0196-206X/00/2206-0448

Developmental and Behavioral Pediatrics Vol. 22, No. 6, December 2001

Copyright # 2001 by Lippincott Williams & Wilkins, Inc. Printed in U.S.A.

Journal Article Reviews

STUART W. TEPLIN, M.D., Editor
CATHERINE L. GRUS, PH.D.
ADRIAN D. SANDLER, M.D.
MICHAEL I. REIFF, M.D.

This section provides brief reviews of articles from many journals that relate to the interests of individuals seeking
information on research and teaching in developmental and behavioral pediatrics. The reviews will not provide critical
comments, but the articles have been selected from peer-reviewed journals.
Readers are invited to recommend articles for inclusion in this section. If you read or author an article you believe would
interest our readers, please send a copy to Mary F. Sharkey, Journal of Developmental and Behavioral Pediatrics, 345 West
70th Street, #6F, New York, NY 10023.

ADOLESCENT ANXIETY/DEPRESSION: ADOLESCENT MOTHERS WITH OLDER

SCREENING
Dierker L, Albano AM, Clarke GN, et al: Screening for anxiety
and depression in early adolescence. J Am Acad Child Adolesc
Psychiatry 40:929, 2001. Prevalence estimates for anxiety
and depression during childhood and adolescence range from
8% to 22% and 2% to 5%, respectively. Dimensional rating
scales have traditionally been used as the initial approach to
case identification. Questions remain about the diagnostic
accuracy of dimensional rating scales. Can they distinguish
between anxiety and depression? Can they discriminate between
an individual with a single condition and one with comorbid
conditions? How effective are they in identifying cases drawn
from the community? This study used classroom screening and
diagnostic interview data. The analyses examined the level of
diagnostic and discriminative accuracy of three dimensional
rating scales used to detect cases of anxiety, depression, and
comorbidity within and across these categories in a school-
based sample of adolescents. Subjects included 632 youths from
three sites. Classroom screening instruments, the Center for
Epidemiologic Studies-Depression Scale (CES-D), the Revised
Childrens Manifest Anxiety Scale (RCMAS), and the Multi-
dimensional Anxiety Scales for Children (MASC) were
administered to these youths. Samples of high-scoring and
nonhigh-scoring youths participated in diagnostic interviews
conducted within 2 months of the screenings. The MASC
emerged as the most successful measure of individual and
comorbid anxiety conditions, particularly among females. The
CES-D composite score was associated with the diagnosis of
major depression, after controlling for comorbidity. The
RCMAS was limited in its ability to detect anxiety and/or
depression. The authors cite the relatively new use of these
leading rating scales within communities to identify high-
scoring samples to target for intervention programs. In this
setting, scores mirroring a diagnostic gold standard become less
important than identification of the core features of a disorder
that may be most responsive to specific prevention efforts. The
authors suggest that this will be an important next step in
evaluating the psychometric utility of these instruments. They
conclude that these rating scales provided moderate prediction
of clinical status; the MASC performed best in detecting anxiety
symptoms. M.I.R.
ADULT PARTNERS
Agurcia CA, Rickert VI, Berenson AB, Volk RJ, Wiemann CM:
The behavioral risks and life circumstances of adolescent
mothers involved with older adult partners. Arch Pediatr
Adolesc Med 155:822, 2001. Adult males who are at least
5 years older than their adolescent girl partners father more than
20% of all live births to these adolescent girls. These age-
discrepant couples tend to have great differences in maturity,
sexual and life experiences, social position, financial resources,
and educational attainment. There has been an increasing
interest in enforcing widely ignored statutory rape laws in an
effort to reduce the rates of pregnancy and to protect these
vulnerable young women. This study was undertaken to
compare behavioral risks and life circumstances of adolescent
mothers with older partners versus those with similar-aged
partners. Nine hundred thirty-one adolescent mothers who
delivered at the University of Texas Medical Branch at
Galveston were interviewed after delivery and by mail survey
at 12 months postpartum. Demographic information was
obtained, as well as information regarding intimate partner
violence and substance use, social support, and social isolation.
Thirty-seven percent of mothers with older partners had
completed 9th grade or less compared with 17% of mothers
with same-aged partners. Adolescent mothers with older adult
partners were more likely than adolescents with similar-aged
partners to have experienced a subsequent planned pregnancy or
to be trying to conceive at the time of follow-up, regardless of
whether they currently lived with a parent or guardian, or
whether their current partner had also fathered their previous
child. These mothers with older partners were also less likely to
be employed or enrolled in school. They were more likely to
have established their own households, but received less social
support. The use of alcohol or other drugs and exposure to
intimate partner violence did not differ among the groups.
Adolescent mothers with older partners were, however, more
likely to report that their partners refused to use condoms.
Adolescent mothers who had older partners and were not living
with a parent or guardian were more likely to report that their
partner did not allow the use of contraception. The authors
conclude that, given their limited educational attainment and
family support, a subsequent pregnancy could easily place these

448
 Journal Article Reviews
mothers and their offspring at considerable financial and
educational disadvantage. M.I.R.
ATTENTION-DEFICIT HYPERACTIVITY
DISORDER: SENSORY DYSFUNCTIONS
Mangeot SD, Miller LJ, McIntosh DN, et al: Sensory modulation
dysfunction in children with attention-deficit hyperactivity
disorder. Dev Med Child Neurol 43:399, 2001. Sensory
modulation is the capacity to regulate and organize the degree,
intensity, and nature of responses to sensory input. Sensory
modulation dysfunction (SMD) presents with two opposite
behavioral patterns: sensation seeking and sensation avoiding.
Emotional responses associated with sensory avoiding are
typically explosive, aggressive, and hostile behaviors. Emo-
tional responses associated with sensation seeking include
disregard for others, inability to regulate intensity and duration
of interaction with others, and mania. A high percentage of
children with attention disorders are noted to have sensory
processing problems and/or to show difficulty modulating
sensory responses. This study investigated the presence of SMD
among children with attention-deficit hyperactivity disorder
(ADHD). Twenty-six children with ADHD (18 boys, 8 girls),
ages 5 to 13 years (mean age 8.2 years), and 30 typically
developing children of similar age and gender were tested using
electrodermal responses (EDR), which are changes in electrical
conductance of the skin. Experimenters, blind to participants
groups, administered stimuli in five sensory domains: olfactory,
auditory, visual, tactile, and vestibular. Medications were
discontinued 24 to 48 hours before the physiologic testing.
Parental report measures of sensory, emotional, and attentional
problems were administered, including the Short Sensory
Profile and the Child Behavior Checklist. Compared with the
typical sample, children in the ADHD group displayed greater
abnormalities in sensory modulation on both physiologic and
parent-report measures. The group with ADHD showed greater
reactivity to sensory stimuli, with larger initial reactions and
subsequent habituation. Twenty-four percent of children with
ADHD scored within normal limits on the Short Sensory
Profile, whereas 29 of 30 typically developing children scored
within normal limits. The children with ADHD also displayed
more variability in responses. Within the ADHD group, levels
of SMD were highly correlated with measures of psychopathol-
ogy on the Child Behavior Checklist. The findings suggest that
sensory processing abilities may be impaired in a subgroup of
children with ADHD and that such impairment may have
behavioral significance. A.D.S.
ATTENTION-DEFICIT HYPERACTIVITY
DISORDER: TREATMENT ISSUES
Pelham WE, Gnagy EM, Burrows-Maclean L, et al: Once-a-day
Concerta methylphenidate versus three-times-daily methylphe-
nidate in laboratory and natural settings. Pediatrics 107,
2001. URL: http://www.pediatrics.org/cgi/content/full/107/6/
e105 This study assesses the efficacy and duration of action of
Concerta, an extended-release preparation of methylphenidate
(MPH). Sixty eight children with attention-deficit hyperactivity
disorder (ADHD), ages 6 to 12 years, participated in a within-
subject, double-blind comparison of placebo, short acting MPH
administered three times a day, and Concerta given once a day.
Each childs dose was based on his maintenance dose before the
study: children on MPH 5 mg three times daily (t.i.d.) took
Concerta 18 mg, those on MPH 10 mg t.i.d. took Concerta 36
mg, and those on 15 mg t.i.d. took Concerta 54 mg. Children
449
received each medication for 7 days. Teachers completed a daily
report card, and parents and teachers completed a weekly
behavior rating scale. To evaluate the time course of medication
effects, children spent 12 hours on Saturdays in a laboratory
classroom setting. Reports of adverse events were collected. On
virtually all measures and in all settings, both drug conditions
were significantly different from placebo, and the two drugs
were not different from each other. In the lab setting, effects of
Concerta were comparable to t.i.d. methylphenidate and lasted at
least through 12 hours. Effects were evident for academic
performance and social behavior with peers. This study provides
a model for clinical trials of new psychoactive drugs in children,
with multiple raters, in natural and lab settings, and across a
range of domains of impairment. A.D.S.
Thiruchelvam D, Charach A, Schachar RJ: Moderators and
mediators of long-term adherence to stimulant treatment in
children with ADHD. J Am Acad Child Adolesc Psychiatry
40:922, 2001. Numerous short-term studies have shown that
stimulant medications are effective in treating symptoms of
restlessness, inattentiveness, and impulsivity in children with
attention-deficit hyperactivity disorder (ADHD). There are a
limited number of studies that provide information about long-
term adherence to stimulant medication. The objective of this
study was to identify and investigate moderators and mediators
of adherence to stimulant medication. This knowledge would
help to customize treatment programs to assist those children
most likely to need help with continuing a regimen of stimulant
medication. Seventy-one children, diagnosed with ADHD and
taking methylphenidate, were followed prospectively on an
annual basis for a 3-year period. Medication adherence was
measured, along with moderators and mediators. Moderators
(baseline characteristics specific to the child) included symp-
toms of ADHD, oppositional and defiant disorder (ODD),
conduct disorder (CD), learning disabilities, anxiety, age,
psychosocial adversity, and family dysfunction. Response to
treatment in school was used to assess mediators (factors that
arise after initiation of treatment and affect whether a child
continues to take stimulant medication). Eighty-one percent of
subjects continued to use stimulant medication at 12 months,
and 52% of subjects adhered to stimulants for the 3 years of the
study. Some of the children who discontinued stimulants
subsequently returned to using them at later points in time.
The most salient moderating factor influencing stimulant
treatment adherence was the absence of ODD at school
(children discontinuing medication were 11 times more likely
to have ODD). Adherents to the medication regime were also
more likely than nonadherents to be younger and to have more
teacher-rated ADHD symptoms at school. The authors suggest
that oppositional defiant symptoms at school, especially in the
presence of lower levels of ADHD symptoms, are a strong
indicator that a child will have difficulty continuing to take
medication continuously for 3 years and that targeting these
children with resources designed to improve stimulant medi-
cation adherence may be particularly important, especially as
they approach adolescence. M.I.R.
AUTISM: AMANTADINE TREATMENT
King BH, Wright DM, Handen BL, et al: Double-blind, placebo-
controlled study of amantadine hydrochloride in the treatment of
children with autistic disorder. J Am Acad Child Adolesc
Psychiatry 40:658, 2001. Excitatory amino acids are involved
in neuronal regulation. Areas of the brain found to exhibit
cellular abnormalities in autism show a high degree of N-methyl-
D-aspartate (NMDA) receptors. Amantadine hydrochloride has
been found to have noncompetitive NMDA antagonist activity.
450 Journal Article Reviews
There are limited data suggesting amantadine may decrease
behaviors such as aggression and hyperactivity. Thirty-nine
subjects with autism, ages 5 to 19 years, were recruited and
enrolled in this multicenter study. Subjects all had a high degree
of irritability and hyperactivity and an IQ greater than 35. The
Aberrant Behavior Checklist (ABC) and Clinical Global
Impressions (CGI) scales were used as primary outcomes.
Nineteen subjects were randomly assigned to receive amantadine
and 20 to receive placebo. The treatment phase was 4 weeks. The
dosing regimen was once a day for the first week and twice a day
thereafter, with a dose of 5 mg/kg per day. The mean placebo
response rate was 37% versus amantadine at 47% (not
significant). When assessed on parent-rated ABC scales of
irritability and hyperactivity, there were no significant differ-
ences between groups. Analysis of blinded investigator-rated
ABC scores at baseline and again at 5 weeks showed statistically
significant improvement in absolute change from baseline
scores of hyperactivity and inappropriate speech. CGI ratings
were higher in the amantadine group: 53% showed global
improvement versus 25% in the placebo group ( p = .076).
Amantadine was well tolerated. Although the findings are
inconclusive, they suggest that further studies of this medication
are warranted. A.D.S.
CHRONIC ILLNESS
Spieth LE, Stark LJ, Mitchell MJ, et al: Observational assessment
of family functioning at mealtime in preschool children with
cystic fibrosis. J Pediatr Psychol 26:215, 2001. The authors
of this study investigated family functioning during mealtimes
in families of children with and without cystic fibrosis (CF).
Groups were matched for age of child, gender, number of
parents and siblings present at the meal, and SES. Ages of the
children ranged from 2 years to 5 years, 11 months. Families
were videotaped during mealtimes, and meals were coded for
the presence of certain behaviors. Differences were noted
between the groups, with families of children with CF rated as
lower on an overall measure of family functioning, as well as in
the areas of communication, interpersonal involvement, affect
management, behavior control, and roles. Scores on all scales
fell into the unhealthy range for families with a child with
CF. However, the weight-for-age percentile was not associated
with overall ratings of family functioning. Results appeared to
indicate that having a child with CF poses specific challenges
for the family. C.L.G.
Special Series: Empirically supported treatments in pediatric
psychology. J Pediatr Psychol 26:253, 2001. This special
series includes a review article of empirically supported
treatments for regimen adherence, two commentaries on this
article, and reviews of two books on treatment adherence. The
review article addresses intervention studies that target non-
adherence to regimens for asthma, juvenile rheumatoid arthritis,
and type 1 diabetes. The prevalence and correlates of non-
adherence, possible intervention strategies, and an overview of
the medical characteristics and treatments for each of these
diseases are presented. Intervention studies for each illness are
examined according to criteria developed by a task force from
the American Psychological Association (Chambless criteria) to
assess their efficacy. C.L.G.
Ireys HT, Chernoff R, DeVet KA, Kim Y: Maternal outcomes of a
randomized controlled trial of a community-based support
program for families of children with chronic illness. Arch
Pediatr Adolesc Med 155:771, 2001. Parents of children with
chronic illness are at high risk for mental health problems such
as anxiety and depression. This randomized controlled clinical
trial with repeated measures 1 year apart examined maternal
JDBP/December, Vol. 22, No. 6
outcomes of a support intervention for families of children with
specific chronic illnesses. A population-based sample of 193
mothers of children ages 7 to 11 years with diabetes, sickle cell
disease, cystic fibrosis, or moderate-to-severe asthma was
included. About 15% of those contacted refused to participate,
and 14% of the families were lost to follow-up. The 15-month
intervention, the Family-to-Family Network, was designed to
enhance mothers mental health by linking mothers of school-
age children with mothers of older children with the same
condition. The program was community-based and included
telephone contacts, face-to-face visits, and special family
events. The veteran Network Mothers aimed to identify
naturally occurring sources of support, point out examples of
effective parenting by the mothers, and point out opportunities
for strengthening these sources of support and existing
parenting skills. The main outcome measures were the Beck
Depression Inventory and the Psychiatric Symptom Index.
Maternal anxiety scores for participants in the experimental
group decreased during the intervention period for all diagnos-
tic groups, whereas scores for the control group increased
(F = 5.07, p = .03). In a multiple regression analysis, the
intervention was a significant predictor of posttest anxiety
scores. Effects were greater for mothers with higher baseline
anxiety ( p < .001) and for those who were themselves in poor
health ( p < .01). The study provides solid empiric evidence for
the beneficial effect of a parent-to-parent family support
intervention on the mental health status of mothers of children
with chronic illnesses. A.D.S.
IRON DEFICIENCY AND COGNITIVE
DEVELOPMENT
Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi
PG: Iron deficiency and cognitive achievement among school-
aged children and adolescents in the United States. Pediatrics
107:1381, 2001. The relationship between iron status and
cognitive achievement in older children is unclear. The National
Health and Nutrition examination Survey III 19881994
provides cross-sectional data on children 6 to 16 years of age
and contains measures of iron status, including transferrin
saturation, free erythrocyte protoporphyrin, and serum ferritin.
Children were considered iron-deficient if any two of these
measures were below age and gender norms. Anemia was
defined using norms for standard hemoglobin measures. Scores
on standardized tests of academic achievement were compared
among children with normal iron status, iron deficiency without
anemia, and iron deficiency with anemia. Logistic regression
was used to estimate the association of iron status with
achievement, controlling for confounding factors. Among
5938 children in the sample, 3% were iron deficient. The
prevalence of iron deficiency was highest among adolescent
girls (8.7%). Compared with children with normal iron status,
children with iron deficiency, with or without anemia, had lower
math achievement (93.7, 86.4, and 87.4 respectively). Children
with iron deficiency had twice the risk of scoring below average
in math than children with normal iron status (odds ratio 2.3;
95% confidence interval: 1.14.4). Although causality cannot
be inferred, the association raises questions about screening and
therapy. A.D.S.
NEGLECT AND COGNITIVE DEVELOPMENT
Strathearn L, Gray PH, OCallaghan MJ, Wood DO: Childhood
neglect and cognitive development in extremely low birth weight
infants: A prospective study. Pediatrics 108:142, 2001. This
 Journal Article Reviews
study from Brisbane, Australia, examines the relationship
between child maltreatment and cognitive development in
extremely low birth weight infants, adjusting for perinatal and
parental risk factors. A total of 352 infants with birth weight less
than 100 g were followed prospectively for 4 years. At 4 years,
269 (76%) of these children were cognitively assessed, using the
McCarthy general cognitive index. Perinatal risk factors and
parental risk factors were measured prospectively. Cognitive
z scores were calculated at 1, 2, and 4 years, and head circ-
umference z scores at birth, 2 years, and 4 years. Fifty-two (15%)
of the children were referred to child protective services for
suspected maltreatment; 32 (11.9%) were referred before the
4-year assessment. Fifty percent of these 32 infants were referred
before the age of 5.5 months. Thirty-one children (60% of those
referred) had one or more substantiated report, including 19
children with substantiated neglect. Those cognitively assessed
at 4 years included 32 of the 52 referred infants. The adjusted
general cognitive index at 4 years was significantly reduced in
infants referred for neglect (cognitive z score: 17.6; 95%
confidence interval: 3.3, 31.9). Infants whose neglect was
substantiated had a progressive decline in their cognitive
function over time (cognitive z scores: .97, 1.37, and
2.05 standard deviations at 1, 2, and 4 years, respectively),
compared with nonneglected infants. They had significantly
smaller head circumference at 2 and 4 years, but not at birth
(adjusted z score at 4 years: .81; 95% confidence interval:
.17, 1.46). Perinatal risk factors and physical disability were
not related to maltreatment referral; only parental factors were
independent predictors. The findings indicate that childhood
neglect is associated with delayed cognitive development and
head growth in this high-risk population. A.D.S.
PHYSICAL ACTIVITY: PSYCHOSOCIAL
CORRELATES
Strauss RS, Rodzilsky D, Burack G, Colins M: Psychosocial
correlates of physical activity in healthy children. Arch Pediatr
Adolesc Med 155:897, 2001. Pubertal and postpubertal
children spend only 8 to 10 minutes per day in aerobic activity.
Family, peers, and schools are known to influence and affect
physical activity levels in children. The aims of this study were
to (1) describe social and cognitive factors associated with
physical activity in children 10 to 16 years of age, (2)
investigate the relationship between sedentary activities and
physical activity, and (3) explore the relationship between
physical activity and self-esteem. Ninety-two children, ages 10
to 16 years, were recruited for the study. Each child completed a
physical activity questionnaire that included scales to measure
self-efficacy, social influences, and health beliefs. Levels of
habitual physical activity were assessed with a biaxial
accelerometer worn on the waists for 1 week during waking
hours. Self-esteem was measured by the Piers-Harris Children
Self-Concept Scale, and anxiety was measured using the
Revised Childrens Manifest Anxiety Scale. Children spent
over 10 sedentary hours each day and were involved in vigorous
physical activity for only 12 to 13 minutes per day. There was
also a significant decline in activity level as children progressed
through adolescence (particularly in girls). The childs belief in
his or her ability to become physically active (self-efficacy) was
a major correlate of high-level activity in the study children. In
contrast, the childrens health beliefs about the benefits of
physical activity were not related to actual activity levels.
Sedentary time was equally divided between viewing television,
sitting at the computer, and doing homework (previous studies
have tended to focus solely on television viewing as a marker
for sedentary behavior). In this study high-level (but not
451
moderate-level) physical activity was associated with improved
scores on self-esteem measures. No relationship was observed
between physical activity levels and anxiety. The authors
conclude that, although high-level physical activity is an
important element in the development of childrens self-esteem,
healthy children rarely engage in vigorous physical activity. To
be most effective, intervention efforts should primarily target
decreasing television and computer time and increasing self-
efficacy. M.I.R.
PLAY AND EMOTIONAL ADJUSTMENT
Coplan RJ, Gavinski-Molina M, Lagace-Seguin DG, Wichmann
C: When girls versus boys play alone: Nonsocial play and
adjustment in kindergarten. Dev Psychol 37:464, 2001. The
authors investigated the relationship between nonsocial play and
adjustment outcomes. Participants were 77 children attending
kindergarten who were studied over the course of the school
year. Reticent behavior, in both boys and girls, was associated
with shyness and negatively associated with social and
academic competence. Solitary-passive play was positively
associated with measures of adjustment, whereas for boys this
association was negative. The presence of solitary-active play
was related to parent ratings of greater emotional dysregulation
and teacher ratings of lower social competence and greater
internalizing problems. Girls who engaged in at least one
episode of solitary-active play had significantly more external-
izing problems than girls who did not. The authors conclude that
these results represent a beginning in the understanding of
potential gender differences in nonsocial play behaviors in
young children. C.L.G.
POSTTRAUMATIC STRESS DISORDER
Foa EB, Johnson KM, Feeny NC, Treadwell KRH: The Child
PTSD Symptom Scale: A preliminary examination of its psy-
chometric properties. J Clin Child Psychol 30:376, 2001. This
article presents information on the development and validation
of a new self-report measure of posttraumatic stress disorder
(PTSD) in children, the Child PTSD Symptom Scale (CPSS).
The CPSS was designed to be a screening tool. The authors
note a need for such a measure because existing measures of
PTSD in children do not include all of the DSM-IV criteria for
PTSD. Participants in the standardization sample included 75
children and adolescents, ages 8 through 15 years (mean,
11.8 years), who had experienced an earthquake. The CPSS
contains one item for each of the DSM-IV criteria for PTSD
and seven additional items that ask about daily functioning.
Participants completed the CPSS approximately 25 months after
the earthquake. Of note, 24% of the sample reported symptoms
that would be consistent with a diagnosis of PTSD. Assessment
of the reliability and validity of the CPSS indicated this mea-
sure has adequate psychometric properties. Functional impair-
ment was related to PTSD severity. The authors concluded that
the CPSS is a reliable and valid instrument for assessing the
severity of symptoms associated with PTSD after a single
traumatic incident. C.L.G.
SUICIDAL IDEATION: EARLY PREDICTORS
McGee R, Williams S, Nada-Raja S: Low self-esteem and
hopelessness in childhood and suicidal ideation in early
adulthood. J Abnorm Child Psychol 29:281, 2001. The
authors examined individual and family characteristics during
childhood that may lead to suicidal ideation in early adulthood.
Participants were part of a longitudinal study; they were
452 Journal Article Reviews
enrolled at age 3 years and have been evaluated repeatedly
through adulthood. Data for the present study was obtained
from a sample of 732 of the participants. When asked at ages
18, 21, or both, 17.3% of the sample reported having thoughts
of suicide, with significantly more females (21.2%) than males
(13.7%) endorsing this. Path analyses were conducted and
revealed that low self-esteem and feelings of hopelessness early
in life were predicted by family characteristics. Socioeconomic
disadvantage predicted higher levels of hopelessness and lower
levels of self-esteem in boys, whereas in girls socioeconomic
disadvantage predicted only lower self-esteem. Harsh parent-
child interactions predicted hopelessness in girls. Harsh parent-
child interactions predicted thoughts of self-harm among boys,
and poor family climate predicted thoughts of self-harm in girls.
For boys, thoughts of self-harm was related to later suicidal
ideation; this path was not observed in girls. C.L.G.
VIOLENCE
Moskowitz H, Griffith JL, DiScala C, Sege RD: Serious injuries and
deaths of adolescent girls resulting from interpersonal violence:
Characteristics and trends from the United States 19891998.
Arch Pediatr Adolesc Med 155:903, 2001. Research on youth
violence has focused mainly on boys. However, in the United
States, a womens experience of violence from both strangers
and intimate partners, often with medical and psychological
sequelae, is also a major problem. This study was undertaken to
determine the pattern of severe violence-related injuries among
adolescent girls in the United States, including those perpetrated
by strangers and intimate partners. Data from the National
Pediatric Trauma Registry (NPTR) and the Centers for Disease
Control and Preventions Web-Based Injury Statistics and
Query Reporting System were analyzed. The records of 612
adolescent girls who were seriously injured secondary to an
assault were compared with 2656 adolescent boys with a similar
history. In addition, 3487 adolescent girls who died by homicide
were compared to 17,292 boys who had been murdered.
Although more adolescent boys than girls were treated for
assault-related injuries, the number of assaulted adolescent girls
continues to be alarming. Although there was a dramatic decline
in weapons-related injury among adolescent boys in the 1990s,
this was only weakly mirrored among adolescent girls. In
JDBP/December, Vol. 22, No. 6
addition, adolescent girls who were assaulted were more likely
to have significantly higher levels of pre-existing cognitive or
psychosocial impairments than were adolescent boys who were
assaulted. There was also a trend for adolescent girls to have
more injury-related impairments at discharge from the hospital
than did boys. Adolescent girls were more likely than boys to
have been stabbed and less likely to have been shot. Contrary to
current information in the lay media (which focuses primarily
on boys), this study found that adolescent girls were more likely
than boys to have been assaulted in a home (rather than at
school) and that girls are less likely than boys to be victims of
handgun violence, but more likely than boys to be injured by
piercing weapons. The study suggests that there is a need to
further refine approaches to violence prevention by taking into
account the different needs of adolescent boys versus those of
girls. Prevention programs for girls should focus on preventing
attacks from occurring in a girls or a friends home. M.I.R.
Jackman GA, Farah MM, Kellerman AL, Simon HK: Seeing is
believing: What do boys do when they find a real gun?
Pediatrics 107:1247, 2001. A convenience sample of 29 boys,
ages 8 to 12 years, was recruited. Parents were asked to rate their
childs interest in guns. Parents of eligible subjects were asked to
bring to the exercise one of their childs playmates and/or
brothers of similar age. Each pair or trio of boys was left in a
room with a one-way mirror and observed for 15 minutes. Two
water pistols and an actual .38 caliber handgun were concealed
in separate drawers. The handgun contained a radio transmitter
that was activated when the trigger was depressed with sufficient
force to fire the gun. After the exercise, each boy was asked
whether he thought the gun was real or a toy. Before leaving,
each child was counseled about gun safety. A total of 64 boys (29
groups) took part in the study. Boys in 21 of the groups (72%)
discovered the handgun. Boys in 16 of the groups handled the
gun, and one or more members of 10 of the groups (a total of 16
boys) pulled the trigger. Approximately half of the boys who
found the gun thought it was a toy or were unsure if it was real.
Parental estimates of their childs interest in guns did not predict
actual behavior on finding the gun. Boys who were believed to
have a low interest in guns were just as likely to handle the gun
or fire it as those with high interest. More than 90% of the boys
who handled the gun or pulled the trigger reported that they had
received previous instruction on gun safety. A.D.S.