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审视家族病史在儿科行为转诊中的重要性。

Examining the Importance of Family History in Pediatric Behavioural Referrals.

作者信息

Gander Sarah, Campbell Sarah A, Flood Kathryn E, Crowley Emma Grace

机构信息

Pediatrics, Saint John Regional Hospital, Saint John, CAN.

Pediatrics Research, Saint John Regional Hospital, Saint John, CAN.

出版信息

Cureus. 2019 May 31;11(5):e4790. doi: 10.7759/cureus.4790.

Abstract

In recent years, there has been a substantial increase in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Without appropriate management of symptoms and care, ADHD has been associated with a variety of negative child and adult outcomes. Environmental and familial factors that may contribute to three different pediatric referral types (academic, behavioural, and attentional) associated with ADHD were examined in the current study. In total, data from 477 families who were interviewed as a part of the intake process to a pediatric clinic were included in this study. Data for the current study was extracted from the intake questionnaires and included information on family history of mental health issues, socioeconomic status, and family relationships. The sample included children between the ages of three and 17 and mostly comprised males ( = 340). A frequency analysis of the data demonstrated relatively high rates of mental health issues within families (61.4%); almost half of the mothers reported some post-secondary education (46.1%) and most reported having normal relationships with their children (mothers, 78%; fathers, 62.9%). Finally, three stepwise regression analyses were conducted to predict referral type. All three regressions yielded significant models. Fifteen percent of the variability of the academic referral type was predicted by being male, age at the time of referral, mother's education level, and mother's learning. The behavioural referral types were predicted by a family history of depression, being male, mother-child relationship, and age at the time of referral; these accounted for 23% of the variance. Attentional referral type was predicted only by mother-child relationship that captured 6% of the variance. Overall, this study describes a population of parents of children with academic, behavioural, and attention-related referrals to pediatrics. Results indicate that mothers have a profound influence on their child's referral types, something that may transfer into later diagnosis and perhaps prognosis. Clinicians and researchers alike should focus their efforts toward developing integrative service assessment and treatment approaches that include important people in the child's life. The implementation of Community Social Pediatrics (a streamlined, inclusive approach to care) should be considered in urban centres like this one, where referrals like this are prevalent.

摘要

近年来,儿童注意力缺陷多动障碍(ADHD)的诊断数量大幅增加。若不对症状进行适当管理和护理,ADHD会导致儿童和成人出现各种负面后果。本研究考察了可能导致与ADHD相关的三种不同儿科转诊类型(学业、行为和注意力方面)的环境和家庭因素。本研究共纳入了477个家庭的数据,这些家庭是在一家儿科诊所的接诊过程中接受访谈的。本研究的数据取自接诊问卷,包括心理健康问题家族史、社会经济地位和家庭关系等信息。样本包括3至17岁的儿童,且大多为男性(n = 340)。对数据的频率分析表明,家庭中存在心理健康问题的比例相对较高(61.4%);近一半的母亲拥有某种高等教育学历(46.1%),且大多数母亲表示与孩子关系正常(母亲为78%;父亲为62.9%)。最后,进行了三次逐步回归分析以预测转诊类型。所有三次回归均得出了显著模型。学业转诊类型15%的变异性可由性别、转诊时的年龄、母亲的教育水平和母亲的学习情况预测。行为转诊类型可由抑郁症家族史、性别、母子关系和转诊时的年龄预测;这些因素解释了23%的方差。注意力转诊类型仅由母子关系预测,该因素解释了6%的方差。总体而言,本研究描述了一群将孩子因学业、行为和注意力相关问题转诊至儿科的家长。结果表明,母亲对孩子的转诊类型有深远影响,这可能会影响到后续的诊断,甚至预后。临床医生和研究人员都应致力于开发综合服务评估和治疗方法,将孩子生活中的重要人物纳入其中。在像这样转诊情况普遍的城市中心,应考虑实施社区社会儿科学(一种简化、包容的护理方法)。

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