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Responsive Research: how trying to meet contextual needs dictated my research agenda
1. Responsive Research : how trying to meet contextual needs dictated my research agenda Yanki Yazgan, M.D. Marmara University Faculty of Medicine, Istanbul
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5. Why I have been out of focus during all these years...
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7. 40.4 % of Turkish population under age 19 The largest age group (for total, male and female) in Turkey is between 15-19 that constitutes 10.6 % of the whole community (followed by ages 10-14, 10.1 %; ages 5-9, 9.9 % and 0-4, 9.7 %).
31. Hüzün ( tristesse ) (And we should) understand the central importance of hüzün as a cultural concept conveying wor l dly failure, listlessness and spiritual suffering .... ... hüzün has been central to Istanbul (say, Turkish) culture, poetry and everyday life over the past two centuries ... “ .. it is a way of looking at life that implicates us all, not only spiritual state but a state of mind that is ultimately as life affirming as it is negating. ” Pamuk, 2000
32. Loss after loss “ If I am to convey the intensity of the tristesse that Istanbul caused me to feel as a child, I must describe the history of the city following the destruction of the Ottoman Empire, and -even more important- the way this history is reflected in the city's 'beautiful' landscapes and its people. “
33. Poverty?? “ ... to convey these neighborhoods as traditional, spoiled and untouched by the West, Tanpinar wrote that 'they were ruined, they were poor and wretched' but had 'retained their own style and their own way of life.' (not anymore)
38. ADHD in community: how to respond to unmet needs, how to best identify who needs most?
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54. Recruited sample N=3892 Teacher Rating N=3229 Parent Rating N=3229 Usable data N=3110 Usable data N=3131 Declined consent N=663 Forms returned but incomplete= 98 Nonparticipation N=21 RESULTS Missing data 87+11
55. 40.7 (9.6 % ) Fathers 36.4 (5.5 % ) Mothers 9.6 (2.3 % ) Children Mean (SD) Age 7 (0.2%) Very high 261 (8.7%) High 2256 (74.9%) Average 365 (12.1%) Low 122 (4.0%) Very low Household income 298 (9.7%) Separated 2774 (90.3%) Living together Marital status 888 (30.0%) University or higher 635 (21.4%) High school 1439 (48.6%) < High school Father’s education 740 (24.8%) University or higher 668 (22.3%) High school 1581 (52.9%) < High school Mother’s education
56. * Age for grades 1-2=6.6 (0.6); for grades 3-4 = 8.6 (0.6); for grades 5-6 =10.6 (0.7); for grades 7-8 = 12.6 (0.7). Parent SNAP IV scores for children age 7 to 14 years by gender and by grade (N=3110) 0.42 (0.40) 0.41 (0.39) 0.42 (0.37) 0.53 (0.43) Overall 0.42 (0.47) 0.42 (0.47) 0.43 (0.43) 0.58 (0.52) Hyperactivity 0.39 (0.44) 0.39 (0.43) 0.40 (0.42) 0.48 (0.46) Inattention Mean (STD) Mean (STD) Mean (STD) Mean (STD) Scale 345 374 371 353 N G IRLS 0.51 (0.44) 0.59 (0.51) 0.63 (0.52) 0.60 (0.50) Overall 0.48 (0.50) 0.61 (0.58) 0.67 (0.61) 0.65 (0.60) Hyperactivity 0.52 (0.52) 0.57 (0.57) 0.59 (0.55) 0.53 (0.52) Inattention Mean (STD) Mean (STD) Mean (STD) Mean (STD) Scale 371 412 370 374 N BOYS 7 – 8 5 – 6 3 – 4 1 – 2 CHILD’S GRADE *
57. Teacher SNAP IV scores for children age 7 to 14 years by gender and by grade (N=3110) Scores for boys > scores for girls ////both parents and teachers. Teacher scores > parent scores across all age groups and both genders. Gender difference is greater for teacher reports 0.49 (0.56) 0.49 (0.56) 0.59 (0.73) 0.53 (0.57) Overall 0.36 (0.57) 0.33 (0.57) 0.46 (0.74) 0.35 (0.56) Hyperactivity 0.62 (0.66) 0.64 (0.66) 0.71 (0.83) 0.69 (0.84) Inattention Mean (STD) Mean (STD) Mean (STD) Mean (STD) Scale 350 379 362 338 N GIRLS 0.82 (0.73) 0.77 (0.67) 0.99 (0.75) 0.85 (0.77) Overall 0.68 (0.78) 0.67 (0.75) 0.86 (0.82) 0.73 (0.83) Hyperactivity 0.94 (0.81) 0.87 (0.75) 1.11 (0.85) 0.96 (0.93) Inattention Mean (STD) Mean (STD) Mean (STD) Mean (STD) Scale 379 405 376 352 N BOYS 7 – 8 5 – 6 3 – 4 1 – 2 CHILD’S GRADE
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64. SNAP IV scores according to thresholds on the parent- and teacher–rated PC S Children below the established cut offs on the PCS have higher SNAP scores by parents and teachers. 1.77 (0.77) 1.58 (0.78) 1.11 (0.77) 0.58 (0.61) Mean (SD) 85 243 356 2228 N Teacher 1.05 (0.58) 0.78 (0.56) 0.96 (0.58) 0.44 (0.40) Mean (SD) 77 220 346 2153 N Parent Total 1.44 (0.94) 1.20 (0.98) 0.87 (0.87) 0.48 (0.66) Mean (SD) 85 243 356 2228 N Teacher 0.97 (0.70) 0.75 (0.64) 0.91 (0.68) 0.47 (0.48) Mean (SD) 77 220 346 2153 N Parent Hyperactivity 2.10 (0.83) 1.95 (0.87) 1.36 (0.88) 0.67 (0.71) Mean (SD) 85 243 356 2228 N Teacher 1.12 (0.63) 0.81 (0.63) 1.00 (0.64) 0.40 (0.42) Mean (SD) 77 220 346 2153 N Parent Inattention Below cut off by parent & teacher ≤ 2.5 TPC ≤ 3 PPC Above cut off by parent & teacher SNAP Subscale
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66. Demographic characteristics of probable ADHD cases versus controls based on parent or teacher ratings after controlling for gender (0.0001) 1.08 (0.53, 2.21) 5.61 (3.50, 9.01) Yes vs. No 15.10 Need for Psychiatric treatment 1.12 (0.51, 2.46) 4.07 (2.44, 6.80) Yes vs. No 7.75 (0.0054) Past Psychiatric treatment (0.0103) 2.96 (1.85, 4.74) 1.32 (0.86, 2.00) < high school vs. > high school 6.59 Father’s education (0.0001) 4.41 (2.55, 7.63) 1.12 (0.74, 1.70) < high school vs. > high school 15.74 Mother’s education (0.0036) 4.43 (2.89, 6.77) 1.75 (1.07, 2.85) < average vs. > average 8.47 Income 1.72 (0.88, 3.39) 0.66 (0.31, 1.42) 7-8 vs. 1-2 0.27 (0.11, 0.65) 1.56 (0.82, 2.99) 5-6 vs. 1-2 11.43 (0.0096) 1.11 (0.54, 2.29) 1.04 (0.51, 2.12) 3-4 vs. 1-2 Grade 0.10 (0.03, 0.40) 1.44 (0.77, 2.70) School 2 vs. School 3 18.08 (0.0001) 1.12 (0.46, 2.75) 0.60 (0.32, 1.12) School 1 vs. School 3 School Odds Ratio (95% CI) Odds Ratio (95% CI) Wald test (P-value) b T EACHER ADHD P ARENT ADHD
This is in accord with some kind of traditional turkish thinking; we never let any inquiry down. That may yield innovative approaches op-lender, op-reader
I was known as the leading person in the field of ADHD not because of my immense expertise, but my somewhat slightly more experience of using stimulants in treatment.
(for which I had no interest while I was at Yale together with the gurus of the genetics research in developmental disorders).
Was i like that while in the US? İt seems that I have tried going beyond what was made available to me? Neuroimaging work that Jim has initiated and supported Brad for developing. I had taken one end of the work, in particular the basal ganglia assymmetry and corpus callosum area in TS and normal individuals. I decided to look for behavioral laterality measures for which I could find almost noone to consult with therefore I went as far as Massachussets, to find marcel kinsbourne as a consultant (with help of Bruce Wexler) and generous support of Jim Leckman and Donald Cohen. Bob schultz was new in the filed and more focuısed on his original work of intelligence, then, if i do not misremember.
The importance of nonclinical activities and nonclinical personnel in helping children and families to improve their relationships and life satisfaction. We have accumulated experience during the intervention studies we performed in the disaster affected areas after the 1999 earthquake. We have published our experience extensively, therefore, I will suffice by giving an informal summary of what we learned and how.
We accumulated our experience mainly in these circumstances.
The change associated with treatment was prevalent as the risk was higher (figure following) Risk. The number of Stressful and traumatic experiences; pretrauma psychiatric and behavioral status the PTS sx increase as the level of risks (such as preexposure sx) increase
After 1999, many of he professionals in our group extended the work into nondisaster conditions, that were not much different from the earthquake area in terms of the inadequacy of services, helplessness and pessimism of the parents, and hesitancy of the teachers. School-based interventions are now more widely used, actively sought by educational authorities and local governments, despite the fact that we are again and still much behind the needs arising.
School counselors and school psychologists may shift to a supervisory role under difficult circumstances when therapeutic needs surpass the available traditional clinical resources, roles should change Taking responsibility for managing and coordinating the organizational process in collaboration with the mental health team Leading parents and teachers for being mental health agents. In countries where child psychiatrists and other “mental health professionals” are scarce, can we use other community members? Can teachers and parents serve a mediating role for fostering development of the youth Empowering teachers and parents as mental health agents
The three schools had a total student population of 3892. Of these, consent was obtained on 3229 (82%). Teacher data was available on 3110 (79%)
Scores for boys>scores for girls for both parents and teachers. Teacher scores>parent scores across all age groups and both genders. Gender difference is greater for teachers… Scores for boys>scores for girls for both parents and teachers. Teacher scores>parent scores across all age groups and both genders. Gender difference is greater for teachers…
Low level of income seems to have greater association with being identified by teacher (OR=4.43 [2.89-6.77]) compared to being identified by parents (OR=1.75 [1.07-2.85]) Lower education in mothers (OR=4.41 [2.55-7.63]) and lower education in fathers (OR=2.96 [1.85-4.74]) seem to be associated with being identified as probable ADHD by teachers. Parental report on past psychiatric treatment (OR=4.07 [2.44-6.80]) as well as current psychiatric treatment need are associated with being identified by parents (OR=5.61 [3.50-9.01])
In addition to sports based Experiential learning opportunities, cognitive educational activities taking advanage of the positive atmosphere created by the joy and fun.
an Oprah style celebrity, trained and supervised before and after the “town hall” meetings, where I was present as “the expert guest”, more like a Q and A session. Both of us were already known to the audience well before through the mass media channels. The meeting was followed by two smaller seminars targeting the “opinion leaders” of the local community, a somewhat “training of the trainers” session where I discussed what would be the most frequent questions that can be heard from the parents of children aged 3-14 years. May seem ambitious, but...
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