Program Brief

Children's Health Highlights

To increase understanding of issues involved in improving delivery of health care to children and adolescents, a special research focus is needed. This program brief provides an overview of current programs, activities, and priorities of the Agency for Healthcare Research and Quality (AHRQ) in the area as well as summaries of selected findings from recent AHRQ-supported research.

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Acute Care/Injuries
Adolescent Health
Attention Deficit/Hyperactivity Disorder
Chronic Illnesses
Costs, Use, and Access to Care
Emergency Care/Hospitalization
Mental Health
Newborns and Infants
Oral Health
Otitis Media
Preventive Services
Quality of Care/Patient Safety
Other Research
For More Information


Children and adolescents are growing and developing, and their health care needs, use of services, and outcomes are very different from those of adults. Unlike adults, children and adolescents usually are dependent on parents and others for access to care and evaluations of the quality of that care. Furthermore, adolescents differ from younger children; they are moving from childhood to adulthood and have their own unique health care needs, preferences, and patterns of use.

For these and many other reasons, a special research focus is needed to increase understanding of the issues involved in improving the delivery of health care to children and adolescents.

In 1997, six strategies for increasing the quantity and quality of child health services research (CHSR) were proposed by Christopher B. Forrest, M.D., Ph.D., of the Johns Hopkins School of Public Health, Lisa Simpson, M.B., B.Ch., Deputy Director of the Agency for Healthcare Research and Quality (AHRQ), and Carolyn Clancy, M.D., Director of AHRQ's Center for Outcomes and Effectiveness Research. In an article published in the June 11, 1997, issue of the Journal of the American Medical Association, they explained the need to:

  1. Expand the disease orientation of health services research to include a focus on child health development.
  2. Establish child-sensitive standards for setting research priorities.
  3. Increase the size and capacity of the CHSR workforce.
  4. Develop appropriate laboratories to study child health care.
  5. Improve coordination of research funding across the Federal Government, foundations, and the private sector.
  6. Enhance the research function of health care delivery in the private sector.

Finding ways to improve outcomes, quality, and access to health care for America's 70 million children and adolescents is a critical goal of health services research and a continuing priority for AHRQ (see Dougherty, D., Simpson, L., and Eisenberg, J., in the April 2000 issue of Health Services Research, pp. xi-xix). For many years, AHRQ has supported and conducted research on children's health issues. These activities are coordinated across the Agency's health services research portfolio to ensure that projects are appropriately addressed in all program areas.

In FY 2001, AHRQ announced $16 million in total support for new research and training grants, contracts, and interagency agreements relating directly to health care issues concerning children and adolescents.

This program brief provides an overview of current AHRQ programs, activities, and priorities in health care research for children and adolescents, as well as summaries of selected findings from recent AHRQ-supported research projects. It reflects AHRQ's commitment to build the infrastructure and capacity for child health services research and ensure that practitioners and policymakers have the knowledge and tools they need to:

If copies of publications are available, that is noted under descriptions. Online information is available for AHRQ research programs, including grant announcements and application kits.

Go to Child Health to find updates on child health initiatives at AHRQ, relevant conferences and workshops, funding announcements, and more.

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Acute Care/Injuries

In 2000, children and adolescents under age 18 had over 212 million ambulatory health care visits, including 49 million visits to hospital outpatient and emergency departments. Only 15 percent of visits to physicians' offices were for well-child care, while a high number of visits were for acute care.

Fifty-four percent of visits to hospital emergency departments by 5-14 year olds are due to injuries, and injuries are the leading cause of death among those 1-24 years old in the United States. AHRQ's research portfolio on acute care and injuries focuses on the effectiveness, quality, and costs of care for children and adolescents.

Research in Progress

Study focuses on using evidence to enhance care for childhood illnesses.
Description: Investigators are examining whether providing evidence at the point of ambulatory pediatric care will improve antibiotic use in pediatric disorders, reduce duration of therapy for acute sinusitis, reduce use of bronchodilators, and increase the use of intranasal steroids for allergic rhinitis.
Principal Investigator: Robert L. Davis (AHRQ grant HS10516).

Researchers are developing decision rules for use of chest x-ray to diagnose pneumonia in young children.
Description: Although a relatively low proportion of chest x-rays reveal radiographic pneumonia, many young children are referred for chest-rays, resulting in unnecessary exposure to radiation and additional cost. The goal of this study is to develop decision rules that will help clinicians predict when children with lower respiratory tract infections should be sent for chest x-rays.
Principal Investigator: Melinda Mahabee-Gittens (AHRQ grant HS11038).

Recent Findings

One in five childhood injuries may be caused by abuse.
Description: Investigators examined data from 12,510 office visits during which primary care physicians (PCPs) evaluated 659 injuries, assessed the causes of the injuries, and determined their level of suspicion that the injuries were caused by abuse. The PCPs had “some suspicion” of abuse for 21 percent of the injuries.
Citation: Flaherty, Sege, Mattson, et al. Ambulatory Pediatrics 2(2):120-6, 2002 (AHRQ grant HS09811).

Analysis affirms current guidelines for treating high fever.
Description: An analysis of six management strategies for a hypothetical group of 100,000 3- to 36-month-old children was conducted. Findings show that current guidelines for treating children up to age 3 who have a high fever and no obvious source of infection are the most cost effective (i.e., obtain complete blood counts and cultures, and treat children with antibiotics if the white blood cell count is equal to or greater than 15 x 109/L).
Citation: Lee, Fleisher, and Harper, Pediatrics 108(4):835-44, 2001 (NRSA grant T32 HS00063).

Criteria reduce unnecessary x-rays for blunt trauma victims.
Description: Researchers evaluated the use of National Emergency X-Radiography Utilization Study criteria for identifying which of over 3,000 children were at low risk for cervical spine injury (CSI). Five criteria can identify pediatric blunt trauma victims who are at low risk for CSI, thereby reducing unnecessary x-rays by 20 percent.
Citation: Viccellio, Simon, Pressman, et al. Pediatrics Electronic Pages 108(2):E20, 2001 (AHRQ grant HS08239).

Researchers synthesize evidence on diagnosis and treatment of sinusitis in children.
Description: Researchers found little evidence on how to accurately diagnose acute sinusitis in children and note a lack of consensus on which clinical signs and symptoms are most useful for diagnosis. The various antibiotics used to treat pediatric sinusitis are equally effective; no convincing evidence supports the use of ancillary decongestants and antihistamines, and limited evidence supports the use of steroids.
Availability: A summary of this evidence report (AHRQ Publication No. 01-E007) and the full report, Diagnosis and Treatment of Uncomplicated Acute Sinusitis in Children (AHRQ Publication No. 01-E005), are available from the AHRQ Publications Clearinghouse. (AHRQ contract 290-97-0019).

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Adolescent Health

Researchers have begun to target studies at the distinctive health care needs of adolescents. Establishing healthy behaviors early can reduce risks of acquiring many diseases. Recent AHRQ-funded studies have focused on such adolescent prevention topics as screening for sexually transmitted diseases and smoking cessation.

Research in Progress

Study focuses on eliminating barriers to implementation of adolescent preventive health guidelines.
Description: This quality improvement (QI) intervention addresses provider and system-level barriers to delivery of preventive services to adolescents during primary care visits. The goal is to determine whether a systems intervention in a managed health care organization—including provider training and customized screening and charting tools—results in increased delivery of clinical preventive services to adolescents than the usual standard of care.
Principal Investigator: Charles E. Irwin (AHRQ grant HS11095).

Researchers examine the role of a regular source of care for at-risk youth.
Description: This study focuses on disparities in the use of physician services, the role of having a usual source of care, and the characteristics likely to result in greater use of services.
Principal Investigator: Tanisha V. Carino (NRSA fellowship F31 HS00150).

Internet learning modules for physicians may improve chlamydia screening for adolescents.
Description: Study physicians will complete a year-long series of Internet learning modules that integrate case-based education with audit, feedback, and benchmarking of practice profiles. The goal is to improve chlamydia screening and treatment rates among patients aged 16-26, which should result in lower rates of pelvic inflammatory disease.
Principal Investigator: Jeroan Allison (AHRQ grant HS11124).

Researchers are testing an intervention for smoking cessation among rural teens.
Description: The goal is to determine the usefulness of a theory-based motivational tobacco intervention for rural smokers ages 14 to 18 who seek emergency care. Researchers will develop a transportable version of the intervention for emergency facilities.
Principal Investigator: Kimberly A. Horn (AHRQ grant HS10736).

Investigators seek to improve STD screening for asymptomatic teens.
Description: This QI intervention involves a small-group educational program for clinic personnel on sexually transmitted diseases, including chlamydia. The sessions will be augmented with weekly supervision and followup to reinforce the educational content.
Principal Investigator: Mary-Ann Shafer (AHRQ grant HS10537).

Recent Findings

Premature birth does not affect adolescent self-esteem.
Description: Premature infants who weighed less than 2 pounds were at high risk for neurodevelopmental, cognitive, behavioral, and emotional difficulties. However, once they reached adolescence, their self-esteem was similar to that of other adolescents.
Citation: Saigal, Lambert, Russ, et al. Pediatrics 109(3):429-33, 2002 (AHRQ grant HS08385).

Delivery of smoking prevention/cessation services differs.
Description: Researchers analyzed survey responses from pediatricians and family physicians and found that doctors used more tobacco interventions when they were familiar with the Public Health Service guidelines, spent more time with adolescent patients, and spent more time alone with patients.
Citation: Klein, Levine, and Allan. Arch Pediatr Adolesc Med 155:597-602, 2001 (AHRQ grant HS08192).

Not all teens receive reproductive health services.
Description: In a survey of 354 family physicians, respondents reported asking 79 percent of their adolescent patients about contraceptive use, 73 percent about condom use, 72 percent about sexual relationships, and 61 percent about sexual behavior. Female doctors and younger doctors are among those more likely to provide reproductive health screening and counseling during adolescent visits.
Citation: Kelts, Allan, and Klein. Fam Med 33(5):376-81, 2001 (AHRQ grant HS08192).

Providers' role in preventing alcohol problems is unclear.
Description: This article summarizes what is known about adolescent alcohol use and how it can be addressed in primary care settings. Studies show that few primary care doctors follow existing guidelines that recommend yearly screening of adolescents for alcohol problems.
Citation: Knight. Ambulatory Pediatr 1(3):150-61, 2001 (AHRQ/NIAAA interagency agreement).

Adolescents accurately characterize the care they receive.
Description: To develop quality measures for adolescent care, researchers recruited 400 adolescents, audiotaped their visits with physicians, and conducted phone surveys to assess their recollection of the preventive health care they received. Adolescents' recall of the care they received was good.
Citation: Klein, Graff, Santelli, et al. Health Serv Res 34(1):391-404, 1999 (AHRQ grant HS08192).

Researchers develop and test a taxonomy of adolescent health.
Description: Researchers used four domains of health to group adolescents into 13 profile types. They also identified combinations of problems that characterize different subgroups of adolescents to develop a taxonomy of adolescent health and tested the taxonomy in four ethnically diverse groups of urban and rural youths ages 11 to 17.
Citations: Riley, Forrest, Starfield, et al. Med Care 36(8):1228-36, 1998; Riley, Green, Forrest, et al. Med Care 36(8):1237-48, 1998 (AHRQ grant HS07045).

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Asthma is a chronic inflammatory disease of the airways that affects approximately 5 million U.S. children a year. An estimated 400,000 of these children have moderate to severe asthma. It is the most common chronic disease of childhood, with about one-fourth of those affected being less than 5 years of age. Illness associated with asthma is on the rise, and reducing asthma-related morbidity continues to be a major objective for the U.S. Public Health Service.

Research in Progress

Study examines underuse of preventive care among black children.
Description: This study is exploring the factors that contribute to the disparity between black and white children in preventive asthma care. Factors include insurance coverage, access to preventive health care, financial resources, and health beliefs.
Principal Investigator: Andrea Ireland (AHRQ grant HS11929).

Researchers study treatment adherence among children with cystic fibrosis and asthma.
Description: The aims of this study are three-fold: (1) assess the extent of adherence problems in children with cystic fibrosis and asthma, (2) compare patterns of adherence in two pediatric pulmonary populations, and (3) identify key barriers associated with poor adherence.
Principal Investigator: Avani Modi (AHRQ grant HS11768).

Researchers explore the family effects of having a child with asthma.
Description: This project will extend previous research on the impact of having a child with asthma and the burden asthma places on the family's resources, availability of care, and barriers to care.
Principal Investigator: Nazil Baydar (AHRQ grant HS13110).

Project underway to test the cost-effectiveness of recently developed practice guidelines for pediatric asthma.
Description: This 5-year study is being conducted in three unrelated, geographically dispersed managed care settings. The researchers are evaluating educational and organizational approaches to QI for pediatric asthma care, focusing primarily on symptom assessment. They also will examine other outcomes, including functional status, health care use, and patient satisfaction.
Principal Investigator: Kevin Weiss (AHRQ grant HS08368).

Effects of Medicaid enrollment gaps on asthma outcomes are being studied.
Description: Researchers are evaluating the effect of gaps in enrollment in Tennessee's Medicaid program for children with asthma by studying two markers for use of asthma care—emergency room visits and hospitalizations.
Principal Investigator: William O. Cooper (AHRQ grant HS10249).

Two studies explore the effects of managed care on the quality of pediatric asthma care.
Description: The first study is investigating the impact of the transition from fee-for-service to managed care on quality of treatment, quality of life, and health outcomes for indigent children with asthma, as well as the impact of organizational policies on quality and outcomes. Bruce Stuart (AHRQ grant HS09950). The second study involves 2,700 children with asthma who are enrolled in nine Medicaid managed care organizations in California, Washington, and Massachusetts. Researchers are studying health plan payment mechanisms, provider profiling and incentives, and disease management programs; patient-level features; and other variables.
Principal Investigator: Tracy Lieu (AHRQ grant HS09935).

Evaluation of school-based asthma care is underway.
Description: Children's functional status, school days missed, and resource use are among the indicators researchers are using to evaluate the impact of using school-based health centers to deliver care for asthma.
Principal Investigator: Mayris P. Webber (AHRQ grant HS10136).

Researchers are assessing the use of telecommunications in asthma care.
Description: The researchers are assessing the effectiveness of Telephone-Linked Communications for Asthma, a computer-based system that monitors, educates, and counsels parents and children who have asthma.
Principal Investigator: Robert Friedman (AHRQ grant HS10630).

Study compares two pediatric asthma management programs.
Description: Researchers are comparing a modified “easy breathing” program with a disease management program being used by 66 providers in 18 communities. Outcome measures will include adherence to guidelines, antiinflammatory prescription and use rates, hospitalization and ER visits, patient/family satisfaction, and quality of life.
Principal Investigator: Michele M. Cloutier (AHRQ grant HS11147).

Multisite intervention project for children with asthma may lead to improved outcomes and reduced costs.
Description: Using a family-focused QI intervention for children with asthma, this study is targeting providers of care to poor, inner-city, minority youths ages 5-18 who are enrolled in a community health center-based Medicaid managed care organization. The goals are to develop a method to deliver patient-linked guideline prompts at the point of care using affordable information technology; evaluate the system's effects on the process and outcomes of pediatric asthma care; and evaluate the effects on patient outcomes of a family-focused education intervention delivered by a community health worker.
Principal Investigator: Judith Fifield (AHRQ grant HS11068).

Study findings will build an asthma case-management model for Head Start.
Description: The researchers are developing a pediatric asthma management model for Head Start personnel using evidence-based asthma management criteria. The goal is to improve the asthma management practices of children, parents, and staff, as well as reduce school absences and use of acute care services.
Principal Investigator: Perla A. Vargas (AHRQ grant HS11062).

Researchers are evaluating quality improvement strategies.
Description: These researchers will compare the effects of office-based QI with regular practice on processes and outcomes of care for children with asthma ages 2 to 18. Effectiveness and cost-effectiveness will be evaluated in this managed care setting.
Principal Investigator: Charles J. Homer (AHRQ grant HS10411).

Recent Findings

Experts develop policy recommendations for pediatric asthma.
Description: Experts and leaders in childhood asthma outline policy recommendations for ensuring children are quickly diagnosed and treated, agencies are prepared to address needs, and children are safe from environmental risks that worsen asthma.
Citation: Lara, Rosenbaum, Rachelefsky, et al. Pediatrics 109(5):919-30, 2002 (AHRQ grant K08 HS00008).

Improving medication use will reduce racial/ethnic disparities.
Description: Study findings show that despite having worse asthma than white children, black and Hispanic children with similar insurance and sociodemographic characteristics are 31 and 42 percent less likely to be using inhaled antiinflammatory medication to prevent the onset or worsening of an asthma episode.
Citation: Lieu, Lozano, Finkelstein, et al. Pediatrics 109(5):857-65, 2002 (AHRQ grant HS09935).

Few parents are reducing household asthma triggers.
Description: In a study of 638 children with asthma, 45 percent of the parents had received written instructions about avoiding asthma triggers in their homes. Providing parents with these instructions was not associated with their efforts to do so.
Citation: Finkelstein, Fuhlbrigge, Lozano, et al. Arch Pediatr Adolesc Med 156:258-64, 2002 (AHRQ grant HS08368).

Minority children get fewer medications than white children.
Description: Investigators analyzed responses to questionnaires, as well as prescription, demographic, provider, and other data on 1,000 asthmatic children and their families. Black and Hispanic children received fewer bronchodilators, and Hispanic children received fewer inhaled steroids than white children (Intramural).
Citation: Ortega, Gergen, Paltiel, et al. Pediatrics Electronic Pages 109(1):E1, 2002 (AHRQ Publication No. 02-R046)
Available from: AHRQ Publications Clearinghouse.

Mild asthma does not significantly affect quality of life.
Description: Researchers analyzed asthma symptom data (based on parent and child daily logs); child-reported health status and quality-of-life (QOL) scores; and child-reported anxiety scale, depression inventory, and behavior checklist data for 339 children. Children with mild or moderate asthma do not differ in emotional functioning, symptoms, or total QOL scores, but those with moderate asthma report more activity limitations.
Citation: Annett, Bender, Lapidus, et al. J Pediatr 139(6):854-61, 2001 (AHRQ grant HS09123).

Tobacco smoke increases risk of respiratory diseases.
Description: A literature review reveals the following: environmental tobacco smoke (ETS) increases the risk of respiratory diseases (including asthma) in children, and the home is the most important source of ETS exposure. The impact of ETS on respiratory symptoms is strongest in a child's first 2 years (Intramural).
Citation: Gergen. Respir Physiol 128:39-46, 2001 (AHRQ Publication No. 02-R022)
Available from: AHRQ Publications Clearinghouse.

Comorbidities led to higher use and cost of health care.
Description: Records of 71,818 children enrolled in a health care group plan revealed that children with asthma were three times more likely than those without asthma to have coexisting problems. The problems (sinusitis, otitis media, and allergic rhinitis) led to higher health care use and costs.
Citation: Grupp-Phelan, Lozano, and Fishman. J Asthma 38(4):363-73, 2001 (NRSA training grant T32 HS00034).

Medicaid children use emergency departments most often.
Description: Investigators studied health care use and asthma symptoms of 804 children. Medicaid children used the emergency department almost twice as often for asthma care as privately insured children.
Citation: Ortega, Belanger, Paltiel, et al. Med Care 39(10):1065-74, 2001 (NRSA training grant T32 HS00034).

Rates of diagnosis vary despite similarities in symptoms.
Description: An asthma screening survey administered to a metropolitan and a nonmetropolitan group of American Indian and Alaska Native students found similar rates of asthma symptoms and medical visits for these symptoms. However, the students' locale, ethnicity, and socioeconomic status had a stronger effect on physician diagnosis of asthma than prevalence of asthma symptoms (Intramural).
Citation: Stout, White, Redding, et al. Public Health Rep 116:51-57, 2001 (AHRQ Publication No. 02-R005)
Available from: AHRQ Publications Clearinghouse.

Few children with asthma use controller medication despite guidelines.
Description: Researchers conducted a 1-year study of 13,352 children with asthma who were cared for in three managed care organizations. They found that despite national guidelines recommending use of inhaled corticosteroids, few children with persistent asthma symptoms used them regularly.
Citation: Adams, Fuhlbrigge, Finkelstein, et al. Arch Pediatr Adolesc Med 155:501-7, 2001 (AHRQ grant HS08368).

Bilingual scale helps clinicians assess asthma symptoms.
Description: A new Spanish-English scale for measuring the control of asthma in Latino children from low-income families has been developed and tested with parents of 234 inner-city Hispanic children with asthma (Intramural).
Citation: Lara, Sherbourne, Duan, et al. Med Care 38(3):342-50, 2000 (AHRQ Publication No. 00-R021)
Available from: AHRQ Publications Clearinghouse.

Factors that predict hospitalization of children with asthma have not changed over time.
Description: Researchers found that teenagers and boys were more likely than children aged 5 to 12 and girls to be hospitalized for severe respiratory distress or failure. Region of the country and hospital teaching status also were significantly associated with differences in severity of asthma among hospitalized children. The research team reviewed hospital records of more than 168,000 children in 746 hospitals in 1990 and more than 174,000 children in 811 hospitals in 1995.
Citation: Meurer, George, Subichin, et al. Arch Pediatr Adolesc Med 154:143-9, 2000 (AHRQ grant HS09564).

Children with asthma did not improve following a pharmacist-delivered intervention.
Description: Researchers assessed changes in disease control, functional status, and cost associated with a structured program of pharmacist-delivered care for children with asthma and found no evidence that they improved in pulmonary function, functional status, quality of life, asthma management, or satisfaction with care.
Citation: Stergachis, Gardner, Anderson, and Sullivan. J Am Pharm Assoc 42(5):743-52, 2002 (AHRQ grant HS07834).

Asthma affects Puerto Rican children more severely than it does other Latino children.
Description: Puerto Rican children with asthma are affected by their illness significantly more than Cuban American or Mexican American children. Puerto Rican children usually have a smaller airway size, more severe inflammatory reactions, and lower birthweight than other Latino children, and their mothers are more likely to smoke cigarettes than other Hispanic mothers.
Citation: Lara, Morgenstern, Duan, et al. West J Med 170:75-84, 1999 (NRSA training grant T32 HS00007).

Environmental tobacco smoke contributes to early childhood asthma.
Description: Data from the Third National Health and Nutrition Examination Survey (NHANES) reveal that almost half of the cases of early childhood asthma, chronic bronchitis, and wheezing result from secondhand cigarette smoke. (Intramural).
Citation: Gergen, Fowler, Maurer. Pediatrics Electronic Pages 101(2):E8, (AHRQ Publication No. 98-R033)
Available from: AHRQ Publications Clearinghouse.

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Attention Deficit/Hyperactivity Disorder

Attention deficit/hyperactivity disorder (ADHD) is a psychiatric disorder distinguished by symptoms of inattention, hyperactivity, and impulsivity, and it may be accompanied by learning disabilities, depression, anxiety, conduct disorder, and oppositional defiant disorder. ADHD is one of the most common childhood-onset disorders, with a prevalence rate of approxiately 4 percent to 12 percent for school-aged children.

AHRQ has supported the development of evidence reports on the diagnosis and treatment of ADHD, research on the costs associated with the disorder, and efforts to improve quality of care for ADHD.

Research in Progress

Workshops will facilitate applications of research to practice.
Description: This conference grant supports a series of learning opportunities to improve care for children with ADHD. The goal is to promote the translation of the evidence about the diagnosis and treatment of ADHD into clinical practice.
Principal Investigator: Charles Homer (AHRQ grant HS12070).

Study examines use of computers in caring for children with ADHD.
Description: The researchers will develop and evaluate a computerized system for laptop use in the examining room to improve the care of children with ADHD.
Principal Investigator: Paula Lozano (AHRQ grant HS11859).

New tools are being developed to help families cope with ADHD.
Description: Researchers are developing tools for families with children who have ADHD to help them coordinate the child's care and inform parents, teachers, and health providers.
Principal Investigator: Clinical Tools, Inc., Chapel Hill, NC (AHRQ contract 290-99-0008).

Recent Findings

Costs are similar for ADHD and asthma.
Description: Data from the 1996 Medical Expenditure Panel Survey reveal annual health care costs for children with ADHD and asthma were $479 and $437 more than the those of the general population of children.
Citation: Chan, Zhan, and Homer. Arch Pediatr Adolesc Med 156:504-11, 2002 (AHRQ Publication No. 02-R074).
Available from: AHRQ Publications Clearinghouse.

Evidence report focuses on children with ADHD.
Description: Researchers assessed the effectiveness and long- and short-term safety of pharmacological and nonpharmacological interventions for ADHD.
Availability: Copies of the report summary (AHRQ Publication No. 99-E0017) and full report, Treatment of Attention-Deficit/Hyperactivity Disorder (AHRQ Publication No. 00-E005), are available from the AHRQ Publications Clearinghouse. (AHRQ contract 290-97-0017).

AHRQ technical review focuses on the screening tests used to diagnose ADHD.
Description: The researchers identified several rating scales that effectively discriminate between ADHD children and normal controls. Broad-band behavior rating scales were ineffective in identifying ADHD children, as were imaging procedures (CT, CAT scan, MRI) and neurological screening tests.
Availability: Copies of the summary (AHRQ Publication No. 99-0049) and technical review, Diagnosis of Attention-Deficit/Hyperactivity Disorder (AHRQ Publication No. 99-0050), are available from the AHRQ Publications Clearinghouse. (AHRQ contract 290-94-2024).

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Chronic Illnesses

Approximately 20 million children suffer from at least one chronic health condition. Of the 200 chronic conditions and disabilities that affect young people, AHRQ's current research focuses most predominantly on diabetes, cerebral palsy, respiratory problems, and traumatic brain injury. For a description of projects and findings on other chronic illnesses, see the sections on asthma, ADHD, and mental health in this program brief.

Recent Findings

Palliative care services should be partially hospital based.
Description: In examining the characteristics of deaths occurring in children's hospitals, researchers find that children with complex chronic conditions are in the hospital longer and spend longer periods on mechanical ventilation than other children and could benefit from hospital-based palliative care services.
Citation: Feudtner, Christakis, Zimmerman, et al. Pediatrics 109(5):887-93, 2002 (AHRQ grant K08 HS00002).

Multidisciplinary care did not prevent adverse outcomes among children with type-1 diabetes.
Description: Researchers assessed how glycemic control and the frequency of glycemic monitoring affected the incidence of adverse events, hospitalizations, and emergency room visits of 300 youngsters with type-1 diabetes. Despite multidisciplinary care, glycemic control did not improve during the 1-year study period, and participants were hospitalized three times as often as the general pediatric population.
Citation: Levine, Anderson, Butler, et al. J Pediatr 139:197-203, 2001 (NRSA training grant T32 HS00063).

Children with diabetes can learn to live well, despite the ever-present risk of serious illness and death.
Description: Attitudes of juvenile diabetes patients toward their illness early in its course can lead to emotional and ethical predicaments involving issues of control, stigma, risk, and responsibility. Because advances in medical therapy will keep patients with chronic diseases living longer in states of “dangerous safety,” the inescapable threat of illness and death needs to be integrated into the concept of a well-lived life.
Citation: Feudtner. Cult Med 173:64-7, 2000 (AHRQ training grant T32 HS00009 and HS07476).

Medicaid-insured children with chronic diseases receive most of their care from generalist physicians.
Description: To calculate annual rates of generalist, subspecialist, and pediatric subspecialist use, investigators analyzed Medicaid claims data for over 57,000 children and adolescents with 11 chronic conditions. Findings show that Medicaid-insured children with chronic diseases received most of their care from generalists.
Citation: Kuhlthau, Ferris, Beal, et al. Pediatrics 108(4):906-12, 2001 (AHRQ grant HS09416).

Evidence report discusses rehabilitation for traumatic brain injury (TBI) in children.
Description: Researchers examined the effectiveness of early, intensive rehabilitation; the use and outcomes of special education; the role of developmental stage as a predictor of problems resulting from TBI; and the ability of support services to improve family coping and alleviate the burden of illness.
Availability: The report summary (AHRQ Publication No. 99-E025) and full report, Rehabilitation of Traumatic Brain Injury in Children and Adolescents (AHRQ Publication No. 00-E001), are available from the AHRQ Publications Clearinghouse (contract 290-97-0018).

Medications are the third-largest health care expense for children infected with HIV.
Description: An analysis of medical costs for 100 children with AIDS and 41 children with HIV revealed that medications constitute the third-largest expense. The largest expenses are for hospital stays and outpatient services (Intramural).
Citation: Hsia. AIDS Care 10(6):761-70, 1998 (AHRQ Publication No. 99-R031)
Available from: AHRQ Publications Clearinghouse.

Costs are high for families that have children with diabetes.
Description: Questionnaires were sent to 197 families with a diabetic child and 142 families with no diabetic children. More than 60 percent of affected families reported having to pay a deductible for either insulin, syringes, or blood-testing strips; more than 85 percent paid a copayment for these items.
Citation: Songer, LaPorte, Lave, et al. Diabetes Care 20(4):577-584, 1997 (NRSA Fellowship F32 HS00038).

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