Children assessing

The concept that infants and children may be a sensitive subgroup relates to their relative immaturity compared to adults. Children, as well as the unborn child, have in some cases appeared to be uniquely vulnerable to toxic effects of chemicals because periods of rapid growth and development render them more susceptible to some specific toxic effects when compared to adults. In addition to such toxicodynamic factors, differences in toxicokinetics may contribute to an increased susceptibility during these periods. It should be noted, however, that during the developmental and maturational periods the susceptibility to exposure to xenobiotics in children may be higher, equal, or even lower than in adults. Except for a few specific substances, not very much is known about whether and why the response to a substance may differ between age groups. It should also be borne in mind that, in terms of risk assessment, children are not simply small adults, but rather a unique population (Nielsen et al. 2001). 

The US-EPA Child Specific Exposure Factors Handbook (US-EPA 2006), first published in 2002, consolidates all children s exposure factors data into one document. The document provides a summary of the available and up-to-date statistical data on various factors assessing children s exposures. These factors include drinking water consumption soil ingestion inhalation rates dermal factors including skin area and soil adherence factors consumption of fruits, vegetables, fish, meats, dairy products, homegrown foods, and breast milk activity patterns body weight consumer products and life expectancy. 

Saxe and colleagues (1997) have developed the Child Stress Reaction Checklist, which is a 30-item, Likert-scale parent interview that assesses children s PTSD symptoms across the major symptom domains. Eor assessment of younger children in particular, Richters and colleagues (1990) have developed a cartoon interview to assess PTSD. Scheeringa et al. (1995) have devel-... 

Richters, J.E. and Martinez, P., and Valla, J.P. (1990) A Cartoon-Based Interview for Assessing Children s Distress Symptoms. Washington DC National Institute of Health. 

Ginsberg, G., D. Hattis, and B. Sonawane. 2004. Incorporating pharmacokinetic differences between children and adults in assessing children s risks to environmental toxicants. Toxicol. Appl. Pharmacol. 198(2) 164-183. 

Armstrong TW, Hushka LJ, Tell JG, Zaleski RT (2000) A tiered approach for assessing children s exposure. Environ Health Perspect, 108(6) 469-474. 

Cohen Hubal EA, Sheldon LS, Zufall MJ, Burke JM, Thomas K (2000a) The challenge of assessing children s residential exposure to pesticides. J Expo Anal Environ Epidemiol, 10 638-649. 

Ginsberg G, Hattis D, Russ A, Sonawane B (2004c) Physiologically based pharmacokinetic (PBPK) modeling of caffeine and theophylline in neonates and adults Implications for assessing children s risks from environmental agents. J Toxicol Environ Health A, 67(4) 297-329. 

An age-related difference in the extent of gastrointestinal absorption of chromium(III) was reported in one study (Sullivan et al. 1984) it is not known if a similar relationship would exist for chromium(VI). No other information is available which evaluated potential differences between adults and children. Toxicokinetic studies examining how aging can influence the absorption, distribution, and excretion of chromium, particularly chromium(VI) would be useful in assessing children s susceptibility to chromium toxicity. There are no data to determine whether there are age-specific biomarkers of exposure or effects or any interactions with other chemicals that would be specific for children. There is very little available information on methods for reducing chromium toxic effects or body burdens it is likely that research in adults would also be applicable to children. 

Another laboratory value that is often obtained in these exposures is serum pseudoeholinesterase. Serum pseudocholinesterase activities are often assessed as normal in children because the reference standards may not be reliable when assessing children. To add to the complexity, the normal range of serum cholinesterase activity is wide (Sofer et al, 1989). Authors have described the limitations of this measurement in determining therapy for children. In fact, it is recommended that a therapeutic and diagnostic trial of atropine should be given whenever there is any possibility of intoxication with these chemicals (Sofer et al, 1989). 

Available at http //www.mentalhealth.samhsa.gov/publications/allpubs/SMA95-3022/default.asp, the booklet includes information about screening scales primary care physicians might find useful in assessing children for behavior problems and PTSD. 

The Diagnostic and Statistical Manual for Mental Disorders is another tool used by social work practitioners in the assessment process to identify clearly those categories that are applicable to children and to caution the professional on developmental differences that prevent the use of some diagnostic codes with children (American Psychiatric Association, 1994). Goldman (1998) proposes a quick and practical schema that allows the practitioner to apply the DSM-IV diagnoses to children. He proposes that the clinician first confirm the full criteria in the DSM-IV and then consider using the following questions as a way to assess children. 

During the following school year, follow-up assessments were conducted in order to provide longitudinal data on the practice of solvent abuse, to examine the stability of the psychological test findings from the initial assessment and to supplement the range of measures used at the initial assessment. Children who had been individually assessed and who were still at school were retraced and reexamined on questionnaires and a similar battery of psychological tests. 

Assessment presents particular challenges for the school. There are two elements to this the first relates to the identification and assessment of children s needs and the second is concerned with how best to assess children s progress. According to the SENCO, some staff are too keen to ask for external assessment rather than carry out some of the basic assessment fliemselves. This is partly because of a lack of expertise, experience and confidence. Training is therefore a major professional development issue for all staff. The school is gradually trying to build up this expertise so that assessment is related to the curriculum and is able to provide evidence of children s learning. 

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