Approximately 5 million (or 7%) of children in the united States have a chronic medical condition that affects their daily functioning (national Center for Health Statistics, 2006). the prevalence of chronic medical conditions in children has more than tripled in recent decades (Perrin, Bloom, & gortmaker, 2007), which may be attributed to a decrease in infant mortality, improved medical care for pediatric life-threatening conditions, and amplified incidence of communicable diseases, many of which affect central nervous system function. In addition to genetic causes or susceptibility, environmental factors such as neurotoxin exposure, infectious disease, and acquired injuries may lead to compromised brain function and overall child adjustment.Although medical stabilization may be of primary concern when treating pediatric health conditions, secondary effects on brain function, particularly frontal-subcortical circuit function, are of critical importance givenCopyright American Psychological Association. Not for further distribution. 300 steck-silvestri et al.circuit influence on adaptive behavior, psychosocial adjustment, and psychopathology. these neuropsychological effects of medical conditions not only influence overall adjustment but also affect the length, duration, intensity, and course of medical care in a reciprocal manner.this chapter presents the neuropsychological, behavioral, and emotional sequelae in pediatric illnesses with psychopathology (see table 13.1), but it is important to recognize that this discussion is illustrative, not exhaustive. the chapter concludes with an epilepsy case example highlighting the importance of clinical and neuropsychological assessment methods that lead to effective interventions.nEuRODEvELOPMEntAL InSuLtS Prematurity and Low Birth WeightAdvances in neonatal care have resulted in increased survival rates of extremely low birth weight (ELBW; <1,000 g or 2.2 lb) or very preterm (<28 weeks gestation) infants. Born with immature nervous systems vulnerable to insult, these children experience increased risk of attention, internalizing, and adaptive behavior problems (e.g., P. Anderson & Doyle, 2003). Meta-analyses show that the cognitive functioning of preterm children is directly proportional to birth weight and gestational age (Bhutta, Cleves, Casey, Cradock, & Anand, 2002). Children with ELBW are more likely than children of normal birth weight to have cerebral palsy, asthma, low IQ and adaptive functioning, and executive, memory, and motor impairments (taylor, Drotar, Schluchter, & Hack, 2006).neuroimaging findings have suggested that ELBW infants are more likely to have white matter brain injury and reduced brain volume (e.g., Skranes et al., 2007), including hippocampal volume (Isaacs et al., 2000), which could account for their frequent attention, executive, working memory, visual-perceptual, social, and learning problems. Psychosocial concerns have been reported in about 40% of children with low birth weight (LBW), with about 27% experiencing psychiatric diagnoses (...
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