The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.

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Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

BACKGROUND
Previous studies have identified significant variability in attention-deficit / hyperactivity disorder (ADHD) prevalence estimates worldwide, largely explained by methodological procedures. However, increasing rates of ADHD diagnosis and treatment throughout the past few decades have fuelled concerns about whether the true prevalence of the disorder has increased over time.


METHODS
We updated the two most comprehensive systematic reviews on ADHD prevalence available in the literature. Meta-regression analyses were conducted to test the effect of year of study in the context of both methodological variables that determined variability in ADHD prevalence (diagnostic criteria, impairment criterion and source of information), and the geographical location of studies.


RESULTS
We identified 154 original studies and included 135 in the multivariate analysis. Methodological procedures investigated were significantly associated with heterogeneity of studies. Geographical location and year of study were not associated with variability in ADHD prevalence estimates.


CONCLUSIONS
Confirming previous findings, variability in ADHD prevalence estimates is mostly explained by methodological characteristics of the studies. In the past three decades, there has been no evidence to suggest an increase in the number of children in the community who meet criteria for ADHD when standardized diagnostic procedures are followed.

ADHD Prevalence Estimates Across Three Decades: An Updated Systematic Review and Meta-Regression Analysis

Within the past two decades, an "affect revolution" [Fischer and Tangney, Self-conscious Emotions: The Psychology of Shame, Guilt, Embarrassment, and Pride 1995:3-22] in research has revolutionized the ways in which emotion processes have been conceptualized and subsequently studied This review discusses the literature on emotion regulation (ER) in childhood and adolescence by first summarizing the trajectory of emotional development from infancy through adolescence, followed by a discussion of the biological and environmental influences on ER, and then a review of the literature linking ER to psychosocial functioning The penultimate section offers practical suggestions for identifying ER difficulties in children and strategies for intervention efforts Potential areas for future research conclude the review

Emotion regulation in children and adolescents.

Context Decades of randomized controlled trials have produced separate evidence-based treatments for depression, anxiety, and conduct problems in youth, but these treatments are not often used in clinical practice, and they produce mixed results in trials with the comorbid, complex youths seen in practice. An integrative, modular redesign may help. Objective Standard/separate and modular/integrated arrangements of evidence-based treatments for depression, anxiety, and conduct problems in youth were compared with usual care treatment, with the modular design permitting a multidisorder focus and a flexible application of treatment procedures. Design Randomized effectiveness trial. Setting Ten outpatient clinical service organizations in Massachusetts and Hawaii. Participants A total of 84 community clinicians were randomly assigned to 1 of 3 conditions for the treatment of 174 clinically referred youths who were 7 to 13 years of age (70% of these youths were boys, and 45% were white). The study was conducted during the period from January 12, 2005 to May 8, 2009. Interventions Standard manual treatment (59 youths [34% of the sample]; cognitive behavioral therapy for depression, cognitive behavioral therapy for anxiety, and behavioral parent training for conduct problems), modular treatment (62 youths [36%]; integrating the procedures of the 3 separate treatments), and usual care (53 youths [30%]). Main Outcome Measures Outcomes were assessed using weekly youth and parent assessments. These assessments relied on a standardized Brief Problem Checklist and a patient-generated Top Problems Assessment (ie, the severity ratings on the problems that the youths and parents had identified as most important). We also conducted a standardized diagnostic assessment before and after treatment. Results Mixed effects regression analyses showed that modular treatment produced significantly steeper trajectories of improvement than usual care and standard treatment on multiple Brief Problem Checklist and Top Problems Assessment measures. Youths receiving modular treatment also had significantly fewer diagnoses than youths receiving usual care after treatment. In contrast, outcomes of standard manual treatment did not differ significantly from outcomes of usual care. Conclusions The modular approach outperformed usual care and standard evidence-based treatments on multiple clinical outcome measures. The modular approach may be a promising way to build on the strengths of evidence-based treatments, improving their utility and effectiveness with referred youths in clinical practice settings. Trial Registration clinicaltrials.gov Identifier: NCT01178554

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Testing Standard and Modular Designs for Psychotherapy Treating Depression, Anxiety, and Conduct Problems in Youth: A Randomized Effectiveness Trial

Brain-derived neurotrophic factor-5-HTTLPR gene interactions and environmental modifiers of depression in children

Background
Family accommodation has been studied in obsessive compulsive disorder using the Family Accommodation Scale (FAS) and predicts greater symptom severity, more impairment, and poorer treatment outcomes. However, family accommodation has yet to be systematically studied among families of children with other anxiety disorders. We developed the Family Accommodation Scale—Anxiety (FASA) that includes modified questions from the FAS to study accommodation across childhood anxiety disorders. The objectives of this study were to report on the first study of family accommodation across childhood anxiety disorders and to test the utility of the FASA for assessing the phenomenon.

Methods
Participants were parents (n = 75) of anxious children from two anxiety disorder specialty clinics (n = 50) and a general outpatient clinic (n = 25). Measures included FASA, structured diagnostic interviews, and measures of anxiety and depression.

Results
Accommodation was highly prevalent across all anxiety disorders and particularly associated with separation anxiety. Most parents reported participation in symptoms and modification of family routines as well as distress resulting from accommodation and undesirable consequences of not accommodating. The FASA displayed good internal consistency and convergent and divergent validity. Accommodation correlated significantly with anxious but not depressive symptoms, when controlling for the association between anxiety and depression. Factor analysis of the FASA pointed to a two-factor solution; one relating to modifications, the other to participation in symptoms.

Conclusions
Accommodation is common across childhood anxiety disorders and associated with severity of anxiety symptoms. The FASA shows promise as a means of assessing family accommodation in childhood anxiety disorders.

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Family accommodation in pediatric anxiety disorders.

Most researchers rely exclusively on the reports of protective service workers to determine children's abuse history. In this report, information about children's maltreatment experiences is obtained from protective service workers and three supplementary sources of data: parents, medical records, and clinical observations. Fifty-six children from 34 families receiving protective services for verified reports of physical abuse, neglect, sexual abuse, and/or emotional maltreatment participated in the study, with most children known to have experienced more than one type of abuse. The supplementary data provided important information about the range and severity of children's maltreatment experiences. Review of the parent and medical record data led to identification of 28 children who had additional types of maltreatment experiences that were not reported by their protective services workers—nine cases of physical abuse, two cases of neglect, five cases of sexual abuse, and 12 cases of emotional maltreatment. Supplementary data also revealed information about incidents of specific types of abuse that were more severe than those reported by the children's protective service workers in an additional 24 cases. A method was devised to synthesize information provided from the different sources of data examined in this report to derive 0–4 point ratings of four categories of maltreatment experiences: (1) physical abuse, (3) neglect, (3) sexual abuse, and (4) emotional maltreatment. The Kappa reliability coefficients for each of these scales were .88, .73, .83, and .90, respectively. Data demonstrating the relationship between these maltreatment ratings and various indices of the children's socioemotional and cognitive functioning were also presented to provide preliminary support for the validity of these scales. The findings from this study suggest that multiple sources of data should be examined in order to obtain accurate assessments of children's maltreatment experiences, and that independent raters can synthesize discrepant data to obtain reliable and valid estimates of children's abuse history. Clinical and methodological issues relevant to the improved assessment of children's maltreatment experiences are also discussed.

The use of multiple informants to assess children's maltreatment experiences

From several different perspectives, the question of long-term outcomes for learning-disabled children is an important one Answers to scientific questions about the nature and developmental course of learning disabilities, as well as the resolution of policy issues concerning the allocation of resources for intervention, may depend on results from follow-up studies of learning-disabled persons Unfortunately, different follow-up studies have produced a variety of conflicting results Through a careful analysis of the methodologies employed in existing studies, this month's Topical Review not only shows why the research has produced inconsistent results, but also shows how some of these inconsistencies can be resolved A final contribution of this article is to point out the need for specific methodologies in future follow-up research with learning-disabled children—JKT

Long-Term Follow-up Studies of Learning-Disabled Persons

Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders

https://www.childpsych.theclinics.com/article/S1056-4993(03)00027-0/pdf

Lawrence A. Vitulano

Papers

Family accommodation in pediatric anxiety disorders.

The use of multiple informants to assess children's maltreatment experiences

Long-Term Follow-up Studies of Learning-Disabled Persons

Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders

Psychosocial issues for children and adolescents with chronic illness: self-esteem, school functioning and sports participation.