How Can a Child with ADHD Be Supported And Included In School Essay

How Can a Child with ADHD Be Supported And Included In School Education - Essay Example Potential teacher factors which might be important to consider in such compatibility equations are discussed, along with the implications of these variables for school-based assessment and intervention processes and future research. A substantial literature on children with attention deficit/hyperactivity disorder (ADHD) has accumulated over the past 2 decades. An impressive portion of this literature has addressed the difficulties students with ADHD experience in school classrooms and the efficacy of interventions to minimize these difficulties. Medication and behaviour management procedures remain the two most commonly employed school-based interventions for children with ADHD (Rapport, 1992, 155-163). Due to well-documented limitations associated with both strategies, some combination of the two is generally accepted as the optimal approach to treatment. Nevertheless, an increasingly common finding in studies which examine the efficacy of such a combined approach to treatment is the considerable variability in treatment response among individual students (Pelham, 1993). As such, a case-by-case assessment of treatment ingredients and potencies is necessary (Abramowitz, 1994; Hoza, 1992). Hence, successful sch ool outcomes for students with ADHD depend upon the degree to which treatment components and potencies match the needs of particular children. This "match" between treatment and student may best be conceptualized as a "compatibility equation" (in this case, student-treatment compatibility) in which characteristics of both child and treatment are taken into consideration in planning treatment and evaluating outcome. Studies examining student response to treatment can be criticized for an almost singular focus on treatment ingredients, as well as a relative neglect of student characteristics that may mediate treatment outcome. Yet perhaps the most striking limitation of school-based treatment outcome research has been the lack of consideration of teacher characteristics that may have a significant bearing on outcome. Two additional compatibility equations --teacher-treatment compatibility (the match between different teachers and different treatment ingredients and potencies) and student-teacher compatibility (the match between a particular teacher and a particular student with ADHD with regard to a variety of factors) -- have been virtually ignored. This article suggests that a more adequate and predictive model from which to conceptualize classroom outcome for students with ADHD will be one in which "teacher factors" are given greater consideration. Goodness-of-Fit and System Theory The terms compatibility and match can be traced most directly to the goodness-of-fit literature (Thomas, 1998). Goodness-of-fit is a concept that has been applied productively to child-care-giver interactions (Bell & Harper, 2003; Thomas & Chess, 2001); several authors have noted that the concept may be relevant to child-teacher

Parental Perspectives Dissertation Example | Topics and Well Written Essays - 19000 words

Parental Perspectives - Dissertation Example This study has broadened my thought process, my zeal, inner strength, passion, knowledge, and focus on how I can help our youth discover what it takes to reach their educational goals. I also dedicate this dissertation to all those that are close to my heart: my husband, children, parents, family, and friends that supported me through this process. Their support has allowed me to climb to the mountaintop in accomplishing my goals and to continue fulfilling the desires of my heart. I owe a special thanks to my wonderful children, Jermaay and Cladorian, who are my pride and joy. Thank you for sacrificing your wants and needs and for being patient with mommy. To Floyd, my loving husband, who listened, supported and made many sacrifices for me during this difficult process; I deeply thank you. Acknowledgments This dissertation took more commitment and devotion than I ever imagined and I could not have done it by myself. So many people helped me through this challenging time of my educational journey. I am truly thankful for the grace that God bestowed upon me over these past three years. I am very grateful and honored to have such a supporting family, friends, church and cohort who provided constant encouragement. I must acknowledge my wonderful mentor, Dr. April Flanagan, who came to my rescue in the midst of my uncertainties in my research plan. I started research for my dissertation in Atlanta, Georgia, with a solid foundation and then my husband received military orders to transfer to Okinawa, Japan for three years. As a result, my research topic had to change, and I was forced to switch my focus and start over. Dr. Flanagan was a true asset in the writing of my dissertation, due to her extensive experience... This phenomenological study investigates how parents perceive their involvement in student learning. Kohls, Stafford, and Miller (2003) assert that public dissatisfaction, international comparisons and the skills needed for the 21st-century workforce â€Å"by policy makers, parents, the business community and the public have resulted in demands that schools be held accountable for learning† (p. 1). In Okinawa, Japan, the language barrier restricts military and government civilian parents of non-Japanese speaking children from entering the more challenging domestic school systems (O. Lee, August 11, 2005, personal communication). The expense of registration and monthly tuition fees for private and Japanese public schools is another issue that military and government civilian families encounter if they choose not to use the provided school system available (Military Resources & Benefits, n.d.). Parents’ expectations about their role in their children's education are essential to student learning and academic success. When parents believe their children are not receiving the best education possible, the reason is often that they feel powerless to do anything about it other than basic home intervention (Bloom, 1992). For example, parents are establishing goals and possibilities for their children to become academically successful, such as seeking technical support through computerized tutorials when questions occur on schoolwork or allowing the child to call a fellow classmate or searching the text for guidance.

Compareable between lean and six sigma Article Example | Topics and Well Written Essays - 2000 words

Compareable between lean and six sigma - Article Example Thus this paper will identify the weaknesses and strengths of both Six Sigma and lean and the ways in which they compliment each other. Six Sigma and lean are among the two most commonly used continuous improvement tools (Mousa, 2013, p. 1137). Lean originated out of the Toyota Production System and its focus is on the elimination of waste in production which begins from the time an order is placed and ends when the order is delivered (Pojasek, 2003, p. 85). Six Sigma was introduced by the Motorola Corporation and is designed to eliminate variations in production and services and their processes so that defects are reduced and customer satisfaction is improved (Desai, 2006). In other words, lean focuses on reducing waste, while Six Sigma focuses on reducing defects. Therefore, it has been suggested that when lean and Six Sigma philosophies are combined an organization may benefit from significant improvements in a short period of time at a significantly reduced cost (Mousa, 2013, p. 1137). This paper will compare and contrast Six Sigma and Lean with a view to demonstrating their compatibility and differences for continuous improvement. The paper is divided into four parts. The first part of this paper presents a review of literature on lean and Six Sigma. The second part of this paper provides a comparison of the two philosophies. The third part of this paper will discuss the implications for practice and the final part of this paper will make suggestions for further studies. Lean is a philosophical approach to managing production and consist of facilitating a system for eliminating or reducing waste and any activity that does not add value for the end customer (Dora, Kumar, Goubergen, Molnar, & Gellynck, 2013). At its core, lean is a continuous improvement technique focused on â€Å"just-in-time (JIT), quality systems and team works† (Wong, Wong, & Ali, 2009, p.

Preparedness Homeland Security 2 Essay Example | Topics and Well Written Essays - 2500 words

Preparedness Homeland Security 2 - Essay Example The New York subway system is governed by the Metropolitan Transportation Authority (MTA). It has 468 stations in its network. It has over 840 miles of track that service approximately 5.1 million passengers per week. In 2007, The New York subway system was ranked number 4 amongst the worlds transit system with a massive 1.563 billion riders per year. In 2009 subways cars were reported to travel 344.5 million miles per week with 8,279 miles per day being covered by 6,380 cars (Subways, p. 1). The subway system is massive and very vulnerable. A transportation system of this size is evidently significant to the operation of New York City on a day to day basis. This is an unfortunate acknowledgement that is apparent in terrorist attacks. Al-Qaeda associates openly plead guilty to plotting severe attacks on the Metropolitan subway system in 2009. The MTA: The MTA has had no reason in the past to afford special conditions on behalf of terrorism. The subway stations have had no need to sanction high end security to avoid bomb attacks. This ultimately makes an attack by suicide bombers an element of surprise. A surprise attack has the quality of being able to do massive amounts of damage with little resources. Being located underground is not a positive outlook when dealing with bomb threats. Bombs have the capacity to cause a massive collapse of the railway structures. Dependant on the type of explosive being used and where these explosives are located in the MTA system, there can be enough collateral damage to corrupt the entire underground network. The major issue that is presented with any public transportation is accessibility. Any local person can use the facilities at any given time. In the case of the New York underground railway terrorists are afforded a twenty-four hour gap to engage in any attack. They have access from any publicly available entrance during the process of each attack. They also have locations to choose from. This

Dualism by Plato and Descartes Assignment Example | Topics and Well Written Essays - 1000 words

Dualism by Plato and Descartes - Assignment Example Whereas for Descartes, so has to be integrated with the body for it to function while Plato thought that the soul ought to be separated from the body so that it can think better. For Plato, the soul has already a â€Å"pure and perfect† knowledge even before the birth of the body and it is at its thinking best when it is in this condition without the distraction of everyday life. While Descartes thought the soul is necessary to animate the body, Plato thought that the soul is in its â€Å"ideal† condition when it is separated from the body upon death.Considering this viewpoint of Plato that the soul has already a perfect knowledge even before it was born to a body, provides human experience with moral value because the soul already has this moral predisposition even before it was born into a body. Cartesian dualism provides us the confidence that this moral predisposition has its use when the soul animates the body because it provides human endeavor a sense of rectitude .

Micro Small and Medium Enterprise Essay Example for Free

Micro Small and Medium Enterprise Essay Some of these hurdles comprise of inefficacy of SMEs to access continued development and success. Lack of Finance: One of the crucial factors that prompts in the success or failure of enterprise is technology. The best use of technology no doubt enables enterprise in reducing cost of production, maintain consistency in quality, improve productivity and finally develop the competitiveness of the enterprise. Lack of technology: One of the crucial factors that prompts in the success or failure of enterprise is technology. The best use of technology no doubt enables enterprise in reducing cost of production, maintain consistency in quality, improve productivity and finally develop the competitiveness of the enterprise. Lack of Knowledge: Â  Lack of knowledge and information about the various schemes announced by the government. Lackof Marketing Assistance: One of the chief problems that they do not have marketing expertise or not in a position to hire someone who can jazz up their sales. Paucity of marketing support and limitation of the resources is a characteristic of all SMEs. In this framework the discussion focuses on SMEs typical traits and how these effect upon marketing characteristics within SMEs. When it comes to marketing of products or services internationally, any small or medium company is always constrained by its scarcity of budgets, which in turn limits its growth. A B2B marketplace is a platform where sellers can list thei businesses free of cost and leverage the power of internet. Not only they solve companies problem of reach to the buyers worldwide, the online marketplace also support their communication needs and help them display an array of products. Lack of right staff: Last but not the least SMEs are largely dependent on their staffs, if you fail in the recruitment process, you fail indeed. SMEs must hire right employees, who give their best and support the enterprise through their performances Lack of planning: Another problem that is mainly faced by SME sector is the proper division of time, which is usually the outcome of improper planning and strategy. Moreover, if you are in debt then you have to be careful from your bankers and suppliers and off course your employees who will be on your nerves on the salary day

Management of Childhood Psoriasis with Acitretin

Management of Childhood Psoriasis with Acitretin Abstract: Psoriasis is a chronic inflammatory disease of the skin which can occur at any age-group. Psoriasis in childhood is not uncommon and has genetic susceptibility but usually an environmental trigger such as infection is thought to initiate the disease process. Childhood psoriasis has profound effects on both physical and psychosocial health of the patient. Treatment of mild psoriasis can be done with topical therapies but those which do not respond to topical therapies can be treated with phototherapy and systemic therapies. The use of systemic therapies in childhood is mainly based on the published data, case series, expert opinion and the experience as there is lack of controlled trials in the age group. Based on the experience retinoid are probably the second line drugs for the treatment of childhood psoriasis which do not respond to topical therapies and phototherapy. Using acitretin in a low dose and with proper physical examinations and laboratory investigations will reduce the h azard of potential serious adverse events. This article gives the review of use of acitretin in the childhood psoriasis. INTRODUCTION: Psoriasis is the chronic inflammatory disease of the skin having the world wide prevalence of 1-3% and is clinically characterized by erythematous papules and plaques covered with silvery scales(1, 2). Psoriasis can occur at any age. Psoriasis in pediatric population is not uncommon and exerts a major impact on physical and psycho-social health of a child. In about one-third of the psoriatic population, the onset of disease is seen during the pediatric age(3). In a study of 419 patients from Northern India, the age of onset of psoriasis ranged from 4 days to 14 years(4). The presence of positive family history was found to be 23% and 34.3% in two different studies(5, 6). Pediatric psoriasis has the genetic susceptibility but the environmental factors often trigger the initiation of the disease process. The most common triggering factors include respiratory infection, sore throat, stress and trauma. There are different variants of psoriasis in children like plaque, guttate, napkin, er ythrodermic, pustular and nail psoriasis(2). Plaque psoriasis is the most common subtype and the pustular psoriasis is the least common subtype(7). Psoriasis in childhood and adolescence require proper management. Both the patient and the parents must be given the knowledge about the disease and its nature. Psoriasis in childhood affects the health-related quality of life. It is found that, the risk of mental illness like depression and anxiety is increased in children with psoriasis than those without psoriasis(8). Due to the presence of visible skin lesions the children with psoriasis suffer from the low self-esteem(9). Fortunately, childhood psoriasis is usually mild and can be treated with topical therapies. Systemic treatment is required only if the disease do-not respond to topical therapies, phototherapy and if the disease is significantly impairing the psychosocial aspect of the child health. Systemic therapies for psoriasis in children are not approved by FDA. Due to the lack of controlled trials use of systemic therapies are based on case reports, published data and expert opinion. On the basis of published data and experience retinoids appear to be the second-line drug of choice for children(10). ACITRETIN: Retinoids encompasses all the compounds either natural or synthetic, which possess the biological activity like vitamin A(11). Synthetic Retinoids are classified into three generations. Acitretin and etretinate are the second generation synthetic retinoids and are also known as aromatic retinoids(12, 13). Acitretin is the free and active metabolite of etretinate. Etretinate is strongly lipophilic and tends to accumulate more in the adipose tissue and thus has a longer elimination half-life, in contrast acitretin is less lipophilic and thus clears rapidly from the body and has the shorter elimination half-life(14).Intake with food increases the absorption of acitretin so, the bioavailability of acitretin is more when taken with food than on the empty stomach(15). Due to the longer elimination half-life of etretinate it has been largely replaced by acitretin. However, it is found that re-esterification of acitretin to etretinate can take place with the concomitant intake of alcohol. So , the female patient especially of childbearing age should be strictly instructed to not take alcohol during the period of treatment with and 2 months after the completion of treatment (16). USE IN PEDIATRIC PSORIASIS: Pediatric psoriasis is usually mild and topical therapies are the first choice of treatment. Systemic therapy is not the first choice in childhood psoriasis. It is used in the treatment of recalcitrant psoriasis which do not respond to topical therapy, phototherapy and if it is significantly impairing the psychosocial aspects of the child health. Due to the lack of controlled trials, the use of acitretin is based on the published data, case reports and the expert opinion. However, the significant risk benefit of the treatment should always be weighed with the risk of disease without treatment. Long term use of acitretin in children with inherited disorder of keratinization supports the safety of acitretin in children, but the monitoring is always required(17). Acitretin is used effectively in the treatment of generalized pustular psoriasis, erythrodermic psoriasis, palmoplantar psoriasis and severe recalcitrant plaque psoriasis but acitretin is not effective in psoriatic arthropathy( 12, 18). Acitretin is used as either monotherapy or in combination with topical agents and narrowband ultraviolet phototherapy. In a multicenter cohort study by Ergun et al. 61 patients among 289 patients were treated with acitretin at a dose of 0.3-0.5 mg/kg/day with the mean duration of treatment being 9.16+-9.06 months. 47.5% of the patient achieved at least PASI- 75 response. 70.7% of the patient well tolerated the treatment with no side effects. 25.9% experienced the mucocutaneous side-effects, 1.7% had hyperlipidemia and 1.7% had nausea(19). In a multicenter retrospective analysis by Lernia et al. including 18 children with plaque psoriasis ,8(44.4%) patient achieved a PASI-response 75 at 16 weeks. The starting dose of acitretin was 0.2-0.5mg/kg/day but the dose was increased to 0.6mg/kg/day in two patients after 8 weeks. Three out of eight patients achieving PASI-75 response stopped therapy for the interval of 2-6 months but had to restart the treatment after relapse and the treatment was effective even after re-introduction. 9 patient discontinued treatment due to lack of efficacy and 1 patient discontinued treatment due to arthralgia. All patients had the mucocutaneous side-effects like chelitis, dry lips, dry mouth and pruritus. The laboratory values of the patients were within the baseline during the treatment(20). Ergin et al. reported a case of infantile pustular psoriasis treated with acitretin with the initial dose of 0.5mg/kg/day which was later increased to 0.7mg/kg/day. The skin lesion was cleared in the end of 4 months and then the acitretin was tapered to 0.3mg/kg/day for three months and then discontinued. Oral prednisolone was used initially then it was tapered and discontinued. Slight increase in serum triglyceride was observed but it returned to normal after the dose was tapered. No other adverse events were observed(21). Salleras et al. reported a case of 4-year-old girl with congenital erythrodermic psoriasis treated with acitretin at a dose of 0.5mg/kg/day and the complete remission achieved in three months. The discontinuation of the drug led to relapse so the patient was maintained in 0.5-0.75mg/kg/day of acitretin during the aggravation of the disease. The patient was followed till 7 years of age and no other secondary effects were observed(22). A case of annular pustular psoriasis in a 14-month old girl reported by Haug et al. was treated with acitretin in the dose of 0.9mg/kg/day and the patient achieved complete remission after 4 months. The dose of acitretin was reduced and tapered at 0.1mg/kg/day and discontinued after 10 months with no relapse in the following three years. The patient experienced mild side effects like chelitis, reversible hypercholesterinemia and elevation of alkaline phosphatase(23). Acitretin is aa excellent option in a child with palmo-plantar psoriasis. A 14-year-old boy with palmo-plantar psoriasis treated with acitretin at a dose of 10mg/day had a good response with improvement within 6 weeks. At 3-month follow-up the patient had almost lesion free. The patient had experienced adverse events like mild chelitis and xerosis but the laboratory values remain unchanged. Later the patient was maintained on acitretin 10mg every other day together with the topical combination of 15% liquor carbonis detergens compounded in triamcinolone 0.1% ointment applied every night(24). Combination with other therapies: Acitretin has been used in combination with NB-UVB phototherapy, methotrexate and cyclosporine A(24, 25). The effect of acitretin together with NB-UVB is found to be synergistic. A case of 3.5-year-old boy with severe pustular psoriasis (von Zumbusch type) reported by kopp et al. was started on acitretin 1mg/kg/day with the short-term use of systemic methylprednisolone for controlling the acute stage. However, any attempt to reduce or discontinue the steroid led to exacerbation of the disease. Then the patient was given NB-UVB phototherapy three times per week. Later, after five exposures the corticosteroid was tapered and discontinued. The patient was then maintained on NB-UVB phototherapy two times weekly together with acitretin 0.3mg/kg/day. Disease was well controlled with this combination regimen. The laboratory values remained unchanged during the acitretin treatment(26). A 9-year-old boy with generalized pustular psoriasis was treated with acitretin 10mg/day and was maintained at 10mg three times week for a year. Later he developed skin pain and localized area of pustules which led to increase in the dose of acitretin 20mg/day during the flare but later tapered to 10mg/day for the next year. But the patient eventually required the addition of NB-UVB phototherapy to maintain the remission. The patient is well maintained by this combination(24). Adverse events of acitretin: Acitretin in known to exert a number of adverse events. Most of the adverse events are dose dependent and reverse back to normal after decreasing the dose or after discontinuation of therapy. However, it is usual to have the minor side-effects on the long term treatment with acitretin. The most common adverse events of acitretin is the muco-cutaneous adverse events. Dry lips being the most common one and be treated with the use of emollients. Others include dry dry mouth, cheilitis, stomatitis and gingivitis and taste disturbances. Acitretin causes dryness with inflammation of mucous membrane and transitional epithelia which occasionally leads to epistaxis, rhinitis, photophobia, conjunctivitis and xeropthalmia. Alopecia, nail-fragility and paronychia have also been observed(27). Rarely patients may have the photosensitivity reactions. Retinoid dermatitis which resembles unstable psoriasis can develop 25% of the patients receiving high dose of acitretin therapy(28). Muco cutaneous side effects can be treated symptomatically, and if severe effects occur the dose reduction can be tried before the discontinuation of the drug. Acitretin causes transient elevation of liver enzymes. The elevation is dose dependent and usually reverse back to normal after reducing the dose or after discontinuation of the therapy. Severe hepatotoxic reactions resulting from retinoids are rare. In a data of 1877 patients receiving oral acitretin only 0.26% of the patients showed overt chemical hepatitis(29). However, the hepato-toxic reactions in children are rare because the cofactors like diabetes, alcoholism, and obesity are less likely in children(12). Acitretin also exerts the effects on lipid profile which is reverse back to normal within 8 weeks after the discontinuation of the drug(30). Retinoids are seen to cause the elevation of triglyceride and cholesterol and decrease in the high density lipoprotein. In a study it is seen that 35% of the patients had the elevation in serum triglyceride above 300mg/dl and about 15% of the patients had the elevation of cholesterol level(31). The decrease in the high density lipoprotein is also observed(29). Retinoids have been known to cause the skeletal abnormalities especially in children. The long term treatment with etretinate is also associated with the extraspinal tendon and the calcification of ligament. However, the study including 19 children and young adults, treated with etretinate for continuous 5 years do not show any skeletal abnormality(32). No cases of diffuse idiopathic skeletal hyperostosis was seen in a retrospective study on long term use of acitretin in a low dose(33). No significant radiologic abnormalities associated with retinoids was detected in a patient of severe pustular psoriasis treated with low dose of acitretin for 9 years(34). It is usually not recommended to use oral retinoids for the treatment of psoriasis in children due to the report of occasional bone changes like premature epiphyseal closure, skeletal hyperostosis and extra-osseous calcification observed in the children on the long term treatment with etretinate(35, 36). If acitretin is to be used in a child, the child should be observed carefully for any abnormalities of growth and bone development. Routine radiography is not recommended because of the radiation hazards, but the atypical musculoskeletal pain must be investigated with x-rays. Growth chart of the child on acitretin should be maintained (27). Arthralgia, arthritis, myalgia may also occur during the treatment with acitretin. A few case of vasculitis, Wegener granulomatosis and erythema nodosum are also observed. Retinoids are teratogenic drugs. The defect due to retinoids is termed as retinoic acid embryopathy. The malformations seen in the fetus include microtia/anotia, micrognathia, cleft-palate, conotruncal heart disease and aortic arch abnormalities, thymic defects, retinal or optic nerve abnormalities and central nervous system malformations(37). Even though only one report of human teratogenicity due to acitretin has been published(27), acitretin should be cautiously used as acitretin is converted to etretinate which has a longer elimination half-life. The female patient of child-bearing should strictly be instructed for the use of two effective contraceptive method stating 1-month prior of treatment, during the period of treatment and 3 years after the discontinuation of treatment(38). However, the risk of teratogenicity by use of acitretin in children is less because of the least chance of a child to get pregnant. The concomitant use of retinoid with tetracycline and minocycline has led to pseudo-tumour cerebri(29). Pseudo-tumor cerebri was reported in a case of 14-year-old boy treated with isotretinoin and tetracycline(39). Retinoids also causes blurring of vision, headache and reduced night vision. Patient with severe headache, vomiting and visual disturbances should stop acitretin immediately and consult the doctor(27). The concomitant use of vitamin A with acitretin must be restricted. MONITORING GUDELINES: Before starting the treatment with acitretin, proper history taking and careful physical examination should be performed. Laboratory investigations including complete blood count, lipid profile, liver enzymes and blood sugar in diabetics should be done. Monitoring of the liver enzymes and fasting serum cholesterol and triglyceride must be done every 2-4 weeks of therapy for the first two months and then every three months(27). Children on acitretin therapy must have their growth charted. Female of child bearing age and their parents should be counselled about the teratogenic effect of the drug and use of contraception during and after the treatment. The pregnancy should be ruled out before the initiation of acitretin therapy with two negative pregnancy tests. CONCLUSION: Acitretin is a non-immunosuppressive drug that can be effective in the treatment of childhood psoriasis. It is seen that acitretin is more effective in pustular and erythrodermic psoriasis and moderately effective in the plaque type psoriasis in children. Acitretin is used both as monotherapy and as combination therapy. As the use of acitretin in children lack sufficient data and evidence, its use in children should always be weighed with risk benefit of treatment and risk if the disease is left untreated. The side effects are mostly dose dependent so it can be minimized by using the lowest possible dose. The dose of 0.5-1mg/kg/day was seen to be effective. It should be used cautiously in the female patient. Long term treatment with acitretin require proper clinical and laboratory evaluation. REFERENCES 1.Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet (London, England). 2007;370(9583):263-71. 2.Al-Mutairi N. Childhood Psoriasis: Springer International Publishing; 2016. 3.Raychaudhuri SP, Gross J. A comparative study of pediatric onset psoriasis with adult onset psoriasis. Pediatric Dermatology. 2000;17(3):174. 4.Kumar B, Jain R, Sandhu K, Kaur I, Handa S. Epidemiology of childhood psoriasis: a study of 419 patients from northern India. Digest of the World Core Medical Journals. 2004;43(9):654-8. 5.Seyhan M, CoÃ…Å ¸kun BK, SaÄÅ ¸lam H, Ozcan H, KarincaoÄÅ ¸lu Y. Psoriasis in childhood and adolescence: evaluation of demographic and clinical features. Pediatrics International Official Journal of the Japan Pediatric Society. 2006;48(6):525-30. 6.Fan X, Xiao FL, Yang S, Liu JB, Yan KL, Liang YH, et al. Childhood psoriasis: a study of 277 patients from China. Journal of the European Academy of Dermatology Venereology. 2007;21(6):762. 7.de Moll EH, Chang MW, Strober B. Psoriasis in adults and children: Kids are not just little people. Clinics in Dermatology. 2016;34(6):717. 8.Kimball AB, Wu EQ, Guerin A, Yu AP, Tsaneva M, Gupta SR, et al. Risks of developing psychiatric disorders in pediatric patients with psoriasis. Journal of the American Academy of Dermatology. 2012;67(4):651-7.e1-2. 9.Fox FE, Rumsey N, Morris M. Ur skin is the thing that everyone sees and you cant change it!: exploring the appearance-related concerns of young people with psoriasis. Developmental neurorehabilitation. 2007;10(2):133-41. 10.Burden AD. Management of psoriasis in childhood. Clinical and experimental dermatology. 1999;24(5):341-5. 11.Orfanos CE, Stadler R, Gollnick H, Tsambaos D. Current developments of oral retinoid therapy with three generations of drugs. Non-aromatic, monoaromatic and polyaromatic retinoids (arotinoids). Current problems in dermatology. 1985;13:33-49. 12.Gautam M, Tahiliani H, Nadkarni N, Patil S, Godse K. Acitretin in pediatric dermatoses. 2016;17(2):87. 13.Brecher AR, Orlow SJ. Oral retinoid therapy for dermatologic conditions in children and adolescents Journal of the American Academy of Dermatology. Journal of the American Academy of Dermatology. 2003;49(2):171-82. 14.Wiegand UW, Chou RC. Pharmacokinetics of acitretin and etretinate. Journal of the American Academy of Dermatology. 1998;39(2 Pt 3):S25-33. 15.McNamara PJ, Jewell RC, Jensen BK, Brindley CJ. Food increases the bioavailability of acitretin. Journal of clinical pharmacology. 1988;28(11):1051-5. 16.Grà ¸nhà ¸j Larsen F, Steinkjer B, Jakobsen P, Hjorter A, Brockhoff PB, Nielsenà ¢Ã¢â€š ¬Ã‚ Kudsk F. Acitretin is converted to etretinate only during concomitant alcohol intake. British Journal of Dermatology. 2000;143(6):1164-9. 17.Lacour M, Mehta-Nikhar B, Atherton DJ, Harper JI. An appraisal of acitretin therapy in children with inherited disorders of keratinization. The British journal of dermatology. 1996;134(6):1023-9. 18.Cordoro KM. Systemic and light therapies for the management of childhood psoriasis: part II. Skin Therapy Letter. 2008;13(4):1-3. 19.Ergun T, Seckin Gencosmanoglu D, Alpsoy E, Bulbul-Baskan E, Saricam MH, Salman A, et al. Efficacy, safety and drug survival of conventional agents in pediatric psoriasis: A multicenter, cohort study. 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