-regulation, 455 and social behavior problems, 78-79 and social withdrawal and isolation, 400 stability of, 77 traits or dimensions of, 75-76, 76t vignette on, 74b Temperament Assessment Battery for Children, 782 Temperature, peripheral, biofeedback on, 913t, 915 Temporal-sequential ordering, problems with, 539 Temporary Assistance for Needy Families (TANF), 171 Tension-type headache, 217 Teratogens, 210, 257, 315 Terminal care See End of life care Terminal illness, palliative care for See Palliative care Termination, in stages of change model, 446, 447f Terrorism See Disaster(s) Tertiary circular reactions, 33 Tertiary prevention services, poverty and, 177 Test anxiety, 453b, 458 Test de Vocabulario en Imagenes Peabody (TVIP), 795 Test of Early Mathematics Ability–2, 812-813t Test of Early Reading Ability������������������� –������������������ 3, 812-813t Test of Early Written Language������������������� –������������������ 2, 812-813t Test of Mathematical Abilities������������������� –������������������ 2, 812-813t Test of Nonverbal Intelligence�������������� –������������� 3, 806 Test of Reading Comprehension������������������� –������������������ 3, 812-813t Test of Written Expression, 812-813t Test of Written Language�������������������� –������������������� 3, 813-814 Test of Written Spelling������������������ –����������������� 4, 812-813 Test-retest reliability, 765 Tests of Achievement and Proficiency, 812-813t Tests of General Educational Development, 812-813t Tetrabenazine, for tics, 903 Tetrahydrobiopterin deficiency, 299 Tetrahydrocannabinol (THC), 441, 442-445t for eating disorders, 906 for tics, 903-904 Tetrasomy 12p, 230f, 231 Texas School for the Blind and Visually Impaired, 715 Thematic apperception tests, 768-769 Theory of mind, 374 Therapeutic suggestion stage, of hypnosis, 914t Therapeutic touch, 952 Thermal biofeedback, for recurrent and chronic pain, 554 Thermography, biofeedback on, 913t, 915 Thiamine deficiency, 282t Thiamine, for alcohol abuse, 442-445t Thimerosal and autism, 680 exposure to, 322 Thinking See also Cognition evaluative, 541 Thioridazine for disruptive behavior, 892-893 for psychosis, 899t Third-person effect, of media, 194, 194f Thorazine See Chloropromazine Thought disorders, 474-475, 475-477 Thrombocytopenia, in Down syndrome, 239 “Throwaways,” 174-175 Thumb sucking, 28-29, 630-637, 632t Thyroid disease, attentional problems due to, 528 Thyroid, physical examination of, 760 Tiagabine, for seizures, 216t Tiapride, for tics, 903 Tic(s), 222, 631-632 See also Repetitive behavior(s); Tourette syndrome complex, 222 course of, 637 defined, 222, 637 diagnosis of, 222 dystonic, 637 etiology of, 629-630 motor, 222, 637 simple, 222 treatment of, 222 nonpharmacologic, 639 pharmacologic, 638t, 903-904 α2-adrenergic agonists for, 638t, 639, 903 antipsychotics for, 638-639, 638t, 903 baclofen for, 903 benzodiazepines for, 903 botulinum toxin for, 639 metoclopramide for, 639 nicotinergic agents for, 903 pergolide for, 903 sulpiride for, 903 tetrabenazine for, 903 tiapride for, 903 self-regulation techniques for, 918, 918-919b vocal, 222, 637 Tic disorder chronic, 637 transient, 637 Ticket to Work Employment Network, 962 TIME (Toddler and Infant Motor Evaluation), 650, 767 Time-in, 859t Time-out, 46, 859-860t for oppositional behavior/noncompliance, 386 Tissue-type plasminogen activator (tPA), for stroke, 217 Title I funding, 816 Title V, 177, 923 Tizanidine (Zanaflex) for cerebral palsy, 657 for recurrent and chronic pain, 553t INDEX 1039 Tobacco See Cigarette smoking Toddler(s), 24-38 anticipatory guidance on school achievement in, 501t, 502 attachment in, 24-25 cultural variations in, 26-27 study of, 25-26 autonomy and mastery in, 28-29 causality in, 33 chronic health condition in, 347 cognitive development in, 31-34, 32t communication by, 34-35 cultural context of development in, 186-187 developmental assessment of, 788-796 Flynn effect in, 789 frequently used standardized tests for, 789-796, 794t vs measures of cognition and intelligence, 789 parent resources on, 796 predictive validity of, 789 quality control in, 788-789 selection and administration of, 788, 788f written report of, 788 divorce of parents of, 128 Down syndrome in, 241t feeding of, 563-564, 564f, 565t habituation of attention in, 33 joint attention in, 27-28 language development in, 34-35, 718 clinical implications of, 35 expressive, 32t, 34-35 receptive, 32t, 35 reciprocal, 34 of speech sounds, 718-719, 718t late, 39 motor development in, 29-31, 645-648 fine, 30-31, 647-648 gross, 31, 31t, 646-647 nutrition for, 35, 36 cultural context of, 186-187 object permanence in, 33 oppositional behavior/noncompliance in, 383, 384f oppositionality in, 381 palliative and end of life care for, 356, 358 physical growth of, 35-36 play by, 33-34 recognition memory in, 33 response to disaster by, 203 risk of intellectual disability in, 668 self-control in, 454 sensory maturation of, 29-31 separation of, 26 cultural variations in, 26-27 sexuality of, 416-417, 416t sleep of, 620 sleep problems of, cultural context of, 186-187 social cognition in, 375 social difficulties in, 377t, 378 social referencing in, 27-28 social withdrawal and isolation in, 399, 399t, 403 treatment of, 404t social-emotional development in, 24-29 state control in, 29-30 understanding of death by, 149 Toddler and Infant Motor Evaluation (TIME), 650, 767 Toilet training, 29, 602-606 failure of (See also Encopresis) epidemiology of, 610 in preschool years, 47 Toilet training (Continued) refusal of, 612 in special populations, 612-613 Tolerance, 439-440 Tolterodine (Detrol), for daytime incontinence, 605 Toluene, abuse of, 323 Tongue thrusting, 36 Tonic labyrinthine reflex, 645-646 Tonic neck reflex, 31 Tonsillectomy, 741 Topical agents, for recurrent and chronic pain, 553t Topiramate (Topamax) for recurrent and chronic pain, 552, 553t for seizures, 216t TORCH infections, maternal, 263 TORDIA (Treatment of SSRI-Resistant Depression in Adolescents), 886t, 895-896 Total communication, 695, 723 Tourette syndrome, 222, 637-639 course of, 637 diagnosis of, 637 etiology of, 629-630 familial nature of, 637-638 other behavioral and learning problems with, 637 treatment of, 638, 903 Toxin(s), 314-328 See also Substance abuse attentional problems due to, 528 in breast milk, 318 and CNS, 314-315 epidemiology of, 314 and growth and development, 88 in infancy and childhood, 319-323 carbon monoxide as, 323 inhalational, 323 lead as, 319-321 clinical manifestations of, 321t effect on development and behavior of, 319-320, 319f epidemiology of, 319 follow-up for, 321t management of, 320-321, 321t prevention and screening for, 320, 321t, 322t sources of, 319, 319f mercury as, 321-322 other metals as, 322 pesticides as, 322-323 solvents as, 323 neonatal withdrawal from, 318 obstetric anesthesia as, 317-318 prenatal, 315-317 alcohol as, 316, 316f cigarettes as, 316-317 cocaine as, 317 marijuana as, 317 opiates as, 317 neonatal withdrawal from, 318 polychlorinated biphenyls as, 317-318 specific hazards of, 315 unique pediatric vulnerabilities to, 315 tPA (tissue-type plasminogen activator), for stroke, 217 Tracheomalacia, 740 Tracheostomy, with multiple disabilities, 741-742 Tracking, in schools, 166 Traditional Chinese medicine, 951 “Traditional” family, 95-96, 95t Training programs, in developmentalbehavioral pediatrics, 9, 9t Tranquilizers, abuse of, 438 Transactional model, 24, 74-75 Transcultural adoption, 139 Transferrin, serum, 282-283 Transgendered person, defined, 415-416 Transient ischemic attack, 217 Transient myeloproliferative disorder, in Down syndrome, 239 Transition to adulthood, with developmental disabilities, 957 education in, 961-962, 961t health care in, 958-960, 959t residential, 962 self-determination and autonomy in, 962-963, 963t sexuality in, 960-961, 960t vignette on, 957b, 963-964 vocational, 962 Transitional objects, 28 Transitioning, with special education services, 940 Translocation, 229-230 balanced, 229-230 Down syndrome due to, 235 reciprocal, 228f, 229-230 robertsonian, 228-229f, 229-230 unbalanced, 229-230 Transracial adoption, 139 Trauma post-traumatic stress disorder due to, 468-469, 469t poverty and mortality from, 172-173 Traumatic brain injury, language disorders due to, 725 Traumatic sexualization, 114 Traumatized child, crisis management for, 872 Trazodone (Desyrel) for depression, 895 for recurrent and chronic pain, 553t Treacher Collins syndrome, hearing impairment in, 689t Treatment for Adolescents with Depression Study (TADS), 464, 886t, 895-896 Treatment of SSRI-Resistant Depression in Adolescents (TORDIA), 886t, 895-896 Treatment plans discussion of, 754 parental adherence to, 852 Tremor(s), 222 Triarchic theory of intelligence, 805-806 Trichophagia, 635-636 Trichorrhexis nodosa, due to inborn errors of metabolism, 293-295t Trichotillomania, 635-636, 636f Tricyclic antidepressants (TCAs) for ADHD, 888t, 889t, 890-891 for anxiety, 896-897 for depression, 893 for recurrent and chronic pain, 552, 553t Trinucleotide expansions, 253-254 Triple X, 227 Triplo-X Syndrome, 227 Trisomy, 226-227 Trisomy 8, mosaic, 230-231 Trisomy 13, 226 Trisomy 18, 226 Trisomy 21 See Down syndrome (DS) Trisomy rescue, 235-236 Trisomy X, 227 Truancy, 520 management of, 520 Trust funds, 959t Trust, in palliative and end of life care, 360, 360b 1040 INDEX Tube feeding blended table foods for, 283-284 constipation and diarrhea due to, 283 formula with increased calorie density for, 284-285, 285t indications for, 283 infant formula for, 283 with multiple disabilities, 739-740 pediatric enteral feeding products for, 283 regimens for, 284 specialty pediatric enteral formulas for, 284, 284t weaning from, 285, 285t Tuberous sclerosis, and autism, 682 Turner syndrome, 227-228 Tutorial programs, for neurodevelopmental dysfunctions, 544-545 TVI (teacher of students with visual impairment), 710-711, 713 TVIP (Test de Vocabulario en Imagenes Peabody), 795 Twelve-step support groups, for substance abuse, 449 Twice exceptional gifted child, 511-512 Twins, 120-121 Two-income families, 95t, 96 Tympanometry, 692 Tympanostomy tubes, 723 Tyrosine aminotransferase deficiency, 300-301 Tyrosine hydroxylase deficiency, 302 Tyrosinemias, 300-301 U UAPs (university-affiliated programs), in infrastructure of care and services for individuals with disabilities, 6-7 UBE3A gene, in Angelman syndrome, 246 Ultrasonography, cranial, 839 Unattached children, during and after disasters, 205 Unbalanced translocation, 229-230 Unborn child, forming mental representation of, 14-15 Unconditioned stimulus (US), 857t Unconventional treatments, legal issues with, 969 Underachieving gifted child, 508-509 Underactive bladder, 603 Underarousal, 731-732, 733t Undercontrolling families, 115 Underfeeding, 109, 565-566 Undermanagement, of acute minor illness, 327 Underreactivity, 731-732, 733t Underresponsiveness, 731-732, 733t Understimulation, family dysfunction related to, 110-111 Unemployment, with chronic health conditions, 348-349 Unfisting, 647-648 Uniparental disomy (UPD), 231-232, 231f Universal Declaration of Human Rights, 989-990 Universalizing, 849 University centers for excellence for developmental disabilities, University-affiliated faculties, in infrastructure of care and services for individuals with disabilities, 6-7 University-affiliated programs (UAPs), in infrastructure of care and services for individuals with disabilities, 6-7 Unmarried parents living together, families with, 96-97, 96t, 126 Unresponsive parents, 116-117 UPD (uniparental disomy), 231-232, 231f Upper airway obstruction, 740 with cerebral palsy, 659-660 Urbanization, in history of developmentalbehavioral pediatrics, 2-3 Urea cycle disorders, 292t, 296-298, 297t Ureter, ectopic, urinary incontinence due to, 603 Urethral valves, posterior, urinary incontinence due to, 603 Urge containment exercises, for daytime incontinence, 605 Urge incontinence, 603 Uridine diphosphate galactose 4-epimerase deficiency, 306 Urinalysis, for daytime incontinence, 604 Urinary continence, development of, 602-609 Urinary frequency, extraordinary daytime, 603 Urinary incontinence, 602-609 daytime, 602-606 common presentations of, 602-603 defined, 602 epidemiology of, 602 evaluation of, 603-604, 604f intensive, 606 giggle, 603 management of, 604-606, 605f behavioral approaches in, 604-605 medication in, 605-606 pathophysiology of, 602-603 stress, 603 urge, 603 vignette on, 602b nocturnal, 606-608 defined, 606 epidemiology and natural history of, 606 evaluation of, 606, 607f genetics of, 606 management of, 606, 607f alternative and complementary therapy for, 608 anticholinergics for, 608 behavioral strategies in, 607 desmopressin for, 608 enuresis alarms for, 607-608 guidelines for, 606 imipramine for, 608 nonresponders to, 608 monosymptomatic, 606 etiology of, 606 treatment of, 606-608, 607f non-monosymptomatic, 606 pathophysiology of, 606 vignette on, 602b Urine tests, for inborn errors of metabolism, 291t Urine, unusual odor of, due to inborn errors of metabolism, 293-295t Urologic procedures, with neurogenic bowel and bladder, 743-744 US (unconditioned stimulus), 857t U.S Children’s Bureau, Usher syndrome, hearing impairment in, 689t Utilitarian ethics, 986 Utility measures, 765 V Vaccination, and autism, 680 “Vagabond” children, 109 Vagal tone, in stress response, 408 Vaginal discharge, in neonates, 416 Vaginal reflux, urinary incontinence due to, 602-603 Vagus nerve stimulator, for seizures, 215 Validity, 765 predictive, 765 Valproic acid for bipolar disorder, 466, 466t for seizures, 216t Value system, in adolescence, 63t, 65, 68 Variable penetrance, 210 Variegated babbling, 718t Vegans, 567 Vegetarian diet, 567 Vegetative vocalizations, 718t Velocardiofacial syndrome, 249-250 Velopharyngeal insufficiency, language disorders due to, 726-727 Venlafaxine (Effexor XR) for anxiety, 897t, 898 for depression, 894, 895-896 for recurrent and chronic pain, 553t Ventilation, counseling for, 848 Ventilatory support, with multiple disabilities, 741-742 Ventriculoperitoneal shunts, 743 Verbal apraxia, developmental, 727 Verbal dysfluency, 538 Verbal dyspraxia, developmental, 727 Verbal-motor dyspraxia, 540 Vertical nystagmus, 762t Very-low-birth-weight infants, physical growth of, 36 Very low calorie diets, for obesity, 599 Vest, for chronic respiratory disease, 741 Vestibular hypersensitivity, 733t Vestibular sensory processing problems, 733t, 734t Vestibular-based postural disorder, 730, 731b, 731t Victimization, peer, 153-154 Victor, the Wild Boy of Aveyron, Video games, demographics on use of, 193f Vigabatrin, for seizures, 216t, 240 Vigilance, tests of, 768 Vineland Adaptive Behavior Scales-Revised, 766 Violence See also Aggression anticipatory guidance for, 392 chemical restraint medications for, 871, 871t confidentiality on, 966 crisis management for, 870-871, 871t defined, 390, 390t differential diagnosis of, 870-871 etiology of, 391 forms of, 870 initial management of, 871, 871t in media, 192b, 195-196, 195f in neighborhood, 175 nonrestrictive techniques for, 871 physical restraint for, 871 prevention of, 391-392 screening for, 392 unique role of pediatric health care providers with, 391-392, 392t Viorst, Judith, 407 Virtue ethics, 986-987 Visceromegaly, CNS disorders with, 836-838, 837f Vision screening, 699 Visual acuity, of infants and toddlers, 29 Visual impairment, 698-716 agencies and websites for, 699 due to amblyopia, 698-699 due to anterior segment abnormalities, 700-709t assessment and evaluation of, 713-714 due to cataract, 700-709t INDEX 1041 Visual impairment (Continued) with cerebral palsy, 659 characteristics and definitions of, 699-710 CNS conditions associated with, 710t congenital cause(s) of, 698 aniridia as, 700-709t coloboma as, 700-709t Leber congenital amaurosis as, 700-709t microphthalmia as, 700-709t ocular albinism as, 700-709t oculocutaneous albinism as, 700-709t optic nerve abnormalities as, 700-709t optic nerve hypoplasia as, 700-709t persistent hyperplastic primary vitreous as, 700-709t Peters anomaly as, 700-709t cortical/cerebral, 699b, 700-709t in developing countries, 698 developmental and educational implications of, 711-713, 711f epidemiology of, 698 due to glaucoma, 700-709t interventions and management for, 710-711 with multiple disabilities, 699 physician and educator roles with, 714-715 postnatal causes of, 698-699 in premature infants, 262-263, 698, 700-709t prevention of, 698 due to retinal disorders, 700-709t due to retinitis pigmentosa, 700-709t due to retinopathy of prematurity, 698, 700-709t in school-age children and adolescents, 713 screening for, 699 secondary transition and employment with, 714 vignette on, 699b Visual processing assessment of, 800t dysfunction of, 800-801, 800-801b Visual screening, 699 Visual-motor dyspraxia, 540 Visuospatial dysfunctions, 538-539 Visuospatial processing, 795 Vitamin A deficiency, 282t Vitamin B6 deficiency, 282t Vitamin B6, for autism, 952-953 Vitamin B12 deficiency, 282t Vitamin C deficiency, 279, 282t Vitamin D deficiency, 282t Vitamin D requirements, 279 Vitamin E deficiency, 282t Vitamin K deficiency, 279 Vitamin requirements, 279, 279-280b, 280 Vitamin therapy, 952-953 Vitreous, persistent hyperplastic primary, 700-709t Vocal play, 718t Vocal polyps, 728 Vocal tics, 222, 637 Vocalizations, vegetative and reflexive, 718t Vocational counseling, for intellectual disability, 670 Vocational rehabilitation, 962 Vocational training, planning for, 501t, 505 Vocational transition, 962 Voice, 718t Voice disorders, 727-728 Voiding diary, 603 Voiding disorders, functional, 603 behavioral approaches for, 605 evaluation of, 605f Voiding postponement, 603 Volume adjustment for learning differences, 826t for neurodevelopmental dysfunctions, 544t von Recklinghausen neurofibromatosis, 250-251 Vulnerability(ies) and coping, 492-493 and stress response, 492 Vulnerable child(ren), 337-342 clinical presentation of, 338-339 diagnosis of, 339, 339f etiology of, 338, 338t management of, 340-341, 340t prevalence of, 337 prevention of, 339-340, 340t vs resiliency, 341 spectrum of, 337 vignette on, 337b vs vulnerable child syndrome, 337 Vulnerable child syndrome, 20-21, 27, 325-326 diagnostic criteria for, 337, 338t historical background of, 337 Vyvanse See Amphetamine(s) W Waardenburg syndrome, hearing impairment in, 689t WAIS (Wechsler Adult Intelligence Scale), 766 Waking states, in newborn, 17-18, 18t Walking, 31, 647 War See Disaster(s) WATI Assistive Technology Checklist, 825 Watson, James B., Watson-Glaser Critical Thinking Appraisal, 812-813t WBS (Williams-Beuren syndrome), 248-249 Weaning, 564 Wechsler Adult Intelligence Scale (WAIS), 766 Wechsler Individual Achievement Test–2 (WIAT-2), 812t, 813-814 Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV), 766, 806 Wechsler Intelligence Scales, 663, 813-814 Wechsler Preschool and Primary Scale of Intelligence������������������������������ –����������������������������� Third Edition (WPPSI-III), 789, 794t, 795, 806 Wechsler Preschool and Primary Scale of Intelligence–Revised (WPPSI-R), 766 Weight of infants and toddlers, 35 for length, 277-278 Weight gain, 277 for failure-to-thrive, 589-590, 589t fear of, in anorexia nervosa, 570t, 572 parental concerns about, 565-567 Weight loss in adolescents, differential diagnosis for, 573 in anorexia nervosa, 570, 570-572, 572f Werdnig-Hoffmann disease, 220 West, Charles, West Nile virus encephalitis, 221 “Wet dreams,” 418 Whey-based formula, for tube feeding, 283 Whining, 862 White House Conference on Child Health and Protection, White matter disease, differential diagnosis of, 837f, 838 WIAT-2 (Wechsler Individual Achievement Test��������������������������������� –�������������������������������� 2), 812-813t, 813-814 WIC (Supplemental Food Program for Women, Infants, and Children), 177 WICS model, of giftedness, 506-507 Wide Range Achievement Test������������������� –������������������ 3, 812-813t William T Grant Foundation, 9, 9t Williams syndrome, 248-249 language disorders in, 724 music therapy for, 948 Williams-Beuren syndrome (WBS), 248-249 Wine, intoxication with and withdrawal from, 442-445t Winnicott, D W., 876, 879 WISC-IV (Wechsler Intelligence Scale for Children, Fourth Edition), 766, 806 Withdrawal in behavioral style assessment, 780-781t neonatal drug, 318 social, and peer rejection, 153 from substance of abuse, 439-440, 442-445t treatment of, 447-449 in temperament, 19t, 76t, 82t Wolman disease, 310 Women’s health, poverty and, 176-177 Woodcock-Johnson Psycho-Educational Battery–Revised, 768 Woodcock-Johnson Reading Mastery Tests�������������������������������������� –������������������������������������� Revised, 812-813t, 813-814 Woodcock-Johnson Tests of Achievement III (WJ-III), 794t, 796, 812-813t, 813-814 Woodcock-Johnson Tests of Cognitive Ability III, 813-814 Word analysis, assessment parameters for, 822-823t Word finding skills, norm-referenced assessment of, 722t Word problems, assessment parameters for, 822-823t Word processing, assessment parameters for, 822-823t Word recognition, assessment parameters for, 822-823t Work Sampling System, 768 Work style, in comprehensive formulation of assessment, 842t Work-family conflicts, 95 WPPSI-III (Wechsler Preschool and Primary Scale of Intelligence, Third Edition), 789, 794t, 795, 806 WPPSI-R (Wechsler Preschool and Primary Scale of Intelligence��������������������� –�������������������� Revised), 766 Writing assessment of, 812-813t parameters for, 821, 823, 822-823t, 822t neurodevelopmental dysfunction and, 542 Writing disabilities, 539-541 Writing Process Test, 812-813t Written summary, assessment parameters for, 822-823t X 45,X, 227-228 Xanthine oxidase deficiency, 303 Xenical (orlistat), for obesity, 599-600 X-linked inheritance, 210, 246, 253 47,XXX, 227 47,XXY, 226-227 47,XYY, 227 Y Yale Child Study Center, 9, 9t Yoga, as self-regulation technique, 912t, 915 Young Mania Rating Scale, 465 1042 INDEX Youth Risk Behavior Survey, 570 Youth Self-Report, 403 “Yo-yo” children, 109 Z Z score, 764 Zaleplon, for ADHD, 892 Zanaflex (tizanidine) for cerebral palsy, 657 for recurrent and chronic pain, 553t Zeitgebers, 619 Zellweger syndrome, 303-304 Zelnorm (tegaserod), for recurrent and chronic pain, 552 Zidovudine, for HIV infection, 273t Zinc deficiency, 280, 282t Zinc supplementation, 281 for eating disorders, 906 Ziprasidone adverse effects of, 900 for agitation or violence, 871t Ziprasidone (Continued) for bipolar disorder, 901t for psychosis, 900t for tics, 638, 638t Zolpidem (Ambien) for ADHD, 892 for recurrent and chronic pain, 553t Zonisamide, for seizures, 216t ... member Peer related Friends dropped out Male Female 58 46 52 44 33 17 38 25 32 18 14 22 19 18 12 13 13 15 20 16 — 5 5 31 24 23 14 14 12 17 11 likely to be less efficacious than systematic approaches... Pediatr 149 (2) :25 2 -25 6, 20 06 Resnick MD, Bearman PS, Blum RW, et al: Protecting adolescents from harm Findings from the National Longitudinal Study on Adolescent Health JAMA 27 8(10): 823 -8 32, 1997... www.census.gov/population/www/socdemo/education/cps2004 html Accessed August 25 , 20 06 Kemp SE: Dropout policies and trends for students with and without disabilities Adolescence 41(1 62) :23 5 -25 0, 20 06 Laird J, DeBell M,