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BackgroundTo determine whether parental presence during induction of anesthesia is an effective preoperative behavioral intervention, a randomized controlled trial with children undergoing outpatient surgery was conducted.MethodsEighty-four children were randomly assigned to a parent-present or pare

Background: The devastating effects of traumatic events on children are modulated by risk and protective factors. This study examines the differential effects of traumatic displacement of preschool children and their families following Scud missile attacks on Israel during the Persian Gulf War. Methods: Three groups participated in the study: families displaced after their houses were damaged, undisplaced families from the same neighborhood (without home damage), and families from a distant city that was threatened but not directly attacked. Data concerning the traumatic event, the child (personality, internalizing, externalizing, and stress symptoms), the mother (Symptom Checklist-90—Revised), and the family (Family Adaptability and Cohesion Evaluation Scales) were gathered 6 months after the end of the war. Results: Displaced children and mothers showed higher externalizing and stress symptom levels compared with undisplaced and threatened subjects. Destruction of the house and displacement, but not mere distance from the missile impact, explained symptomatic behavior. Inadequate family cohesion predicted symptomatic reaction for 3- and 4-year-old children but not for older ones. Conclusions: Both human and nonhuman factors contribute to the preschool child's adaptive mechanisms that regulate environmental stressful stimuli. These riskmodifying factors become more autonomous of caretakers with increasing age.

VALID concern about the high rate of cocaine use among pregnant women has resulted in an apparent rush to judgment about the extent and permanency of specific effects of intrauterine cocaine exposure on newborns. Predictions of an adverse developmental outcome for these children are being made despite a lack of supportive scientific evidence. Whatever the true outcome, we are concerned that premature conclusions about the severity and universality of cocaine effects are in themselves potentially harmful to children. Although the prevalence of cocaine/crack use is declining (in 1990 an estimated 6.6 million individuals reported use in the preceding year compared with 12 million in 1988), certain groups continue to use the drug at high or increasing rates. 1,2 Also, more women of childbearing age seem to be affected by cocaine use compared with previous drug epidemics. 3 At present no reliable national estimates of the extent or patterns of cocaine

Early mother-infant interactions support infants' abilities to deal with stressful situations such as the withdrawal of maternal attention. The "still-face" paradigm provides a framework for studying the range of social regulatory capacities available to infants during stressful times. This study examined the responses of 62 3-4-month-old infants during the still-face situation. Infants' responses were coded in real time along 3 dimensions: gaze, affect, and state. 3 findings are presented: (1) Generally, infants responded to the still-face situation with predominantly neutral affect and looking away from their mothers. (2) Infants who looked longer at their mothers early in the still-face showed longer early positive affect and protested her absence less. (3) Girls more often showed an intensely negative response to the still-face. These findings are discussed in the context of the development of social regulatory capacities in infancy.

The age-related changes and individual stability of measures of visual habituation and changes with age were assessed in a sample of 38 infants seen longitudinally at 3, 4, 5, and 6 months. Three findings are presented. First, there was a gradual decrease in the duration of certain quantitative habituation measures between 3 and 6 months. Five measures—accumulated looking time, length of longest look and look at criterion, length of the baseline looking time, and the rate or slope of decline in looking—changed with age. Second, for individual infants, four of these habituation measures were reliable only between 3 and 4 months and not afterwards. Third, despite only moderate and early reliability in quantitative measures, a qualitative description of the habituation function—the pattern of decline—was more stable. Half of the infants in this sample maintained the same habituation pattern over 2 or 3 months. These findings are discussed in terms of developmental discontinuities in the middle months of the first year.

The present study aimed to explore the neural correlates of two characteristic deficits in Autism Spectrum Disorders (ASDs): social impairment and restricted, repetitive behavior patterns. To this end, we used comparable experiences of social exclusion and rule violation to probe potentially atypical neural networks in ASD. In children and adolescents with and without ASD, we used the interactive ball-toss game (Cyberball) to elicit social exclusion and a comparable game (Cybershape) to elicit a non-exclusive rule violation. Using functional magnetic resonance imaging (fMRI), we identified group differences in brain responses to social exclusion and rule violation. Though both groups reported equal distress following exclusion, the right insula and ventral anterior cingulate cortex were hypoactive during exclusion in children with ASD. In rule violation, right insula and dorsal prefrontal cortex were hyperactive in ASD. Right insula showed a dissociation in activation; it was hypoactive to social exclusion and hyperactive to rule violation in the ASD group. Further probed, different regions of right insula were modulated in each game, highlighting differences in regional specificity for which subsequent analyses revealed differences in patterns of functional connectivity. These results demonstrate neurobiological differences in processing social exclusion and rule violation in children with ASD.

Despite significant social difficulties, children with autism spectrum disorder (ASD) are vulnerable to the effects of social exclusion. We recorded EEG while children with ASD and typical peers played a computerized game involving peer rejection. Children with ASD reported ostracism-related distress comparable to typically developing children. Event-related potentials (ERPs) indicated a distinct pattern of temporal processing of rejection events in children with ASD. While typically developing children showed enhanced response to rejection at a late slow wave indexing emotional arousal and regulation, those with autism showed attenuation at an early component, suggesting reduced engagement of attentional resources in the aversive social context. Results emphasize the importance of studying the time course of social information processing in ASD; they suggest distinct mechanisms subserving similar overt behavior and yield insights relevant to development and implementation of targeted treatment approaches and objective measures of response to treatment.

Severe hypercalcemia occurred in a child with metastatic disease from a rhabdoid tumor of the kidney. Because there was no evidence of skeletal involvement by tumor, an investigation of the cause for hypercalcemia was undertaken. A greatly elevated serum concentration of immunoreactive parathyroid hormone (iPTH) was documented. This together with the observation of histologically normal parathyroid glands and the immunohistologic demonstration of parathyroid hormone within tumor cells supports the hypothesis of ectopic iPTH production by the tumor. The concurrence of an unusual metabolic complication with an infrequently encountered tumor variant is notable.

Relatively little is known about the psychiatric disorders of preschool children who present to mental health facilities for evaluation and treatment. The present study examines a series of 193 cases comprising all children under age 5 evaluated at a child psychiatric clinic over a 2-year period. The sample included 113 boys and 80 girls with a mean age of 39.8 months. Demographic information and patterns of referral are presented in addition to an assessment of the level of psychosocial stress in the family. These data are related to the presenting problems and final diagnoses. The applicability and appropriateness of DSM-III diagnostic categories to the disorders of preschool children are discussed.

again, and happily had a normal daughter. "For them, she had been worth it all." The medical concerns about matters such as "genetic counseling were basically irrelevant to them." Counseling a family "not to have more children" is not genetic counseling. Genetic counseling provides reliable information, not divine guidance, and is relevant to people irrespective of their religious beliefs. Information regarding children is everyone's right. Religion is one domain; genetic counseling is another. Frederick Hecht, M.D. The Genetics Center Southwest Biomedical Research Institute Tempe, A Z 85281

This research was done to learn more about the frequency and characteristics of conflicting research in case-control studies. In a survey of the epidemiological and medical literature, we found 56 topics in which the results of a case-control study were in conflict with the results from other studies of the same relationship. Cancer was the associated disease for 30 of the controversial topics. We suggest that much of the disagreement may occur because a set of rigorous scientific principles has not yet been accepted to guide the design or interpretation of case-control research. Consequently, the investigator's 'judgement' is the main precaution against scientific hazards and distortions in the validity of evidence. To correct this deficiency, we propose using the principles of an experimental trial to develop the scientific standards for case-control research.

• One hundred seventy-four preterm survivors of hyaline membrane disease, born 1961 through 1971, were followed up for at least six years with serial psychological and neurological evaluations. This relatively mature population had a mean birth weight of 2,133 g and gestational age of 34.6 weeks. All children had consecutive preschool and school age psychological tests. The mean preschool test score was 91 (SD = 13) and the mean school age score was 101 (SD =16). The ten-point difference between the mean preschool and school age test scores was significant. Perinatal variables and indexes of disease severity did not correlate with test scores. Higher test scores were correlated with higher paternal educational and employment levels. Improving test scores by school age may be due to test instruments that measure different cognitive skills and/or the diminishing effects of prematurity. ( AJDC 1985;139:20-24)

Background Problems with reward system function have been posited as a primary difficulty in autism spectrum disorders. The current study examined an electrophysiological marker of feedback monitoring, the feedback-related negativity (FRN), during a monetary reward task. The study advanced prior understanding by focusing exclusively on a developmental sample, applying rigorous diagnostic characterization and introducing an experimental paradigm providing more subtly different feedback valence (reward versus non-reward instead of reward versus loss). Methods Twenty-six children with autism spectrum disorder and 28 typically developing peers matched on age and full-scale IQ played a guessing game resulting in monetary gain (“win”) or neutral outcome (“draw”). ERP components marking early visual processing (N1, P2) and feedback appraisal (FRN) were contrasted between groups in each condition, and their relationships to behavioral measures of social function and dysfunction, social anxiety, and autism symptomatology were explored. Results FRN was observed on draw trials relative to win trials. Consistent with prior research, children with ASD exhibited a FRN to suboptimal outcomes that was comparable to typical peers. ERP parameters were unrelated to behavioral measures. Conclusions Results of the current study indicate typical patterns of feedback monitoring in the context of monetary reward in ASD. The study extends prior findings of normative feedback monitoring to a sample composed exclusively of children and demonstrates that, as in typical development, individuals with autism exhibit a FRN to suboptimal outcomes, irrespective of neutral or negative valence. Results do not support a pervasive problem with reward system function in ASD, instead suggesting any dysfunction lies in more specific domains, such as social perception, or in response to particular feedback-monitoring contexts, such as self-evaluation of one’s errors.

A.R.C. Institute of Animal Physiology, Babraham, Cambridge, CB2 4AT (Received 17 January 1978) For over 30 years, the method by which the brain regulates the secretion of gonadotrophic hormones has been studied by electrical stimulation of those parts of the central nervous system thought to be implicated in the control process. Much of the work has been performed on the female rat. In this species, anaesthetic doses of sodium pentobarbitone, administered immediately before the pro-oestrous 'critical period', block the preovulatory surge of luteinizing hormone (LH) for 24 h. The same treatment also reduces the early phase of the pro-oestrous secretion of follicle-stimulating hormone (FSH; Daane & Parlow, 1971). Electrical stimulation of the preoptic part of the hypothalamus can overcome this blocking effect and analysis of the optimum parameters required to restore normal secretion of gonadotrophins may give some insight into the endogenous process (e.g. Everett, 1965; Fink & Aiyer, 1974

The study by Bennett and co-workers (see p 888) addresses the question of developmental outcome in a sample of premature infants with hyaline membrane disease (HMD). Their report joins several recent studies on premature survivors in the last five years. 1-3 In this study, these authors followed up 161 preterm infants for two years and had an impressive return rate of 80% to 85%. They found that birth weight consistently correlated with Bayley scores at the age of 2 years. This reaffirms similar conclusions from earlier reports of infants born from 1965 to 1975. Because of a lack of both a detailed description of their data base and a display of the statistical analysis, it is difficult to comment further on their conclusions. For example, only mean birth weight was stated without a range, and there were no data on such perinatal risk factors as Apgar scores, time receiving ventilatory

To the Editor.— The recent study of otitis media by Schwartz et al,1 has basic methodologic problems that call into question the validity of the conclusions. The first relates to the definition of otitis media with effusion (OME). Criteria in the study have not been validated, and (more importantly) only 60% of the diagnoses of OME were confirmed by tympanometry. Did the other 40% really have OME? Would analysis using only children whose diagnosis was confirmed by tympanometry have led to the same results?