Innovations In Clinical Neuroscience

SEP-OCT 2014

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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142 suicidality in children and adolescents. The meta-analysis also focused international attention on the urgent need for the development of a proper a ssessment and monitoring tool to meet this need. While the FDA provided warning about suicidality risk in children and adolescents, it did not advise that antidepressants be avoided in children and adolescents. However, media attention and, at times, overreaction to this issue and medico- legal concerns by clinicians have led to a significant reduction in the prescription of antidepressants to children and adolescents and a related increase in deaths from suicide and self poisonings over that past decade. 3 The FDA did not anticipate or expect this unfortunate outcome, but did have a duty to detect and warn about safety concerns with medications. The FDA was judicious in not advising against prescribing antidepressants in pediatric populations, and their decision to strongly urge proper assessment and monitoring of suicidality in those individuals being treated for depression with psychiatric medications was the most prudent, near-term solution to manage this issue. The problem was that a simple, reproducible, age-appropriate, and linguistically validated scale for specifically assessing and monitoring suicidality in pediatric populations was not available at the time to address this need. In this article, we describe the development of a pediatric suicidality assessment and tracking scale and a novel approach to its age-appropriate linguistic validation. METHOD The most frequent approach to the development of psychiatric scales for the pediatric population is to consult child psychiatrists, child psychologists, and pediatricians who have experience in communicating with children in healthcare settings. In our early attempts to develop a pediatric suicidality assessment and tracking scale from the adult Sheehan-Suicidality Tracking Scale (S-STS), 4 we consulted such experts. In spite of much interesting input, each expert used his or her own unique clinical approach. We found that even among experts, these a pproaches were often conflicting, the results somewhat haphazard, and the processes used not reproducible and consistently methodical. We searched for an approach that would be methodical, reproducible, and consistent and that might have an empirical foundation. We convened an Education Advisory Committee. Its members included faculty in academic departments of education who specialized in elementary and high school education, child and adult psychiatrists, and elementary school teachers in both the public and private sector, who provided valuable input on a range of possible challenges and solutions. The first author of this article (D.A.) proposed the solution that was finally adopted: use the empirically based system already in place and widely adopted by school systems throughout the United States, Canada, and the United Kingdom for linguistic validation of educational texts. The specialists who are currently charged with the oversight and practical implementation of this approach in the educational system are reading specialists. The empirical foundation for this system was first suggested and begun by Edward W. Dolch in 1936 5 and subsequently developed into a more organized system in his later publications. 6 He identified 220 words (Dolch's Sight Word List), in three tiers, that children need to be able to instantly recognize by sight, by the end of the first grade, to master their reading skills in English. In 1972 and in subsequent publications, particularly in 1999, Edward B. Fry expanded Dolch's sight word lists to 1,000 words (Fry's 1000 Instant Words). 7–9 Fry's lists are broken down differently from Dolch's lists. Fry's lists are divided into groups of 25 words, based on frequency of use and difficulty. Even though Dolch and Fry approached their selections using a slightly different methodology, their selections overlap substantially and are largely in agreement. Fry found that 25 words make up 33 percent, 1 00 words make up 50 percent, and 300 words make up 65 percent of all words found in English language publications. Almost every sentence uses several of the first 300 words in the Fry list. The first 100 words are usually mastered by first grade, the second 100 words mastered by second grade, the third 100 mastered in third grade, and the remaining 700 words are mastered in fourth and fifth grades. Zeno et al 10 further extended this system in 1995 to 154,000 words covering a more extensive graded vocabulary used in kindergarten through 12th grade and in college throughout the United States. In the largest systematic word frequency count ever conducted, Zeno et al 10 empirically investigated and identified the usual words mastered by each grade from kindergarten through college in the educational system. They developed dictionaries that assist in identifying when students most frequently encounter these words across all grades. Other similar dictionaries and systems are widely used by reading specialists in the educational system to ensure that all reading materials can be understood by children at each grade and age. 11 Based on recent research, other authors found that after children master the sight words they usually best learn the more difficult multisyllabic words encountered in children's novels by decoding the polysyllabic words and learning the word in the context of a phrase. Other education specialists systematically organized these "vocabulary words" or phrases into graded lists. We used the method published by Beck et al 12 for "vocabulary words" in conjunction with the "sight words" in the Dolch 220 list and the Fry 1000 list. Unlike sight words, which are recognized on sight, vocabulary words are decoded. The gradation of these words and phrases in an age-appropriate manner Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 1 , N U M B E R 9 – 1 0 , S E P T E M B E R – O C T O B E R 2 0 1 4 ]

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