Many Children Held Back In Elementary School Do Not Receive Plan For Special Education Services
Many children who are retained in kindergarten, first or third grade for academic reasons do not subsequently receive a document outlining the individualized special education services they should receive, according to a report in the June issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Each year, 5 percent to 10 percent of American students are retained at the same grade level, according to background information in the article. One in 10 students age 16 to 19 have repeated a grade. “Some of these students may require special education services at the time they are retained, in subsequent years or both,” the authors write. “One approach to supporting a child with low academic achievement is the provision of special education services, as indicated in an Individualized Education Program (IEP). An IEP is a legally binding document describing a child’s special education services and is developed after the child has undergone a special evaluation and has been determined eligible for services.”
Eligibility for an IEP varies from state to state, but under the Individuals With Disabilities Education Act, every American child has the right to an evaluation. Michael Silverstein, M.D., M.P.H., of Boston Medical Center, and colleagues studied 380 children nationwide who were retained in elementary school for academic reasons (300 in kindergarten or first grade and 80 in third grade). The children were followed up through fifth grade.
Of the children retained in kindergarten or first grade, 40 (12.9 percent) had an IEP on record during the year they were held back, 60 (18.2 percent) received an IEP in the next one to five years and 210 (68.9 percent) never received an IEP. Twenty (18.9 percent) of the third-graders had an IEP during or before the year they were retained, 10 (8.8 percent) received one in the next one to two years and 60 (72.3 percent) never received one.
Children retained in kindergarten and first grade were less likely to have an IEP if they had a high socioeconomic status or lived in the suburbs rather than rural areas. “Among kindergarten/first grade retainees with persistently low academic achievement in math and reading, as assessed by standardized testing, 38.2 percent and 29.7 percent, respectively, never received an IEP,” the authors write.
“Although debates about the value of grade retention abound, the practice, in and of itself, has never been demonstrated to be an effective intervention relative to subsequent academic achievement or socioemotional adjustment,” the authors write. “Therefore, some experts in the field believe that retention should be accompanied by focused individualized assessments of children’s special education needs. Although our results do not definitely demonstrate that retained children have been denied their rights to such assessments, they raise the question of whether the potential special education needs of retained children, particularly those who demonstrate persistent academic difficulties, are being addressed consistently.”
Arch Pediatr Adolesc Med.
2009;163[6]:547-553.
Source
Archives of Pediatrics & Adolescent Medicine
Many U.S. Children Have Inadequate Access To Pediatric Trauma Care
Approximately 30 percent U.S. children live more than one hour away from a pediatric trauma center by ground or by air transportation, according to a report in the June issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
More children between ages 1 and 14 die of injuries than of all other causes combined, according to background information in the article. Trauma centers have been shown to provide a survival benefit to severely injured adult and pediatric patients. Although a comprehensive inventory of adult trauma centers is regularly updated, no similar listing of pediatric trauma centers currently exists.
Michael L. Nance, M.D., of the Children’s Hospital of Philadelphia, and colleagues used information from national, state and local trauma systems authorities to create a catalog of verified pediatric trauma centers along with self-identified trauma centers. Using U.S. Census and Postal Service data, along with information about air medical services, the authors calculated access to age-specific trauma care services for American children younger than 15.
A total of 170 verified pediatric trauma centers were identified, located in 41 states (including the District of Columbia). An estimated 71.5 percent of children younger than 15 were within 60 minutes of one of the centers by ground or by air transportation, whereas 43 percent were within 60 minutes if only ground transportation was considered. The authors estimate that 17.4 million U.S. children would not have access to a pediatric trauma center within 60 minutes.
“Access ranged from 22.9 percent of the population in the most rural areas of the United States to 93.5 percent in the most urban,” the authors write. Access also varied by state, ranging from more than 90 percent of children having access in 11 states to less than 25 percent having access in 12 states. “The addition of 24 candidate centers [not verified] increased coverage to 77.4 percent of the pediatric population being within 60 minutes of a pediatric trauma center.”
“While this study does not directly address outcome from injury as it relates to pediatric trauma care access, it stands to reason that limited access may equate to suboptimal trauma care and a lower likelihood of survival,” the authors write. “Several authors have demonstrated superior outcomes for children treated in designated pediatric trauma centers.” Adult-focused trauma centers may lack pediatric-specific personnel and equipment; however, most injured children are still treated at these facilities.
“Understanding the distribution of existing pediatric trauma centers and gaps in access will allow for more thoughtful trauma systems planning,” they conclude. “The creation of an inventory of pediatric trauma care centers allowed us to perform these access calculations. A hospital’s capacity to provide optimal care for injured children, however, is dynamic, and our inventory captures only a fixed moment in time. To optimize pediatric trauma care planning, the development of a thorough, standardized and continuously updated catalog of pediatric trauma care resources is necessary.”
Arch Pediatr Adolesc Med.
2009;163[6]:512-518.
Source
Archives of Pediatrics & Adolescent Medicine
Oregon Gov. Signs Sex Education Bill; Tenn. Rep. Withdraws Bill To Give Parents Record Access
The following summarizes recent action on reproductive health-related legislation in two states.
~ Oregon: Gov. Ted Kulongoski (D) on Tuesday signed a measure (H.B. 2509) that requires school districts to provide students in all public elementary and secondary schools with medically accurate, age-appropriate sex education courses, KOHD reports. The law stipulates that schools emphasize the best way for students to prevent pregnancy and reduce the spread of sexually transmitted infections is to practice abstinence and that the best approach for adults is to engage in mutually monogamous relationships with partners without STIs. In addition, the law requires that students be given current, statistically based information about the efficacy of all methods of preventing STIs. The measure also requires that sex education courses include instruction on the benefits of delaying pregnancy until after adolescence, as well as information about the characteristics of an emotionally and physically healthy relationship. The law directs schools to provide students with information on state laws related to young people’s rights and responsibilities with regard to childbearing and parenting (KOHD, 6/2).
~ Tennessee: State Rep. Tony Shipley (R) on Tuesday withdrew from consideration a bill (H.B. 1762) he sponsored that would have given parents full access to their children’s medical records, the AP/Chattanooga Times Free Press reports. Under the measure, physicians would have been required to provide written results of any tests or procedures performed on minors upon request from their parents or guardians. The measure could have jeopardized about $6.5 million in federal family planning funding that is attached to privacy requirements, according to legislative analysts (AP/Chattanooga Times Free Press, 6/2).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
New Technology At Great Ormond Street Hospital Is Aiding Faster Emergency Referrals To Its Specialist Paediatricians, England
Thanks to the introduction of an innovative IT system at the Children’s Acute Transport Service (CATS) hosted at Great Ormond Street Hospital for Children NHS Trust (GOSH), referring hospitals can now share perfect quality medical data on emergency patients more quickly and securely than ever before.
The product, named CATS-i, has been co-developed by software manufacturer Cimar UK and GOSH. Over the last 12 months, the technology has been trialled by the CATS team at GOSH. CATS is a paediatric intensive care retrieval service for the North Thames and East Anglia region. The team provides telephone advice and sends a specialist team to safely bring sick children back to the intensive care unit at GOSH and other tertiary centres. More than 50 hospitals in and around London regularly refer patients to the service.
Dr Padmanabhan Ramnarayan, consultant for the CATS team at GOSH and a co-inventor of CATS-i explains. “Previously, we simply relied on telephone conversations with referring clinicians and relatively low quality radiology (X-rays, CT scans) to make a quick assessment about a diagnosis. Radiology data would often be sent via courier, which loses us valuable time. In an emergency situation, every second counts and this is where CATS-i offers us a clear advantage. For example, in a recent case, a boy had been in a road traffic accident outside London and with the help of CATS-i we quickly determined from his medical data that he had a windpipe injury. The child was brought to GOSH by helicopter and was given life-saving treatment by our tracheal team.”
CATS-i offers a unique web-transmission service which allows pristine medical images to be transmitted from any hospital in the UK to remote recipients anywhere, securely, reliably and fast via an internet browser. The images are losslessly compressed (i.e. retaining absolute image quality), secure and encrypted throughout, so patient data confidentiality is not compromised. The user cannot send anything until they have a secure token issued by the CATS office each time.
The CATS-i project was commended in NHS Innovations London’s Innovator Awards 2008.
NHS Innovations London has recently brokered an agreement between GOSH and Cimar UK to distribute the co developed service.
Dr Ramnarayan continues: “We’re very excited about this product being available commercially. It’s satisfying to see something that we’ve worked so hard on being made available to others so that they can improve the service to their patients”.
A prime-time BBC 1 series following the work of the CATS team is due to be screened later this year.
Source
NHS Innovations London
Mysterious Ailments May Be The Result Of Undiagnosed Genetic Defects
One in every 3,000 babies is born with an inborn error of metabolism — a genetic defect that interferes with their ability to process substances like carbohydrates, proteins and fats. Until recently, tests to detect many of these very rare, disabling, and sometimes fatal disorders like fatty acid oxidation disorders were rarely used. If the child died, the cause would be listed as unknown or Sudden Infant Death Syndrome (SIDS). If they survived, they would experience a range of symptoms and medical problems throughout their lives such as delays in development, seizures, difficulty with growth and autistic behavior.
New state-mandated screening tests for newborns and the availability of specialized medical centers have improved the timely detection and treatment of metabolic disorders. The Biochemical Genetics Program at NewYork-Presbyterian Morgan Stanley Children’s Hospital — one of only a few specialized programs in New York state — offers a complete diagnostic and treatment center.
“Early and accurate diagnosis and detection is an essential first step for appropriate management and treatment of patients with these defects, giving them the opportunity to build healthy lives, improve their quality of life, and minimize the burden of their disease,” says Dr. Wendy Chung, director of Clinical Genetics at NewYork-Presbyterian Morgan Stanley Children’s Hospital and the Herbert Irving Assistant Professor of Pediatrics in Medicine at Columbia University College of Physicians and Surgeons.
Following a multidisciplinary approach, the Biochemical Genetics Program specialists provide treatment specific to patients’ metabolic condition. This may include dietary management with a metabolic nutritionist, enzyme replacement therapy and, in advanced cases, transplantation for bone marrow, liver, kidney or heart.
“Our program offers enrollment in cutting-edge clinical trials and research studies for many of these rare disorders,” says Dr. Chung. “Reproductive planning is also available, ensuring patients with metabolic disorders, or parents of a child with a disorder, that they will have healthy children.”
The program has been bolstered with the recruitment of Dr. Maryam Banikazemi, internationally recognized for her work in the field of lysosomal storage disorders. Dr. Banikazemi is a pediatrician at NewYork-Presbyterian Morgan Stanley Children’s Hospital and assistant professor of clinical pediatrics at Columbia University College of Physicians and Surgeons.
The team includes a metabolic nurse, registered dietitian, social worker and genetic counselor. Other specialists include gastroenterologists, cardiologists, neurologists, orthopedic surgeons, ophthalmologists, pulmonologists and transplant surgeons.
In addition to diagnosing and treating children, the Biochemical Genetics Program is available to adults. “We see adults with mysterious ailments; liver failure, hypoglycemia, even symptoms like persistent carpal tunnel syndrome can be a sign of a metabolic disorder,” says Dr. Chung, who notes that adult patients commonly are misdiagnosed and treated for other conditions.
Inborn Errors of Metabolism
Inborn errors of metabolism, also known as congenital metabolic diseases or metabolic disorders, are usually due to defects of single genes that code for enzymes that break down and build chemicals in the body. In most of the disorders, problems arise due to accumulation of chemicals which are toxic or interfere with normal function, or to a deficiency in essential chemicals. The earliest screening for a congenital metabolic disease, phenylketonuria (PKU), was pioneered in the late 1960s, and involves using blood samples on filter paper obtained by pricking a newborn baby’s heel on the second day of life. This PKU test is still in use today. Congenital hypothyroidism was the second disease widely tested in the 1970s. The development of tandem mass spectrometry screening in the early 1990s led to a large expansion of potentially detectable congenital metabolic diseases. Additional tests have been added to many screening programs over the last decade. Newborn screening has been adopted by most countries around the world, though the lists of screened diseases vary widely.
Sources
NewYork-Presbyterian Morgan Stanley Children’s Hospital and Columbia University Medical Center
Risk Of Teenage Depression Symptoms Lowered By Family Obligation In Chinese Homes
A new study of Chinese-American youth has found that family obligation, for example caring for siblings or helping elders, plays a positive role in the mental health of Chinese-American adolescents and may prevent symptoms of depression in later teenage years.
Published in the Journal of Family Psychology, the study found that 14-year-olds who reported a greater sense of family obligation reported fewer depressive symptoms by the time they reached 16. The findings suggest that family obligation may be protective against depressive symptoms. The authors suggest that a greater sense of family obligation in the early teenage years could provide teenagers with a strong family bond that makes them feel secure even when they move through adolescence and become more autonomous.
The longitudinal study surveyed 218 Chinese-American teenagers over a two-year period. As participants grew older, their actions to help and support their families decreased. However, their attitude and respect toward their families remained stable, indicating that immigrant adolescents continue to endorse their traditional cultural values even when their behaviors suggest they are becoming less traditional.
Notes:
The study was authored by Linda Juang and Jeffrey Cookston, both associate professors of psychology at San Francisco State University. It will be published in the June issue of the Journal of Family Psychology, a special issue focusing on families and immigration.
Source:
Elaine Bible
San Francisco State University
To Raise Children In Foreign Lands, Immigrants Overcome Great Odds
A recent surge in immigration rates has led psychologists to study how these families are coping and thriving in their adopted countries. In a special June issue of the Journal of Family Psychology, published by the American Psychological Association, researchers report that close family ties are crucial for immigrants’ successful transition to their new country.
“The articles in this issue examine the psychological experiences of a diverse set of immigrant families and their children who arrive in North America, Europe and Israel from many corners of the world,” said Susan S. Chuang, PhD, of the University of Guelph in Ontario, Canada. Chuang wrote the Introduction to the special issue, along with Uwe Gielen of Saint Francis College. “This research helps us to better understand the profound impact the immigration experience has on family relationships.”
Recent census data show that the number of immigrant children in the United States is growing rapidly. They account for approximately 20 percent of the child population, and that number is expected to increase to 30 percent by the year 2015. Asians are one of the fastest-growing ethnic minority groups in the United States, and several of the issue’s articles focused on these families and their struggles.
This recent surge in immigration rates means more and more families are finding themselves struggling to adapt to new countries and cultures. These families and their children face a host of challenges, including discrimination, isolation and financial stresses, say psychologists who contributed to this special issue.
One study examined the impact of family financial stresses on the academic achievement of Chinese-American adolescents. Most of the parents in this study of 444 families had emigrated to the United States from China. The authors found that the teenagers who were more aware of their families’ economic woes were more likely to suffer depressive symptoms, especially older adolescents, and did worse in school than those who were not as affected by money problems.
A study found Chinese immigrant mothers of preschoolers were more likely to engage in high levels of authoritative parenting practices. Authoritative parenting involves developing a close, nurturing relationship with children while also maintaining a reasonably high level of expectations and guidelines. The findings showed an authoritative parenting style led to fewer behavior problems among the children in the study. The researchers point out that overall, Chinese parents are more accepting of authoritative parenting practices than previously thought.
Another longitudinal study determined that, within couples, Chinese-American parents were more consistent in their parenting messages to their children than were white American parents. White American parents were more accepting of their children’s behavior, perhaps in an effort to build up their children’s self-esteem. Chinese-American parents’ greater control of their children’s behavior was linked to fewer behavior problems.
One article also looked at how family obligations affected the mental health of hundreds of Chinese-American high school students in the San Francisco area. Students who were born in China felt more family obligation than students who were born in the United States. But, those who endorsed greater family obligation were less likely to suffer from symptoms of depression, the researchers found.
“These findings highlight the important role of family obligation to Chinese-American adolescents’ mental health,” wrote the study’s lead author Linda Juang, PhD, of San Francisco State University.
Chuang, one of the special issue’s editors, said the issue’s other articles provide a unique glimpse of immigrant families from countries such as Russia and parts of Africa, who have arrived in other Western countries including Canada, Germany, Israel, Portugal, and the Netherlands. “Only by studying immigrant families and children across a broad range of societies can we accurately evaluate the research on immigrants to the United States,” she said.
Special Issue: “Understanding Immigrant Families From Around the World: Introduction to the Special Issue,” Journal of Family Psychology Vol. 23, No. 3.
Articles:
“Understanding Immigrant Families From Around the World: Introduction to the Special Issue” – apa/journals/releases/fam233275.pdf
“Family Economic Stress and Academic Well-Being Among Chinese-American Youth: The Influence of Adolescents’ Perceptions of Economic Strain” apa/journals/releases/fam233279.pdf
“Authoritative Parenting Among Immigrant Chinese Mothers of Preschoolers” apa/journals/releases/fam233311.pdf
“Relations Among Parental Acceptance and Control and Children’s Social Adjustment in Chinese American and European American Families” apa/journals/releases/fam233321.pdf
“A Longitudinal Study of Family Obligation and Depressive Symptoms Among Chinese American Adolescents” apa/journals/releases/fam233396.pdf
Source:
Audrey Hamilton
American Psychological Association
Doctors Warn That Alcoholic Beverages combined with Trampolines Must Be Avoided
During the warmer months, the use of trampolines is more frequent and as a result children are more likely to be hospitalized with related injuries, especially after bouncing with adults at the same time, according to doctors’ warnings.
In a letter to this week’s BMJ, Dr. Andrew Bogacz and his colleagues at Ninewells Hospital and Medical School in Dunndee, evaluated and compared during a six week period, fifty trampoline related accidental cases, with the safety guidelines of the Royal Society for the Prevention of Accidents (RoSPA).
Their results concluded that the greater the number of people using the trampoline at the same time, the more possibilities of getting injured. The lightest or smallest person has five times more chances to get wounded.
Dr. Bogacz explained that a 20kg child can experience the energy corresponding to a 3.5 m fall when bouncing with an adult of 80kg, therefore concluding that the severity of the injury grows significantly with the difference between child and adult weights.
Adult supervision is also critical in avoiding trampoline injuries, they explain … “to ensure safety guidelines are followed, exuberance is controlled, and help is provided with setting up and dismounting from the trampoline.”
They also conclude that alcohol and trampolines do not mix. During summer garden parties, many children have been hurt while being supervised or bouncing with adults, but they were under the influence of alcoholic beverages, making them less responsible of their actions. “Adults, please note that lager, wine, and trampolines do not mix.”
“Trampoline injuries”
Andrew Bogacz, speciality registrar, department of emergency medicine, Brodie Paterson, consultant, department of emergency medicine, Adarsh Babber, speciality registrar, department of surgery, Simon Menelaws, medical student, Dundee, Tim Drew, lecturer, institute of motion research and analysis
BMJ 2009; 338:b2197
Stephanie Brunner (B.A.)
New Genetic Immune Disorder In Children Discovered By Scientists
Your immune system plays an important function in your health – it protects you against viruses, bacteria, and other toxins that can cause disease. In autoinflammatory diseases, however, the immune system goes awry, causing unprovoked and dangerous inflammation. Now, researchers from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health, and other institutions have discovered a new autoinflammatory syndrome, a rare genetic condition that affects children around the time of birth. The findings appear in the current issue of the New England Journal of Medicine.
The scientists have termed the new autoinflammatory syndrome DIRA (deficiency of the interleukin-1 receptor antagonist). Children with the disorder display a constellation of serious and potentially fatal symptoms that include swelling of bone tissue; bone pain and deformity; inflammation of the periosteum (a layer of connective tissue around bone); and a rash that can span from small individual pustules to extensive pustulosis that covers most of the patient’s body. Most of the children begin to have symptoms from birth to 2 weeks of age.
“The beauty of this discovery is that the symptoms of this devastating disease can now be treated,” said NIAMS director and immunodermatologist, Stephen I. Katz, M.D., Ph.D. “The abnormal inflammatory pathways seen in this disease may also help us understand other common diseases that share clinical features, such as psoriasis, as well as other autoinflammatory disorders.”
“We knew when we saw these children that we were dealing with a previously unrecognized autoinflammatory syndrome. The clinical characteristics were distinct from other diseases we had seen before,” said NIAMS researcher and lead author Raphaela Goldbach-Mansky, M.D., M.H.S. When her colleague, Dr. Ivona Aksentijevich, tested the first patient for genetic abnormalities, their suspicions were confirmed, and ultimately abnormalities were found in a number of other cases.
All the children had inherited mutations in IL1RN, a gene that encodes a protein known as interleukin-1 receptor antagonist (IL-1Ra). IL-1Ra binds to the same cell receptors as the inflammatory protein interleukin-1, and acts as a brake on this inflammatory protein. Without IL-1Ra, the children’s bodies cannot control systemic inflammation that can be caused by interleukin-1.
The scientists identified nine patients from six families with DIRA in the Canadian province of Newfoundland, the Netherlands, Lebanon, and Puerto Rico. Those who were alive at the time of diagnosis – six in all – were treated with anakinra, a drug that is normally used for rheumatoid arthritis and is a synthetic form of human IL-1Ra. Although the patients were resistant to other medications such as steroids, most responded successfully and immediately to anakinra. “Our first patient had been unresponsive to several treatments, and his health care team had almost given up. But with anakinra, he was out of the hospital in 10 days and his symptoms resolved,” Dr. Goldbach-Mansky said.
Although the mutation that causes DIRA is rare, as many as 2.5 percent of the population of northwest Puerto Rico are carriers. Since DIRA is recessively inherited, these data suggest that it may be present in about 1 in 6,300 births in this population. Because the mutation was found in three independent Dutch families, newborn screening for DIRA in this population, as well as that of northwest Puerto Rico, may be warranted, Dr. Goldbach-Mansky said.
“The DIRA discovery can be attributed to an innovative and collaborative effort between clinicians and laboratory researchers at NIAMS and an international team of dedicated investigators,” said NIAMS Clinical Director and coauthor Daniel L. Kastner, M.D., Ph.D. “Moreover, the unveiling of this novel autoinflammatory syndrome provides us with a tool to further dissect the role of interleukin-1 in human biology and disease.”
Notes: In addition to the NIAMS, other support came from the National Cancer Institute; the National Institute of Allergy and Infectious Diseases; the NIH Clinical Center; the National Human Genome Research Institute; Memorial University of St. John’s, Newfoundland; the University of Iowa, Iowa City; the University of Utrecht, Netherlands; the University of Toronto, Canada; Lund University, Malmo, Sweden; Shafallah Medical Genetics Center, Qatar; Feinstein Institute, Manhasset; and Erasmus Medical School, Rotterdam, Netherlands.
Source:
Trish Reynolds
NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases
Youth Gang Members Feel Safe Despite Increased Danger, MSU Research Finds
Children who join gangs feel safer despite a greater risk of being assaulted or killed, according to federally funded research led by a Michigan State University criminologist.
The findings by MSU’s Chris Melde, which appear in the online edition of the journal Criminology, may help explain why youth continue to join street gangs despite the well-established danger.
“It’s a paradox,” said Melde, assistant professor of criminal justice. “Gang members essentially are not allowed to show fear and this can have a profound impact on adolescents. Their quest for acceptance, along with their immersion into this culture steeped in violence, may ultimately numb their reaction to violence, including their fear of victimization.”
While many researchers look at the downside of gang membership, Melde’s research explores the potential benefits – or at least the perceived benefits. The current research is part of a larger project led by professor Finn-Aage Esbensen at the University of Missouri-St. Louis and funded by the National Institute of Justice, a department of the U.S. Department of Justice.
The project is believed to be the first long-term analysis of its kind. Melde and his colleagues studied 1,450 public school students in the sixth through ninth grades during a two-year period. The students came from 15 schools in four states: Arizona, New Mexico, Massachusetts and South Carolina.
The students who joined gangs said they had higher levels of victimization, but also reported a relatively large decrease in fear at the same time. Victimization ranged from the fear of home invasion to being attacked.
The study also highlights a possible intervention point. Because fear, which affects decision-making, generally peaks immediately following a violent action – and before the gang can organize a response – Melde said that might be the best time to try convincing gang members to quit.
“Intervening in their lives right then may impact their decision whether they stay in a gang or not,” he said.
Source:
Andy Henion
Michigan State University