- Email: [email protected]
Asperger's Syndrome in Young Children: A Developmental Guide for Parents and Professionals
BOOK REVIEWS
about physical therapies, occupational therapy, and music therapy, just to name a few other modalities helpful for individuals with autism. As a teacher of future child and adolescent psychiatrists, I would echo many of the same observations I made while wearing my academic and clinical hats. I would take away nothing from the theoretical components of the book, for sometimes training programs go too light on science so as not to sacrifice practical clinical time and experience. However, theoretical understanding is the foundation for quality clinical care. Again, trainees could benefit from additional practical translations and clinical applications of the theory and research so well explained in the Handbook. Finally, I cannot totally divorce the part of me that is the mother of a child with autism when I read any scientific or clinical work on the topic. Nothing is more frustrating than medical or psychiatric material written by someone who either has no clue or no empathy about what it is really like to brush an autistic toddler_s teeth or take him for a haircut. Although the Handbook_s third edition was never intended to be a how-to manual for clinicians, parents, teachers, or child care workers, it does pass the Btoothbrushing-and-haircut test[ in that it conveys an implicit respect for parents and caregivers and devotes substantial space to the scientific underpinnings of family considerations, behavioral management, school, and other arenas that are frequently so much more important to the daily lives of autistic individuals and their families than isotopes and research questionnaires, as important as those and other topics are to future advancement in the field. In the preface to the third edition, the editors write BA Handbook portrays what is known and reveals what is poorly understood. I In spite of great effort and decades of commitment by researchers and clinicians, the fate of most autistic individuals remains cloudy; and even with new knowledge, there are still too many areas of controversy. That investigators and clinicians, working alongside families and advocates, have learned so much, often with very tight resources, speaks to their commitment to understanding and caring for autistic children and adults. The goal of this Handbook is to document their achievements and inspire their future efforts[ (p. xix). By this standard, the editors and contributors to the Handbook_s third edition, have achieved, even exceeded, their goals. Mary Lynn Dell, M.D., Th.M. Emory University School of Medicine Atlanta
Disclosure: The author has no financial relationships to disclose.
J. AM. ACAD. CH ILD ADOLESC. PSYCH IATRY, 45:6, JUNE 2006
Asperger’s Syndrome: Intervening in Schools, Clinics and Communities. Edited by Linda J. Baker and Lawrence A. Welkowitz. Mahwah, NJ: Lawrence J. Erlbaum Associates, 2005, 298 pp., $34.50 (softcover). Asperger_s Syndrome in Young Children: A Developmental Guide for Parents and Professionals. By Laurie Leventhal-Belfer and Cassandra Coe. London: Jessica Kingsley Publishers, 2004, 303 pp., $19.95 (softcover). With increased awareness of Asperger_s syndrome (AS), the number of books on the topic geared toward parents and family members has similarly grown, putting child psychiatrists in the role of recommending books on to parents and clinicians. The two reviewed here both reach for wide audiences of parents and clinicians not deeply familiar with AS. These books are apples and oranges, however, making direct comparisons difficult. The Baker and Welkowitz volume will appeal primarily to clinicians and to savvy parents familiar with AS, whereas that of Leventhal-Belfer and Coe will be most useful for parents grappling with a new diagnosis of AS in their family. We discuss the merits of each volume separately. Asperger_s Syndrome: Intervening in Schools, Clinics and Communities represents the fruition during the past decade of a study group working with patients with AS. The editors have gathered contributions from a veritable BWho_s Who[ in AS, with Bflexibility[ in working with patients with AS emerging as a unifying theme among these chapters. For example, the editors recount one patient_s rigid refusal to employ a numerical mood-monitoring scale, yet this patient_s eager acceptance of a Bspiciness[ scale to monitor (and respond) to varying states. Child psychiatrists will probably find themselves most drawn to chapters on Btheory of mind[ (TOM) and pharmacology. Attwood, a master grower in the AS world, chronicles the evolution of the TOM construct. Though not currently an explicit criterion necessary for an AS diagnosis, TOM is frequently used to explain how individuals with AS lack Bthe ability to recognize and understand thoughts, beliefs, desires, and intentions of other people to make sense of their behavior and predict what they are going to do next[ (p. 12). Attwood describes 11 measures now employed to evaluate TOM in patients ages 4 to 40+, including several tasks that can be used for screening in the office. Also appealing to clinicians will be techniques such as Gray_s social stories with descriptive and perspective sentences and didactic TOM training through comic strip conversations. Successive chapters familiarize readers with other important terminology. Bolick describes Bfunctional assessments of behavior[ and Bpositive behavioral support[ programs for young students with AS, as well as distinctions between Bdiscrete trial teaching[ and Bfloor time.[ Although not exhaustive, these chapters provide rich bites of information on, and examples of, appropriate interventions. College supports for students with AS remains largely uncharted territory, so
761
Copyright @ 2006 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
BOOK REVIEWS
description of the Keene State College (KSC) program is a welcome offshoot. The KSC program emphasizes the benefits of peer mentors both to process social interactions and to grow social networks for students with AS, as well as a way to weed out room isolation and Internet preoccupations. Robert Hendren and Andr2s Martin contribute the chapter on pharmacology. They summarize medication studies on autism spectrum disorders (ASDs) and extrapolate from medication trials for symptoms of other disorders that overlap with ASD (e.g., obsessive-compulsive disorder). They also provide commonsense guidelines for using and combining medications in the sometimes more medication-sensitive AS population. Although the emphasis is on selective serotonin reuptake inhibitors and neuroleptics, evidence surrounding the use of mood stabilizers, stimulants, !-adrenergic agonists, amantadine, naltrexone, famotidine, and secretin is described. This synopsis will equip clinicians with a useful overview of various agents families may inquire about during typical clinical visits. Final chapters address Bsensory integration[ (SI) and legal aspects of AS. Derived from work by Ayers in the 1970s, the SI chapter emphasizes SI training, and distinguishes terms, such as SIPT (sensory integration and praxis testing), and Bsensory diets.[ Gilman discusses SI misconceptions surrounding qualifications for service delivery, appropriate ages for SI, and consultation benefits beyond direct service delivery. The legal issues chapter provides clinicians a helpful framework for patient advocacy. The chapter clarifies that BAsperger_s syndrome has no assured designation as a disability triggering a school district_s obligation to provide interventions[ (p. 259). Rather, steps to determine when AS represents a disability for a given patient are provided, and case law is cited to assist clinicians in recommending appropriate services to families. This case law infusion provides readers with concrete information useful in discussions with school districts. For example, useful topics are addressed such as reasonable expectations of a school (Bbasic floor of opportunity[ rather than the BCadillac[ best education possible requests sometimes made by families), and Bleast restrictive environment[ constraints on school districts regarding outside placements. Asperger_s Syndrome in Young Children: A Developmental Guide for Parents and Professionals is intended to assist those concerned about their own young children or tasked with providing care to this population. The first half of the book describes normal development, divergences in children with AS, what usually occurs in a formal evaluation, and a Bparent_s journey[ on learning that a child has AS. The early chapters detail the normal developmental trajectory by categories, such as sensory and motor development, communication, cognitive development, play, social/emotional development, and relationship with parents. The authors provide lay descriptions of the buzzwords in the AS world, such as useful descriptions of pragmatic, expressive, and
762
receptive language. Relevant Bred flags[ signaling a child may have AS are summarized in brief, bullet-point tables, allowing parents to peruse them quickly to identify the presence of symptoms. Case examples are sprinkled through to emphasize the diverse presentations of children with AS. Symptoms are described in vignettes of children both with and without AS, so that gestalt differences may emerge. Although families take various roads to reach an AS diagnosis, be it through their pediatrician or following conversations with school staff, these authors emphasize that AS is a psychiatric diagnosis requiring evaluation by a psychiatrist or psychologist. Clinicians are distinguished so that parents may recognize what a speech pathologist does in comparison to what an occupational therapist does. Multiple overlapping and comorbid conditions such as nonverbal learning disorder, semantic-pragmatic language disorder, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, and generalized anxiety disorder are briefly mentioned and described. The authors further provide a simplified internalizing and externalizing symptom framework to evaluate various children with ASD, providing vignettes of predominantly externalizing, internalizing, and Bcombined[ children. Although these personalized vignettes are long and may not appeal to clinicians, they are sensitive to the plight of families confronting a diagnosis of AS. The parent journey chapter employs a modified Kubler-Ross paradigm of parental reactions, including denial, anger, bargaining, depression, and acceptance in working through management of a child with AS, yet with Badvocacy[ interjected as a response (instead of the acceptance endpoint). The second section of this book describes various interventions in counseling and school environments. Therapy is encouraged for children with AS to allow therapists to Battune[ to how the child sees the world, to Bprovide structured support using concrete, visual help to understand his social world,[ and to help the child learn alternative expressions to tantrums, isolation, and stress. The potential benefits of therapy for parents of children with AS are also addressed. Additional chapters are authored by a speech therapist, an occupational therapist, and a clinical psychologist, all richly experienced treating children with AS. These chapters address programs targeting peer relationships, sensory motor difficulties, and problems with communication. Many of the chapters include a question-and-answer format that may appeal to parents too overwhelmed to focus on big chunks of a book at this time but who can browse for answers immediately relevant to them. References for dealing with the specific types of setting such as school are included as well as online resources. Intervening in Schools will likely appeal to parents experienced with ASD and looking for explanations of terms they have heard (e.g., TOM, SI) Clinicians, too, may appreciate familiarizing themselves with these terms and their
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 45:6, JUNE 2006
Copyright @ 2006 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
BOOK REVIEWS
intellectual seeds. They may also find this text useful in their quest to remain abreast of contemporary thinking about interventions for patients with AS. A Developmental Guide provides a more chronological journey that families may experience in moving forward once AS is suspected or diagnosed in their child. Clinicians may best Btaste[ these books before buying the bushel, as each is unique enough to appeal to different palates. Both provide useful, accurate information and are able to satisfy those hungry for fresh information on AS. Patricia A. Daly, M.D. Dartmouth-Hitchcock Medical Center Lebanon, NH
Jeff Q. Bostic, M.D., Ed.D. Massachusetts General Hospital Boston DOI: 10.1097/01.chi.0000215155.07142
Disclosure: The authors have no financial relationships to disclose.
Note to Publishers: Books for review should be sent to Andr2s Martin, M.D., M.P.H., Yale Child Study Center, 230 Frontage Road, P.O. Box 207900, New Haven, CT 06520-7900.
Early Puberty and Adolescent Pregnancy: The Influence of Alcohol Use Julianna Deardorff, PhD, Nancy A. Gonzales, PhD, F. Scott Christopher, PhD, Mark W. Roosa, PhD, Roger E. Millsap, PhD Objective: Early pubertal timing predicts deleterious outcomes for young girls, including substance use, risky sexual behavior, and pregnancy. In turn, adolescent pregnancy predicts long-term negative consequences such as reduced educational attainment and income-earning potential. Despite evidence of the direct links between early puberty and negative outcomes, this study is the first to examine the role that alcohol plays in the timing of sexual intercourse and pregnancy among early-maturing females. Design: Participants were 666 females, aged 18 to 22 years, from 4 major ethnic groups in Arizona (non-Hispanic white, black, Latino, and Native American). All women included in the sample had experienced a pregnancy in their teens or early 20s. Participants completed a self-administered questionnaire that inquired about their timing of menarche, sexual initiation, first alcohol use, and age at first pregnancy. A mediating model predicting age at pregnancy was tested by using path modeling. Results: Early puberty was found to be associated with earlier age of alcohol use and sexual initiation, which in turn predicted early pregnancy. Age at first sexual intercourse and age at first substance use significantly mediated the relation between age at menarche and age at first pregnancy. The results did not vary by ethnic group. Conclusions: Girls who mature early are more likely to engage in early substance use and sexual intercourse, which in turn puts them at greater risk for adolescent pregnancy. It is important that health care providers are sensitive to the risks associated with early maturation among young girls and provide preventive screening, education, and counseling related to alcohol use and sexual initiation for this group. Pediatrics 2005;116:1451Y1456.
Prenatal Exposure to Cigarettes, Alcohol, and Coffee and the Risk for Febrile Seizures Mogens Vestergaard, MD, PhD, Kirsten Wisborg, MD, DMSci, Tine Brink Henriksen, MD, PhD, Niels JLrgen Seeber, MD, John R. Kstergaard, MD, DMSci, JLrn Olsen, MD, PhD Objective: Febrile seizure is a common type of seizure in childhood, probably caused by both genetic and early environmental factors. Little is known about the effect of environmental factors that operate in prenatal life, although the fetal brain may be particularly vulnerable as a result of extensive brain growth and differentiation in this period. We evaluated the association between prenatal exposure to cigarettes, alcohol, and coffee and the risk for febrile seizures in 2 population-based birth cohorts. Methods: The Aarhus Birth Cohort consisted of 25196 children of mothers who were scheduled to deliver at Aarhus University Hospital (1989Y1996). The Aalborg-Odense cohort consisted of 10400 children of women who attended antenatal care in Odense or Aalborg (1984Y1987). Both cohorts were linked with the Danish National Hospital Register and followed until December 1998 with a complete follow-up. We extracted from medical records additional information on febrile seizures in children in the Aarhus Birth Cohort who were born between 1989 and 1992. Results: We found a slightly increased risk for febrile seizures in children who were exposed to 10 or more cigarettes per day in the Aarhus Birth Cohort, but the corresponding association was weak in the AalborgOdense cohort. We found no association between maternal alcohol and coffee consumption and the risk for febrile seizures. The results were similar for simple and complex febrile seizures. Conclusions: Our data suggest that prenatal exposure to low to moderate levels of alcohol and coffee has no impact on the risk for febrile seizures, whereas a modest smoking effect cannot be ruled out. Pediatrics 2005;116:1089Y1094.
J. AM. ACAD. CH ILD ADOLESC. PSYCH IATRY, 45:6, JUNE 2006
763
Copyright @ 2006 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
about physical therapies, occupational therapy, and music therapy, just to name a few other modalities helpful for individuals with autism. As a teacher of future child and adolescent psychiatrists, I would echo many of the same observations I made while wearing my academic and clinical hats. I would take away nothing from the theoretical components of the book, for sometimes training programs go too light on science so as not to sacrifice practical clinical time and experience. However, theoretical understanding is the foundation for quality clinical care. Again, trainees could benefit from additional practical translations and clinical applications of the theory and research so well explained in the Handbook. Finally, I cannot totally divorce the part of me that is the mother of a child with autism when I read any scientific or clinical work on the topic. Nothing is more frustrating than medical or psychiatric material written by someone who either has no clue or no empathy about what it is really like to brush an autistic toddler_s teeth or take him for a haircut. Although the Handbook_s third edition was never intended to be a how-to manual for clinicians, parents, teachers, or child care workers, it does pass the Btoothbrushing-and-haircut test[ in that it conveys an implicit respect for parents and caregivers and devotes substantial space to the scientific underpinnings of family considerations, behavioral management, school, and other arenas that are frequently so much more important to the daily lives of autistic individuals and their families than isotopes and research questionnaires, as important as those and other topics are to future advancement in the field. In the preface to the third edition, the editors write BA Handbook portrays what is known and reveals what is poorly understood. I In spite of great effort and decades of commitment by researchers and clinicians, the fate of most autistic individuals remains cloudy; and even with new knowledge, there are still too many areas of controversy. That investigators and clinicians, working alongside families and advocates, have learned so much, often with very tight resources, speaks to their commitment to understanding and caring for autistic children and adults. The goal of this Handbook is to document their achievements and inspire their future efforts[ (p. xix). By this standard, the editors and contributors to the Handbook_s third edition, have achieved, even exceeded, their goals. Mary Lynn Dell, M.D., Th.M. Emory University School of Medicine Atlanta
Disclosure: The author has no financial relationships to disclose.
J. AM. ACAD. CH ILD ADOLESC. PSYCH IATRY, 45:6, JUNE 2006
Asperger’s Syndrome: Intervening in Schools, Clinics and Communities. Edited by Linda J. Baker and Lawrence A. Welkowitz. Mahwah, NJ: Lawrence J. Erlbaum Associates, 2005, 298 pp., $34.50 (softcover). Asperger_s Syndrome in Young Children: A Developmental Guide for Parents and Professionals. By Laurie Leventhal-Belfer and Cassandra Coe. London: Jessica Kingsley Publishers, 2004, 303 pp., $19.95 (softcover). With increased awareness of Asperger_s syndrome (AS), the number of books on the topic geared toward parents and family members has similarly grown, putting child psychiatrists in the role of recommending books on to parents and clinicians. The two reviewed here both reach for wide audiences of parents and clinicians not deeply familiar with AS. These books are apples and oranges, however, making direct comparisons difficult. The Baker and Welkowitz volume will appeal primarily to clinicians and to savvy parents familiar with AS, whereas that of Leventhal-Belfer and Coe will be most useful for parents grappling with a new diagnosis of AS in their family. We discuss the merits of each volume separately. Asperger_s Syndrome: Intervening in Schools, Clinics and Communities represents the fruition during the past decade of a study group working with patients with AS. The editors have gathered contributions from a veritable BWho_s Who[ in AS, with Bflexibility[ in working with patients with AS emerging as a unifying theme among these chapters. For example, the editors recount one patient_s rigid refusal to employ a numerical mood-monitoring scale, yet this patient_s eager acceptance of a Bspiciness[ scale to monitor (and respond) to varying states. Child psychiatrists will probably find themselves most drawn to chapters on Btheory of mind[ (TOM) and pharmacology. Attwood, a master grower in the AS world, chronicles the evolution of the TOM construct. Though not currently an explicit criterion necessary for an AS diagnosis, TOM is frequently used to explain how individuals with AS lack Bthe ability to recognize and understand thoughts, beliefs, desires, and intentions of other people to make sense of their behavior and predict what they are going to do next[ (p. 12). Attwood describes 11 measures now employed to evaluate TOM in patients ages 4 to 40+, including several tasks that can be used for screening in the office. Also appealing to clinicians will be techniques such as Gray_s social stories with descriptive and perspective sentences and didactic TOM training through comic strip conversations. Successive chapters familiarize readers with other important terminology. Bolick describes Bfunctional assessments of behavior[ and Bpositive behavioral support[ programs for young students with AS, as well as distinctions between Bdiscrete trial teaching[ and Bfloor time.[ Although not exhaustive, these chapters provide rich bites of information on, and examples of, appropriate interventions. College supports for students with AS remains largely uncharted territory, so
761
Copyright @ 2006 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
BOOK REVIEWS
description of the Keene State College (KSC) program is a welcome offshoot. The KSC program emphasizes the benefits of peer mentors both to process social interactions and to grow social networks for students with AS, as well as a way to weed out room isolation and Internet preoccupations. Robert Hendren and Andr2s Martin contribute the chapter on pharmacology. They summarize medication studies on autism spectrum disorders (ASDs) and extrapolate from medication trials for symptoms of other disorders that overlap with ASD (e.g., obsessive-compulsive disorder). They also provide commonsense guidelines for using and combining medications in the sometimes more medication-sensitive AS population. Although the emphasis is on selective serotonin reuptake inhibitors and neuroleptics, evidence surrounding the use of mood stabilizers, stimulants, !-adrenergic agonists, amantadine, naltrexone, famotidine, and secretin is described. This synopsis will equip clinicians with a useful overview of various agents families may inquire about during typical clinical visits. Final chapters address Bsensory integration[ (SI) and legal aspects of AS. Derived from work by Ayers in the 1970s, the SI chapter emphasizes SI training, and distinguishes terms, such as SIPT (sensory integration and praxis testing), and Bsensory diets.[ Gilman discusses SI misconceptions surrounding qualifications for service delivery, appropriate ages for SI, and consultation benefits beyond direct service delivery. The legal issues chapter provides clinicians a helpful framework for patient advocacy. The chapter clarifies that BAsperger_s syndrome has no assured designation as a disability triggering a school district_s obligation to provide interventions[ (p. 259). Rather, steps to determine when AS represents a disability for a given patient are provided, and case law is cited to assist clinicians in recommending appropriate services to families. This case law infusion provides readers with concrete information useful in discussions with school districts. For example, useful topics are addressed such as reasonable expectations of a school (Bbasic floor of opportunity[ rather than the BCadillac[ best education possible requests sometimes made by families), and Bleast restrictive environment[ constraints on school districts regarding outside placements. Asperger_s Syndrome in Young Children: A Developmental Guide for Parents and Professionals is intended to assist those concerned about their own young children or tasked with providing care to this population. The first half of the book describes normal development, divergences in children with AS, what usually occurs in a formal evaluation, and a Bparent_s journey[ on learning that a child has AS. The early chapters detail the normal developmental trajectory by categories, such as sensory and motor development, communication, cognitive development, play, social/emotional development, and relationship with parents. The authors provide lay descriptions of the buzzwords in the AS world, such as useful descriptions of pragmatic, expressive, and
762
receptive language. Relevant Bred flags[ signaling a child may have AS are summarized in brief, bullet-point tables, allowing parents to peruse them quickly to identify the presence of symptoms. Case examples are sprinkled through to emphasize the diverse presentations of children with AS. Symptoms are described in vignettes of children both with and without AS, so that gestalt differences may emerge. Although families take various roads to reach an AS diagnosis, be it through their pediatrician or following conversations with school staff, these authors emphasize that AS is a psychiatric diagnosis requiring evaluation by a psychiatrist or psychologist. Clinicians are distinguished so that parents may recognize what a speech pathologist does in comparison to what an occupational therapist does. Multiple overlapping and comorbid conditions such as nonverbal learning disorder, semantic-pragmatic language disorder, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, and generalized anxiety disorder are briefly mentioned and described. The authors further provide a simplified internalizing and externalizing symptom framework to evaluate various children with ASD, providing vignettes of predominantly externalizing, internalizing, and Bcombined[ children. Although these personalized vignettes are long and may not appeal to clinicians, they are sensitive to the plight of families confronting a diagnosis of AS. The parent journey chapter employs a modified Kubler-Ross paradigm of parental reactions, including denial, anger, bargaining, depression, and acceptance in working through management of a child with AS, yet with Badvocacy[ interjected as a response (instead of the acceptance endpoint). The second section of this book describes various interventions in counseling and school environments. Therapy is encouraged for children with AS to allow therapists to Battune[ to how the child sees the world, to Bprovide structured support using concrete, visual help to understand his social world,[ and to help the child learn alternative expressions to tantrums, isolation, and stress. The potential benefits of therapy for parents of children with AS are also addressed. Additional chapters are authored by a speech therapist, an occupational therapist, and a clinical psychologist, all richly experienced treating children with AS. These chapters address programs targeting peer relationships, sensory motor difficulties, and problems with communication. Many of the chapters include a question-and-answer format that may appeal to parents too overwhelmed to focus on big chunks of a book at this time but who can browse for answers immediately relevant to them. References for dealing with the specific types of setting such as school are included as well as online resources. Intervening in Schools will likely appeal to parents experienced with ASD and looking for explanations of terms they have heard (e.g., TOM, SI) Clinicians, too, may appreciate familiarizing themselves with these terms and their
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 45:6, JUNE 2006
Copyright @ 2006 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
BOOK REVIEWS
intellectual seeds. They may also find this text useful in their quest to remain abreast of contemporary thinking about interventions for patients with AS. A Developmental Guide provides a more chronological journey that families may experience in moving forward once AS is suspected or diagnosed in their child. Clinicians may best Btaste[ these books before buying the bushel, as each is unique enough to appeal to different palates. Both provide useful, accurate information and are able to satisfy those hungry for fresh information on AS. Patricia A. Daly, M.D. Dartmouth-Hitchcock Medical Center Lebanon, NH
Jeff Q. Bostic, M.D., Ed.D. Massachusetts General Hospital Boston DOI: 10.1097/01.chi.0000215155.07142
Disclosure: The authors have no financial relationships to disclose.
Note to Publishers: Books for review should be sent to Andr2s Martin, M.D., M.P.H., Yale Child Study Center, 230 Frontage Road, P.O. Box 207900, New Haven, CT 06520-7900.
Early Puberty and Adolescent Pregnancy: The Influence of Alcohol Use Julianna Deardorff, PhD, Nancy A. Gonzales, PhD, F. Scott Christopher, PhD, Mark W. Roosa, PhD, Roger E. Millsap, PhD Objective: Early pubertal timing predicts deleterious outcomes for young girls, including substance use, risky sexual behavior, and pregnancy. In turn, adolescent pregnancy predicts long-term negative consequences such as reduced educational attainment and income-earning potential. Despite evidence of the direct links between early puberty and negative outcomes, this study is the first to examine the role that alcohol plays in the timing of sexual intercourse and pregnancy among early-maturing females. Design: Participants were 666 females, aged 18 to 22 years, from 4 major ethnic groups in Arizona (non-Hispanic white, black, Latino, and Native American). All women included in the sample had experienced a pregnancy in their teens or early 20s. Participants completed a self-administered questionnaire that inquired about their timing of menarche, sexual initiation, first alcohol use, and age at first pregnancy. A mediating model predicting age at pregnancy was tested by using path modeling. Results: Early puberty was found to be associated with earlier age of alcohol use and sexual initiation, which in turn predicted early pregnancy. Age at first sexual intercourse and age at first substance use significantly mediated the relation between age at menarche and age at first pregnancy. The results did not vary by ethnic group. Conclusions: Girls who mature early are more likely to engage in early substance use and sexual intercourse, which in turn puts them at greater risk for adolescent pregnancy. It is important that health care providers are sensitive to the risks associated with early maturation among young girls and provide preventive screening, education, and counseling related to alcohol use and sexual initiation for this group. Pediatrics 2005;116:1451Y1456.
Prenatal Exposure to Cigarettes, Alcohol, and Coffee and the Risk for Febrile Seizures Mogens Vestergaard, MD, PhD, Kirsten Wisborg, MD, DMSci, Tine Brink Henriksen, MD, PhD, Niels JLrgen Seeber, MD, John R. Kstergaard, MD, DMSci, JLrn Olsen, MD, PhD Objective: Febrile seizure is a common type of seizure in childhood, probably caused by both genetic and early environmental factors. Little is known about the effect of environmental factors that operate in prenatal life, although the fetal brain may be particularly vulnerable as a result of extensive brain growth and differentiation in this period. We evaluated the association between prenatal exposure to cigarettes, alcohol, and coffee and the risk for febrile seizures in 2 population-based birth cohorts. Methods: The Aarhus Birth Cohort consisted of 25196 children of mothers who were scheduled to deliver at Aarhus University Hospital (1989Y1996). The Aalborg-Odense cohort consisted of 10400 children of women who attended antenatal care in Odense or Aalborg (1984Y1987). Both cohorts were linked with the Danish National Hospital Register and followed until December 1998 with a complete follow-up. We extracted from medical records additional information on febrile seizures in children in the Aarhus Birth Cohort who were born between 1989 and 1992. Results: We found a slightly increased risk for febrile seizures in children who were exposed to 10 or more cigarettes per day in the Aarhus Birth Cohort, but the corresponding association was weak in the AalborgOdense cohort. We found no association between maternal alcohol and coffee consumption and the risk for febrile seizures. The results were similar for simple and complex febrile seizures. Conclusions: Our data suggest that prenatal exposure to low to moderate levels of alcohol and coffee has no impact on the risk for febrile seizures, whereas a modest smoking effect cannot be ruled out. Pediatrics 2005;116:1089Y1094.
J. AM. ACAD. CH ILD ADOLESC. PSYCH IATRY, 45:6, JUNE 2006
763
Copyright @ 2006 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.