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Pediatric Issues
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Coch, D. (2007). Neuroimaging research with children: Ethical issues and case scenarios neuroimaging research with children: Ethical issues and case scenarios. Journal of Moral Education, 36(1), 1-18.
There are few available resources for learning and teaching about ethical issues in neuroimaging research with children, who constitute a special and vulnerable population. Here, a brief review of ethical issues in developmental research, situated within the emerging field of neuroethics, highlights the increasingly interdisciplinary nature of research with children. Traditional boundaries between behavioural, psychological, neuroscientific and educational research are being blurred by multidisciplinary studies of learning and human development. Developmental and educational researchers need to be aware of the ethical quandaries inherent in such research, and moral educators need to encourage researchers to consider the ethical aspects of developmental neuroimaging. To this end, fictional case scenarios were designed to address two topics in the ethical conduct of neuroimaging research with children: inadvertent findings in paediatric neuroimaging and inclusion of young children in pharmacological clinical trials. The latter is contrasted with an educational trial in an alternate scenario, underscoring similarities in ethical issues across types of developmental research. It is hoped that discussions elicited by such scenarios will contribute to both moral education and paediatric neuroethics. ABSTRACT FROM AUTHOR Copyright of Journal of Moral Education is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts)
*Downie, J. & Marshall, J. (2007). Pediatric Neuroimaging Ethics. Cambridge Quarterly of Healthcare Ethics, 16, 147-160. This article is an excellent review of the unique ethical concerns with pediatric populations in neuroimaging. The authors discuss several modalities, outlining the direct and indirect physical and psychological risks, and extend the ethical discussion into broader issues such as resource allocation decisions and stigmatization. The problem of overuse of neuroimaging techniques and risk of neglecting relevant environmental factors, particularly in childhood behavioral problems, is mentioned, along with the limitations of predictions and interpretations of imaging results. On a clinical level, they discuss the need for the development of various protocols as new situations arise, such as unexpected findings from an imaging exam and how to communicate these results to parents without unnecessarily frightening them. They also point out the ethical importance of confidentiality and privacy of children’s health information, as it may be used inappropriately in school settings in assessment, for example. The overall message of the article stresses the importance of remaining humble in one’s interpretations of neuroimages, and of remaining vigilant in the protection of children, whose brains are in constant flux as they develop.
(An example of how neuroimaging is being used in current literature, and a good venue to identify ethical issues) Duffy, A. (2007). Does bipolar disorder exist in children? A selected review. Canadian Journal of Psychiatry, 52(7), 409-417.
Although there is increasing recognition that a substantial proportion of patients with bipolar disorder (BD) experience an onset of illness in adolescence, significant controversy remains over the validity of the diagnosis in very young children. In careful studies of adult patients dating from Kraepelin, first mood episodes not uncommonly occurred during adolescence. Some of these early-onset patients experienced subthreshold mood disturbances or predisposing temperaments earlier in childhood. Earlier onsets of BD have been reported in more recent clinical and community samples of children. Several factors possibly contributed to these earlier onsets, including exposure to psychotropics, bias in favour of a mood rather than a psychotic diagnosis, and recognition of softer-spectrum BDs. However, the validity of the diagnosis of BD in impulsive, irritable, labile, or behaviourally dysregulated children remains to be proven. Studies of high-risk children of well-characterized parents with BD have demonstrated that BD most often debuts as a depressive episode in mid to late adolescence and that activated episodes are rare prior to age 12 years. Some children manifest antecedent nonspecific psychopathology in early childhood. Therefore, as currently diagnosed, BD does not manifest as such typically until at least adolescence. (English) ABSTRACT FROM AUTHOR.
*Giedd, J. N. (2001). Neuroimaging of pediatric neuropsychiatric disorders: Is a picture really worth a thousand words? Arch Gen Psychiatry, 58, 443-444. Giedd discusses the current uses of imaging in clinical medicine and the potential uses in the future. Much of the article discusses situations in which imaging is helpful, such as in differential diagnosis to rule out a tumor. He also discusses the relief felt by parents who are reassured by the images that the problem is 'not their fault'. His most important point is to caution against the dangers of false-positives and false-negatives using imaging. Good clinical judgment remains an essential part of diagnosis even with neuroimaging technology, and Giedd recommends specifying exactly what information is being sought prior to scanning any particular patient.
Hinton, V. J. (2002). Ethics of neuroimaging in pediatric development. Brain & Cognition, 50(3), 455.
Neuroimaging in pediatrics is accompanied by all the ethical dilemmas associated with neuroimaging in adults, magnified significantly. The defining characteristics of childhood make working ethically with the population particularly problematic. Children have not developed the rational capabilities necessary to make informed decisions and the variability and change associated with development contribute to heightened risks and/or benefits of any procedure and limit interpretation of data. As a consequence, fewer pediatric than adult neuroimaging research studies have been done, further limiting general knowledge of the field. Significant strides have been made just within the past few years with the collection of normative data sets of healthy children. Recommendations on how to proceed with pediatric neuroimaging studies while ensuring ethical treatment of the participants are presented. Copyright 2002 Elsevier Copyright of Brain & Cognition is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts)
Pediatric Issues
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