Diabetes Mellitus is the most common endocrine disease found in children, and its reported incidence is increasing. Most investigators now agree that improved diabetic control is effective in decreasing both long and short term complications. The delineation of factors which affect control are, therefore, of importance. Classically, the physician has emphasized insulin dose, presence of infection, diet, and exercise. Emotional factors have long been thought to play a role in diabetes mellitus. The exact nature of this role, however, has been rather elusive and controversial. The authors review this literature, summarize the major viewpoints, and conclude that psychological factors can influence the physiology of the disease. The focus of this paper is the synthesis of recent advances in basic metabolic, endocrinologic, and stress research, relevant to juvenile diabetes, into a psychophysiologic model. The authors discuss future research directions necessary for clarification of the model, as well as its psychological and physiological therapeutic implications.

The terms "Munchausen syndrome by proxy" or "Polle syndrome" have been used to describe children who are victims of parentally induced or fabricated illness. This report gives case histories of two siblings (a 7-month-old girl and a 4-year-old boy) with recurrent episodes of cardiorespiratory arrest that were induced by a mother who skillfully resuscitated the children and who demonstrated model parental behavior. Polygraphic monitoring with hidden camera was used to determine that the episodes of cardiorespiratory arrest were parentally induced in the infant. The 4-year-old sibling had previously undergone multiple diagnostic and surgical procedures. After the diagnosis was made in the infant, and the mother was no longer permitted to be alone with the children, neither child had further episodes. A psychologic profile of the mother is presented, and special features of these two and other cases in the literature are reviewed. These cases represent a form of child abuse. A parentally induced illness should be considered in the differential diagnosis of unusual illnesses with bizarre features, even when the parent's behavior appears exemplary.

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The routine use of stimulants in pediatrics has increased dramatically over the past 3 decades and the long-term consequences have yet to be fully studied. Since 1978 there have been 7 articles identifying electroencephalogram (EEG) abnormalities, particularly epileptiform discharges in children with attention deficit hyperactivity disorder (ADHD). Many have studied the prevalence of these discharges in this population with varying results. An article published in 2011 suggests that EEG technology should be considered prior to prescribing stimulants to children diagnosed with ADHD due to a high prevalence of epileptiform discharges. The 2011 study found a higher prevalence (26%) of epileptiform discharges when using 23-hour and sleep-deprived EEGs in comparison with other methods of activation (hyperventilation or photostimulation) and conventional EEG. We sought to replicate the 2011 results using conventional EEG with the added qEEG technologies of automatic spike detection and low-resolution electromagnetic tomography analysis (LORETA) brain mapping. Our results showed 32% prevalence of epileptiform discharges, which suggests that an EEG should be considered prior to prescribing stimulant medications.

Parental behavior has often been cited as a crucial factor in children's ability to cope with stress. However, there has been little study of ways parents help their children adjust to stressful life events. In the present study, 34 parents and children (ages 4-9) were observed preparing for a stressful life event (elective surgery). Parents were asked to prepare their children for the upcoming stress and were given stress-related hospital equipment to use with their child. Specific hypotheses were selected to study the relationships of five parent helping behaviors to children's active preparatory play with stress-relevant materials. Children's preparatory play alone and with an examiner were also observed to test for effects of children on their parents' helping behavior. As expected, parent helping behaviors were significantly related to children's active preparatory play. With the exception of highly directive behavior, however, the relationship of parent helping behavior to child play was dependent on the child's age. This study suggests the importance of further investigating parental involvement in studying the process of children's coping with stress.

Our results find that compared with the healthy population, a large number of patients with ASD have isolated epileptiform discharges despite never having a seizure. Our findings support the use of EEG in children, adolescents, and young adults with ASD, regardless of gender or age. This is particularly true for those who exhibit aggressive behaviors or those who have failed previous medication attempts with stimulants, antidepressants, and/or antipsychotics.

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