Evaluation
of a Residency
Training
Program
in
Behavioral
Pediatrics
Sheridan Phillips, PhD, Stanford B. Friedman, MD, Jean Smith, MD,
and Marianne
E. Felice,
MD
From the Division of Behavioral Pediatrics, Department of Pediatrics, and Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore
ABSTRACT. The impact of behavioral training upon first-year residents was evaluated by assessing attitudes with regard to 15 clinical “entities,” including behavioral disorders, physical disorders, and “mixed” disorders. Each entity was rated at four times: beginning ofthe year, start of the behavioral rotation, end of the rotation, and end of the year. Multiple-choice questions were also in-cluded to assess knowledge regarding behavioral
pediat-rics. Data were collected from 37 residents, from 1977 to 1980. For behavioral disorders and mixed disorders, resi-dents’ self-reported competence increased with regard to diagnosis, management, advising parents, and knowledge of resources. Further, the greatest change occurred during the 2-month rotation. In contrast, change in perceived competence for physical disorders was not specific to the rotation but, rather, increased evenly over the year. Rat-ings of faculty and housestaff interest remained constant across testing points, and residents’ “desire to learn more” and prediction of “future relevance” showed a slight decrease over time, for all disorders. Knowledge regarding behavioral pediatrics increased significantly from the be-ginning of the year to the start of the rotation, and also during the rotation. These data demonstrate that changes in residents’ perceived competence are directly related to
their rotation experience, and suggest that behavioral
issues can be introduced successfully during the first year
of residency training. Pediatrics 1983;71:406-412; behav-ioral pediatrics, biosocial pediatrics, pediatric
educa-tion, program evaluation, pediatric residency training.
The past decade has seen a surge of interest in
behavioral pediatrics, and increasing
acknowledg-Received for publication March 26, 1982; accepted May 26, 1982. Dr Felice’s current address: Department of Pediatrics, Univer-sity of California, San Diego Medical Center, San Diego. Presented in part at the Annual Meeting of the American Pediatric Society, San Francisco, April 1981.
Reprint requests to (S.P.), MSTF-Suite 400, University of Mary-land School of Medicine, 10 South Pine St, Baltimore, MD 21201.
PEDIATRICS (ISSN 0031 4005). Copyright © 1983 by the
American Academy of Pediatrics.
ment of the need for residency training in this area. This trend is exemplified by the report of the Task Force on Pediatric Education,’ which strongly rec-ommended that all pediatric residency training pro-grams include at least one full-time rotation in biosocial pediatrics. This recommendation reflected the belief of most clinicians that they have had inadequate training in biosocial problems,2’3 and yet are often consulted about behavioral and develop-mental issues.47
As a consequence of this recent interest, a num-ber of pediatric departments have attempted to
incorporate behavioral pediatrics into residents’
core education. However, since we have entered the “era of accountability,” training programs have ex-perienced increasing pressure to evaluate their use-fulness. Only in this way will it be possible to assess
the effect of different approachefi to training and determine which model(s) appear fruitful. The fact that relatively few evaluations have been reported thus far reflects both the short period of time that such programs have existed and a host of challenges which confront prospective evaluators. These in-dude the absence of standardized norms; the need to develop assessment instruments that are reliable, valid, and practical to administer and score; the difficulty of identifyin,g cooperative “control”
pop-ulations which admittedly provide little or no
train-ing in behavioral pediatrics; and the variability among programs and criteria.
in both years, and (2) training was first introduced in the PL-1 year. The curriculum for PL-1 residents emphasized normal growth and development, com-mon behavior problems, and the psychosocial needs of the hospitalized child or adolescent. Training was both didactic and experiential, utilizing day care
centers and schools as well as the wards and
am-bulatory settings. Continuity was provided by a preceptor. Approximately 12 interns were trained each year; two were on each rotation.
It was hypothesized that both didactic and ex-periential training, during this intensive period, would have an impact upon residents’ attitudes and upon their knowledge with regard to behavioral
pediatrics. This report presents an assessment of
the effect of training focused upon first-year resi-dents.
METHODS
Data were collected from 37 first-year pediatric residents at the University of Maryland School of Medicine, over the course of 3 academic years (July
1977 to June 1980). (All residents were requested, at the outset of their first year, to participate in an
evaluation effort by completing questionnaires
de-signed to assess their experience with regard to behavioral pediatrics. Residents were encouraged
to participate and to respond honestly, but were
not required to respond. Data were obtained from all but one resident, who left the program during his first year and could not be located.) Each resi-dent completed a questionnaire at four points in time during his/her PL-1 year: at the beginning of the academic year, at the start of the rotation in
behavioral pediatrics, at the end of the rotation in
behavioral pediatrics, and at the end of the aca-demic year. The exception to this was those two residents, in each academic year, who began the behavioral pediatric rotation in July. For these residents, the “beginning of year” test was also the “start of rotation” test. Similarly, there were two residents each year who completed their behavioral pediatric rotation at the end of the academic year; their “end of rotation” test was thus also their “end of year” test. (Results were analyzed separately for the subset of 25 residents who completed four sep-arate tests over the course of the academic year. As findings were equivalent to those for the entire cohort of 37 residents, only data from all 37 resi-dents are presented.)
The questionnaire administered to residents
con-sisted of four sections. Section 1 was a single rating
of “current interest” in behavioral pediatrics, using a five-point scale ranging from 1 (“no interest”) to 5 (“extreme interest”).
Using a “critical incidence” approach, section 2
assessed attitudes toward 15 clinical “entities,”
shown in Table 1. For purposes of statistical anal-ysis, these entities were grouped into the four cat-egories shown in Table 1. This categorization was
performed prior to any data analysis by six
profes-sionals knowledgeable about behavioral pediatrics (the four authors and two behavioral pediatricians at the University of Maryland School of Medicine). Each judge was asked, independently, to place the 15 entities into the appropriate group. Definitions were as follows: “physical” entities, those which, for diagnosis and/or management, require attention
primarily to physical issues; “mixed” entities, those
which, for diagnosis and/or management, require approximately equal attention to behavioral and physical ones; “behavioral” entities, those which, for diagnosis and/or management, require attention
primarily to behavioral issues. Behavioral entities
were further subdivided into two groups: those en-tities that were emphasized during the behavioral pediatric rotation and those that were discussed but not emphasized in the rotation. With regard to the judges’ categorization, all six agreed regarding the appropriate grouping for 12 of the entities, and five of the six agreed with regard to three entities.
Section 2 ofthe questionnaire presented residents with each of these clinical entities and asked them to respond to each entity by completing the rating scale shown in Table 2. Section 2 thus assessed the residents’ self-perception of their competence,
knowledge, and interest with regard to each of these
clinical entities.
Section 3 of the questionnaire assessed attitudes toward the 15 clinical entities using a Semantic
Differential Scale based on the work of Osgood et
al.8 Residents were asked to respond to each clinical entity by rating it according to 11 bipolar adjectives
TABLE 1
.
Clinical Entities Presented to First-Year Residents in Evaluation QuestionnairePhysical
Chronic glomerulonephritis Streptococcal pharyngitis Mixed
Deafness Down’s syndrome Enuresis
Minimal brain dysfunction Terminally ill child Well-child care
Behavioral (emphasized in rotation) Conversion reaction
School phobia Suicidal behavior
Behavioral (not emphasized in rotation)
Childhood psychosis Sexual promiscuity
Stealing
TABLE 2. Rating Scale Used in Section 2 of
Question-naire to Obtain Residents’ Self-Reported Perception of Competence, Knowledge, and Interest with Regard to Each of 15 Clinical Entities
5
4
3.
2
DIAGNOSIS MANAGEMENT
Topic Rating
1. Your current feelings of overall 1 (no compe-competence in making a diagno- tence) to 5
(ex-sin treme
compe-tence) 2. Your current feelings of overall 1 (no
compe-competence in management tence) to 5
(ex-treme
compe-tence)
3. Ability to counsel and advise 1 (no ability) to 5 parents regarding this entity (extreme
abil-ity)
4. Knowledge of community and/ 1 (no knowledge)
or professional resources to as- to 5 (extreme sist with diagnosis or manage- knowledge) ment
5. Desire to learn more about this 1 (no desire) to 5
entity (extreme
de-sire)
6. Perceived level of interest of 1 (no interest) to
this pediatric faculty in this cliii- 5 (extreme
in-ical entity terest)
7. Perceived interest of this house- 1 (no interest) to
staff (PL 1-3) in this clinical en- 5 (extreme
in-tity terest)
8. Perceived relevance of this en- 1 (no relevance)
tity to your ultimate profes- to 5 (extreme
sional career relevance)
(eg, repelled-attracted, frustrated-satisfied, hopeful-resigned).
Section 4 of the questionnaire consisted of mul-tiple-choice questions designed to assess knowledge with regard to behavioral pediatrics. Although ap-proximately 20 questions were asked in each aca-demic year, only six questions were directly com-parable across all 3 years due to attempts to reword and improve test items.
All data were analyzed statistically using a one-way, repeated-measures analysis of variance. On these measures for which the overall F was statis-tically significant at the .05 level or better, Tukey’s tests were employed as post hoc tests to detect the location of change (eg, beginning of year v start of
rotation; start of rotation v end of rotation). It was
hypothesized that the greatest amount of change
related to behavior would be observed over the course of the behavioral pediatric rotation (ie,
be-ginning of rotation v end of rotation). All effects
reported were statistically significant at the .05 level or better, unless otherwise indicated.
RESULTS
Examining ratings of “current interest in behav-ioral pediatrics” at each of the four test points revealed mean scores of 4.00, 4.08, 4.17, and 4.11,
respectively, for section 1 of the questionnaire.
These indicated definite to extreme interest on the part of the residents, and did not change signif-icantly during the academic year.
The results of self-rated competence in diagnosis,
from section 2 of the questionnaire, are shown in Fig 1 (left). An increase in diagnostic competence occurred in all four types of entities over the course of the year. However, the location differed depend-ing upon the entity group. The only significant change for physical entities occurred between the beginning and the end of the year, showing a grad-ual increase over the year. In contrast, the signif-icant change for behavioral entities emphasized in the rotation was directly related to the rotation. There was a significant increase from the beginning of the year to the start of the rotation, and also from the start of the rotation to the end of the rotation. However, the increase during the rotation
was significantly greater than that from the begin-fling of the year to the start of the rotation. (To compare significant changes during two different testing phases, a t test was used to contrast the
difference scores in each testing phase.) There was no significant change from the end of the rotation
to the end of the year. The
“behavioral-empha-sized” group thus showed the greatest increase dur-ing the behavioral pediatric rotation. Behavioral
entities not emphasized in the rotation
demon-strated a significant increase from the beginning of
year to start of rotation, and a comparable,
signif-icant increase during the rotation. Mixed entities demonstrated a marginally significant increase dur-ing the rotation, and no significant change from either the beginning of year to start of rotation or from the end of rotation to end of year.
The results of self-rated competence in
manage-COMPETENCE
Physical
-..-.-. Mixed
Behavioral
...‘...‘.
emphasizedmmoonot
emphasized
. Begin StrI End End Begin Start End End
Year Rotation Rotation Year Year Rotation Rotation Year Fig 1
.
Mean ratings of PL-1 residents’ attitudes, usingfive-point scale (none to extreme), with regard to four
types of clinical entities: physical, mixed,
behavioral-emphasized in rotation, and behavioral-discussed but
KNOWLEDGE OF RESOURCES 5
4
3.
2
5.
4’
COUNSEL AND ADVISE
Behavioral
a... emphasized GiooioGonot
emphasized
HOUSESTAFF
FACULTY
Physical
-‘.-.--. Mixed
Behavioral
,...., emphasized ioO-0’O.O.O not
emphasized
2-I I I
Begin Start End End
Year Rotation Rotation Year
Begin Start End Year Rotatton Rotation
End
Year
ment are shown in Fig 1 (right). All four types of entities revealed a significant increase during the year. However, the only significant change for
phys-ical entities occurred between the beginning and end of the year, whereas the other entity groups demonstrated change that was directly related to the behavioral pediatric rotation. Behavioral enti-ties emphasized in the rotation showed a significant increase from the beginning of the year to start of
rotation, and also from the start to end of the
rotation; the extent of change during the rotation was significantly greater than that from the begin-ning of year to start of rotation. Behavioral entities not emphasized in the rotation showed a significant increase during the rotation but not during the other two testing phases. Mixed entities also dem-onstrated a significant increase only during the rotation.
Residents’ ratings of their ability to counsel and advise parents are shown in Fig 2 (left). All entity groups showed a significant increase during the course of the year. For physical entities, this rep-resented a gradual change during the year and was unrelated to the rotation. “Behavioral-emphasized”
entities increased significantly from the beginning of year to the start of rotation, and then demon-strated a significantly greater increase during the rotation. Behavioral entities not emphasized in the rotation showed a significant increase during the rotation, and also from the end of the rotation to the end of the year. However, the amount of change during the rotation was significantly greater than that from the end of rotation to end of year. Mixed entities displayed a significant increase only during the behavioral pediatric rotation.
The results regarding knowledge of resources to assist with diagnosis and/or management are shown in Fig 2 (right). Physical entities showed a
signif-icant increase from the beginning to the end of the year, unrelated to the rotation. Behavioral entities
emphasized in the rotation demonstrated a
signif-icant increase in all three phases, but the change during the rotation was significantly greater than that from the beginning of year to start of rotation, or that from the end of rotation to end of year.
Behavioral entities not emphasized during the
ro-tation showed a significant change from the
begin-ning of year to the start of rotation, and then demonstrated a significantly greater increase during the rotation. Mixed entities increased significantly only during the rotation.
The perceived interest of the faculty in these entities is shown in Fig 3 (left). There were no significant changes, for any group of entities, during the course of the year. The perceived interest of the housestaff is shown in Fig 3 (right). Again, no significant change in interest ratings were found.
The residents’ rated desire to learn more about these entities is shown in Fig 4 (left). All entity groups showed a significant decrease over the course of the year. This represented a gradual
de-clime, unrelated to the rotation, for physical entities
and for mixed entities. For behavioral-emphasized entities, the significant decrease occurred during the behavioral pediatric rotation. Behavioral enti-ties not emphasized in the rotation demonstrated a significant decrease during the rotation, and a com-parable, significant decrease from the end of the
rotation to the end of the year.
Ratings of perceived relevance for one’s future career are shown in Fig 4 (right). Physical entities revealed no significant change during the year. Mixed entities and behavioral entities emphasized in the rotation demonstrated a significant, gradual decrease over the course of the year, which was
INTEREST
Fig 2. Mean ratings of PL-1 residents’ attitudes, using
five-point scale (none to extreme), with regard to four types of clinical entities: physical, mixed,
behavioral-emphasized in rotation, and behavioral-discussed but not emphasized in rotation.
. I +-
I
Begin Start End End Begin Start End End
Year Rotolion Rotatce Year Year Rotation Rotation Year
Fig 3. Mean ratings of PL-1 residents’ attitudes, using five-point scale (none to extreme), with regard to four types of clinical entities: physical, mixed,
behavioral-emphasized in rotation, and behavioral-discussed but
5
4
3
2
DESIRE TO LEARN MORE
Physical
-.-...-.. Mixed Behavioral ... emphasized
OioO’O.O.O flOt
emphasized
FUTURE RELEVANCE
BegIn Start End End
Year Ratalian Rotation Year
Begin Start End Year Rotation Rotation Fig 4. Mean ratings of PL-1 residents’ attitudes, using five-point scale (none to extreme), with regard to four
types of clinical entities: physical, mixed,
behavioral-emphasized in rotation, and behavioral-discussed but not emphasized in rotation.
unrelated to the rotation. Behavioral entities not
emphasized in the rotation showed a significant decrease from the beginning of the year to start of rotation, during the rotation, and from the end of rotation to end of year. The amount of change was comparable in all three phases.
To summarize the results from section 2 of the questionnaire, three sets of ratings showed gradual change for physical entities-unrelated to the ro-tation-in contrast to mixed entities and both groups of behavioral entities, which demonstrated significantly greater change during the behavioral pediatric rotation. This was the case for “competence in management,” “ability to counsel and advise parents,” and “knowledge of resources.” Results for “competence in diagnosis” were similar but less pronounced. The “interest of housestaff” and “interest of faculty” did not change during the year. “Desire to learn more” decreased over the course of the year for all entity groups; this ap-peared related to the rotation only for behavioral-emphasized entities. Perception of “future rele-vance” was unchanged for physical entities and decreased gradually over the course of the year for the other three entity groups; this decrease ap-peared especially pronounced for behavioral enti-ties not emphasized in the rotation.
Few significant findings were obtained from sec-tion 3 of the questionnaire, a semantic differential scale assessing attitudes toward the 15 clinical en-tities. The number of items that demonstrated change during the year were not appreciably differ-ent from that which would be expected by chance. Furthermore, there was no meaningful pattern of change. These results are thus not presented.
Section 4, multiple-choice questions which as-sessed knowledge of behavioral pediatrics, con-tamed only six questions which were directly
com-parable for all 37 residents from 1977 to 1980. These were available for two testing points: beginning of year and end of year. Mean performance (percent correct) was 58.0% and 67.8%, showing a significant increase in knowledge during the year. Scores at all four testing points were available for 24 residents (academic years 1978 to 1980), based upon 20 ques-tions that were directly comparable. Mean
perform-ance at the beginning of year, start of rotation, end of rotation, and end ofyear was: 56.5%, 62.6%, 69.8%, and 66.4%, respectively. This represented a
signif--4 icant increase during the year, due to significant
Year change from the beginning of year to start of rota-tion, and a comparable, significant increase during the rotation. There was no significant change from the end of rotation to the end of year.
DISCUSSION
These residents’ self-reported interest in behav-ioral pediatrics was high even at the start of their PL-1 year, which may be why their rated interest did not increase significantly during the academic year. This indicates that they entered the training program with positive attitudes regarding the im-portance of behavioral and developmental issues for pediatricians, and that they maintained these attitudes during their first year of residency train-ing. These data may reflect some selection bias, both with regard to residents’ self-selection and the admission criteria for internship used by the faculty. However, although this group of residents might be particularly interested in behavioral pediatrics, their attitudes could also be indicative of the heightened interest in behavior generally evidenced in the field of pediatrics.
Four self-report measures, which focused upon specific clinical entities, demonstrated clear effects of training during the behavioral pediatric rotation.
This was the case for residents’ rated competence in management, ability to counsel parents, knowl-edge ofresources and, to a lesser extent, competence in diagnosis. In general, ratings for behavioral en-tities and mixed entities demonstrated the greatest increase during the 2-month behavioral rotation. In contrast, ratings for physical entities showed a grad-uai increase over the course of the year, unrelated to the rotation. It should be emphasized that these results do not merely reflect more experience with patients, inasmuch as the data evidence the greatest change for behavioral and mixed entities during a specific 2 months of the 12-month academic year. These effects thus are directly related to the rota-tion experience.
Different results were found for the perceived
interest of the faculty and the interest of the
were consistently rated as “moderately” to
“def-initely” interested, these ratings did not change during the year. It was interesting to note, however, that those behavioral entities not emphasized in the rotation were rated of lesser interest than all other
entities, even at the beginning of the PL-1 year.
This suggests that the program was accurately de-signed to emphasize entities that are intrinsically more interesting to pediatric residents.
The residents’ rated desire to learn more dem-onstrated a gradual decline during the year, regard-less of type of entity. This decline was unrelated to the rotation except for behavioral entities empha-sized during the rotation. Presumably, the resi-dents’ decreased desire to learn more reflects their increased feelings of competence, rather than
lessened interest, inasmuch as their stated interest
in behavior, as measured by section 1, remained unchanged during the course of the year. We as-sume that this decline also does not represent an
artifact of repeated testing, using the same clinical
entities, as general decreased enthusiasm would
presumably be reflected in declining ratings for all
items, which was not the case.
Although residents’ perception of “future rele-vance” remained unchanged for physical entities, it decreased gradually during the year for the other entity groups. This decline may reflect the
resi-dents’ increased knowledge and experience.
Infor-mal discussion with our residents suggests that they learn to appreciate the expertise and time required for appropriate management of even common be-havior problems. This may prompt many residents
to decide, in their future careers, to focus on pre-vention and anticipatory guidance, and to deal with behavior problems by developing consultation/re-ferral resources-their own task being to identify problems promptly and to refer effectively.
Our efforts to assess attitude change using a
semantic differential scale were not successful: this
measure did not detect change which was appreci-ably different from chance. This may reflect the
fact that the original adjectives used by Osgood et
al8 were modified so as to be more appropriate for rating clinical entities. However, the original scale was used to assess attitudes toward clinical entities among pediatric residents at Duke University Med-ical Center, and this scale also yielded virtually no significant change.9 It may be that a “clinical entity”
is too far removed from specific patients to elicit
the type of feeling assessed by a
semantic-differen-tial procedure. This use of the scale is also a depar-ture from the original, linguistic basis for its
devel-opment.
Comparable increases in residents’ knowledge of behavioral pediatrics, assessed by multiple-choice questions, were evidenced both during the rotation
and also from the beginning of the year to the start of the rotation. This change was thus not specific only to the rotation, and the absolute amount of change was not great. Although it is encouraging to find evidence of increased knowledge, it is hoped that residents have acquired more information than is shown by these results. Clearly, more work is required to develop a sensitive assessment of knowl-edge related to behavioral and developmental is-sues.
In summary, the clearest effects of the training program were found for residents’ self-reported competence, both for diagnosis and management, their perceived ability to advise parents, and their knowledge of resources. For behavioral and mixed entities, the greatest change occurred during the 2-month behavioral pediatric rotation. In contrast, self-reported change for physical entities was not specific to the rotation. These data demonstrate
that changes in residents’ perception of their own
competence were directly related to their experi-ence in the behavioral pediatric rotation.
Several limitations of this study should be noted. These data are based upon self-report, with no objective corroboration that residents’ competence has actually increased. Also, our results represent relatively short-term changes. Ideally, program evaluation should assess the impact of training for these residents 5 years later, and it should
deter-mine whether the health of their patients has been improved as a consequence of the training program in behavioral pediatrics. These limitations ifiustrate the difficulty of documenting the effect of training, in any subject area, with regard to outcome mea-sures that are both reliable and valid.
The present study represents one approach to assessing at least the immediate impact of training for residents. Three conclusions may be drawn from these results. First, a repeated-measures design can demonstrate a clear effect of training that is directly related to the rotation experience, without the need for a control group. Second, mandated training in behavioral pediatrics has had a positive impact upon these residents’ perceptions of their own com-petence. Third, behavioral issues can be introduced successfully during the first year of residency train-ing.
ACKNOWLEDGMENTS
This work was supported in part by the W. T. Grant
Foundation.
The authors thank the pediatric residents who partic-ipated in the study for their patience and tolerance; David Bromberg, MD, Alice Heisler, MD, Evelyn Curtis, and Charlene Johnson for help in obtaining data; and J. Richard Hebel, PhD, and James F. Gardner, SCM, for
assistance with data processing. We would also like to
express our appreciation for the support of the W. T.
REFERENCES
1. The Future of Pediatric Education: A Report by the Task
Force on Pediatric Education. Evanston, IL, American
Academy of Pediatrics, 1978
2. Market Facts Inc: A Study to Evaluate Short and Long
Term Training and Educational Needs of Medical
Stu-dents Specializing in Pediatrics. A report to the American
Academy of Pediatrics, 1977
3. Dworkin PH: Training in developmental pediatrics. Am J
Dis Child 1979;133:709
4. Toister RP, Worley LM: Behavioral aspects of pediatric practice: A survey of practitioners. J Med Educ 1976;5:1019
5. Coleman JV, Patrick DL, Baker SM: The mental health of children in an HMO program. J Pediatr 1977;91:150
6. Goldbert ID, Regier DA, Mclnemy TK, et al: The role of the pediatrician in the delivery of mental health services to children. Pediatrics 1979;63:898
7. Starfield B, Gross E, Wood M, et al: Psychosocial and psychosomatic diagnoses in the primary care of children.
Pediatrics 1975;66:159
8. Osgood CE, Suci GJ, Tannenbaum PH: The Measurement
ofMeaning. Chicago, University of Illinois Press, 1975
9. Trent PJ, Hock RA, Yancy WS: Evaluation of behavior and development training for pediatric residents. J Med Educ
1982;57:113
FAMILY STUDY OF CONGENITAL HYDROCEPHALUS
This study concerned 74 patients with uncomplicated congenital hydroceph-alus who were born in Northern Ireland between 1974 and 1977. Three of their 159 sibs (1.89 percent) were also themselves hydrocepahlic, which represents a
recurrence risk of 26 times the population incidence. There was a smaller but
significant increase of congenital hydrocephalus among first-cousins; three of 846 (0.35 percent) first-cousins were affected, five times the population fre-quency. The occurrence of neural tube defects among sibs and cousins was similar to that for the general population. For the purpose of genetic counseling, this study indicates that once X-linked inheritance has been excluded in uncom-plicated congenital hydrocephalus, the over-all empirical risk of recurrence is approximately one in 50; or one in 40 after an affected male and one in 80 after a female index patient.
Abstracted from Adams C, Johnston WP, Nevin NC: Family study of congenital hydrocephalus.
