Treatment choices

Andrew Collier asks, who decides what's best?

Frameworks used in cluttering treatments: Past, present, and future

BACKGROUND: This integrative review is of two literatures on cluttering treatments. It integrates into those two reviews a third literature to show an alternative way for cluttering to be treated in the future. OBJECTIVE: The aim is to encourage professionals involved in treating those who clutter to reflect on how conceptual frameworks can affect their treatment choices. METHODS: Works from three literatures on interventions are examined. Literatures covering two historic periods of cluttering treatments are compared to one another and to a third literature that offers an alternative framework for working with those who clutter. RESULTS: Treatment approaches to cluttering have almost universally focused on remediating impairments associated with the disorder. This impairment focus flows from a medical model –a model that views cluttering as a disease, located in the person, in need of remediation. An alternative framework, called the social model, one that focuses on the social conditions surrounding cluttering, is reviewed for its applicability to cluttering therapy. CONCLUSIONS: The medical model, used by authors since cluttering first appeared in the literature, carries within it assumptions about the selection and sequencing of clinical goals aimed at reducing cluttering symptoms. The social model alternative would likely shift the focus to working on ways for promoting the life participation of those who clutter. The applicability of social model practices to the treatment of cluttering is explored and encouraged.

A Retrospective Study on Alopecia Areata in Children: Clinical Characteristics and Treatment Choices

<b><i>Background:</i></b> Although children are affected frequently with alopecia areata (AA), data are limited on clinical characteristics and treatment choices. <b><i>Materials and Methods:</i></b> We retrospectively reviewed the records of the pediatric dermatology department over a 12-year period to identify children with AA. Clinical data were collected. <b><i>Results:</i></b> Three hundred and sixty-four children with AA were identified, aged 1–12 years, 214 males and 150 females. The mean age of onset was 6.6 years (±3.3). The disease presented with patches on the scalp in the majority (90.7%), whereas only 6 children had alopecia totalis or universalis. The most commonly prescribed treatment was topical steroids (69.1%), followed by the combination of topical steroids and minoxidil 2% (14.3%). Oral steroids were prescribed in only 16 children. Follow-up at 3 months was available for only 70 children and the majority (84.3%) had some hair regrowth. Hair regrowth was unrelated to the number of plaques (<i>p</i> = 0.257), disease location (<i>p</i> = 0.302), and atopy (<i>p</i> = 0.999). Hair regrowth only correlated with the type of treatment (<i>p</i> = 0.003) with potent topical and intralesional steroids giving the best results. <b><i>Conclusion:</i></b> AA usually presents with a mild form in children, and potent topical steroids are the mainstay of treatment.