Richard A Wahl

Interests

Teaching

Adolescent Medicine, Adolescent Psychology, Reproductive Health

Research

Spirituality in adolescent healthcare, Evolutionary developmental psychology.

Courses

Scholarly Contributions

Journals/Publications

• Nuno, V. L., Wertheim, B., Murphy, B., Wahl, R. A., & Roe, D. (2019). Does the Nurtured Heart Approach improve ADHD behaviors in children? A randomized unblinded controlled trial.. Family Process.
• Nuno, V. L., Wertheim, B. C., Murphy, B. S., Glasser, H. N., Wahl, R. A., & Roe, D. J. (2020). The Online Nurtured Heart Approach to Parenting: A Randomized Study to Improve ADHD Behaviors in Children Ages 6-8.. Ethical Human Psychology and Psychiatry,, 20(1), 169 - 186. doi:http://dx.doi.org/10.1891/EHPP-D-20-00013
• Nuno, V. L., Wertheim, B., Murphy, B., Wahl, R. A., & Roe, D. (2020). Does the Nurtured Heart Approach improve ADHD behaviors in children? A randomized unblinded controlled trial.. Family Process.
• Nuño, V. L., Wertheim, B. C., Murphy, B. S., Wahl, R. A., & Roe, D. J. (2019). Testing the efficacy of the Nurtured Heart Approach to reduce ADHD symptoms in children by training parents: Protocol for a randomized controlled trial. Contemporary clinical trials communications, 13, 100312.
• Andrews, J. G., & Wahl, R. A. (2018). Duchenne and Becker muscular dystrophy in adolescents: current perspectives. Adolescent health, medicine and therapeutics, 9, 53-63.
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  Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are life-limiting and progressive neuromuscular conditions with significant comorbidities, many of which manifest during adolescence. BMD is a milder presentation of the condition and much less prevalent than DMD, making it less represented in the literature, or more severely affected individuals with BMD may be subsumed into the DMD population using clinical cutoffs. Numerous consensus documents have been published on the clinical management of DMD, the most recent of which was released in 2010. The advent of these clinical management consensus papers, particularly respiratory care, has significantly increased the life span for these individuals, and the adolescent years are now a point of transition into adult lives, rather than a period of end of life. This review outlines the literature on DMD and BMD during adolescence, focusing on clinical presentation during adolescence, impact of living with a chronic illness on adolescents, and the effect that adolescents have on their chronic illness. In addition, we describe the role that palliative-care specialists could have in improving outcomes for these individuals. The increasing proportion of individuals with DMD and BMD living into adulthood underscores the need for more research into interventions and intracacies of adolescence that can improve the social aspects of their lives.
• Cabeza De Baca, T., Wahl, R. A., Figueredo, A. J., Barnett, M. A., & Ellis, B. J. (2016). Adversity, adaptive calibration, and health: An integrative Life History Approach.. Adaptive Human Behavior and Physiology., 2(2), 93-115. doi:10.1007/s40750-016-0042-z
• Wahl, R. A. (2009).

  The effect ofEchinacea purpurearoot and osteopathic manipulative treatment in recurrent otitis media is unproved

  . Focus on Alternative and Complementary Therapies. doi:10.1111/j.2042-7166.2009.tb01865.x
• Wahl, R. A., Aldous, M. B., Worden, K. A., & Grant, K. L. (2008). Echinacea purpurea and osteopathic manipulative treatment in children with recurrent otitis media: a randomized controlled trial. BMC Complementary and Alternative Medicine, 8(1), 1-9. doi:10.1186/1472-6882-8-56
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  Recurrent otitis media is a common problem in young children. Echinacea and osteopathic manipulative treatment have been proposed as preventive measures, but have been inadequately studied. This study was designed to assess the efficacy of Echinacea purpurea and/or osteopathic manipulative treatment (OMT) for prevention of acute otitis media in otitis-prone children.
• Wahl, R. A., Cotton, S., & Harrison-Monroe, P. (2008). Spirituality, adolescent suicide, and the juvenile justice system. Southern Medical Journal, 101(7), 711-5. doi:10.1097/SMJ.0b013e31817a7e73
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  Spirituality is often overlooked as a coping method and resilience factor in the lives of adolescents. An improved understanding of the role of spirituality in the lives of adolescents will help in understanding the choices many teens face during times of personal crisis. Youth entering the juvenile justice system often present with high rates of mental health problems and suicidal ideation.
• Freeman, M. P., Wright, R., Watchman, M., Wahl, R. A., Sisk, D. J., Fraleigh, L., & Weibrecht, J. M. (2005). Postpartum depression assessments at well-baby visits: screening feasibility, prevalence, and risk factors. Journal of Women's Health, 14(10), 929-35. doi:10.1089/jwh.2005.14.929
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  Postpartum depression (PPD) is a disorder with broad public health implications and consequences that impact almost every aspect of child development.
• Rosenfeld, R. M., Culpepper, L., Doyle, K. J., Grundfast, K. M., Hoberman, A., Kenna, M. A., Lieberthal, A. S., Mahoney, M., Wahl, R. A., Woods, C. R., Yawn, B., , A. A., , A. A., & , A. A. (2004). Clinical practice guideline: Otitis media with effusion. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 130(5 Suppl), S95-118.
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  The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline "Otitis Media With Effusion in Young Children," which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline. The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media (AOM). The subcommittee made recommendations that clinicians should (1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME; (2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk; and (3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known), or from the date of diagnosis (if onset is unknown). The subcommittee also made recommendations that (4) hearing testing be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME; (5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; and (6) when a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure. Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy, with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that (1) population-based screening programs for OME not be performed in healthy, asymptomatic children and (2) antihistamines and decongestants are ineffective for OME and should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management. The subcommittee gave as options that (1) tympanometry can be used to confirm the diagnosis of OME and (2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery), and provide additional relevant information such as history of AOM and developmental status of the child. The subcommittee made no recommendations for (1) complementary and alternative medicine as a treatment for OME based on a lack of scientific evidence documenting efficacy and (2) allergy management as a treatment for OME based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed. The purpose of this guideline is to inform clinicians of evidence-based methods to identify methods to identify, monitor, and manage OME in children aged 2 months through 12 years. The guideline may not apply to children older than 12 years because OME is uncommon and the natural history is likely to differ from younger children who experience rapid developmental change. The target population includes children with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for use by providers of health care to children, including primary care and specialist physicians, nurses and nurse practitioners, physician assistants, audiologists, speech-language pathologists, and child development specialists. The guideline is applicable to any setting in which children with OME would be identified, monitored, or managed. This guideline is not intended as a sole source of guidance in evaluating children with OME. Rather, it is designed to assist primary care and other clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all children with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
• Wahl, R. A., Sisk, D. J., & Ball, T. M. (2004). Clinic-based screening for domestic violence: use of a child safety questionnaire. BMC Medicine, 2(25). doi:10.1186/1741-7015-2-25
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  Domestic violence affects many women during their lifetime. Children living in homes where they are or have been exposed to violence are at increased risk for adverse outcomes. The American Academy of Pediatrics, the American Academy of Family Practice, and the American College of Obstetrics/Gynecology have recently joined in recommending routine screening of all families for the presence of domestic violence. We present our experience with an office-based domestic violence screening questionnaire.
• Kurtzman, T. L., Otsuka, K. N., & Wahl, R. A. (2001). Inhalant abuse by adolescents. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 28(3), 170-80.
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  The deliberate misuse of volatile substances poses a poorly recognized risk for considerable morbidity and mortality in adolescent populations worldwide. The abuse of inhalants continues to be a significant problem among our country's youth. While many household and industrial chemicals can be inhaled, glues, paints, and aerosol propellants are among the most commonly abused. Adolescents are often unaware of the health threats posed by inhalation of solvents. Inhalation can result in serious organ system dysfunction or even sudden death. This review discusses the prevalence of inhalant abuse in the United States, summarizes the various types of substances used, highlights the major physiologic effects of inhalants, and briefly discusses associated risk behaviors, prevention and medical management.
• Wahl, R. A., Shapiro, E., Elliott, S. P., & Binkiewicz, A. I. (2001). Office laboratory procedures, office economics, parenting and parent education, and urinary tract infection. Current Opinion in Pediatrics, 13(6), 603-15.
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  We once again review four areas of interest to office-based pediatricians: office laboratory procedures, office economics, parenting and patient education, and urinary tract infections. Sean Elliott reviews the current status of the Clinical Laboratories Improvement Amendments (CLIA) and their continuing impact on physician office laboratories. Eve Shapiro reviews office economics, this year focusing on managed care, the physician workforce, practice management, and health care financing for the uninsured. Anna Binkiewicz provides an update on parenting and parent education, with recent reports on nutrition and childhood immunizations. Richard Wahl again reviews recent research on urinary tract infection, discussing voiding physiology, dysfunctional voiding patterns, acute urinary retention, urine collection techniques, diagnosis in young infants, and antibiotic prophylaxis.
• Wahl, R. A., Shapiro, E., Elliott, S. P., & Walter, J. J. (2000). Office laboratory procedures, office economics, parenting and parent education, and urinary tract infection. Current opinion in pediatrics, 12(6), 619-31.
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  We again review four areas of interest to office-based pediatricians: office laboratory procedures, office economics, parenting and patient education, and urinary tract infections. Sean Elliott provides an update on the Clinical Laboratories Improvement Amendments (CLIA) and their impact of office practice. Eve Shapiro reviews office economics, focusing on measuring quality of care, use of performance data, costs of new technologies, and the impact of managed care on the medical marketplace. John Walter offers an update on parenting and parent education, with approaches to counseling families about overuse of antibiotics, teen pregnancy, hyperactivity, violence, and asthma. Richard Wahl reviews the recent research on urinary tract infection, with special attention paid to office diagnosis and management, longitudinal studies of children with urinary tract infections, and the controversy surrounding the American Academy of Pediatrics Task Force on Circumcision report.
• Wahl, R. A. (1999). Nutrition in the adolescent.. Pediatric annals, 28(2), 107-11. doi:10.3928/0090-4481-19990201-07
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  PIP: This article reviews the nutritional requirements of puberty and the clinical assessment of nutritional status, and discusses the nutritional risks imposed by vegetarian diets, pregnancy, and athletic involvement. Energy (calories) and protein are essential in pubertal development. Adolescent females require approximately 2200 calories/day, whereas male adolescents require 2500-3000 calories/day. Additional intake requirements include fat, calcium, iron, zinc, vitamins, and fiber. The clinical assessment of nutritional status begins with obtaining a good diet history of the patient and this could be offered by the body mass index. Nutritional deficiencies and poor eating habits established during adolescence can have long-term consequences, including delayed sexual maturation, loss of final adult height, osteoporosis, hyperlipidemia, and obesity. As for vegetarian adolescents, nutritional risks include lack of iodine, vitamin B12, vitamin D, and some essential fatty acids. In addition, substances in some grains reduce gut absorption, thus increasing mineral deficiencies. Pregnancy may also be a risk factor for poor nutrition during adolescence. A pregnant adolescent has different nutritional needs because she is still growing. Among adolescent athletes many are turning to nutritional supplements in an attempt to improve athletic performance. A balanced, varied diet provides adequate calories and nutrition to meet the needs of most adolescents. They also have greater water needs than do adult athletes. Details on adolescent health concerns are further discussed in this article.
• Wahl, R. A., Ball, T. M., Duncan, B., & Shapiro, E. (1999). Office laboratory procedures, office economics, parenting and parent education, and urinary tract infection. Current opinion in pediatrics, 11(6), 605-14.
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  These authors review four areas of office pediatric practice: office laboratory procedures, office economics, parenting and parent education, and urinary tract infections. Thomas Ball reviews the literature published this past year on physician office laboratories, with updates on the Clinical Laboratories Improvement Amendments, laboratory utilization, and office diagnosis of infectious mononucleosis. Eve Shapiro offers an update on office economics, discussing physician organizations and managed care, and a medical ethics evaluation of medical economics. Burris Duncan provides an update on parenting and parent education, with emphasis on defining "the best interests of the child." Richard Wahl summarizes the past year's publications on pediatric urinary tract infections, reviewing the circumcision debate, dysfunctional voiding, vesicoureteral reflux, and the diagnosis and follow-up of acute pyelonephritis.
• Wahl, R. A., Ball, T. M., Duncan, B., & Shapiro, E. (1998). Office laboratory procedures, office economics, patient and parent education, and urinary tract infection. Current opinion in pediatrics, 10(6), 641-50.
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  This review provides an update on four areas of office practice: office laboratory procedures, office economics, patient and parent education, and urinary tract infection. Thomas Ball reviews physician office laboratories, with updates on the Clinical Laboratory Improvement Amendments, office proficiency testing, and office testing for streptococcal pharyngitis and Helicobacter pylori. Eve Shapiro reports on office economics, focusing on the influence of managed care on pediatric practice. Burris Duncan provides a review of the new National Institutes of Health asthma guidelines, and challenges us to become more involved in patient education. Richard Wahl reviews urinary tract infections, vesicoureteral reflux, dysfunctional voiding, and appropriate imaging studies. Our approach is to provide pediatricians with useful and practical information for their office practices.
• Wahl, R. A., Ball, T. M., Duncan, B., & Shapiro, E. (1997). Office laboratory procedures, office economics, patient and parent education, and urinary tract infection. Current opinion in pediatrics, 9(6), 642-51.
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  This review provides an update on four important areas in office pediatrics: office laboratory procedures, office economics, patient and parent education, and urinary tract infection. Ball reviews new information about physician office laboratories, with updates on the Clinical Laboratory Improvement Amendments, streptococcal pharyngitis, urinalyses, office stool examination, and information on Helicobacter pylori serology. Shapiro reports on office economics, highlighting new office technologies, physician operated networks, managed care, recent legislation, and the "cost versus quality" debate. Duncan provides a very thought provoking essay on parent and patient education, focusing on improving parenting skills. Wahl reviews the recent literature on urinary tract infections, with emphasis on host-bacteria interactions, diagnostic evaluations, pyelonephritis, renal cortical scarring, and long term follow-up of vesicoureteral reflux. We hope we have provided pediatricians with useful and practical information for their office practices.
• Byrum, C. J., Wahl, R. A., Behrendt, D. M., & Dick, M. (1982). Ventricular fibrillation associated with use of digitalis in a newborn infant with Wolff-Parkinson-White syndrome. The Journal of pediatrics, 101(3), 400-3.
• Wahl, R. A., & Dick, M. (1980). Congenital deafness with cardiac arrhythmias: the Jervell and Lange-Nielsen syndrome. American annals of the deaf, 125(1), 34-7.