Greetings:
The National Interns and Residents Match is complete and we are very pleased to have a terrific group of new residents — seven Pediatric and four Med/Peds — including:
Julia Pascu |
Universitatea de Medicina Si Farmacie Carol Davila, Romania |
Lauren Olson |
St. George's University, Grenada |
Eula Biyo |
De La Salle University, Iriga City, Philippines |
Suzanne Essengue |
Medical Faculty of the Catholic University of Louvain, Brussels, Belgium |
Lourdes De Leon |
University of Perpetual Health Medical College, Binani Laguna, Philippines |
Carlito Laude |
Cebu Institute of Medicine, Cebu, Philippines |
Heather Morgan |
UMKC School of Medicine, Kansas City, MO |
Jiten Patel |
University of West Indies, Trinidad |
Becky Nicholas |
University of Kansas, Wichita, KS |
Kristi Kim |
University of Kansas, Kansas City, KS |
Paul Bassett |
University of Kansas, Wichita, KS |
Our Annual Spring Symposium was held on Friday, May 9, 2003 in Wahl Hall East. The hot topics were seizures, learning disabilities, headaches, obesity, scoliosis, and sports medicine. There also was a Healthy Steps Kansas Pre-conference on Tuesday, May 8, 2003. This was on Developmentally Oriented Pediatrics: Practical Strategies for the Busy Clinician. The KAAP dinner and talk featuring Louis Cooper, MD, immediate past president of the American Academy of Pediatrics was held on Thursday, May 8, 2003 at the Starker's Private Reserve Restaurant.
Professor and Chair
A mother calls about her little boy, John; she’s upset. John is 3 years old and not talking. He did begin speaking at 18 months, but seems to have lost these skills. John isolates himself from his family and other children. He seems to enjoy running in the same pattern through the living room. When he is quiet, he sits on the floor, turning his trucks upside-down and watching the wheels spin. John does not communicate with his parents except through pointing to objects that are exciting to him. At times, John has good eye contact with his parents and smiles at them. At other times, when they call his name, he does not seem to hear. His mother’s voice is shaking as she mentions the word ‘autism’.
Children with symptoms of autism pose difficult challenges to the clinician. Faculty at the Developmental Disabilities Center provides interdisciplinary evaluations of children who are suspected of autism. Clinics represent faculty from multiple disciplines as children with autism pose multiple concerns to families.
Families frequently ask, “What caused this problem? Is it something that I have done?” They tie symptoms to specific events, such as moving or being vaccinated. Thus, a developmental pediatrician is extremely important in evaluating children. The developmental pediatrician may examine etiology, health, and whether subsequent medical testing is advisable.
Frequently, families report language problems. Sometimes the child does not talk. Sometimes the child repeats what has been said or mimics parts of videos. It is imperative that a speech and language pathologist be involved with the evaluation of a child with autism. Frequently, alternative and augmentation communication systems need to be in place while the child is learning to speak and follow directions.
Some children with autism spectrum disorders have motor coordination problems. People with Asperger’s Disorder may have difficulty with handwriting. Individuals on the autism spectrum may have sensory disturbances. They may be very selective in what they eat. Noises may bother them. An evaluation of autism requires an occupational/physical therapist to examine motor and sensory issues.
Children with autism spectrum disorders frequently show atypical cognitive development. Parents may report that visual skills may be extraordinary and the child may read at age three, however, the child does not seem to understand what is being said. Parents may report tantrums when transitioning the child from one activity to the next. Psychologists are important to assess various aspects of cognitive development and behavior difficulties.
In many situations, assessments from various disciplines are provided in a piecemeal fashion. The parent may go from one provider to the next getting information and different diagnoses. Information is not integrated and may, in fact, sound contradictory. Evaluations at the Developmental Disabilities Center provide a solution. Assessments are done in an interdisciplinary manner. Part of the assessment team conducts interviews with the parents. Other team members are involved in evaluating the child. Assessment information can be shared and integrated on-site. Parents and school personnel work as a team brainstorming and problem-solving. This leads to the development of a comprehensive evaluation that details the child’s strengths and weaknesses as well as techniques and strategies that might be used at home and school. The plan may be followed by inservice training to schools and parents on implementing appropriate services and/or connecting parents and school personnel with services that are available in their community.
We strongly feel that this interdisciplinary, integrated approach provides a comprehensive assessment and plan for children with autism, as well as those suspected of autism.
For more information or to arrange for an appointment please contact the Developmental Disabilities Center at (913) 588-5900.
Less than 30 years ago, best practice for prescribing behavior management recommendations to parents was based on structural aspects of the child’s problem behavior. That is, clinicians would interview parents about what the behavior “looked” like—the form, or topography of problem behavior. Clinicians would frequently begin consultation with parents by teaching them how to use positive behavior management strategies by rewarding the child’s good behavior and providing some form of punishment or natural consequence for problem behavior (e.g., throw your food and lose your chance to eat dinner, no desert, etc.).
A problem with this model is that the clinician would rarely identify the underlying reason, or function, for the child’s problem behavior: What is the child “getting” by acting this way? Thus, this model of assessment for childhood behavior problems proved to be inadequate because it did not identify the types of consequences that reinforce problem behavior for individual children. Not knowing what reinforces a child’s problem behavior leads clinicians to prescribe reinforcement-based procedures that are mismatched to the consequences that reinforce problem behavior. An example would be using a token economy system that provides preferred edibles for good behavior even though the child primarily tantrums to gain parental attention.
These types of mismatched behavior management strategies rarely work, which results in an over-dependence on punishment after caregivers do not observe decreases in the youngster’s frequency or intensity of problem behaviors. We attempt to minimize parental use of physical punishment for the following reasons:
Current best practice for managing childhood behavior problems has evolved to incorporate functional assessment methods for identifying the actual reinforcers of problem behavior, rather than emphasizing the form of problem behavior. The function of problem behavior (and changes in functions over time and across settings) can be assessed in several ways:
An analogue functional analysis systematically exposes the child to environmental consequences that may reinforce problem behaviors in controlled situations for short intervals (5 or 10 minutes per condition). The outcome of an analogue functional analysis is a semi-quantitative measure of the reasons problem behavior is occurring at a given point in time. In analogue functional analyses, the clinician determines the degree to which problem behavior is maintained by
Such an analysis allows clinicians to select reinforcement-based interventions that are most likely to be effective because they are matched to reinforcers that maintain problem behavior (e.g., teaching parents how to differentially provide attention for appropriate behavior when attention reinforces problem behavior). Finally, functional assessment makes it possible for clinicians to provide more focused and less costly intervention that does not solely rely on physical punishment to change child behavior.
Psychologist and Assistant Professor
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The University of Kansas Medical Center