Mary Coleman
As part of the University-Community Partnerships Program, UCSF is teaming up with the San Francisco Unified School District to bring research directly where it's needed most - teachers and school staff. A speaker series, "Hear from the Experts," is one of the first programs implemented by the 20-member Partnerships Council, which launched in May and has a mission to strengthen the connection between the University and the community.
"This speaker series is an excellent example of translational work: bringing science to practice," says Program Director Elba Sanchez. "I am thrilled for this wonderful opportunity and partnership between UCSF and San Francisco Unified."
The monthly series runs from October 2006 to April 2007 and covers such topics as attention deficit hyperactivity disorder (ADHD), autism, depression, and sexual health among youths and school-aged children.
The November lecture was conducted by Mary Coleman, MD, MPH, UCSF assistant clinical professor of pediatrics and a developmental and behavioral pediatric specialist, who explained ways to determine whether a child's behavior is normal or aberrant, and when to refer the child for clinical evaluation.
In her talk, Coleman focused on the definition of "normal" behavior, showed how the development and behavior of a child can be analyzed on a continuum, and explained that development and behavior are products of both biology and the environment.
Members Sought
The University-
Community Partnerships Council is seeking two staff or faculty representatives - one from UCSF Medical Center and one from the School of Dentistry.
Contact Elba Sanchez
for more information
at 415/502-4966.
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"When defining what is 'normal' behavior, there are many factors, such as chronologic and developmental age, cultural variations and social norms," says Coleman. "But what's happening in the environment plays a large role. For example, if, after 9/11, the whole of society is more anxious, then does some degree of anxiety become the 'new normal'?"
Coleman says 12 percent to 30 percent of school-aged children have psychosocial problems that impede learning and development. She also says 70 percent to 90 percent of cases are missed by primary care physicians if standardized developmental and behavioral screening tools are not used.
Assessing Children's Behavior
Since teachers may be the first to discover developmental or psychosocial difficulties in children, Coleman in her lecture presented several developmental screening tools for teachers. Coleman described child behavior as occurring on a left-to-right continuum from normal "variation" to "problem behavior" to "disordered behavior."
"When deciding where to place the child's behavior on the continuum, look at the frequency and the severity of the behavior compared to other students the same age. How intense are the symptoms? Does the behavior affect function in the home or classroom? What is the burden of suffering for the child and the family?" says Coleman. "I believe that if the behavior lies in the problem or disorder category, then it requires clinical attention."
Although current research shows that biology and the environment both play a role in development and behavior, Coleman suggests that environmental factors are oftentimes underestimated, and that high-stress environments can lead to problem or disordered behaviors.
"We must analyze how the environment produces or contributes to behavioral and developmental difficulties exhibited by the child," says Coleman. "For example, if a child is traumatized by an environment that is filled with violence, he may exhibit hyperactivity, which may be mistaken for ADHD."
For a more accurate assessment, Coleman recommends observing the child in several environments - the classroom, the playground and at home - to see whether the problem behavior occurs across domains or is isolated to one location.
Protective factors help children overcome adverse environmental circumstances. These protective factors include support from family and teachers, positive social interactions, good physical health, normal intelligence, emotional adaptability and ability to handle stress.
At UCSF, Coleman utilizes a computer program, developed at Johns Hopkins University called the Child Health and Development Interactive System (CHADIS), that helps to quantify behavioral symptoms and identify environmental risk and protective factors to assist with differential diagnoses and courses of action.
"The goal of our work in developmental and behavioral pediatrics is to support the child's long-term development of autonomy, adaptability and capacity for relationships to enhance future development and success," says Coleman.
Related Links:
University-Community Partnerships Program
UCSF Forms University-Community Partnerships Council
UCSF Today, May 26, 2006
