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Short-term Effectiveness of Anticipatory Guidance to Reduce Early Childhood Risks for Subsequent Violence

Ernest H. Friedman, MD
Arch Pediatr Adolesc Med. 1997;151(9):965. doi:10.1001/archpedi.1997.02170460103030.
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Sege et al1 reported short-term effectiveness of brief, inexpensive, anticipatory guidance to reduce early childhood risks for subsequent violence. Among parents who had never used a time-out prior to the office visit, there was a marked increase in the use of time—outs. Neurobiological features are suggested by the fact that even brief (1-5 seconds) spontaneous pauses in ongoing patterned behaviors are accompanied by an immediate reduction of serotonin neuronal activity to, or below, baseline levels.2 This hypothesis is supported by serotonergic modulation of dopamine3 lateralized to the right hemisphere; optimal response organization and working memory at intermediate dopamine tone in a mediofrontostriatal activation system; and deactivation of the right hemisphere, a state marker of depression, promoting dominance of the left hemisphere associated with cardiac arrhythmia, vasoconstriction, and aggressive responding.4,5

These findings suggest evaluating the effects of repeated interventions over time on the number of time—


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