Most recent papers:

• Needs of families of children with cerebral palsy in Bangladesh: A qualitative study.
  Reshma Parvin Nuri, Heather Michelle Aldersey, Setareh Ghahari.
  Child Care Health and Development. October 22, 2018
  --- - |2+ Abstract Purpose Families of children with disabilities often have needs related to the care of their child with a disability. Although there has been extensive exploration of family needs in high‐income contexts, there is little known about this issue in low and middle‐income countries like Bangladesh. In this study, we explored the needs of families of children with cerebral palsy in Bangladesh. Such understanding is important as it will help to improve services for children with disabilities and their families. Methods We used a qualitative approach and interviewed 20 family members of children with cerebral palsy who visited the Centre for the Rehabilitation of the Paralysed, Bangladesh. We thematically analyzed data from semistructured interviews. Results Five different themes were found on needs of families with children with disabilities: (a) financial needs, (b) needs for disability‐related services, (c) needs for family and community cohesion, (d) informational needs, and (e) emotional needs. Participants overwhelmingly reported that financial needs were their highest priority. Conclusion Needs of families of children with disabilities must be considered in rehabilitation services to improve children's outcomes. Further studies are required to explore needs of families of children with disabilities who do not have access to rehabilitation services. - 'Child: Care, Health and Development, EarlyView.
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  October 22, 2018   doi: 10.1111/cch.12624   open full text
• Does fatigue and distress in a clinical cohort of adolescents with CFS correlate with fatigue and distress in their parents?
  M.E. Loades, K.A. Rimes, S. Ali, K. Lievesley, T. Chalder.
  Child Care Health and Development. October 20, 2018
  --- - |2+ Abstract Objectives Previous studies have found that parents of children with CFS are more fatigued, and mothers are more distressed than healthy controls. Managing the disabling symptoms of CFS can result in disruption and burden for the family. Most research has focused on mothers. This study sought to further explore the associations between adolescent fatigue and distress, and parental fatigue and distress, as well as family functioning, including both mothers and fathers. Design Cross‐sectional study of a clinical cohort of consecutive attenders at a specialist chronic fatigue unit. Methods Questionnaires were completed by adolescents (N = 115, age 11‐18) with a confirmed diagnosis of CFS and their mothers (N = 100) and fathers (N = 65). Results Maternal fatigue was significantly correlated with maternal distress, but not with adolescent fatigue, depression, anxiety or functioning. This pattern held true for paternal fatigue. Maternal and paternal anxiety and depression were significantly correlated with family functioning. Paternal and maternal distress were correlated with each other. Mothers and fathers tended to have a consistent view of family functioning. Family functioning, specifically being overwhelmed by difficulties and scoring lower on strengths and adaptability was positively associated with adolescent depression. Unexpectedly, higher levels of adolescent fatigue and poorer physical functioning were associated with better family functioning as rated by the mother. Conclusions Parents of adolescents with fatigue scored near to or within normative range for non‐clinical samples on distress, fatigue and family functioning. Parental distress may contribute to or result from poorer family functioning. Family functioning, particularly building strengths and adaptability, may be clinically important in CFS, as well as attending to parental, (particularly paternal) distress in families where adolescents are low in mood. - 'Child: Care, Health and Development, Volume 0, Issue ja, -Not available-.
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  October 20, 2018   doi: 10.1111/cch.12626   open full text
• Palestinian children's narratives about living with spina bifida: Stigma, vulnerability and social exclusion.
  Maha Sudki Nahal, Åsa B. Axelsson, Asma Imam, Helena Wigert.
  Child Care Health and Development. October 18, 2018
  --- - |2+ Abstract Background Living with spina bifida in Palestine is a critical issue that might influence various aspects of the individual's life. It is a challenge for children, their families, and health care providers since it requires lifelong treatment and follow‐up of care provision. However, little focus has been placed on these children's perceptions about their daily life experiences with spina bifida. Purpose To illuminate the lived experience of children with spina bifida in the West Bank, Palestine. Methods A qualitative study was conducted using the phenomenological hermeneutical method to interpret the meaning of being a child with spina bifida in Palestine. Ten children with spina bifida, aged 7–18 years, were interviewed. The two local authors independently analyzed the Arabic transcriptions, while the two Swedish authors analyzed the transcriptions after translation to English. Finally, the four authors discussed their analysis and reached agreement about the themes. Results Studying the children's experience with spina bifida helped us highlight their feelings, needs, and challenges. The findings were formulated into one main theme, Vulnerability and suffering due to social exclusion and stigma, which was grounded in three themes: Experiencing negative self‐concept, Experiencing vulnerability, and Obtaining a sense of security. These three themes were in turn derived from subthemes. Conclusion The Palestinian children in this study faced physical, emotional, and psychosocial challenges, which negatively influenced their health and development. They were vulnerable and stigmatized, and they lived with a negative self‐concept. The findings could help health professionals, families, and caregivers to achieve a deeper understanding of what being a child with disabilities entails, and the findings may also serve as a platform for interventions that seek to promote these children's development and to enable them to experience childhood as a meaningful and positive process. - 'Child: Care, Health and Development, Volume 0, Issue ja, -Not available-.
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  October 18, 2018   doi: 10.1111/cch.12625   open full text
• Displaced Rohingya children at high risk for mental health problems: findings from refugee camps within Bangladesh.
  Naila Z. Khan, Asma Begum Shilpi, Razia Sultana, Shaoli Sarker, Sultana Razia, Bipasha Roy, Abu Arif, Misbah Uddin Ahmed, Subas Chandra Saha, Helen McConachie.
  Child Care Health and Development. October 18, 2018
  --- - |2+ Abstract Background The 2017 political violence against the Rohingya people in the state of Rakhine resulted in a large influx of displaced populations into Bangladesh. Given harsh conditions and experiences in Myanmar, and the harrowing journey to the border, raised levels of child neurodevelopmental disorders (NDDs) and mental health problems were expected. Methods A team of child development professionals, physicians, psychologists and developmental therapists, screened 622 children in a clinic within the refugee camps, using the Developmental Screening Questionnaire (DSQ; 0‐<2 years), and the Ten Questions Plus (TQP) for NDDs, and Strengths and Difficulties Questionnaire (SDQ; 2‐16 years) for mental health problems. Any child positive on the DSQ or the TQP was assessed for NDDs. Results Only 4.8% children aged 0‐<2 years and 7.3% children aged >2‐16 years screened positive for NDDs, comparable to a local Bangladesh population. However, 52% of children were in the abnormal range for emotional symptoms on the SDQ, and 25% abnormal for peer problems. Significant risk factors were being parent‐less and having lost one or more family members in the recent crisis. Conclusions This screening study provides objective evidence of the urgent need for psychosocial support of Rohingya children within camps, with special attention to those without parents, including monitoring of their well‐being and counselling of families and other care‐providers. - 'Child: Care, Health and Development, Volume 0, Issue ja, -Not available-.
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  October 18, 2018   doi: 10.1111/cch.12623   open full text
• The impact of bowel and bladder problems on children's quality of life and their parents: A scoping review.
  Dianne Collis, Ann Kennedy‐Behr, Lauren Kearney.
  Child Care Health and Development. October 17, 2018
  --- - |2+ Abstract Background Functional bladder and bowel problems are common in children and have a serious psychological as well as physical impact. The objective of this scoping review was to synthesise evidence on the impact of such conditions both on children's quality of life (QOL) and their parents. Methods The scoping review followed Arksey and O′Malley's framework. Relevant studies were identified by a comprehensive search of scientific databases. Inclusion criteria focused on children with bladder and bowel dysfunction, their QOL, and impact on parents. Studies were analysed for aims, study populations, measures, and results. Results A total of 783 records were retrieved with 30 meeting the criteria. Most studies found that QOL was reduced in children with nocturnal enuresis, day bladder dysfunction, bowel dysfunction, and combined bladder and bowel dysfunction. Parents' QOL and social–emotional functioning were also negatively affected. Conclusions Functional bladder and bowel problems should be identified and treated as early as possible to minimise negative impacts on QOL of children and their carers. Future research should focus on how to best provide early and effective intervention in the most accessible manner. - 'Child: Care, Health and Development, EarlyView.
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  October 17, 2018   doi: 10.1111/cch.12620   open full text
• Seeking normality: Parents' experiences of childhood stroke.
  Christopher McKevitt, Marta Topor, Anna Panton, Andrew A. Mallick, Vijeya Ganesan, Elizabeth Wraige, Anne Gordon.
  Child Care Health and Development. October 15, 2018
  --- - |2+ Abstract Background Incidence of paediatric stroke has been estimated to range from 1.2 to 13 per 100,000 children under 18 years of age. It is a significant cause of long‐term morbidity in children with long‐term impacts on physical, cognitive, psychological, and social outcomes. However, little is known about the experiences of parents caring for a child with stroke. Such information is needed to inform the development of child‐ and family‐centred care. Methods We conducted in‐depth interviews with parents of children with stroke. Participants were purposively sampled from three regional specialist services in England, based on the age of the child at stroke onset and time since first stroke. Interviews used a topic guide and were audio recorded and transcribed in full. Thematic analysis was conducted to develop an account that reflected patients' experiences from their own perspectives. Results Twelve parents participated with five children classified as having no to mild deficits and seven with moderate to severe deficits. Parents were concerned about the effects of stroke on the child's psychological, cognitive, and social well‐being. Significant impacts on parents own well‐being and on the family were reported. Although most experienced good quality acute care, meeting the child's needs after hospital discharge was problematic, with low levels of awareness of paediatric stroke among professionals and difficulties accessing relevant information and services. Meeting special education needs was variable. Parents were proactive in seeking to establish a sense of normality for the child and themselves. Conclusions The findings illuminate a wider picture of paediatric stroke than indicated by clinical outcomes alone. Parents' experiences varied according to the child's needs but also family's situation and geographical location. Particular attention should be paid to co‐ordinating services to meet multiple needs after discharge from hospital. - 'Child: Care, Health and Development, EarlyView.
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  October 15, 2018   doi: 10.1111/cch.12622   open full text
• Issue Information.
  
  Child Care Health and Development. October 03, 2018
  --- - |2 No abstract is available for this article. - 'Child: Care, Health and Development, Volume 44, Issue 6, November 2018.
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  October 03, 2018   doi: 10.1111/cch.12518   open full text
• Consider the costs of aiding mild hearing loss in the absence of clear benefits: Response to McCreery and colleagues.
  Peter Carew, Fiona K. Mensah, Gary Rance, Traci Flynn, Zeffie Poulakis, Melissa Wake.
  Child Care Health and Development. October 03, 2018
  --- - - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 928-929, November 2018.
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  October 03, 2018   doi: 10.1111/cch.12601   open full text
• Mild hearing loss is a developmental risk: Response to Carew and colleagues.
  R. W. McCreery, E. A. Walker, J. B. Tomblin, J. J. Oleson, S. A. Ambrose, M. P. Moeller.
  Child Care Health and Development. October 03, 2018
  --- - - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 926-927, November 2018.
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  October 03, 2018   doi: 10.1111/cch.12602   open full text
• Recommended practices to organize and deliver school‐based services for children with disabilities: A scoping review.
  Dana R. Anaby, Wenonah N. Campbell, Cheryl Missiuna, Steven R. Shaw, Sheila Bennett, Sitara Khan, Stephanie Tremblay, Jean‐Claude Kalubi‐Lukusa, Chantal Camden, GOLDs (Group for Optimizing Leadership and Delivering Services).
  Child Care Health and Development. September 28, 2018
  --- - |2+ Abstract Background Inclusive educational environments can have a positive effect on the general health and well‐being of children with disabilities. However, their level of academic success and participation remains limited. Considering scarce resources and high needs, identifying efficient methods for providing interdisciplinary services is critical. This scoping review, therefore, aims to (a) synthesize current evidence about principles for organizing and delivering interdisciplinary school‐based support services for students with disabilities and (b) ascertain useful strategies for implementation of principles in the school setting. Methods Scholarly and grey literature in rehabilitation and education were reviewed collaboratively with school‐based stakeholders. A search of five databases identified 13,141 references and resulted in 56 relevant articles published from 1998 to 2017. Information (e.g., principles to organize services and strategies for implementation) was extracted, and thematic analysis was used to summarize findings. Results Within the documents retained, 65% were scientific and 35% were grey. Services primarily targeted students with behavioral issues, followed by those with cognitive and learning disabilities with a focus on improving social–emotional functioning and academic performance. Thematic analysis revealed 10 common principles to guide service organization (e.g., collaborative interventions and support for teachers) and seven implementation strategies (e.g., training and coordination) for employing these principles. Conclusions Findings can guide rehabilitation professionals, educators, and policy makers in restructuring well‐coordinated collaborative services involving training and capacity‐building of school‐based service providers. Such knowledge can contribute to the improved provision of care and, consequently, promote children's school participation and inclusion. - 'Child: Care, Health and Development, EarlyView.
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  September 28, 2018   doi: 10.1111/cch.12621   open full text
• A support programme for caregivers of children with disabilities in Ghana: Understanding the impact on the wellbeing of caregivers.
  Maria Zuurmond, Gifty Nyante, Marjolein Baltussen, Janet Seeley, Jedidia Abanga, Tom Shakespeare, Martine Collumbien, Sarah Bernays.
  Child Care Health and Development. September 27, 2018
  --- - |2+ Abstract Background Four fifths of the estimated 150 million children with disability in the world live in resource poor settings where the role of the family is crucial in ensuring that these children survive and thrive. Despite their critical role, evidence is lacking on how to provide optimal support to these families. This study explores the impact of a participatory training programme for caregivers delivered through a local support group, with a focus on understanding caregiver wellbeing. Methods A qualitative longitudinal study was conducted to investigate the impact of a training programme, “getting to know cerebral palsy,” with caregivers on their wellbeing. Eighteen caregivers, from four districts, were interviewed up to three times over 14 months, to assess impact and the reasons for any changes. Results Low levels of knowledge, high levels of stigma, physical and emotional exhaustion, and often difficult family relationships with social exclusion of the child and caregiver were common themes at the outset. Caregivers struggled to combine their caring and economic activities. This was exacerbated by the common absence of the father. Two months after completion of the training, their reported wellbeing had improved. The reasons for this were an improved understanding about their child's condition, positive attitudinal change towards their child, feelings of hope, and through the group support, a profound realisation that they are “not on their own.” While relationships within the family remained complex in many cases, the support group offered an important and alternative social support network. Conclusions This study illustrates the many benefits of a relatively simple caregiver intervention, which has the potential to offer a mechanism to provide sustainable social support for caregivers and children with cerebral palsy. Any future programme needs to also address more structural issues, including stigma and discrimination, and strengthen approaches to family engagement. - 'Child: Care, Health and Development, EarlyView.
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  September 27, 2018   doi: 10.1111/cch.12618   open full text
• Prematurity and cardiovascular risk at early adulthood.
  Mary C. Sullivan, Suzy Barcelos Winchester, Michael E. Msall.
  Child Care Health and Development. September 21, 2018
  --- - |2+ Abstract Background Theories of early stress exposure and allostatic load offer a lifespan perspective to adult health after prematurity based on these early stressors affecting endocrine and metabolic systems. In this study, we examine cardiovascular and metabolic risk by comparing two groups of preterm infants who experienced a full spectrum of neonatal illness and a term‐born group at age 23. Methods Of the 215 infants recruited at birth, 84% participated at age 23. The cohort included 45 full‐term (FT), 24 healthy preterm (HPT), and 111 sick preterm (SPT) infants. Socio‐economic status was equivalent across groups. Cardiovascular and metabolic outcomes were as follows: blood pressure (BP), fasting glucose and lipid profiles, weight, waist–hip ratio (WHR), and body mass index (BMI). Clinical and subclinical ranges were compared across neonatal groups and gender. Results At age 23, the HPT and SPT groups had higher systolic BP compared with the FT group. The SPT group had lower weight compared with the FT and HPT groups. No group differences were found on diastolic BP, glucose, total cholesterol, high‐density lipids, low‐density lipids, triglycerides, BMI, or WHR. Preterm males had more systolic hypertension and low high‐density lipids than FT males. Former preterm males and females had high WHR ratios and BMI at 23 years. Subclinical prehypertensive rates were highest for the HPT female group, followed by the SPT females. Only one (4.2%) HPT adult male was clinically diabetic. Conclusions As young adults, HPT and SPT infants had early indicators of cardiovascular risk but no indicators of metabolic risk. There is utility in using clinical and subclinical ranges to identify early cardiovascular risk in early adulthood. - 'Child: Care, Health and Development, EarlyView.
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  September 21, 2018   doi: 10.1111/cch.12616   open full text
• Health‐related quality of life experiences in children and adolescents born with esophageal atresia: A Swedish–German focus group study.
  Stefanie Witt, Michaela Dellenmark‐Blom, Sofie Flieder, Jens Dingemann, Kate Abrahamsson, Linus Jönsson, Vladimir Gatzinsky, John Eric Chaplin, Benno Ure, Carmen Dingemann, Monika Bullinger, Rachel Sommer, Julia Hannah Quitmann.
  Child Care Health and Development. September 17, 2018
  --- - |2+ Abstract Background Esophageal atresia (EA) is a rare malformation of the esophagus, which needs surgical treatment. Survival rates have reached 95%, but esophageal and respiratory morbidity during childhood is frequent. Child and parent perspectives and cultural and age‐specific approaches are fundamental in understanding children's health‐related quality of life (HRQoL) and when developing a pediatric HRQoL questionnaire. We aimed to increase the conceptual and cross‐cultural understanding of condition‐specific HRQoL experiences among EA children from Sweden and Germany and investigate content validity for an EA‐specific HRQoL questionnaire. Methods Eighteen standardized focus groups (FGs) with 51 families of EA children aged 2–17 years in Sweden (n = 30 families) and Germany (n = 21 families) were used to explore HRQoL experiences, which were content analyzed into HRQoL domains. The Swedish HRQoL domains were analyzed first and used as framework to evaluate HRQoL content reported in the German FGs. HRQoL experiences were then categorized as physical, social, and emotional HRQoL burden or resource. Results One thousand nine hundred eight HRQoL statements were recorded. All nine EA‐specific HRQoL domains identified in the Swedish FGs (eating, social relationships, general life issues, communication, body issues, bothersome symptoms, confidence, impact of medical treatment, and additional difficulties due to concomitant anomalies) were recognized in the FGs held in Germany, and no additional EA‐specific HRQoL domain was found. The HRQoL dimensions referenced physical burden (n = 655, 34.5%), social burden (n = 497, 26.0%), social resources (n = 303, 15.9%), emotional burden (n = 210, 11.0%), physical resources (n = 158, 8.3%), and emotional resources (n = 85, 4.5%). Conclusion This first international FG study to obtain the EA child and his or her parents' perspective on HRQoL suggests Swedish‐German qualitative comparability of the HRQoL domains and content validity for a cross‐cultural EA‐specific HRQoL questionnaire. EA children make positive and negative HRQoL experiences, but prominently related to physical and social burden, which underlines appropriate follow‐up care and future research. - 'Child: Care, Health and Development, EarlyView.
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  September 17, 2018   doi: 10.1111/cch.12619   open full text
• Associations of adverse childhood experiences and suicidal behaviors in adulthood in a U.S. nationally representative sample.
  Martie P. Thompson, J. B. Kingree, Dorian Lamis.
  Child Care Health and Development. September 03, 2018
  --- - |2+ Abstract Background Suicide is a leading cause of death among adolescents and young adults. The current study extends the research linking adverse childhood experiences (ACEs) to suicidal behaviors by testing these associations using a nationally representative sample, assessing for suicide ideation and attempts in adulthood, controlling for established risk factors for suicidality, and measuring a broad array of ACEs. Methods The sample included 9,421 participants from the National Longitudinal Study of Adolescent Health who participated in four waves of assessments spanning 13 years. We examined longitudinal associations between eight different ACEs (physical, sexual, and emotional abuse, neglect, parental death, incarceration, alcoholism, and family suicidality) with suicidal ideation and suicide attempts in adulthood, while controlling for depression, problem alcohol use, drug use, delinquency, impulsivity, gender, race, age, and urbanicity. We also tested for cumulative associations of ACEs with suicide ideation and attempts. Results Logistic regression analyses indicated that physical, sexual, and emotional abuse, parental incarceration, and family history of suicidality each increased the risk by 1.4 to 2.7 times for suicidal ideation and suicide attempts in adulthood. The accumulation of ACEs increased the odds of suicide ideation and attempts. Compared with those with no ACEs, the odds of seriously considering suicide or attempting suicide in adulthood increased more than threefold among those with three or more ACEs. Conclusions Intervention strategies need to prevent ACEs from occurring and, if they do occur, should take into account the impact of cumulative ACEs on suicide risk. Future research should focus on identifying mediating mechanisms for the ACEs‐suicidality association using longitudinal research designs and determine which ACEs are most important to include in a cumulative ACE measure. - 'Child: Care, Health and Development, EarlyView.
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  September 03, 2018   doi: 10.1111/cch.12617   open full text
• Paternal psychological distress, parenting, and child behaviour: A population based, cross‐sectional study.
  Alisha Gulenc, Emma Butler, Anna Sarkadi, Harriet Hiscock.
  Child Care Health and Development. August 29, 2018
  --- - |2+ Abstract Background Child behaviour problems are common and can lead to later mental health problems. Poor maternal mental health and adverse parenting practices are known risk factors for child behaviour problems. Less is known about the association between paternal mental health and parenting, and child behaviour. We aimed to explore the association between paternal psychological distress and parenting (harsh discipline, low warmth, unreasonable expectations, and overinvolved/protectiveness) with children's internalising and externalising behaviour at 3 years of age. Methods Cross‐sectional surveys of 669 (80% response) fathers of 3‐year‐old children, nested within a randomised controlled trial. Main outcomes of behaviour (Child Behavior Checklist), parenting (Parent Behavior Checklist and overinvolved/protective parenting scale), and psychological distress (Kessler‐6) were measured. Regression modelling examined the associations between paternal factors and child behaviour, adjusting for maternal mental health and parenting, as well as child and family variables. Results In adjusted analyses, paternal psychological distress (b = 0.43, 95% confidence interval [CI] [0.26–0.60], p < 0.001), harsh discipline (b = 0.20, 95% CI [0.13–0.27], p < 0.001), and maternal mental health (b = 0.08, 95% CI [0.03–0.12], p = 0.001) were associated with externalising symptoms. However, only paternal psychological distress, harsh discipline, and being a boy were associated with borderline/clinical levels of externalising problems (all p < 0.05). Paternal psychological distress, harsh discipline, overinvolved parenting, maternal mental health, and difficult child temperament were associated with internalising symptoms (all p < 0.05). However, only paternal harsh discipline and overinvolved parenting were associated with borderline/clinical internalising problems. Conclusions Paternal mental health and parenting are independently associated with child behaviour. Treatments for children with behavioural problems should also address paternal mental health and parenting. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 892-900, November 2018.
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  August 29, 2018   doi: 10.1111/cch.12607   open full text
• Children with specific language impairment are more likely to reach motor milestones late.
  F. Babette Diepeveen, Paula Dommelen, Anne Marie Oudesluys‐Murphy, Paul H. Verkerk.
  Child Care Health and Development. August 29, 2018
  --- - |2+ Abstract Background Delayed language development without an obvious cause is considered an isolated developmental disorder and is called specific language impairment (SLI). SLI is probably the most prevalent developmental disorder in childhood with a generally cited prevalence of 7%. This study aimed to investigate whether SLI is always an isolated disorder or if children with SLI also have delayed motor development. Methods We used data of an earlier study with a prospective nested case‐control design in which developmental data were collected from child health care files. Cases were children (4–11 years) with diagnosed SLI. They were matched by sex and date of birth with control children attending mainstream education. Data of both groups on seven gross and six fine motor milestones which had been registered in the Dutch Developmental Instrument between the ages of 15–36 months were retrieved from child health care files. McNemar tests were performed to test for differences in reaching motor milestones at the age norm between the case and control group. Results Data from 253 children in each group were available. A significant difference was found between both groups in the proportion failing to reach three of the seven investigated gross motor milestones at the age norm (p < 0.05). The proportion of children not reaching the motor milestone at the age norm was significantly higher for five of the six fine motor milestones in children with SLI compared with control children (p < 0.05). Conclusions More children with SLI are late in reaching motor milestones than children without SLI. This means that it is debatable whether SLI can be regarded as a “specific” impairment, which is not associated with other developmental problems. A broader developmental assessment is therefore indicated when diagnosing SLI. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 857-862, November 2018.
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  August 29, 2018   doi: 10.1111/cch.12614   open full text
• Speech and language characteristics in individuals with nonsyndromic submucous cleft palate—A systematic review.
  Jessica O. Boyce, Nicky Kilpatrick, Angela T. Morgan.
  Child Care Health and Development. August 22, 2018
  --- - |2+ Abstract Background Up to 80% of individuals with unrepaired submucous cleft palate (SMCP) experience speech difficulties secondary to velopharyngeal insufficiency. Language delays are reported in the broader cleft lip and/or palate population, suggesting that individuals with SMCP may also be at risk. However, contemporary understanding of this population remains limited as there has been no systematic examination of the literature. This review aims to systematically review and document the speech and language characteristics of individuals with nonsyndromic SMCP and, in addition, to identify factors reported to impact speech and language outcomes. Method This review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Five databases were comprehensively searched using keywords and indexed headings. Included studies had to report speech or language outcomes of individuals with nonsyndromic SMCP. Risk of bias and methodological design quality were examined using tools from the Scottish Intercollegiate Guidelines Network. Relevant data were extracted for analysis. Results Eighteen studies met inclusion criteria, yielding 598 participants. Study results showed that individuals with unrepaired nonsyndromic SMCP may have speech difficulties secondary to velopharyngeal insufficiency including increased nasal resonance and palatalized or glottal articulation. Lower age at primary surgical repair led to better postsurgical speech outcomes. There is a paucity of literature outlining motor or phonological aspects of speech and receptive or expressive language abilities of this population. Conclusion Individuals with nonsyndromic SMCP present with speech difficulties similar to those experienced by individuals with overt cleft palate. Health care professionals should be aware of possible presenting symptoms and consider early SMCP diagnoses where appropriate. Further research is needed to specify the broader communication profile in this population. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 818-831, November 2018.
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  August 22, 2018   doi: 10.1111/cch.12613   open full text
• Medical care experiences of children with autism and their parents: A scoping review.
  Shelby A. Wilson, Catherine C. Peterson.
  Child Care Health and Development. August 22, 2018
  --- - |2 Abstract Children with autism spectrum disorder (ASD) and their families may benefit from the provision of additional supports in health care settings, particularly when preparing for and attending medical appointments. This review examined literature that describes experiences in medical care settings from the perspective of patients under age 18 with ASD and their caregivers. A scoping review was conducted to examine the experiences of children with ASD and their families in medical care settings. Twenty‐nine studies meeting inclusion criteria were identified and reviewed. The review indicated a number of challenges (e.g., parent‐reported problems in parent‐provider communication and overwhelming environments) as well as factors that facilitate positive experiences (e.g., providing positive reinforcement and explaining exam steps) during medical appointments. Children with ASD and their families are faced with many challenges while receiving care in medical settings. The present review identified many challenges families face, as well as facilitators of positive experiences. Understanding the unique experiences of patients with ASD and their parents will help to improve experiences in medical care settings for children, caregivers, and health care providers. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 807-817, November 2018.
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  August 22, 2018   doi: 10.1111/cch.12611   open full text
• Comparison of maternal beliefs about causes of autism spectrum disorder and association with utilization of services and treatments.
  Virginia Chaidez, Erik Fernandez y Garcia, Lulu W. Wang, Kathleen Angkustsiri, Paula Krakowiak, Irva Hertz‐Picciotto, Robin L. Hansen.
  Child Care Health and Development. August 22, 2018
  --- - |2+ Abstract Background This study aimed to describe parental perceptions of the causes of autism spectrum disorder (ASD) in an ethnically diverse sample and explore whether these perceptions relate to treatment choices. Methods The sample consisted of White (n = 224), Hispanic (n = 85), and Asian (n = 21) mothers of a child with ASD. A mixed methods approach was used in this secondary analysis focusing on parental perceptions about the causes of ASD and the relationship of these to utilization of services and treatment. Results Environmental and genetic factors were most often believed to be the cause or one of the causes of ASD by mothers across all ethnic groups studied. Asian mothers were more likely to cite multiple causes. Environmental causes were associated with receiving 20 or more hours of autism‐related services per week, whereas belief in environmental exposures and vaccines and medications as causes were associated with complementary–alternative medicine (CAM) use. Conclusion Our findings suggest that ethnic differences in autism causal beliefs and treatment choices may exist. Future research should be conducted to specifically confirm the findings, to understand parental motivation behind their service and treatment choices, and to gain more insight into the types, usage, and sources of CAM treatments. Clinicians can use parental autism causal beliefs in discussions about treatment recommendations. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 916-925, November 2018.
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  August 22, 2018   doi: 10.1111/cch.12612   open full text
• Prenatal nutrition, stimulation, and exposure to punishment are associated with early child motor, cognitive, language, and socioemotional development in Dar es Salaam, Tanzania.
  Helen O. Pitchik, Wafaie W. Fawzi, Dana Charles McCoy, Anne Marie Darling, Ajibola I. Abioye, Florence Tesha, Emily R. Smith, Ferdinand Mugusi, Christopher R. Sudfeld.
  Child Care Health and Development. August 19, 2018
  --- - |2+ Abstract Background Despite growing evidence that early life experiences and exposures can impact child development, there is limited research on how prenatal and early life nutrition and early life parenting practices predict specific domains of child development in resource‐limited settings. This study examines the association between prenatal factors, birth outcomes, and early life characteristics with motor, cognitive/language, and socioemotional development in Tanzania. Methods We assessed motor, cognitive/language, and socioemotional development among a cohort of 198 children aged 20–39 months in Dar es Salaam, Tanzania, whose mothers were previously enrolled in a randomized, placebo‐controlled trial of prenatal vitamin A and zinc supplementation. Linear regression models were used to assess standardized mean differences in child development scores for randomized prenatal regimen and pregnancy, delivery, and early childhood factors. Results Children born to mothers randomized to prenatal vitamin A had significantly lower reported motor scores in minimally adjusted and multivariate analyses, −0.29 SD, 95% CI [−0.54, −0.04], p = 0.03, as compared with children whose mothers did not receive vitamin A. There was no significant effect of randomized prenatal zinc on any development domain. Greater caregiver–child stimulation was associated with 0.38 SD, 95% CI [0.14, 0.63], p < 0.01, better cognitive/language scores, whereas children who experienced both verbal and physical punishment had 0.29 SD, 95% CI [−0.52, −0.05], p = 0.02, lower scores in socioemotional development. Maternal completion of primary school was associated with higher reported motor and cognitive/language development. Further, children of mothers who were <155 cm tall had lower cognitive and language scores. Conclusion Prenatal vitamin A supplements in a setting with low levels of vitamin A deficiency may not provide child development benefits. However, integrated environmental, educational, parenting, and stimulation interventions may have large positive effects across child development domains in resource‐limited settings. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 841-849, November 2018.
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  August 19, 2018   doi: 10.1111/cch.12605   open full text
• A replicable, low‐burden mechanism for observing, recording, and analysing mother–child interaction in population research.
  Penny Levickis, Sheena Reilly, Luigi Girolametto, Obioha C. Ukoumunne, Melissa Wake.
  Child Care Health and Development. August 19, 2018
  --- - |2+ Abstract Background There is growing evidence that specific styles of parent–child interaction benefit child development, particularly child language development. Direct observational techniques help clarify the behaviours and styles within parent–child interactions that may influence child language outcomes; however, these techniques tend to be labour‐intensive and costly. We report on the development of a replicable, low‐burden mechanism for observing and coding specific maternal linguistic behaviours in a population‐based cohort of 2‐year‐olds. Methods The coding scheme was developed as part of a prospective, longitudinal study examining the associations between maternal responsive behaviours and child language outcomes in slow‐to‐talk toddlers. In the first phase of the study, three coding systems were tested by coding five sample parent–toddler interactions and then comparing them based on (a) the ease of method and thus likely intrarater and interrater reliability and (b) the number of data points. The second phase was to demonstrate how the chosen method could be used in practice with a large at‐risk group of toddlers. Results Of the three coding systems explored, the Observer® XT software was selected for ease of use and because detailed coding of free‐play videos could be achieved in close to real time. Intrarater and interrater reliability were established in 251 mother–child free‐play videos, producing high intraclass correlation coefficients of 0.95 to 0.99 for the six behaviours. Conclusions The study provides evidence that numerous parent–child interactions can be rigourously yet efficiently coded without substantial information loss. The observational mechanism in the current study has been fully developed and is shown to be feasible for research purposes focusing on parent–toddler interactions. However, further testing of the observational mechanism is required to examine whether the same results could be produced if coding was conducted “live” and for shorter duration thereby making it readily useable for clinicians. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 901-907, November 2018.
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  August 19, 2018   doi: 10.1111/cch.12615   open full text
• Parent–child communication and self‐esteem mediate the relationship between interparental conflict and children's depressive symptoms.
  Liuhua Ying, Huayi Zhou, Shasha Yu, Chuansheng Chen, Xuji Jia, Yanli Wang, Chongde Lin.
  Child Care Health and Development. August 19, 2018
  --- - |2+ Abstract Background Previous research has paid little attention to the series mediating effect of parent–child communication and self‐esteem in the relationship between interparental conflict and child outcomes, although several other mechanisms have been found to involve in this relationship. Thus, the purpose of the present study is to test these two factors' serial mediation of the relationship between interparental conflict and children's depressive symptoms in a sample of migrant children in China. Methods Four hundred thirty‐seven participants from two public schools for migrant children in Zhejiang Province, China, were administered four measures including the Children's Perceptions of Interparental Conflict Scale, the Parent–child Communication Questionnaire, the Global Self‐esteem Scale, and the Centre for Epidemiologic Studies Depression Scale for Children. Results Results showed that interparental conflict was positively related to depressive symptoms in migrant children, which was partially and serially mediated by parent–child communication and self‐esteem in that order. Conclusions Parent–child communication and self‐esteem play potential roles in the relationship between interparental conflict and depressive symptoms of migrant children in China. This finding has important implications for psychological service providers working with this group of children or children in similar situations. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 908-915, November 2018.
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  August 19, 2018   doi: 10.1111/cch.12610   open full text
• Quality of goal setting in pediatric rehabilitation—A SMART approach.
  Annemarie Bexelius, Eva Brogren Carlberg, Kristina Löwing.
  Child Care Health and Development. August 15, 2018
  --- - |2+ Abstract Background Setting goals for treatment is often the core of the rehabilitation process. The quality of the set goals has however rarely been evaluated. The aims of this study were therefore to assess the quality of goals set in clinical practice of pediatric rehabilitation using SMART criteria (Specific, Measurable, Achievable, Relevant, and Timed) and to assess if the goals were considered relevant from both a client perspective and expertise perspective. Methods In a retrospective multicase study, a total of 161 goals from 42 children with disabilities (cerebral palsy, n = 22; Down syndrome, n = 16; and developmental disability, n = 4) were assessed. The children were 1.5–5.5 years and had previously participated in goal‐directed, activity‐focused therapy at four pediatric rehabilitation centers. Collaborative goal setting had been used to define the desired treatment outcome. The quality of the goals was assessed using defined SMART criteria. Results Specific: All goals could be reliably linked to International Classification of Functioning, Disability and Health—Children and Youth version chapters within the Activity/Participation domain. Measurable: A total of 75% of the goals were rated as having a well‐defined scaling; in 20%, the scaling was less clear, and in 5%, a scaling could not be determined. Achievable: A total of 80% of the goals were attained. Relevant: All goals were set in collaboration with the family and could therefore be considered relevant from a client perspective. Relevancy judged from a professional perspective was strengthened by the fact that age, baseline status, and diagnosis had an influence on the choice of goals. Timed: All goals were set within a specific time frame. Conclusions The goals set in clinical practice showed high quality with respect to the SMART criteria. The most difficult part was the construction of the goal attainment scale. The goals settled in clinical practice were considered relevant from both a client perspective and expertise perspective. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 850-856, November 2018.
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  August 15, 2018   doi: 10.1111/cch.12609   open full text
• A longitudinal investigation of trust beliefs in physicians by children with asthma and their mothers: Relations with children's adherence to medical regimes and quality of life.
  Ken J. Rotenberg, Serena Petrocchi.
  Child Care Health and Development. August 15, 2018
  --- - |2+ Abstract Objective The study examined the relations between trust beliefs in physicians, adherence to prescribed medical regimes, and quality of life for children with asthma and their mothers. Methods One hundred forty‐three children with asthma (116 males, M = 12 years–7 months) and their mothers were tested twice (Time 1/T1 and Time 2/T2) across a 1‐year period. Standardized measures were administered that assessed the children's and mothers' trust beliefs in physicians, the children's quality of life, and children's adherence to prescribed medical regimes (adherence). Results Correlations were found between children's trust beliefs in physicians, mothers' trust beliefs in physicians, adherence, and quality of life. Structural equation modelling analyses confirmed that (a) children's trust beliefs in physicians predicted their adherence and quality of life and (b) there were reciprocal predictive relations between the children's and mothers' trust beliefs in physicians. Conclusions The findings yield support for the conclusions that (a) trust beliefs in physicians by children with asthma promote their adherence and quality of life and (b) socialization of trust beliefs in physicians is a mutual mother–child process. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 879-884, November 2018.
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  August 15, 2018   doi: 10.1111/cch.12604   open full text
• Issue Information.
  
  Child Care Health and Development. August 10, 2018
  --- - |2 No abstract is available for this article. - 'Child: Care, Health and Development, Volume 44, Issue 5, September 2018.
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  August 10, 2018   doi: 10.1111/cch.12517   open full text
• Father's and mother's beliefs about children's anxiety.
  Ana Beato, Luísa Barros, Ana Isabel Pereira.
  Child Care Health and Development. August 10, 2018
  --- - |2+ Abstract Background Previous research has focused on parenting styles and parental behaviors associated with children's anxiety. Parental beliefs about their child's anxiety have scarcely been studied, in spite of their probable influence in parents seeking help. The present study intended to fil that gap, by exploring what parents think about their children's anxiety and whether these cognitions are related or not to their use of professional help. Method In‐depth semistructured interviews were conducted with 48 parents (50% fathers) of children (9–12 years old) with anxiety problems. Theoretical thematic analysis was performed on the transcripts. Results Three dimensions were derived from the analysis, concerning (a) the causes of child's anxiety, (b) the impact of anxiety in the child's functioning, and (c) the evolution of anxiety. Most parents perceived the child's anxiety as a permanent condition, attributing it to external and parental factors and considering that the anxiety problems have a negative impact on the child's well‐being. Plus, parents who had previously sought professional help for the child's emotional problems tended to believe that anxiety could improve with child's or parents' efforts and with professional guidance, contrarily to those who had not. Implications for research and clinical practice are discussed. Conclusion The present study highlighted important parental beliefs about their children's anxiety that might influence their attitudes and decisions (e.g., seek for professional help). Other parental cognitions should be investigated in order to understand parenting in the context of childhood anxiety. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 784-793, September 2018.
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  August 10, 2018   doi: 10.1111/cch.12603   open full text
• Supporting the mental health of mothers of children with a disability: Health professional perceptions of need, role, and challenges.
  Kim‐Michelle Gilson, Shae Johnson, Elise Davis, Susan Brunton, Elena Swift, Dinah Reddihough, Katrina Williams.
  Child Care Health and Development. August 10, 2018
  --- - |2+ Abstract Background Mothers of children with a disability have a higher risk of mental health difficulties than mothers of typically developing children. Very little is known about how health professionals perceive their role in supporting mothers' mental health. We aimed to explore the perspectives of health professionals working with families of children with a disability about how they provide support for maternal mental health in their roles. Specifically, whether professionals consider it their role and responsibility to provide support, the types of actions that they engage in to do this, and the challenges that they experience. Methods This qualitative semi‐structured interview study included 13 health professionals (allied health professionals, general practitioners, and paediatricians) working with families of a child with a disability. Thematic analysis was conducted on transcribed interview data. Results Four overlapping themes were identified from the data indicating that professionals knew that mothers needed mental health support but were not always clear about their roles and responsibilities to support maternal mental health. Professionals also found it difficult to address maternal mental health difficulties, were not always aware of the best strategies to support maternal mental health, and faced difficulties that could be overcome with training and system improvements. Conclusions Although all health professionals were aware of the frequent occurrence of maternal mental health difficulties and the importance of addressing them, several challenges were identified to managing them successfully. Providing health professionals with training in discussing mental health and clearer referral pathways would contribute to mothers being better supported, in addition to policy change that allows parental support in child health services. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 721-729, September 2018.
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  August 10, 2018   doi: 10.1111/cch.12589   open full text
• Narrating hope and resistance: A critical analysis of sources of agency among Palestinian children living under military violence.
  Guido Veronese, Federica Cavazzoni, Silvia Antenucci.
  Child Care Health and Development. August 07, 2018
  --- - |2+ Abstract Background In light of critical and socioconstructionist theories, the aim of our research was to analyze source of agency, psychological adjustment to trauma as protective factors against political violence in children living in three different refugee camps in Palestine, as well as exploring the risks to which these children are exposed. Methods Thematic content analysis was applied to children's written and drawn productions in order to extract the main categories and themes. Results Four main domains of agency emerged from the analysis: personal growth, political well‐being, social relationships, and geographical context. For each domain, specific dimensions are discussed. Conclusions The results of this preliminary exploration of children's agency suggest that the children's living environment plays a key role in shaping their suffering and reactions to war and ongoing violence. Furthermore, the social nature of the children affected by war‐related suffering forces practitioners and policymakers to question the effectiveness of intervention programs that are predominantly focused on symptoms. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 863-870, November 2018.
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  August 07, 2018   doi: 10.1111/cch.12608   open full text
• Motor development in school‐age children is associated with the home environment including socioeconomic status.
  Luciana Ferreira, Ignacio Godinez, Carl Gabbard, José Luiz Lopes Vieira, Priscila Caçola.
  Child Care Health and Development. July 31, 2018
  --- - |2 Abstract The aim of the present study was to examine how the home environment, including socioeconomic status (SES), affects motor development in school‐age children. Seven hundred seven children (332 boys and 375 girls) aged between 6 and 10 years participated in the study. Motor Development was determined using the Bruininks–Oseretsky Test of Motor Proficiency‐Second Edition. Parents answered the Middle Childhood Home Observation Measurement of the Environment (HOME) Inventory, and Brazilian Association of Market Research Institutes Questionnaire (for SES). Children from “Adequate” homes (HOME score), compared with “Less Adequate,” displayed better motor behavior. Mediation and moderation analysis revealed that motor development increased as SES increased. The proportion of variance in motor development explained by SES increased from 9% to 13% when the home was added as a mediation variable. We also found that the effect of SES on motor development was moderated by age. For older children, the effect was lower than for younger children. The best model used SES as the predictor, HOME as the mediator, and AGE as the moderator variable and explained 17% of the variance in motor development. In summary, these findings suggest that, like previous reports with young children, the HOME environment and SES may play an important role in motor development of school‐age children. Our findings encourage the assessment of the home and interventions that take into account the home environment to improve motor development in school‐age children. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 801-806, November 2018.
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  July 31, 2018   doi: 10.1111/cch.12606   open full text
• Early adversities, family support, and child well‐being: The moderating role of environmental sensitivity.
  Sara Scrimin, Gabriele Osler, Tiziana Pozzoli, Ughetta Moscardino.
  Child Care Health and Development. July 27, 2018
  --- - |2+ Abstract Background Children's well‐being in terms of physical, emotional, social, and academic outcomes is largely influenced by environmental characteristics, with the presence of childhood adversities constituting a risk factor, and support provided by the family working as a protective factor. Yet the role of individual differences in children's sensitivity to environmental influences in these relations is still underexplored; following the differential susceptibility model, it could be a potential moderator. Methods Participants were 227 children (mean age 7.05 years) and their parents, who were interviewed on the number of experienced childhood adversities and family supportive resources, as well as on child well‐being and environmental sensitivity. Results Path analysis showed that, as expected, the number of family adversities was negatively associated with children's physical and emotional comfort and perceived academic performance, whereas supportive resources provided by the family were positively related to child well‐being. Of importance, children's environmental sensitivity moderated these associations emphasizing the negative effects of a stressful environment on physical and social functioning and increasing the positive effect of a supportive environment on children's social performance. Conclusions The present data lend support to a diathesis–stress model, with highly sensitive children being more susceptible to both negative and positive environmental influences in relation to well‐being. Interventions may focus on providing clinical support to these children in the context of particularly aversive environments. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 885-891, November 2018.
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  July 27, 2018   doi: 10.1111/cch.12596   open full text
• The Brief Attachment Scale (BAS‐16): A short measure of infant attachment.
  Tim Cadman, Jay Belsky, Richard M. Pasco Fearon.
  Child Care Health and Development. July 25, 2018
  --- - |2+ Abstract Background Insecure attachment in infancy is associated with a range of later socioemotional problems; therefore, it is important to identify at‐risk children so that support can be provided. However, there are currently no well‐validated brief measures of infant attachment. The aim of this study is to create a brief version of the Attachment Q‐Sort (AQS), one of the gold‐standard measures of attachment. Method Data was used from the National Institute of Child Health and Development Study of Child Care and Youth Development (N = 1,364). The factor structure of the AQS was explored, and Item Response Theory was used to select a reduced number of items. Convergent validity of the shortened measure was assessed through associations with the Strange Situation Procedure. Correlations with sensitivity, externalising, and social competence were also examined. Results The Brief Attachment Scale (BAS‐16) was created consisting of two scales of eight items, relating to (a) harmonious interaction with the caregiver and (b) proximity‐seeking behaviours. The BAS‐16 showed comparable convergent, discriminant, and concurrent validity to the full AQS. Conclusion This brief version of the AQS shows potential as a screening measure for insecure attachment in infancy. Further development and validation is required in separate samples. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 766-775, September 2018.
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  July 25, 2018   doi: 10.1111/cch.12599   open full text
• The development of a short form of the Test of Gross Motor Development‐2 in Brazilian children: Validity and reliability.
  Nadia C. Valentini, Mary E. Rudisill, Paulo Felipe R. Bandeira, Peter A. Hastie.
  Child Care Health and Development. July 25, 2018
  --- - |2+ Abstract Background Assessing children's motor skills is important for identifying children with delays, measuring learning, and determining teaching effectiveness. One popular assessment for measuring fundamental motor skills in children is the Test of Gross Motor Development‐2 (TGMD‐2). Although the TGMD‐2 long form is widely known, a short form of the TGMD‐2 has not been yet proposed and investigated. The aim of this study was to develop a short form of the TGMD‐2 and to examine its validity, interrater reliability and test–retest reliability. Method Data from 2,463 Brazilian children were analyzed. Exploratory and confirmatory factor analysis was used to investigate the validity of reducing the number of TGMD‐2 skills. Results The short‐form version of the TGMD‐2 with six skills has appropriate indices of confirmatory factorial validity (root mean square error of approximation: 0.06, 90% confidence interval [0.06, 0.07]; comparative fit index: 0.94; normed fit index: 0.94: Tucker–Lewis index: 0.83; goodness‐of‐fit index: 0.98; adjusted goodness‐of‐fit index: 0.95), internal consistency (α = 0.70 for the overall test), interrater and intrarater reliability (intraclass correlation coefficients values from 0.81 to 0.96) and test–retest reliability (r values from 0.55 to 0.95). Conclusions From these findings, practitioners now have a valid and reliable, short form of the TGMD‐2 for use in assessing children's motor skill competence; promoting wider use of the test for screening and pedagogical purposes. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 759-765, September 2018.
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  July 25, 2018   doi: 10.1111/cch.12598   open full text
• Behavioural and emotional concerns reported by parents of children attending a neurodevelopmental diagnostic centre.
  Anton R. Miller, Emily Gardiner, Louise Harding.
  Child Care Health and Development. July 24, 2018
  --- - |2+ Abstract Background Behavioural and emotional problems are a salient concern for parents of children with neurodisability, but little is known about the nature of such concerns in this population, nor about the distribution of concern types across ostensibly different subpopulations. Methods Information about behavioural and emotional concerns was extracted from clinical reports of developmental paediatricians (N = 12) who had assessed children aged 3 to 8 years (N = 129) through three clinics at a major developmental and rehabilitation service centre. All concerns were captured at a granular level. A two‐stage, consensus‐based interdisciplinary concept‐sorting technique was used to identify and group thematically related behavioural and emotional concerns into First Stage Groupings, intended to preserve detail and specificity, and a reduced number of Second Stage Clusters. Results A total of 669 discrete concerns were encountered, aggregated to 58 First Stage Concern Groupings and 28 Second Stage Concern Clusters. Findings of the salience of Groupings related to Attention, Concentration and Distractibility, and Anxiousness, Shyness, and Emotional Sensitivity reflect existing literature for children with neurodevelopmental concerns. “Social Isolation/Peer Engagement,” “Tantrums/Outbursts/Meltdowns” and “Volatility/Self‐regulation Difficulties,” and “Sensory Issues” emerged as areas of significant concern and salience as well. Across clinics, three Clusters recurred among the top five observed for each clinic: “Tantrums/Outbursts/Meltdowns,” “Inflexibility/Gets Stuck or Fixated,” and “Social Behaviours.” Conclusions This rich descriptive dataset affords insight into the phenomenology of behaviour and emotional concerns in the daily lives of parents whose children have known or suspected neurodisability. Study findings can inform and sensitize clinicians working with this population. Usefulness is enhanced by inclusion of behavioural material that is subthreshold for a formal psychopathologic diagnosis. Certain concern types are encountered commonly across different clinical subpopulations, supporting a noncategorical view of behavioural and emotional problems as functional attributes that cross neurodisability diagnostic categories. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 711-720, September 2018.
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  July 24, 2018   doi: 10.1111/cch.12594   open full text
• The concept of resilience in childhood disability: Does the International Classification of Functioning, Disability and Health help us?
  Julia Hove, Peter Rosenbaum.
  Child Care Health and Development. July 24, 2018
  --- - |2+ Abstract Background The concept of resilience is popular in both the mainstream media and in health and human services research. Over the last 40 years, the term has been moulded and transformed from the idea of a trait that can be fostered within the individual towards a transactional concept with an emphasis on environmental factors. Although many current definitions are used to describe and talk about resilience, the dynamism of the concept is a common element across most current discussions and research applications. This paper provides an opportunity to place the concept of resilience within a framework for future application at the clinical frontlines. Methods An extensive scoping review on the existing literature was undertaken to explore recurring themes associated with resilience in families and children, particularly in the context of childhood disability. This literature was mapped and categorized in the context of World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to create recommendations for practical application by health professionals. Findings Three major themes emerged: (a) the idea of resilience as a state of an individual at a specific point in time rather than a built‐in trait; (b) the idea of resilience as dynamic rather than static; and (c) the value of a framework into which to place the components of “resilience.” Conclusions The relative ease with which resilience concepts is situated within the ICF is an indication that the ICF framework provides a useful way to incorporate concepts of resilience for clinical application. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 730-735, September 2018.
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  July 24, 2018   doi: 10.1111/cch.12590   open full text
• Associations between maternal responsive linguistic input and child language performance at age 4 in a community‐based sample of slow‐to‐talk toddlers.
  Penny Levickis, Sheena Reilly, Luigi Girolametto, Obioha C. Ukoumunne, Melissa Wake.
  Child Care Health and Development. July 24, 2018
  --- - |2+ Abstract Background In a community sample of slow‐to‐talk toddlers, we aimed to (a) quantify how well maternal responsive behaviors at age 2 years predict language ability at age 4 and (b) examine whether maternal responsive behaviors more accurately predict low language status at age 4 than does expressive vocabulary measured at age 2 years. Design or Methods Prospective community‐based longitudinal study. At child age 18 months, 1,138 parents completed a 100‐word expressive vocabulary checklist within a population survey; 251 (22.1%) children scored ≤20th percentile and were eligible for the current study. Potential predictors at 2 years were (a) responsive language behaviors derived from videotaped parent–child free‐play samples and (b) late‐talker status. Outcomes were (a) Clinical Evaluation of Language Fundamentals—Preschool Second Edition receptive and expressive language standard score at 4 years and (b) low language status (standard score > 1.25 standard deviations below the mean on expressive or receptive language). Results Two hundred eight (82.9% of 251) participants were retained to age 4. In adjusted linear regression analyses, maternal expansions predicted higher receptive (p < 0.001, partial R2 = 6.5%) and expressive (p < 0.001, partial R2 = 7.7%), whereas labels predicted lower receptive (p = 0.01, partial R2 = 2.8%) and expressive (p = 0.007, partial R2 = 3.5%) language scores at 4. The logistic regression model containing only responsive behaviors achieved “fair” predictive ability of low language status at age 4 (area under curve [AUC] = 0.79), slightly better than the model containing only late‐talker status (AUC = 0.74). This improved to “good” predictive ability with inclusion of other known risk factors (AUC = 0.82). Conclusion A combination of short measures of different dimensions, such as parent responsive behaviors, in addition to a child's earlier language skills increases the ability to predict language outcomes at age 4 to a precision that is approaching clinical value. Research to further enhance predictive values should be a priority, enabling health professionals to identify which slow‐to‐talk toddlers most likely will or will not experience later poorer language. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 776-783, September 2018.
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  July 24, 2018   doi: 10.1111/cch.12600   open full text
• Injury among children and young people with and without attention‐deficit hyperactivity disorder in the community: The risk of fractures, thermal injuries, and poisonings.
  Vibhore Prasad, Joe West, Kapil Sayal, Denise Kendrick.
  Child Care Health and Development. July 24, 2018
  --- - |2+ Abstract Background Injuries commonly cause morbidity and mortality in children and young people (CYP). Attention‐deficit hyperactivity disorder (ADHD) is the commonest neurobehavioural disorder in CYP and is associated with increased injury risk. However, large, population‐based estimates of the risk of specific injuries are lacking. We aimed to provide estimates of the risk of fractures, thermal injuries, and poisonings in CYP with and without ADHD. Methods In this population‐based cohort study, we used primary and secondary care medical records from England from the Clinical Practice Research Datalink. There were 15,126 CYP with ADHD frequency‐matched to 263,724 without, aged 3–17 years at diagnosis. The risk of (a) fractures, (b) thermal injuries, and (c) poisonings in CYP with ADHD was compared with those without. Results The absolute rate of injury per thousand person‐years at risk in CYP with versus without ADHD was fracture 28.9 (95% CI [27.5, 30.3]) versus 18.7 (95% CI [18.5, 19.0]), long bone fracture 17.7 (95% CI [16.7, 18.8]) versus 11.8 (95% CI [11.6, 12.0]), thermal injuries 4.4 (95% CI [3.9, 4.9]) versus 2.2 (95% CI [2.1, 2.3]), and poisonings 6.3 (95% CI [5.7, 6.9]) versus 1.9 (95% CI [1.9, 2.0]). Adjusting for age, sex, geographical region, deprivation, and calendar year, CYP with ADHD had 25% increase in risk of fracture (hazard ratio [HR] = 1.25; 95% CI [1.19, 1.31]), 21% increase in risk of long bone fracture (HR = 1.21; 95% CI [1.13, 1.28]), double the risk of thermal injury (HR = 2.00; 95% CI [1.76, 2.27]), and almost four times the risk of poisoning (HR = 3.72; 95% CI [3.32, 4.17]). Conclusions CYP with ADHD are at greater risk of fracture, thermal injury, and poisoning compared with those without. Paediatricians and health care professionals should provide injury prevention advice at diagnosis and reviews. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 871-878, November 2018.
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  July 24, 2018   doi: 10.1111/cch.12591   open full text
• Determinants of parent‐delivered therapy interventions in children with cerebral palsy: A qualitative synthesis and checklist.
  Clarissa Lord, Tim Rapley, Claire Marcroft, Janice Pearse, Anna Basu.
  Child Care Health and Development. July 23, 2018
  --- - |2+ Abstract Introduction Parent‐delivered therapy interventions for children with cerebral palsy can help achieve a sufficient therapy dose, improve parental mental well‐being, and facilitate parent–child relationships creating a more relaxed familial environment. However, parent‐delivered interventions may also lead to increased parental stress, guilt if the therapy is not delivered, and time constraints. The primary aim of this review was to gain a deeper understanding of the determinants of effective parent‐delivered therapy interventions. Method Searches were conducted in the following databases: Medline, PubMed, Scopus, Embase, CINAHL, and Cochrane. Studies had to meet the following inclusion criteria: descriptions of parent/health care professional/child experiences of parent‐delivered therapy interventions for children and young people age 0–18 years with cerebral palsy, published in the English language between January 1989 and May 2017, with qualitative or mixed methods research design. The articles were critically appraised, then synthesized using a meta‐ethnographic approach. Results A literature search identified 17 articles, which met the inclusion criteria. Three main themes were identified: (a) building trusting relationships, (b) enabling the parents to cope, and (c) for parents and health care professionals to see the intervention as a priority. Further synthesis presented three concepts identifying the important aspects of the interventions: empowerment, motivation, and relationships. Conclusions The themes and concepts emerging from this qualitative synthesis can be addressed by specific points of action to support parent‐delivered therapy interventions. We have summarized these in a checklist for use by intervention developers, health care professionals, and parents. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 659-669, September 2018.
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  July 23, 2018   doi: 10.1111/cch.12592   open full text
• Developing a database for Rett syndrome research performed in the European Union: A resource for researchers and stakeholders.
  Folahanmi Tomiwa Akinsolu, Eszter Balczár, Nóra Kovács, Tibor Gáll, Mariann Harangi, Orsolya Varga.
  Child Care Health and Development. July 23, 2018
  --- - |2+ Abstract Background For most rare diseases, which are often significantly under‐resourced, sufficient information on funding landscape is missing, which may prevent effective use of research resources and be an obstacle to making effective decisions on research. The objective of this research was to create a database of Rett syndrome research projects carried out in the European Union (EU) and to provide a research landscape analysis. Method Websites of organizations funding research projects were identified and systematically checked. Projects were analysed by date, place, funder types, and research topics. Results The analysis revealed that the total expenditure on Rett syndrome research was almost €70 million, allocated among 247 projects mostly performed in Italy and the United Kingdom. The main research sponsor was the European Commission. Highlighting research trends and gaps, this work facilitates changes in rare disease research data management. Conclusion This work demonstrates the feasibility of creating an EU‐based research database on Rett syndrome projects. It provides a source of information on research development which is useful for individuals, organizations and key players in the private and public sector to make progressive decisions on Rett syndrome research. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 794-800, September 2018.
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  July 23, 2018   doi: 10.1111/cch.12595   open full text
• Predictors of learning outcomes for children with and without chronic illness: An Australian longitudinal study.
  Tony Barnett, Rebecca Giallo, Margaret Kelaher, Sharon Goldfeld, Jon Quach.
  Child Care Health and Development. July 23, 2018
  --- - |2+ Abstract Background Chronically ill children are at increased risk of poor learning outcomes. Knowledge of the predictors of learning outcomes for this group of people is important to inform the development of education supports that stand the best chance of being effective. This study explored the child, family, and school risk and protective factors during the child's transition to elementary school (aged 6–7 years) that were associated with learning outcomes when children were aged 10–11 years for both children with and without a chronic illness. Methods Data from the Longitudinal Study of Australian Children were used. Predictor variables were entered into separate multivariate regression models for children with and without a chronic illness. Results The strongest predictors of learning outcomes were the child's approach to learning, a consistent parenting style, and family socioeconomic position and were common for both children with and without a chronic illness but strongest for children with a chronic illness. Conclusion A child's approach to learning and a consistent parenting style during the period of the child's transition to elementary school are important and potentially modifiable factors that are predictive of academic performance in later childhood. These factors are particularly relevant for children with a chronic illness, their parents/caregivers, teachers both hospital and school based, and pediatricians and can be used to inform interventions. - 'Child: Care, Health and Development, Volume 44, Issue 6, Page 832-840, November 2018.
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  July 23, 2018   doi: 10.1111/cch.12597   open full text
• Spanish validation of the Spence Preschool Anxiety Scale.
  Mireia Orgilés, Patricia Penosa, Iván Fernández‐Martínez, Juan C. Marzo, José P. Espada.
  Child Care Health and Development. July 22, 2018
  --- - |2+ Abstract Background The Preschool Anxiety Scale (PAS) is a 28‐item measure designed to assess anxiety symptoms in preschoolers aged 31 to 83 months. Methods The present study aims to extend the literature by examining the psychometric properties and factorial structure of the PAS in a Spanish community sample of 274 preschoolers aged 3 to 7 years. Results Factor analysis confirmed the five‐factor original model after removing eight items, suggesting a shorter 20‐item version for the Spanish preschoolers. The scale demonstrated to have good internal consistency (Cronbach's α = 0.84). Moderate but significant correlations with a measure of health‐related quality of life supported the convergent validity of the PAS. Conclusions The Spanish version of the PAS demonstrated to have good psychometric properties, providing these results initial support to its use for assessing a broad range of anxiety symptoms in Spanish‐speaking preschoolers. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 753-758, September 2018.
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  July 22, 2018   doi: 10.1111/cch.12593   open full text
• The 12‐year prevalence and trends of childhood disabilities in Australia: Findings from the Survey of Disability, Aging and Carers.
  Diana H. Arabiat, Lisa Whitehead, Mohammad AL Jabery.
  Child Care Health and Development. July 18, 2018
  --- - |2+ Abstract Aim This paper contributes to knowledge on the prevalence and nature of disabilities in Australian children over a 12‐year period (2003–2015). Understanding the current state of childhood disability is imperative for predicting future needs for long‐term care and early intervention services for this population. Methods We used data on children 0–14 years from the 2003, 2009, 2012, and 2015 survey of Disability, Aging and Carers, which is an ongoing national survey covering both rural and urban areas of all States and Territories of Australia. Results Using the test for trends in population, no significant increases were noted in the prevalence of childhood disabilities over the last 12 years, although the prevalence of any developmental disability increased from 6.9% to 7.42% between 2009 and 2015. The rate and severity of disability was higher among boys compared with girls of the same age for a number of selected disabilities and higher for children aged 5–14 years. Conclusions With the anticipated rise in psychological related disability among Australian children, there is a need to ensure availability of a flexible and responsive model of service delivery for this population. This also implies that respite service coverage may need to be substantially increased to meet children and caregivers' needs. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 697-703, September 2018.
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  July 18, 2018   doi: 10.1111/cch.12588   open full text
• Mothers' perspectives of the experience and impact of caring for their child with a life‐limiting neurodevelopmental disability.
  E. Courtney, G. Kiernan, S. Guerin, K. Ryan, R. McQuillan.
  Child Care Health and Development. June 25, 2018
  --- - |2+ Abstract Background This study explored mothers' perspectives of the experiences and impact on themselves and their family when their child has a life‐limiting neurodevelopmental disability. Methods Twelve mothers were interviewed and topics included mothers' experiences of caring, the impact on themselves and their family of care provision, and the management of day‐to‐day life. Data were analysed using thematic analysis. Results Four themes were identified. “Starting Out” relates to mothers' experiences of the birth of their child and the aftermath. “Keeping the Show on the Road” describes the strategies families employ to manage life day to day and the resources they use. “Shouldering the Burden” describes the range of physical, psychological, and social consequences of the situation for mothers and the family. “The Bigger Picture” relates to the world outside the family and how this is navigated. Conclusions Findings suggest mothers' overall experiences are characterized by a constant struggle, with evidence of negative impacts on family life, though there is also evidence of resilience and coping. Implications regarding the provision of services are discussed. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 704-710, September 2018.
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  June 25, 2018   doi: 10.1111/cch.12580   open full text
• “If I had been given that information back then”: An interpretive description exploring the information needs of adults with cerebral palsy looking back on their transition to adulthood.
  M. Freeman, D. Stewart, C. E. Cunningham, J. W. Gorter.
  Child Care Health and Development. June 11, 2018
  --- - |2+ Abstract Background Young people with cerebral palsy (CP) and their families have identified lack of information received during the transition to adulthood as a barrier to successful outcomes. To date, few studies have explored the information needs, preferences, timing, and method of provision from the perspective of individuals with CP. Method The methodological approach to this qualitative study was interpretive description. Nine adults living with CP, between the ages of 20 and 40, were purposively recruited in Ontario, Canada, to explore, retrospectively, their information needs during the transition to adulthood. Participants completed a 1‐hour interview that explored their experiences seeking and receiving information. Interviews were transcribed verbatim, and data were analysed to create a thematic description of adults' experiences with information. Results Three themes emerged: (a) “Recognizing and supporting information needs,” which highlighted the importance of support systems to assist young people in receiving and seeking information throughout the transition; (b) “Getting creative,” which highlighted strategies young people use when confronted with environmental barriers when seeking information; and (c) “Gaps and advice for the future,” which highlighted the need for real‐life opportunities, during the transition to adulthood, to experience some of the responsibilities of adult life. Conclusion Clinicians assisting young people with CP need purposefully to foster knowledge and skills during the transition to adulthood. They should be not only providers of information but also enablers of opportunities for immersion in real‐life experiences to prepare for adult life. It is important for young people to have the opportunity to discuss challenges and exchange information with their peers. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 689-696, September 2018.
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  June 11, 2018   doi: 10.1111/cch.12579   open full text
• “They're kept in a bubble”: Healthcare professionals' views on transitioning young adults with congenital heart disease from paediatric to adult care.
  A. McLoughlin, C. Matthews, T. M. Hickey.
  Child Care Health and Development. June 07, 2018
  --- - |2+ Abstract Background Due to medical advances, growing numbers of adolescents with congenital heart disease (CHD) survive into adulthood and transferring from paediatric to adult healthcare. This transfer is significant step in a young person's life, and this study examines the views of Irish healthcare professionals' on how best to manage this transition. Methods Purposeful sampling was used to invite participation by healthcare professionals (HCPs) from a variety of disciplines whose caseloads include adolescents and young adults with CHD. Fourteen professionals participated in semistructured interviews regarding their experiences of the transition process and their recommendations. Data were collected during Spring 2016 and analysed using thematic analysis. Results Results indicated that the current approach to transition and transfer could be improved. Professionals identified barriers hindering the transition process such as cultural and attitudinal differences between HCPs dealing with child and adult patients, inadequate preparation and education of patients about their condition, parental reluctance to transfer, and concern about parents' role in on‐going treatment. Measures such as better support and education for both the patients and their parents were recommended, in order to facilitate a smoother transition process for all parties involved. Additionally, HCPs identified the need for better collaboration and communication, both between paediatric and adult healthcare professionals and between hospitals, to ensure greater continuity of care for patients. Conclusions Action is required in order to improve the current transition process. Measures need to be taken to address the barriers that currently prevent a smooth transition process for young adult CHD patients. Professionals recommended the implementation of a structured transition clinic to deal with the wide variety of needs of transitioning adolescent patients and their families. Recommendations for future research are also made. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 736-745, September 2018.
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  June 07, 2018   doi: 10.1111/cch.12581   open full text
• The physical environment in family childcare homes and children's physical activity.
  C. D. Neshteruk, S. Mazzucca, T. Østbye, D. S. Ward.
  Child Care Health and Development. June 06, 2018
  --- - |2+ Abstract Background Family childcare homes (FCCHs) are the second largest provider of childcare in the United States, yet little is known about how this setting influences children's physical activity, particularly related to the physical environment. Thus, the purpose of this study was to determine what aspects of the FCCH physical environment facilitate or hinder children's physical activity. Methods Data were collected from 166 FCCH providers and 496 preschool‐aged children in 2013–2014 as part of the Keys to Healthy FCCHs study. Children's moderate‐to‐vigorous physical activity (MVPA) was measured using Actigraph GT3X+ accelerometers. Wear data from the childcare day were isolated, and cut‐points were applied in order to calculate children's minutes of MVPA per hour. FCCH‐level estimates of child MVPA per hour were calculated. Indoor and outdoor physical environment characteristics were assessed during a 2‐day observation using the Environment and Policy Assessment and Observation modified for FCCHs. General linear models were used to examine the relationship between indoor, portable play equipment, and outdoor FCCH physical environment characteristics and children's MVPA per hour. Results Only indoor play space was significantly associated with children's MVPA (β = 0.33; p = .034), indicating that when provided with more indoor space for active play, children were more physically active. No significant associations were noted between portable play equipment or the outdoor environment and children's MVPA. Conclusions Indoor space was the only physical environment characteristic associated with children's MVPA, suggesting that teaching FCCH providers how to best utilize their indoor play space for active play may be a way to promote children's physical activity. Futures studies should explore the impact of other environmental characteristics of the FCCH (e.g., provider practices and policies) on children's physical activity. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 746-752, September 2018.
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  June 06, 2018   doi: 10.1111/cch.12578   open full text
• A scoping review to explore how universal design for learning is described and implemented by rehabilitation health professionals in school settings.
  J. Kennedy, C. Missiuna, N. Pollock, S. Wu, J. Yost, W. Campbell.
  Child Care Health and Development. June 05, 2018
  --- - |2+ Abstract Background Universal design for learning (UDL) is a framework that provides guidelines to support children with diverse needs in the classroom and promotes inclusion of all children. Although UDL is recognized as a promising approach for school‐based rehabilitation health professionals (RHPs), there are no studies that synthesize evidence on the use of UDL by RHPs in the school setting. Therefore, the research question for this study is: How is UDL described and implemented in school settings by RHPs? This study specifically examined literature from occupational therapy, physiotherapy, and speech‐language pathology. Methods A scoping review was completed to (a) summarize how UDL is described in the rehabilitation literature, (b) summarize the recommended and reported role of RHPs in the delivery of UDL, and (c) identify gaps in the evidence base. CINAHL, Embase, MEDLINE, PsychINFO, Sociological Abstracts, Web of Science, and ERIC electronic databases were searched. Numerical summaries and theoretical thematic analysis were used to describe the data both quantitatively and qualitatively. Results Inclusion criteria were achieved for 45 of the 3,998 screened documents. Most of the included documents lacked a definition of UDL. Analysis suggested that speech‐language pathologists and occupational therapists implement UDL in a variety of ways within the school setting. No physiotherapy literature was found, and limited high‐level empirical research has been conducted within rehabilitation. Conclusion This scoping review provides a broad understanding of how RHPs describe and implement UDL‐aligned services in school settings. UDL is a promising framework that provides RHPs with guidance on how to support children with diverse needs in the classroom, with the overall aim to promote inclusion of all children. There is a need for further research to determine the effectiveness of UDL as implemented by RHPs and to examine the role of physiotherapists in using UDL‐type services. - 'Child: Care, Health and Development, Volume 44, Issue 5, Page 670-688, September 2018.
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  June 05, 2018   doi: 10.1111/cch.12576   open full text
• Notice of temporary withdrawal: ‘A short form of the behavior rating inventory of executive function‐preschool version (BRIEF‐P)’ by M. Zhou.
  
  Child Care Health and Development. October 29, 2017
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  October 29, 2017   doi: 10.1111/cch.12537   open full text
• Cognitive and physical development in HIV‐positive children in South Africa and Malawi: A community‐based follow‐up comparison study.
  L. Sherr, I. S. Hensels, M. Tomlinson, S. Skeen, A. Macedo.
  Child Care Health and Development. October 19, 2017
  Background Child development is negatively impacted by HIV with children that are infected and affected by HIV performing worse than their peers in cognitive assessments. Methods We conducted a descriptive follow‐up comparison study (n=989) in South Africa and Malawi. We tracked child development in 135 HIV‐positive children compared to 854 uninfected children aged 4–13 years attending community‐based organizations at baseline and again 12–15 months later. Results Children with HIV were more often stunted (58.8% vs. 27.4%) and underweight (18.7% vs. 7.1%). They also had significantly poorer general physical functioning (M=93.37 vs. M=97.00). HIV‐positive children scored significantly lower on digit span and the draw‐a‐person task. Conclusions These data clearly show that HIV infection poses a serious risk for child development and that there is a need for scaled up interventions. Community‐based services may be ideally placed to accommodate such provision and deliver urgently needed support to these children.

  October 19, 2017   doi: 10.1111/cch.12533   open full text
• Early interaction in autism spectrum disorder: Mothers' and children's behaviours during joint engagement.
  A. Kaale, L. Smith, A. Nordahl‐Hansen, M. W. Fargerland, C. Kasari.
  Child Care Health and Development. October 15, 2017
  Background More knowledge about the interaction between young children with autism spectrum disorder and their parents is one way to improve intervention. This study aims to investigate the behaviours of mothers and children with autism spectrum disorder during joint engagement, with a focus on pacing or rate (i.e., incidences per minute) of their behaviours when being in this state. Method Video recordings of 10 min of free‐play between 58 children (2–4 years) diagnosed with childhood autism and their mothers were used to examine rate of mothers' and children's behaviours (i.e., toy introduction, toy expansion, positive affect, and language) during joint engagement, the association between rate of mothers and children's behaviours, the relation between rate of mothers' behaviours and time in joint engagement, and how child factors might be associated with the latter. Results Mothers(m) and children(c) showed similar rate of positive affect (Mm = 0.6/Mc = 0.5) and toy expansion (Mm = 0.7/Mc = 0.7) per minute, whereas mothers talked almost three times more than their children (Mm = 10.2/Mc = 3.8). In contrast, mothers introduced fewer toys compared to the children (Mm = 0.7/Mc = 1.2). Rate of mothers' toy introduction, toy expansion, and positive affect was inversely related to time in joint engagement (Regression coefficient = −70.7 to −48.5, p = .006 to .024). Rates of mothers' and children's behaviours were associated (Spearman rank order coefficient = .53 to .29, p < .001 to .03), but neither rate of children's behaviours nor mental age was associated with the observed relation between rate of these maternal behaviours and time in joint engagement. Conclusion Time in joint engagement was related to rate of mothers' behaviours and children's mental age but not to rate of children's behaviours in this study. Thus, intervention teaching parents of young children with autism strategies designed to increase time in joint engagement may be vital. The complex nature of the interaction between mother and child behaviours in promoting joint engagement warrants further elucidation. Key messages Increased understanding of parent and child behaviours during joint engagement is important for identification of targets for parent‐mediated early interventions in autism spectrum disorder. Time in joint engagement was related to rate of mothers' behaviours and children's mental age but not to rate of children's behaviours in this study. Higher rate of some maternal behaviours was inversely related to time in joint engagement, but it is not clear yet if higher rate may facilitate or disrupt joint engagement. The complex nature of the interaction between mother and child behaviours in promoting joint engagement warrants further elucidation.

  October 15, 2017   doi: 10.1111/cch.12532   open full text
• The association between pediatric injury risks and parenting behaviours.
  M. L. Jaques, T. L. Weaver, N. L. Weaver, L. Willoughby.
  Child Care Health and Development. October 06, 2017
  Background Unintentional injuries are the leading cause of death in children ages 1–18 years. Many of these injuries to young children occur in their own homes. Although research has explored injury risk prevention strategies, historically, much of this research has focused on environmental changes and teaching safety practices. Currently, there appears to be a gap in current research exploring how parenting influences children's risk of injury. Methods Mothers (n = 119) of children 5 years and younger were recruited from a paediatric clinic as a part of a larger study and completed measures of parenting challenges, developmentally sensitive parenting, child neglect, parental efficacy, and risk of potential injury situations. Hierarchical logistic regression was used to explore the extent to which developmentally insensitive parenting behaviours put parents at higher risk for behaviours that lead to unintentional injury in children and whether developmentally sensitive parenting behaviours protects children from injury. The association between demographic characteristics and injury risk behaviours was also examined. Results Parents who reported more frequent insensitive parenting behaviours (i.e., yelling, spanking, and putting child in time out) were more likely to report putting their child in an incorrect car seat or taking their child out of a car seat while the car is still moving. In addition, younger parents were at greater risk of storing cleaners and medications unsafely. Conclusion Results from this study highlight the importance of supporting younger mothers and educating parents on effective parenting strategies when trying to prevent unintentional injury risks.

  October 06, 2017   doi: 10.1111/cch.12528   open full text
• Development of a Cerebral Palsy Follow‐up Registry in Jordan (CPUP‐Jordan).
  N. A. Almasri, M. Saleh, S. Abu‐Dahab, S. H. Malkawi, E. Nordmark.
  Child Care Health and Development. October 06, 2017
  Aims This study aims to describe the development of a Cerebral Palsy Follow‐up Registry in Jordan (CPUP‐Jordan) and to provide a baseline child and parent demographic information, birth history of the child participants, and distribution of the participants based on topographical distribution of cerebral palsy (CP) and functional classification systems. Methods The CPUP‐Jordan was developed using a similar framework of a follow‐up surveillance programme for persons with CP in Sweden (CPUP). Standard assessment forms were utilized to collect data related to child and family demographics, child birth history, and functional classifications and physiotherapy and occupational therapy assessments and interventions. Research assistants were trained to conduct the assessments. A secured web‐based system was developed to store data and disseminate knowledge maintained in the registry. Children with CP were included in the registry if they have confirmed diagnosis of CP. The ascertainment age of inclusion and the minimum age of survival required are 4 years. Results One hundred sixty‐seven children were registered between 2013 and 2015 (mean age is 3.6 ± 3.0 years). Forty‐two percent were born premature, and 48% were less than the normal birthweight. Perinatal causes were reported for 54% of the participants. The most common type of CP based on tone disturbance was spastic type, and the most common topographical distributions of motor dysfunction were quadriplegia followed by diplegia. Fifty‐six percent of the participants had severe limitation in ambulation; 48% had restricted manual abilities, and 47% had limited communication abilities even with familiar family members and partners. Conclusions The development of CPUP‐Jordan registry for children with CP proved to be both feasible and informative. The registry baseline descriptive data were similar to those reported in previous research in Jordan supporting validity of the data. The implementation of CPUP‐Jordan at national level is expected to have a positive impact on children with CP, clinicians, policymakers, and researchers.

  October 06, 2017   doi: 10.1111/cch.12527   open full text
• Do not forget the parents—Parents' concerns during transition to adult care for adolescents with congenital heart disease.
  E. L. Bratt, Å. Burström, K. Hanseus, A. Rydberg, M. Berghammer,.
  Child Care Health and Development. October 05, 2017
  Background Growing up with congenital heart disease (CHD) often means transfer to adult care and lifelong medical follow‐up. An optimal transition process usually involves a multipart collaboration between the patient, their parents and other family members, and the healthcare providers. Taking an active role while knowing when it is time to step aside can be difficult for all the concerned parties, even the healthcare professionals. The aim of the present study therefore, was to explore parents' expectations and needs during their adolescent's transition to adult care. Method Semi‐structured interviews were conducted with 18 parents of 16 adolescents (aged 13–18 years) with CHD in 4 pediatric cardiology settings in Sweden. The interviews were analysed with qualitative content analysis. Results The analysis resulted in 2 main themes: (a) Feeling secure—the importance of being prepared and informed. This theme focused on the need to be prepared and informed about transition and future transfer to adult care. (b) Recognizing when to hand over at the right time. This theme addressed the process of handing over the responsibility from the parent to the adolescents and contained handing over from pediatric care to adult care. Conclusion Being prepared and informed about the upcoming transition process was essential. The parents underlined the importance of being involved in the transition planning for gradually handing over responsibility to the adolescent. They also considered establishing contact with the adult healthcare team before transfer as important and needed to be assured that CHD‐related information of importance for the young person's daily life would be given.

  October 05, 2017   doi: 10.1111/cch.12529   open full text
• The Effectiveness of a Psychoeducation Intervention delivered via WhatsApp for mothers of children with Autism Spectrum Disorder (ASD) in the Kingdom of Saudi Arabia: A randomized controlled trial.
  A. Hemdi, D. Daley.
  Child Care Health and Development. September 20, 2017
  Background Mothers of children with autism spectrum disorder (ASD) report high levels of stress and lower levels of well‐being than parents of typically developing children. Current interventions for ASD typically focus on working with the child rather than delivering strategies to help support parents. Objective To evaluate the effectiveness of a psychoeducation intervention developed to support mothers of children with ASD in Saudi Arabia. Method Sixty‐two mothers (23–52 years) of children (26–78 months) were recruited to a multisite randomized controlled trials of the intervention. The intervention consisted of one face‐to‐face session (60 min) and four virtual sessions (30 min each) delivered using WhatsApp. Parenting stress was the primary outcome, with secondary outcomes focusing on maternal depression, anxiety, and happiness, and child behaviour problems and ASD symptoms. Data were collected at baseline T1, immediately postintervention T2 and 8‐week follow‐up T3. Results One‐way analysis of covariance was used at T2 and T3 with T1 scores entered as a covariate. Improvements were found at T2 for stress (F = 234.34, p = .00, and d = −1.52) and depression (F = 195.70, p = .00, and d = −2.14) but not anxiety, and these results were maintained at T3. Changes in child behaviour problems were limited to improvements in hyperactivity at T2 (F = 133.66, p = .00, and d = −1.54). Although changes in stress and depression were statistically significant, change to clinically normal levels was limited to depression. None of the participants had recovered after the intervention (Parent Stress Index Short Form stress scores), whereas 23 mothers (71.87%) in the intervention group had recovered at T2 and 22 (68.75%) at T3 (Hospital Anxiety and Depression Scale depression scores). Conclusion This intervention with WhatsApp support is beneficial but may need to be augmented with other forms of support for mothers of children with ASD including more condensed sessions on stress and interventions targeting anxiety.

  September 20, 2017   doi: 10.1111/cch.12520   open full text
• Reliability and validity of the Korean‐language version of the Communication Function Classification System in children with cerebral palsy.
  J. Y. Choi, E. H. Hwang, D. Rha, E. S. Park.
  Child Care Health and Development. September 20, 2017
  Purpose The Communication Function Classification System (CFCS) and Viking Speech Scale (VSS) are useful systems for describing the broad communication function and speech intelligibility, respectively, of children with cerebral palsy (CP). The aims of this study were to determine the reliability and validity of the Korean version of the CFCS and also to investigate the association between the CFCS and the VSS and other functional classifications for children with CP. Materials and methods Participants were 50 children with CP (33 males, 17 females; mean age 7.2 years, range 4–16 years) recruited from a rehabilitation hospital. We analysed the interrater and intrarater reliabilities of the Korean version of the CFCS and VSS between parents, a physiatrist, and a speech–language pathologist (SLP). The social function domain of the Paediatric Evaluation of Disability Inventory was assessed to examine the concurrent validity of the CFCS and VSS. Results The intrarater reliabilities of the CFCS and VSS were excellent in a physiatrist (ƙ = 0.92, ƙ = 0.94, respectively) and an SLP (ƙ = 0.98, ƙ = 0.98) and very good in parents (ƙ = 0.87, ƙ = 0.89). The interrater reliability of the CFCS and VSS was very good between the physiatrist and SLP (ƙ = 0.87, ƙ = 0.89) and good between parents and the SLP (ƙ = 0.63, ƙ = 0.78) and between parents and the physiatrist (ƙ = 0.61, ƙ = 0.76). The CFCS and VSS were strongly related with the social function domain of Paediatric Evaluation of Disability Inventory. In addition, we found very strong associations between the VSS and CFCS. Conclusions The Korean version of the CFCS is a valid and reliable tool to classify communication ability and is strongly associated with the VSS, a reliable tool to classify speech intelligibility.

  September 20, 2017   doi: 10.1111/cch.12507   open full text
• Which children and young people are excluded from school? Findings from a large British birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC).
  A. Paget, C. Parker, J. Heron, S. Logan, W. Henley, A. Emond, T. Ford.
  Child Care Health and Development. September 14, 2017
  Background Exclusion from school is increasingly recognized as pertinent to child health. National educational data reveal that boys, children who are looked‐after, living in poverty, have special educational needs, or from certain ethnic minorities, are disproportionately excluded from school. As population‐based data on the wider characteristics of excluded children are scarce, we aimed to describe predictors of school exclusion in the Avon Longitudinal Study of Parents and Children. Method Avon Longitudinal Study of Parents and Children, a prospective U.K. population‐based birth cohort study, collected parent reports of permanent school exclusions by 8 years and parent and self‐reports of permanent and fixed‐term exclusions in the preceding 12 months at 16 years. Potential risk factors were examined for associations with exclusion using logistic regression, with a focus on child mental health and neurodevelopment. Results Analyses were based on all available data on 53/8,245 (0.6%) pupils excluded from school by 8 years and 390/4,482 (8.7%) at 16 years. Key factors associated with exclusion at both time points included male gender, lower socio‐economic status, maternal psychopathology, mental health and behavioural difficulties, psychiatric disorder, social communication difficulties, language difficulties, antisocial activities, bullying/being bulled, lower parental engagement with education, low school engagement, poor relationship with teacher, low educational attainment, and special educational needs (all p < .05). Conclusion Exclusion from school was associated with child, family and school‐related factors identifiable at, or prior to, primary school age. Child health professionals have an important role in the holistic, multidisciplinary assessment of children who are at risk of exclusion from school. Mental health and neurodevelopmental difficulties should be recognized and supported, to improve the health and educational outcomes among this vulnerable group.

  September 14, 2017   doi: 10.1111/cch.12525   open full text
• The variation in quality and content of patient‐focused health information on the Internet for otitis media.
  A. Joury, A. Joraid, F. Alqahtani, A. Alghamdi, A. Batwa, J. M. Pines.
  Child Care Health and Development. September 14, 2017
  Background When symptoms of otitis media appear, parents and patients often access the Internet for health information. We study the content and quality of health information in parent–patient‐focused websites for otitis media. Methods We searched the 3 search engines (Google, Yahoo, and Bing) using “otitis media” and “middle ear infection” then reviewed the top 30 hits for each search. We included sites that were focused on providing patient–patient information about otitis media. A variety of instruments were used to assess website content and quality. Results In 35 included websites, there was considerable variation in content, with the average site having 11 out of 15 informational items potentially useful to parents and patients on otitis media (range 4–15). Across included websites, the mean DISCERN score was 47 out of 80 (low to medium quality), 16 (46%) were HONcode certified, and 8 (23%) fulfilled all the JAMA benchmark criteria. The average website was written at a 9th/10th‐grade reading level. Conclusion The content and quality of health information for otitis media in parent‐and‐patient‐focused websites is highly variable. Although easy‐to‐read, high‐quality websites with complete content are available, the average website sites is difficult to read without a high school education and is difficult to use. Consideration should be given to adopting a standard approach for presenting disease‐specific information to parents and patients.

  September 14, 2017   doi: 10.1111/cch.12524   open full text
• The sleeping patterns of Head Start children and the influence on developmental outcomes.
  M. Schlieber, J. Han.
  Child Care Health and Development. September 11, 2017
  Background Sleep has a significant influence on children's development. The objective of this study was to investigate Head Start children's sleeping patterns and the impact on cognitive and behavioural outcomes. Methods Using the 2009 cohort of the Head Start Family and Child Experiences Survey (N = 2,868), information on sleeping patterns was assessed through parent interviews. Cognitive outcomes were assessed using direct assessments (Peabody Picture Vocabulary Test‐IV, the Expressive One‐Word Picture Vocabulary Test, and Subtests of the Woodcock–Johnson III) in addition to teacher report. Behavioural outcomes were assessed through parent and teacher reports. A multiple regression analysis was performed for each outcome variable. Results Descriptive findings showed that 89% of children had a regular bedtime at least 4 days per week and that the average amount of sleep per night was 10.41 hr. White mothers were more likely than other racial groups to adhere to a consistent bedtime, and maternal employment predicted less hour of sleep per night. Multiple regression analyses revealed that disrupted sleep had a negative influence on cognitive outcomes, especially in areas of mathematical problem solving, receptive language, teacher‐reported literacy behaviours, and approaches to learning. Disrupted sleep was associated with the risk of misbehaviour by increasing teacher and parent ratings on aggressive behaviours, hyperactivity, and withdrawing in addition to decreased scores on overall social skills. Having an inconsistent bedtime negatively predicted expressive vocabulary and teacher‐reported literacy behaviours. Conclusions The findings of this study support the influential role of sleep on children's development. Sleeping through the night and having a consistent bedtime were found to be predictive of many areas of cognitive and behavioural development. Head Start staff can provide the supports to increase parental knowledge on appropriate child sleep practices.

  September 11, 2017   doi: 10.1111/cch.12522   open full text
• Self‐concept in institutionalized children with disturbed attachment: The mediating role of exploratory behaviours.
  V. S. Vacaru, P. S. Sterkenburg, C. Schuengel.
  Child Care Health and Development. September 11, 2017
  Background Self‐concept is seen as both an outcome of sociocognitive and emotional development, and a factor in social and mental health outcomes. Although the contribution of attachment experiences to self‐concept has been limited to quality of primary attachment relationships, little is known of the effects of disturbed attachment on self‐concept in institutionalized children. Thus, the current study examined associations between disturbed attachment behaviours in institutionalized children and self‐concept, testing limited exploration as an explanatory factor. Methods Thirty‐three institutionalized children, aged 4–12, participated in a multimethod and multi‐informant assessment of disturbed attachment behaviours (i.e., Disturbances of Attachment Interview and Behavioral Signs of Disturbed Attachment in Young Children), self‐concept (i.e., Pictorial Scale of Perceived Competence and Social Acceptance for Young Children), and exploratory behaviours (i.e., Student Exploratory Behaviours Observation Scale). Analyses were conducted using bootstrapping techniques. Results Global self‐concept converged with teacher‐rated children's self‐concept, except for physical competence domain. Disturbed attachment behaviours were identified in 62.5% of the children, and this was associated with lower levels of exploration and lower scores on self‐concept, compared with children without disturbed attachment behaviours. Furthermore, exploratory behaviours mediated the effects of disturbed attachment behaviours on self‐concept. Conclusions Institution‐reared children with disturbed attachment behaviours were likely to have a negative perception of self and one's own competences. Limited exploratory behaviours explained this linkage. Targeting disordered attachment in children reared in institutions and their caregivers should become a high priority as a means for preventing socioemotional development issues.

  September 11, 2017   doi: 10.1111/cch.12521   open full text
• Bangladeshi school‐age children's experiences and perceptions on child maltreatment: A qualitative interview study.
  M. Atiqul Haque, S. Janson, S. Moniruzzaman, A. K. M. F. Rahman, S. R. Mashreky, U.‐B. Eriksson.
  Child Care Health and Development. September 04, 2017
  Background Child maltreatment (CM) is a public health problem and is recognized as a huge barrier for child development. Most of the research and definitions on CM are from the perspective of high‐income western countries. Because no major studies have been conducted on CM in Bangladesh, the aim of the current study was to explore the experiences of and perceptions on CM in school‐age children in rural and urban Bangladesh in order to understand maltreatment in a local context and from a child perspective. Methods Semistructured individual interviews with 24 children (13 boys and 11 girls), between the ages of 9 and 13 years of which 11 were schoolgoing and 13 non‐schoolgoing, were conducted during July 2013 and analysed according to qualitative content analysis. Results CM was a common and painful experience with serious physical and emotional consequences but highly accepted by the society. Vulnerable groups were especially young children, girls, and poor children. The children's voices were not heard due to their low status and low position in their families, schools, and working places. The main theme that emerged in the analysis was children's subordination, which permeated the five categories: (a) perception of children's situation in society, (b) understanding children's development and needs, (c) CM associated to school achievement, (d) negative impact of CM, and (e) emotional responses. Conclusions Different kinds of abuse are obviously common in Bangladesh, and the schools do not follow the law from 2011 prohibiting corporal punishment at school. The society has to take further steps to live up to the UN Convention on the Rights of the Child, which was ratified already in 1990, to protect the Bangladeshi children from CM.

  September 04, 2017   doi: 10.1111/cch.12508   open full text
• Adolescents' self‐perceived and actual weight: Which plays a dominant role in weight loss behaviour in Lebanon?
  S. Assaad, S. Anouti, F. Naja, L. Nasreddine, N. Hwalla, A. M. Sibai.
  Child Care Health and Development. September 04, 2017
  Background The decision to lose weight among adolescents is complex and is guided by a number of body‐related factors. This study examined the extent of agreement between actual weight, measured as body mass index, and self‐perceived weight and assessed their relative importance in weight loss behaviour among Lebanese adolescents. Methods Data on 278 adolescents aged 13–17 years were drawn from the nationwide Nutrition and Non‐Communicable Disease Risk Factor Survey (Lebanon, 2009). Binary multivariable logistic regressions were conducted to test associations with “effort to lose weight” as the outcome variable, controlling for a number of potential confounders. Results Close to 36% reported trying to lose weight. Around 21% and 13% were overweight and obese, respectively, and 40% and 10% perceived their weight as slightly high and very high, respectively. Inaccurate perceivers, those underestimating or overestimating their weight, constituted 39%, with overall percent agreement between actual and self‐perceived weight being 60.8% (kappa statistic = 0.319, 95% CI [0.242, 0.396]). About a third of the overweight adolescents (30.5%) and more than half of the obese (56.8%) underestimated their weight. In the multivariable analysis, self‐perceived weight was statistically significant and a stronger predictor of weight loss effort than body mass index (adjusted odds ratios = 14.42 and 6.42 for slightly high and very high perceived weight, respectively, compared to odds ratios = 1.47 and 2.31 for overweight and obese adolescents, respectively). Conclusion Health professionals need to consider self‐perceived weight in conjunction with actual weight in their pursuit of weight management goals and in planning prevention programmes that guide weight loss behaviours for adolescents.

  September 04, 2017   doi: 10.1111/cch.12512   open full text
• Effects of video‐feedback intervention on harmonious parent–child interaction and sensitive discipline of parents with intellectual disabilities: A randomized controlled trial.
  M. W. Hodes, M. Meppelder, M. Moor, S. Kef, C. Schuengel.
  Child Care Health and Development. September 03, 2017
  Background This study tested whether video‐feedback intervention based on attachment and coercion theory increased harmonious parent–child interaction and sensitive discipline of parents with mild intellectual disabilities or borderline intellectual functioning. Methods Observer ratings of video‐recorded structured interaction tasks at home formed pretest, post‐test, and 3‐month follow‐up outcome data in a randomized controlled trial with 85 families. Repeated measures analyses of variance and covariance were conducted to test for the intervention effect and possible moderation by IQ and adaptive functioning. Results The intervention effect on harmonious parent–child interaction was conditional on parental social adaptive behaviour at pretest, with lower adaptive functioning associated with stronger intervention benefit at post‐test and follow‐up compared to care as usual. Intervention effects were not conditional on parental IQ. Intervention effects for sensitive discipline were not found. Conclusion Although the video‐feedback intervention did not affect observed parenting for the average parent, it may benefit interaction between children and parents with lower parental adaptive functioning.

  September 03, 2017   doi: 10.1111/cch.12506   open full text
• What the child “SAID” to the dentist: A UK randomized controlled trial.
  R. Yee, L. M. Jones, M. T. Hosey.
  Child Care Health and Development. August 30, 2017
  Background The electronic Survey of Anxiety and Information for Dentists (eSAID) allows children to tell dentists about their feelings and coping preferences. It is a computer “quiz” with 26 questions and free‐text responses that produces a report for the children that they can then hand to their dentist. This is the first study to report the use of eSAID in a hospital paediatric dental clinic. Methods This was a randomized controlled trial to evaluate whether children thought that eSAID benefitted them, made them less anxious, and improved cooperation and their treatment satisfaction. Fifty‐one children aged 8–13 years were randomized to complete either eSAID or a control version in the waiting room before their scheduled dental appointment. The study group had a 26‐item questionnaire; the control had only two items. Both groups scored their anxiety on a 7‐point anxiety scale at the start and again at the end of the quiz. All subjects handed the resultant eSAID report as a printout to their dentist. Dental treatment proceeded as planned. After treatment, each child reported how they thought the eSAID quiz had benefitted them by scoring on a 10 cm Visual Analogue Scale and their satisfaction on the Modified Treatment Evaluation Inventory. The operating dentists scored the children's cooperation using a 10 cm Visual Analogue Scale. Results Overall, the baseline anxiety levels were low (study: mean 1.2; control: mean 1.5). The study group's post‐survey anxiety reduced by 0.4, whereas controls' increased by 0.2; this difference is statistically significant (p = .04). However, it made no difference to the children's self‐reported benefit (p = .30), satisfaction (p > .05), or cooperation (p = .34). Conclusions eSAID reduced pre‐treatment anxiety but made no difference to children's perceived benefit, satisfaction, or cooperation. Future study should include known anxious children.

  August 30, 2017   doi: 10.1111/cch.12510   open full text
• Knowledge, attitudes, and behaviours of healthcare professionals regarding child maltreatment in China.
  X. Li, Q. Yue, S. Wang, H. Wang, J. Jiang, L. Gong, W. Liu, X. Huang, T. Xu.
  Child Care Health and Development. August 15, 2017
  Background A new, recently issued national law and regulation in China conferred the responsibility of healthcare professionals in child maltreatment intervention. However, few studies have reported on the recognition and reporting of child maltreatment by healthcare professionals in China. The aim of this study was to assess healthcare professionals' knowledge, attitudes, and self‐perceived behaviour in terms of identifying, assessing, and reporting child maltreatment cases in China. Methods A cross‐sectional survey of 877 healthcare professionals from four provinces was conducted using a structured questionnaire. Results The respondents demonstrated insufficient knowledge on identifying potential child maltreatment cases. Over 30% of them were less than confident in the medical examination, evaluation, and treatment of child maltreatment cases, especially with regard to cases involving sexual abuse. Only 3.19% of respondents had ever received training on child maltreatment intervention, and as a result, lack of knowledge with regard to dealing with child maltreatment cases, referral procedures, and regulations was indicated to be the main cause of underreporting. Conclusions Healthcare professionals in China have insufficient knowledge, skills, and confidence when it comes to dealing with all aspects of child maltreatment. Although participants reported a positive attitude towards their role in detecting and reporting child maltreatment cases, there are obstacles that hinder them from doing so. Appropriate training courses should be developed to empower professionals with knowledge and skills, as well as increase their confidence in dealing with suspected child maltreatment cases.

  August 15, 2017   doi: 10.1111/cch.12503   open full text
• Understanding frames: A UK survey of parents and professionals regarding the use of standing frames for children with cerebral palsy.
  J. Goodwin, A. Colver, A. Basu, S. Crombie, D. Howel, J. R. Parr, E. McColl, N. Kolehmainen, A. Roberts, J. Lecouturier, J. Smith, K. Miller, J. Cadwgan.
  Child Care Health and Development. August 15, 2017
  Background Standing frames are used for children with cerebral palsy (CP). They may improve body structure and function (e.g., reducing risk of hip subluxation, and improving bladder and bowel function), improving activity (e.g., motor abilities) and participation (e.g., interaction with peers), but there is little evidence that they do. We aimed to identify current UK standing frame practice for children with CP and to understand stakeholder views regarding their clinical benefits and challenges to use. Method Three populations were sampled: clinicians prescribing standing frames for children with CP (n = 305), professionals (health and education) working with children with CP who use standing frames (n = 155), and parents of children with CP who have used standing frames (n = 91). Questionnaires were developed by the co‐applicant group and piloted with other professionals and parents of children with CP. They were distributed online via clinical and parent networks across the UK. Results Prescribing practice was consistent, but achieving the prescribed use was not always possible. Respondents in all groups reported the perceived benefits of frames, which include many domains of the International Classification of Functioning Disability and Health for Children and Youth. Challenges of use are related to physical space and child‐reported pain. Conclusions These survey findings provide information from key stakeholders regarding current UK standing frame practice.

  August 15, 2017   doi: 10.1111/cch.12505   open full text
• The participation of parents of disabled children and young people in health and social care decisions.
  P. McNeilly, G. Macdonald, B. Kelly.
  Child Care Health and Development. August 09, 2017
  Background There is widespread acceptance that parents should be fully involved in decisions about their son or daughter's health and social care. This is reflected in partnership models of practice as well as local and national policy across the United Kingdom. Previous research indicates that parents' experiences of decision making with professionals are mixed. Aim The research reported here aimed to explore parents' experiences of participating in decisions made with professionals about their disabled son or daughter's care. Design This research used mixed methods including survey methodology and qualitative in depth interviews. Setting and participants The research was conducted in one Trust in Northern Ireland. Participants were 77 parents of children and young people with a range of impairments aged between 3 and 28 years. Results Three themes emerged from the data: taking the lead, not knowing, and getting the balance right. Parents wanted to be involved in all aspects of decision making. Although parents reported many examples of good practice, there were also times when they did not feel listened to or did not have enough information to inform decisions. Discussion and conclusion Parents in this research recounted positive as well as negative experiences. Parents took on a protective role when decisions were made about their son or daughter and at times, reported the need to “fight” for their child. The provision of information remains problematic for these families, and at times, this created a barrier to parents' participation in decision making. Partnership approaches to care that recognize parents' expertise are particularly important to parents when decisions are made with professionals.

  August 09, 2017   doi: 10.1111/cch.12487   open full text
• Exposure to overprotective parenting and psychopathology in extremely low birth weight survivors.
  K. L. Day, K. G. Dobson, L. A. Schmidt, M. A. Ferro, S. Saigal, M. H. Boyle, R. J. Van Lieshout.
  Child Care Health and Development. August 04, 2017
  Background Extremely low birth weight (ELBW; <1,000 g) infants are the most vulnerable babies and are at higher risk for experiencing overprotective (i.e., controlling and intrusive) parenting, which is hypothesized to contribute to the risk for mental disorders. Despite the increased risk for anxiety disorders and decreased risk for alcohol or substance use disorders seen in ELBW survivors, no research has examined the impact of parenting. This study investigated if overprotective parenting mediates links between ELBW birth status and psychiatric disorders in adulthood. Study design Participants included ELBW survivors born in 1977–1982 and matched normal birth weight (≥2,500 g) control participants (ELBW n = 81; normal birth weight n = 87) prospectively followed in Ontario, Canada. These individuals retrospectively reported on whether either of their parents was overprotective using the Parental Bonding Instrument. Presence of a current anxiety disorder and of current alcohol or substance use disorders was assessed using the Mini International Neuropsychiatric Interview at age 29–36 years. Results Path analysis showed that overprotective parenting was a significant mediator of the association between ELBW status and risk for an anxiety disorder in adulthood and the risk for an alcohol or substance use disorder in adulthood in ELBW survivors. Overprotective parenting accounted for 53% of the association between ELBW status and the risk for an anxiety disorder in adulthood and 26% of the association between ELBW status and alcohol or substance use disorders. Conclusions Overprotective parenting accounted for a substantial proportion of the increased risk for anxiety and alcohol or substance use disorders in adulthood in ELBW survivors. Despite their perceived vulnerabilities, it is important that the parents of ELBW survivors be supported in their attempts to facilitate their children's pursuit of independence during childhood and beyond.

  August 04, 2017   doi: 10.1111/cch.12498   open full text
• Longitudinal vocabulary development in Australian urban Aboriginal children: Protective and risk factors.
  K. Short, P. Eadie, J. Descallar, E. Comino, L. Kemp.
  Child Care Health and Development. August 03, 2017
  Background Vocabulary is a key component of language that can impact on children's future literacy and communication. The gap between Australian Aboriginal and non‐Aboriginal children's reading and academic outcomes is well reported and similar to Indigenous/non‐Indigenous gaps in other nations. Determining factors that influence vocabulary acquisition over time and may be responsive to treatment is important for improving Aboriginal children's communication and academic outcomes. Aim To determine what factors influence Australian urban Aboriginal children's receptive vocabulary acquisition and whether any of these are risks or protective for vocabulary development. Method One hundred thirteen Aboriginal children in South Western Sydney from the longitudinal birth cohort Gudaga study were assessed on The Peabody Picture Vocabulary Test multiple times: 3 years, just prior to school entry, at the end of the first and second years of formal schooling. Multilevel models were used to determine the effects of 13 fixed and manipulable maternal, child, and family variables drawn from previous research. Results Higher maternal education was found to be protective at 3 years and over time. The number of children in urban Australian Aboriginal households made an impact on vocabulary development and this varied over time. From 3 to 6 years, those with early poor non‐verbal cognitive skills had vocabulary skills that remained below those with stronger non‐verbal skills at 3 years. Girls exhibit an earlier advantage in vocabulary acquisition, but this difference is not sustained after 4 years of age. Conclusions The risk and protective factors for vocabulary development in Australian Aboriginal children are similar to those identified in other studies with some variation related to the number of children in the home. In this limited set of predictors, maternal education, gender, non‐verbal cognitive skills, and the number of children in households were all shown to impact on the acquisition of vocabulary to 3 years and or the developmental trajectory over time.

  August 03, 2017   doi: 10.1111/cch.12492   open full text
• Psychosocial functioning, self‐image, and quality of life in children and adolescents with neurofibromatosis type 1.
  S. Cipolletta, G. Spina, A. Spoto.
  Child Care Health and Development. August 03, 2017
  Background Neurofibromatosis type 1 (NF1) is a genetic disorder associated with neurocutaneus manifestations, as well as attention and learning problems. The aim of this study was to examine the psychosocial functioning, quality of life, and self‐image of children with NF1. Method Two hundred forty participants were recruited, comprising 60 children and adolescents with NF1, 60 parents of children with NF1, 60 children and adolescents without NF1, and 60 parents of children without NF1. The children/adolescents completed the Self‐administered Psychiatric Scales test for Children and Adolescents and the human figure drawing test, whereas parents completed the Child Behavior Checklist. Both children and parents completed the Pediatric Quality of Life Inventory. Results Compared to healthy subjects, individuals with NF1 reported anxiety problems, poorer quality of life, and greater distortions in terms of self‐image. When compared to healthy participants' parents, the parents of NF1 participants reported having more concerns about the quality of life, sociality, school performance, and attention span of their children. Conclusions Results show that the psychological functioning, behavior, self‐image, and quality of life of children and adolescents with NF1 are compromised. Health services should take into account the psychosocial difficulties associated with NF1 and design rehabilitation programs aimed at increasing NF1 children's interpersonal skills, improving their social life and quality of life, and promoting more adaptive behaviors. In addition, health care interventions should also involve the parents of children with NF1.

  August 03, 2017   doi: 10.1111/cch.12496   open full text
• Behaviour of 4‐ to 5‐year‐old nondisabled ELBW children: Outcomes following group‐based physiotherapy intervention.
  L. Brown, Y. R. Burns, P. Watter, P. H. Gray, K. S. Gibbons.
  Child Care Health and Development. July 28, 2017
  Background Extreme prematurity or extremely low birth weight (ELBW) can adversely affect behaviour. Nondisabled ELBW children are at risk of behavioural problems, which may become a particular concern after commencement of formal education. This study explored the frequency of behavioural and emotional problems amongst nondisabled ELBW children at 4 to 5 years of age and whether intervention had a positive influence on behaviour. The relationship between behaviour, gender, and other areas of performance at 5 years was explored. Methods Fifty 4‐year‐old children (born <28 weeks gestation or birth weight <1,000 g) with minimal/mild motor impairment were randomly allocated to intervention (n = 24) or standard care (n = 26). Intervention was 6 group‐based physiotherapy weekly sessions and home programme. Standard care was best practice advice. The Child Behavior Checklist (CBCL) for preschool children was completed at baseline and at 1‐year post‐baseline. Other measures at follow‐up included Movement Assessment Battery for Children Second Edition, Beery Visual‐Motor Integration Test 5th Edition, and Peabody Picture Vocabulary Test 4th Edition. Results The whole cohort improved on CBCL total problems score between baseline (mean 50.0, SD 11.1) and 1‐year follow‐up (mean 45.2, SD 10.3), p = .004. There were no significant differences between groups over time on CBCL internalizing, externalizing, or total problems scores. The intervention group showed a mean difference in total problems score of −3.8 (CI [1.5, 9.1]) between times, with standard care group values being −4.4 (CI [1.6, 7.1]). Males had higher total problems scores than females (p = .026), although still performed within the “normal” range. CBCL scores did not correlate with other scores. Conclusions The behaviour of nondisabled ELBW children was within the “normal” range at 4 to 5 years, and both intervention and standard care may have contributed to improved behavioural outcomes. Behaviour was not related to performance in other developmental domains.

  July 28, 2017   doi: 10.1111/cch.12495   open full text
• Psychological adjustment and behaviours in children of migrant workers in China.
  F. Wang, X. Zhou, T. Hesketh.
  Child Care Health and Development. July 28, 2017
  Background In China, there are around 274 million rural–urban migrants, an estimated 61 million children left behind in rural areas by parents, and 29 million children who accompany their parents to cities. The aim of this study was to compare the psychosocial adjustment and behaviours of left‐behind children and migrant children. Methods Full data were available for 761 left‐behind children and 1,392 migrant children aged 11 to 17 in Zhejiang Province, eastern China. Participants completed a questionnaire focusing on migration status, risks behaviours, and psychological well‐being, measured with the Strengths and Difficulties Questionnaire. Results There were more left behind girls and more urban migrant boys (p < .001). The mean scores on the Strengths and Difficulties Questionnaire were all higher in left‐behind children than migrant children: for emotional symptoms (3.82 vs. 3.03, p < .001), conduct problems (2.55 vs. 2.41, p = .048), hyperactivity (4.25 vs. 3.81, p < .001), and total difficulties (13.46 vs. 12.00, p = .020), whereas the prosocial score was lower (6.68 vs. 6.90, p < .001), all indicating lower levels of well‐being in left‐behind children. Overall, 11.4% of left‐behind children and 8.8% of migrant children scored in the abnormal range for total difficulties. Left behind girls were particularly vulnerable to emotional problems. Left‐behind children were more likely to admit to stealing and cheating on exams, but there were no differences in other risks behaviours, such as smoking and drinking. Conclusions Migration with parents, rather than separation from parents, was associated with better psychological well‐being and fewer behavioural problems. Our findings have relevance for migrant parents in helping to inform decisions about where to raise their children as well as for policymakers in countries where migration is a major issue. When children are left behind, models of community support need to be considered, especially for those who are most vulnerable.

  July 28, 2017   doi: 10.1111/cch.12499   open full text
• Physical activity, sedentary behaviour, and psychosocial well‐being among young South Korean children.
  E.‐Y. Lee, V. Carson.
  Child Care Health and Development. July 28, 2017
  Objective To examine associations between television (TV) viewing, reading, physical activity (PA), and psychosocial well‐being among a representative sample of young South Korean children aged 0–5 years. Methods Findings are based on 1,774 children who participated in the Korea Children and Youth Survey. All measures were questionnaire‐derived. Psychosocial well‐being included social, interactive, and emotional skills (α = .7–.9), and the top quartile denoted high psychosocial well‐being. Multiple logistic regressions were performed to examine relationships after controlling for several confounders. Results Compared to children who participated in PA for <1 hr/week, those who participated in PA for 1‐ <3 hr/week were more likely to show high emotional skills (odds ratio [OR]: 1.40, 95% confidence interval [CI] [1.02, 1.93]), and those who participated ≥3 hr/week were more likely to show high social (OR: 2.01, 95% CI [1.45, 2.78]) and interactive skills (OR: 1.39, 95% CI [1.01, 1.92]). During weekdays, children who read 1– <3 hr/day and ≥3 hr/day, compared to <1 hr/day, were more likely to show high social (OR: 1.61, 95% CI [1.20, 2.16] and OR: 2.47, 95% CI [1.31, 4.67]) and emotional skills (OR: 1.57, 95% CI [1.16, 2.13] and OR: 2.58, 95% CI [1.34, 4.98]). In addition, children who read 1– <3 hr/day, compared to <1 hr/day, were more likely to show high interactive skills (OR: 1.44, 95% CI [1.08, 1.92]). Similar findings for reading on weekends were observed. TV viewing was not associated with social skills or interactive skills. TV viewing for 1– <3 hr/day, compared to <1 hr/day, was associated with increased odds of high emotional skills (OR: 1.71, 95% CI [1.28, 2.27] on weekdays; OR: 1.90, 95% CI [1.39, 2.61] on weekends). Conclusion PA and reading primarily showed favourable associations with psychosocial well‐being, whereas TV viewing did not; thus, PA or reading may be a better option over TV viewing for optimal psychosocial well‐being among young South Korean children. These findings should be confirmed with stronger study designs.

  July 28, 2017   doi: 10.1111/cch.12491   open full text
• Using family and staff experiences of a botulinum toxin‐A service to improve service quality.
  K. L. O. Burton, K. Bau, J. Lewis, K. R. Aroyan, B. Botha, A. G. M. Botman, K. Stewart, M.‐C. A. Waugh, S. P. Paget.
  Child Care Health and Development. July 26, 2017
  Background The decision for families to proceed with botulinum toxin‐A (BoNT‐A) injections for managing childhood conditions involving hypertonia can be complex. Family‐centred care is a service model that facilitates supporting families in this decision‐making process. Understanding families' experiences of services is critical to developing family‐centred care. The aim of this project was therefore to increase understanding of the experiences of families of children attending a BoNT‐A service in order to improve the service and its family‐centred approach to care. Method Sixteen staff of a BoNT‐A service participated in a patient journey mapping exercise. Nine families of the service participated in in‐depth interviews. Interviews were audio‐recorded and transcribed verbatim. Data from the staff session and interviews were analysed independently using grounded, hermeneutic thematic analysis. Results Staff sessions revealed 5 core themes that related to impacting on the family experience. Family interviews revealed 4 core themes, with 7 subthemes and 1 latent theme. Conclusions Areas of importance identified by families relating to BoNT‐A treatment included acknowledgement of individual needs, care coordination, empowerment of families and patients, consistency in service delivery, and the distressing nature of appointment and decision‐making. Comparison of the data from the staff patient journey mapping and family interviews suggested that staff have a good but incomplete understanding of the factors important to families, highlighting the need for consumer engagement in establishing family‐centred care. The themes identified can guide the provision of family‐centred BoNT‐A injection clinics.

  July 26, 2017   doi: 10.1111/cch.12500   open full text
• Exploring quality of life of children with cerebral palsy and intellectual disability: What are the important domains of life?
  E. Davis, D. Reddihough, N. Murphy, A. Epstein, S. M. Reid, A. Whitehouse, K. Williams, H. Leonard, J. Downs.
  Child Care Health and Development. July 26, 2017
  Background Although it is estimated that half of all children with cerebral palsy also have comorbid intellectual disability, the domains of quality of life (QOL) important for these children are not well understood. The aim of this study was to identify important domains of QOL for these children and adolescents. Methods Due to the children's communication impairments, qualitative semi‐structured interviews were conducted with 18 parents. The children (9 males) had a median age of 12 (range 7 to 17) years at interview and nearly two thirds were classified as Gross Motor Function Classification System IV or V. A grounded theory approach was used to identify domains of QOL. Results The 11 domains identified as important to QOL were physical health, body comfort, behaviour and emotion, communication, predictability and routine, movement and physical activity, nature and outdoors, variety of activity, independence and autonomy, social connectedness, and access to services. Conclusions The domains of QOL that emerged from this study will be useful for professionals who support children with cerebral palsy and their families. They will also be important for developing a QOL instrument essential for informing the development of interventions and their monitoring and evaluation.

  July 26, 2017   doi: 10.1111/cch.12501   open full text
• Health beliefs regarding pediatric cerebral palsy among caregivers in Botswana: A qualitative study.
  P. Patel, J. Baier, E. Baranov, E. Khurana, C. Gambrah‐Sampaney, A. Johnson, B. Monokwane, D. R. Bearden.
  Child Care Health and Development. July 25, 2017
  Background Cerebral palsy (CP) is the most common motor disability worldwide with an incidence of 2.5 per 1,000 births globally. Health beliefs among caregivers may be major drivers of health‐related behaviours and service utilization, but little is known regarding health beliefs around CP in Africa. Methods Between July 2013 and September 2015, children with CP were identified in Gaborone, Botswana, and their caregivers were invited to participate in a qualitative study utilizing semistructured in‐person one‐on‐one interviews. Interview questions addressed their understanding of CP, challenges of caring for a handicapped child, and community response to children with CP. Results Sixty‐two caregivers participated in the study. Common themes elicited were variable knowledge about CP, financial and physical burden, lack of therapies and educational resources, and the impact of stigma. Caregivers in Botswana generally subscribed to a biomedical explanation of CP but expressed concerns regarding more stigmatizing folks beliefs expressed in the community. Conclusion Health beliefs regarding CP in Botswana likely have a significant impact on utilization of healthcare resources. Information from this study should inform future educational interventions for caregivers of children with CP.

  July 25, 2017   doi: 10.1111/cch.12490   open full text
• Parent‐child interactions and children with cerebral palsy: An exploratory study investigating emotional availability, functional ability, and parent distress.
  J. Barfoot, P. Meredith, J. Ziviani, K. Whittingham.
  Child Care Health and Development. July 23, 2017
  Background Emotionally available parent–child relationships are supportive of child health and development. When a child has cerebral palsy, a range of child and parent factors can potentially impact the parent–child relationship; however, little research has specifically addressed this question. The aim of this study is to investigate links between parent–child emotional availability and both child functional abilities and parent distress in a sample of parents and children with cerebral palsy. Methods Twenty‐three mothers (mean age 37.3+/−5.7 years) and their children (mean age 4.9+/−3.3 years) with cerebral palsy completed a 20 min videoed parent–child interaction, scored using the Emotional Availability Scales. Parents also completed the Depression Anxiety Stress Scale, the Paediatric Evaluation of Disability Inventory, and the Strengths and Difficulties Questionnaire. Correlational analyses were conducted, and qualitative observations were made. Results Parent–child dyads in which the parent reported depressive symptoms scored poorer on all aspects of parent–child emotional availability. Where parents reported experiencing anxiety or stress, increased parent hostility and decreased child responsiveness was found. There was no relationship between child functional abilities and either parent distress or parent–child emotional availability. Parent sensitivity, structuring, and nonintrusiveness were negatively associated with child peer problems. Both child responsiveness and child involvement were negatively associated with hyperactivity/inattention. Observations of video footage suggested that parent implementation of therapy strategies impacted negatively on parent–child emotional availability for some dyads. Conclusion Findings from this study are consistent with the wider literature showing a link between parental depression and the parent–child relationship and extend this link to the cerebral palsy population. The importance of routine screening for parental mental health problems in early childhood intervention is highlighted by these findings. In addition, this study emphasizes the need to better understand how therapists support parents to implement therapeutic strategies to minimize negative impact on the developing parent–child relationship.

  July 23, 2017   doi: 10.1111/cch.12493   open full text
• Does compliance with healthy lifestyle behaviours cluster within individuals in Australian primary school‐aged children?
  T. Olds, I. Sanders, C. Maher, F. Fraysse, L. Bell, E. Leslie.
  Child Care Health and Development. July 23, 2017
  Background The 3 “movement behaviours” of sleep, screen time, and physical activity are associated with a wide range of health outcomes in children. This study examined whether these behaviours cluster together within individuals in Australian primary school children. Methods Three datasets including 4,449 9‐ to 11‐year‐old children were interrogated—(a) Obesity Prevention and Lifestyle (OPAL), (b) the International Study of Children, Obesity, Lifestyle and Environment (ISCOLE), and (c) the National Children's Nutrition and Physical Activity Survey (NCNPAS). The surveys measured movement behaviours using different instruments (accelerometry, use of time recall, and questionnaires) and different operationalizations of compliance. Observed frequencies of compliance with various combinations of guidelines were compared with expected frequencies based on the assumption of independence, using chi‐square tests. Results Compliance with the sleep guidelines was relatively high (72%, 75%, and 79% in the OPAL, ISCOLE, and NCNPAS datasets, respectively), and compliance with the screen (18%, 35%, and 22%) and physical activity (33%, 57%, and 87%) guidelines was generally lower. Against expectation, there was no evidence of clustering in any of the datasets (p > .99). Conclusions Compliance with movement behaviour guidelines does not cluster within individuals in 9‐ to 11‐year‐old Australian children. It may be unlikely that fostering compliance with one guideline will have a flow‐on effect to the others. Temporal trade‐offs (i.e., the need to choose one movement behaviour above another) in the 24‐hr day may contribute to the lack of clustering.

  July 23, 2017   doi: 10.1111/cch.12497   open full text
• Inequitable health service use in a Canadian paediatric population: A cross‐sectional study of individual‐ and contextual‐level factors.
  C. Holtz, J. Gilliland, A. Thind, P. Wilk, M. K. Campbell.
  Child Care Health and Development. July 23, 2017
  Background Health service use may be influenced by multilevel predisposing, enabling, and need factors but is equitable when driven by need. The study's objectives were as follows: (a) to investigate residential context's effect on child health service use and (b) to examine inequity of child health service use by testing for effect measure modification of need factors. Methods The sample of 1,451 children was from a prenatal cohort recruited from London, Ontario, between 2002 and 2004, with follow‐up until children were toddler/preschooler‐aged. Individual‐level data were linked by residential address to neighbourhood contextual‐level data sourced from Statistics Canada. Multilevel logistic regression modelled factors associated with child health service use. Interaction terms were included in the model to test for effect measure modification of need factors by predisposing and enabling factors. Results Contextual‐level factors were not associated with child health service use. Maternal parity and nativity to Canada modified the effect of the need factor, paediatric health condition, on health service use. Health condition's effect was lowest in children of Canadian‐born mothers with one child only (OR = 1.58, p = .04) and highest in children of Canadian‐born mothers with three or more children (OR = 3.52, p < .01). Further, its effect was higher in children of Canadian‐born mothers compared to children of mothers who migrated to Canada; however, odds ratios were not statistically significant for the latter. Conclusions Results may inform future investigation of the potential inequity of health service use for subgroups of children whose mothers are of lower parity and not Canadian‐born. An understanding of these inequities may inform future healthcare policy and care for paediatric populations. Key Messages A novel method to analytically assess inequity in health service use was explored. The effect of children's health condition on health service use depended on maternal parity and nativity to Canada. Child health service use did not vary by the neighbourhood in which children resided. Healthcare policy could benefit from further investigation of the observed inequities.

  July 23, 2017   doi: 10.1111/cch.12489   open full text
• Taking culture seriously: Can we improve the developmental health and well‐being of Australian Aboriginal children in out‐of‐home care?
  S. Raman, S. Ruston, S. Irwin, P. Tran, P. Hotton, S. Thorne.
  Child Care Health and Development. July 23, 2017
  Background Children in out‐of‐home care have well‐documented health and developmental needs. Research suggests that Aboriginal children in care have unmet health and intervention needs. In metropolitan Sydney, Kari Aboriginal Resources Inc. (KARI), an Aboriginal organization, provides support to indigenous children in care, including clinical assessment and intervention. We wanted to determine the health and developmental needs of a subset of children in out‐of‐home care with KARI, who had been in stable care for at least a year. We wanted to identify child, carer, and intervention characteristics that contributed to children doing well. We also wanted to identify enablers and barriers to providing culturally competent intervention. Methods We used mixed methods. From the KARI clinic database over the past 3 years, we identified children who had been in stable care with KARI for >12 months. We compared clinical measures and outcomes for these children with results from previous audits. We carried out a group discussion and key informant interviews with therapists and caseworkers to identify risk and resilience factors for each child, as well as enablers and barriers to culturally competent intervention. Results The health and developmental profile of the 26 children identified as being in stable care was similar to that of previous audits. Most (88%) were getting speech pathology intervention; one third were getting occupational therapy and psychological intervention; most children and their carers attended cultural programmes. The majority of children (25/26) improved in their developmental health. Caseworkers and therapists identified risk and resilience factors related to child, carer, and home characteristics. They also identified elements of good practice; systemic issues prevented some interventions from being carried out. Conclusions There are challenges delivering a trauma‐informed, culturally respectful service to Aboriginal children in out‐of‐home care in an urban setting, but it can be done if attention is paid to culture and the enablers and barriers are identified.

  July 23, 2017   doi: 10.1111/cch.12488   open full text
• Child understandings of the causation of childhood burn injuries: Child activity, parental domestic demands, and impoverished settings.
  N. Titi, A. Niekerk, R. Ahmed.
  Child Care Health and Development. July 18, 2017
  Background Burns are a global public health problem. In South Africa, the rate of paediatric burn deaths is 5 times higher than other upper middle‐income countries, with concentrations in impoverished settings. Globally, the majority of research focuses on expert and caregiver descriptions of burn occurrence, causation, and prevention, with limited consideration of children's perspectives. This study investigated children's understanding of the causation and prevention of childhood burns. Methods Data were collected from eighteen 10‐ to 11‐year‐old children living in selected impoverished, fire‐affected neighbourhoods in Cape Town, through 3 isiXhosa focus groups. All focus groups were transcribed, coded, and analysed for emerging themes through thematic analysis. Results Themes regarding burn causation and risks centred around 4 themes: (a) developmental limits in context; (b) domestic chores, child capacity, and inability to say “no”; (c) inadequate supervision and compromised caregiving; and (d) unsafe structures. Child accounts of prevention pertained to (e) burn injury prevention activities in comprised environments and emphasized child agency, and upgrading the physical environment. Conclusion The children in this study ascribed burn injuries as the consequence of their developmental limits in the context of poverty, constraints on parental supervision, and unsafe environments. The children recommended safety education and upgrading their physical environments as part of burns injury prevention. The child accounts offer useful insights to inform safety interventions in impoverished settings.

  July 18, 2017   doi: 10.1111/cch.12484   open full text
• Peer support for families of children with complex needs: Development and dissemination of a best practice toolkit.
  J. Schippke, C. Provvidenza, S. Kingsnorth.
  Child Care Health and Development. July 18, 2017
  Background Benefits of peer support interventions for families of children with disabilities and complex medical needs have been described in the literature. An opportunity to create an evidence‐informed resource to synthesize best practices in peer support for program providers was identified. The objective of this paper is to describe the key activities used to develop and disseminate the Peer Support Best Practice Toolkit. Methods This project was led by a team of knowledge translation experts at a large pediatric rehabilitation hospital using a knowledge exchange framework. An integrated knowledge translation approach was used to engage stakeholders in the development process through focus groups and a working group. To capture best practices in peer support, a rapid evidence review and review of related resources were completed. Case studies were also included to showcase practice‐based evidence. Results The toolkit is freely available online for download and is structured into four sections: (a) background and models of peer support, (b) case studies of programs, (c) resources, and (d) rapid evidence review. A communications plan was developed to disseminate the resource and generate awareness through presentations, social media, and champion engagement. Eight months postlaunch, the peer support website received more than 2,400 webpage hits. Early indicators suggest high relevance of this resource among stakeholders. Conclusions The toolkit format was valuable to synthesize and share best practices in peer support. Strengths of the work include the integrated approach used to develop the toolkit and the inclusion of both the published research literature and experiential evidence.

  July 18, 2017   doi: 10.1111/cch.12494   open full text
• Functional gastrointestinal disorders in children from low socio‐economic status and Helicobacter pylori infection.
  F. Jaime, A. Villagrán, C. Hernández, M. Ortiz, C. Serrano, P. R. Harris.
  Child Care Health and Development. July 14, 2017
  Background Most studies on functional gastrointestinal disorders (FGIDs) in children are based on data from the northern hemisphere. Scientific reports are arising in South American population, but little is still known about children from low socio‐economic status (SES), where Helicobacter pylori infection is endemic. Our objective was to evaluate the prevalence of FGIDs in school children from low SES and its relationship with H. pylori infection. Methods Children from 3 public schools of low SES from Santiago de Chile were included. Students completed the Rome III Questionnaire and a survey about other symptoms. Also, the 13C urea breath test determined the presence of H. pylori infection. Results Five hundred six children were included, where 48% were male, with a median age of 15.7 years (range 7.1–19.6). Forty‐two percent had some FGID, aerophagia and functional constipation being the most frequent. Females (adjusted OR 1.5, 95% CI [1.1, 2.2]), those children with parents within the lowest level of education (adjusted OR 1.6, 95% CI: 1.1–2.4), and family history of gastric cancer (adjusted OR 1.9, 95% CI: 1.2–3.1) were related to FGIDs. The prevalence of H. pylori infection was 55.9% (95% CI [50.7, 60.9]). In multivariable analysis, the presence of abdominal pain (OR 1.55, 95% CI [1.02, 2.36]), but not FGIDs, was related to H. pylori infection. Conclusions FGIDs are common in low SES students. A low educational level of the household head, family history of gastric cancer. and being female are related to the development of FGIDs. In this study, no relationship between the presence of H. pylori and FGIDs was found.

  July 14, 2017   doi: 10.1111/cch.12486   open full text
• Participation of children on the autism spectrum in home, school, and community.
  K. Simpson, D. Keen, D. Adams, C. Alston‐Knox, J. Roberts.
  Child Care Health and Development. June 29, 2017
  Background Children on the autism spectrum participate less frequently, and in a narrower range of activities, than their nonautistic peers, but little is known about exact participation patterns across contexts or how this is perceived by caregivers. This study aimed to document patterns of participation and caregiver views with regard to frequency and intensity of activities. Method Caregivers of children on the spectrum aged 5 (n = 90) and 9–10 years (n = 128) completed the Participation and Environment Measure for Children and Youth for home, school, and community. Caregivers reported on frequency of child's participation, level of involvement, and caregivers' desire for change in participation patterns. Results Item‐level analyses revealed similar patterns of participation across home, school, and community for both cohorts with some small age‐appropriate differences. Caregivers generally desired increased diversity, frequency, and involvement in activities but a decreased use of electronics (computers, games, TV, and DVDs). Conclusion The possibility of autism‐specific participation patterns could inform future interventions aimed at enhancing social inclusion. This warrants further investigation through multiinformant designs that seek the perspectives of the child and caregivers.

  June 29, 2017   doi: 10.1111/cch.12483   open full text
• Parental disease prevention health beliefs and triggers for keeping children home from childcare—a qualitative study in Sydney, Australia.
  C. L. King, J. Leask.
  Child Care Health and Development. June 15, 2017
  Background Infectious diseases cause considerable morbidity and mortality in children less than 5 years of age. Children attending childcare centres are at increased risk of contracting infections. It is of public health interest to understand what triggers and underpins parental decisions to send an unwell child to childcare, with the obvious attendant risks to other children and childcare staff as well as the affected child. This study aimed to examine parents' disease prevention health beliefs and practices with a particular focus on how these factors influence childcare attendance decisions. Methods Semistructured, in‐depth interviews were conducted between June 2009 and May 2011 with parents who had at least one child under 5 years of age enrolled in a childcare centre. Six centres in the metropolitan area of Sydney, Australia, were selected to include parents from a range of demographic and socio‐economic backgrounds. Results Forty‐two interviews were conducted, recorded, and transcribed. Themes emerging from the data included “vitamin dirt,” contagion, and contagion prevention and control. These interacted with parents' decision‐making about childcare attendance, and parents made choices in a complex context of obligations to their child, social contract obligations to others, peer expectations, and the need to work. Vaccination received only scant mention as a preventive health measure. Decision‐making by parents concerning childcare attendance was made without reference to any external guidelines. Conclusions This study provides insights into parental disease prevention beliefs, behaviours, and decision‐making. It reveals a need for policies to support parents with unwell children. In addition, resources and educative efforts to raise awareness of vaccination as a preventive health measure, and awareness of infectious disease contagion more broadly, would assist in providing parents with a greater evidence base for making decisions about childcare attendance when their child is unwell.

  June 15, 2017   doi: 10.1111/cch.12481   open full text
• Mild–moderate congenital hearing loss: secular trends in outcomes across four systems of detection.
  P. Carew, F. K. Mensah, G. Rance, T. Flynn, Z. Poulakis, M. Wake.
  Child Care Health and Development. June 14, 2017
  Background Universal newborn hearing screening (UNHS) targets moderate or greater hearing loss. However, UNHS also frequently detects children with mild loss that results in many receiving early treatment. The benefits of this approach are not yet established. We aimed to (i) compare language and psychosocial outcomes between four hearing loss detection systems for children aged 5–8 years with congenital mild–moderate hearing loss; (ii) determine whether age of detection predicts outcomes; and (iii) compare outcomes between children identified via well‐established UNHS and the general population. Methods Linear regression adjusted for potential confounding factors was used throughout. Via a quasi‐experimental design, language and psychosocial outcomes were compared across four population‐based Australian systems of hearing loss detection: opportunistic detection, born 1991–1993, n = 50; universal risk factor referral, born 2003–2005, n = 34; newly established UNHS, born 2003–2005, n = 41; and well‐established UNHS, born 2007–2010, n = 21. In pooled analyses, we examined whether age of detection predicted outcomes. Outcomes were similarly compared between the current well‐established UNHS system and typically developing children in the Early Language in Victoria Study, born 2003, n = 1217. Results Age at diagnosis and hearing aid fitting fell steadily across the four systems. For moderate losses, mean expressive language (P for trend .05) and receptive vocabulary (P for trend .06) improved across the four systems, but benefit was not obvious for mild losses. In pooled analyses, diagnosis before age six months predicted better language outcomes for moderate losses. Children with mild–moderate losses exposed to well‐established UNHS continue to experience expressive language scores well below children in the general population (adjusted mean difference −8.9 points, 95% CI −14.7 to −3.1). Conclusions Treatment arising from UNHS appears to be clearly benefitting children with moderate hearing losses. However, rigorous trials are needed to quantify benefits, versus costs and potential harms, of early aiding of children with mild losses.

  June 14, 2017   doi: 10.1111/cch.12477   open full text
• Influence of eating quickly and eating until full on anthropometric gains in girls: A population‐based, longitudinal study.
  H. Ochiai, T. Shirasawa, H. Nanri, R. Nishimura, H. Hoshino, A. Kokaze.
  Child Care Health and Development. June 14, 2017
  Background In examining childhood overweight/obesity, there is a need to consider both eating quickly and eating until full. This longitudinal study investigated the influence of eating quickly and/or eating until full on anthropometric variables and becoming overweight/obese among Japanese schoolgirls. Methods Study participants were fourth‐grade schoolgirls (aged 9 or 10 years) in Ina Town, Japan. Physical examinations and a questionnaire survey were performed at baseline (fourth grade) and after 3 years (seventh grade). Height, weight, and waist circumference were measured in the physical examinations, while the data on eating quickly and eating until full were collected in the questionnaire survey. Analysis of variance and analysis of covariance were used to compare the differences in each anthropometric variable between fourth and seventh grade among groups. Results Data on 425 non‐overweight/obese schoolgirls in fourth grade were analyzed. Gains in anthropometric variables (body mass index, waist circumference, and waist‐to‐height ratio) from fourth to seventh grade were significantly larger in the “eating quickly and eating until full” group than in the “not eating quickly and not eating until full” group. In contrast, there were no significant differences in the gains between the “eating quickly or eating until full” group and the “not eating quickly and not eating until full” group. The proportion of overweight/obese girls in seventh grade was higher in the “eating quickly and eating until full” group than in the other groups. Conclusions Eating quickly and eating until full had a substantial impact on excess gains in anthropometric variables among schoolgirls, suggesting that modifying these eating behaviors may help prevent non‐overweight/obese girls from the excess gains. Accordingly, school health programs need to focus on not eating quickly and/or not eating until full to prevent overweight/obesity; it is necessary to emphasize “the risk of overweight/obesity associated with these eating behaviors” in schools.

  June 14, 2017   doi: 10.1111/cch.12482   open full text
• Costs and savings of parenting interventions: results of a systematic review.
  K. M. Duncan, S. MacGillivray, M. J. Renfrew.
  Child Care Health and Development. May 30, 2017
  Background This systematic review of economic evaluations of universal preventative or targeted treatment parenting interventions that aim to enhance parent–infant interaction is primarily intended to inform decision makers who have to make difficult spending decisions, especially at a time of reduced spending allocations. A synthesis of available costs and savings about parenting interventions that set out to enhance parent–infant interaction is presented. This topic is important specifically in view of the UK Governments' emphasis on the equalities agenda and the early years. The benefits of positive early life experiences, which include good parent–infant interaction, are far reaching and may be positively correlated with improved educational, health and well‐being outcomes and reduced criminality. Methods A literature search was undertaken using on‐line indexing databases between 2004 and 2014 that included the search terms ‘parent’, ‘infant’, ‘interaction’, ‘cost benefit analysis’ and their synonyms. Results Despite existing economic studies generally focusing upon targeted short‐run outcomes, significant savings were observed in the included studies. Parenting interventions could save the health service around £2.5k per family over 25 years and could save the criminal justice system over £145k per person over the life course. In light of the escalating costs of remedial services, these potential savings may provide the UK and other governments with a robust incentive to invest in early years parenting interventions. Conclusions Parenting interventions can be economically efficient and return savings on investment. Moreover, and one might argue as a moral imperative of democratic societies, population health can be improved and health inequalities reduced. An important debate is needed about early years policy, to include acknowledgement of the differences between UK and international healthcare systems and the potential savings from the synergistic and spin‐off effects of early years interventions to inform decision‐making to fund and implement appropriate action.

  May 30, 2017   doi: 10.1111/cch.12473   open full text
• Examining the psychological and social impact of relative age in primary school children: a cross‐sectional survey.
  A. Price, K. Allen, O. C. Ukoumunne, R. Hayes, T. Ford.
  Child Care Health and Development. May 25, 2017
  Background A number of studies demonstrate that children who are younger within their school year have poorer academic attainment and are more likely to have special educational needs. Few, however, have considered the impact relative age may have on child mental health, behaviour and happiness in school. Methods This paper utilized data from the Supporting Teachers and Children in Schools study (2075 pupils aged 5 to 9 years from 80 primary schools) to explore the relationship among relative age, behaviour and happiness in school. Behavioural and emotional development was assessed by using the teacher‐reported and parent‐reported Strengths and Difficulties Questionnaire and the Pupil Behaviour Questionnaire. Children's happiness within school was assessed by using the How I Feel About My School Questionnaire. Results Relatively younger children had higher Total Difficulties scores on the Strengths and Difficulties Questionnaire than their peers. There was a mean increase per 30‐day decrease in relative age of 0.09 (95% CI: 0.03 to 0.16; p = 0.007) in teacher‐reported and 0.08 (0.001 to 0.16; p = 0.05) in parent‐reported scores. There was little evidence of a relationship between relative age and children's behaviour and happiness in school. Conclusions For children with complex difficulties, being relatively young for their school year may be an additional stressor that may undermine mental health.

  May 25, 2017   doi: 10.1111/cch.12479   open full text
• The support needs of parents having a child with a chronic kidney disease: a focus group study.
  W. W. Geense, B. G. I. Gaal, J. L. Knoll, E. A. M. Cornelissen, T. Achterberg.
  Child Care Health and Development. May 25, 2017
  Background Parents of children with a chronic kidney disease (CKD) have a crucial role in the management of their child's disease. The burden on parents is high: they are often exhausted, depressed and experience high levels of stress and a low quality of life, which could have a negative impact on their child's health outcomes. Support aiming at preventing and reducing parental stress is essential. Therefore, it is necessary to have insight in the problems and support needs among these parents. Objective Our aim is to describe parents' support needs regarding the problems they experience in having a child with CKD. Methods Five focus group interviews were conducted with parents of children: (i) with hereditary kidney disease, (ii) with nephrotic syndrome, (iii) with chronic kidney failure, (iv) using dialysis and (v) after renal transplantation. The children were treated at a paediatric nephrology unit in one university hospital in the Netherlands. The data were thematically analysed. Results Twenty‐one parents participated in the focus groups. Parents need more information about their child's CKD and treatment options, and managing their own hobbies and work. Furthermore, parents need emotional support from their partner, family, friends, peers and healthcare professionals to help them cope with the disease of their child. Additionally, parents need practical support to hand over their care and support in transport, financial management and regarding their child at school. Conclusion Needs regarding balancing their personal life are seldom prioritized by parents as the child's needs are considered more important. Therefore, it is important that healthcare professionals should not only attend to the abilities of parents concerning their child's disease management, but also focus on the parents' abilities in balancing their responsibilities as a caregiver with their own personal life.

  May 25, 2017   doi: 10.1111/cch.12476   open full text
• Understanding the school experiences of children and adolescents with serious chronic illness: a systematic meta‐review.
  A. Lum, C. E. Wakefield, B. Donnan, M. A. Burns, J. E. Fardell, G. M. Marshall.
  Child Care Health and Development. May 23, 2017
  Background Serious chronic illness can have a detrimental effect on school attendance, participation and engagement, leaving affected students at risk of failing to meet their developmental potential. An improved understanding of factors that help to explain or mitigate this risk can help educators and health professionals deliver the most effective support. This meta‐review critiqued the available evidence examining the link between six chronic illnesses (asthma, cancer, chronic kidney diseases, heart diseases, cystic fibrosis and gastrointestinal diseases) and children's and adolescents' school experiences and outcomes, as well as investigating the medical, school, psychosocial and sociodemographic factors that are linked to poorer or better school outcomes. Methods We searched CINAHL, Cochrane Database, EMBASE, ERIC, MEDLINE, ProQuest Theses and Dissertations, and PsycINFO (2000–2015). Systematic and narrative reviews, and meta‐analyses, of original studies examining students' subjective school experiences and objective school outcomes were eligible. We used the Preferred Reporting Items for Systematic Reviews and Meta‐analyses criteria to critically appraise all systematic reviews. The Grading of Recommendations Assessment, Development, and Evaluation system guided our recommendations for practice and research. Results Eighteen reviews of 172 studies including more than 40 000 students were eligible. Therefore, we chose to conduct a meta‐review to provide an overview of the literature on the relationship between chronic illness and school experiences and outcomes. We also explored the associated medical, school, psychosocial and sociodemographic factors affecting the relationship between illness and school experiences and outcomes. Conclusion Students with chronic illness demonstrate mixed school experiences and outcomes that are often worse than students without chronic illness. Modifiable factors, such as students' engagement with school, may be novel yet appropriate targets of educational support to ensure that these students reach their full schooling potential.

  May 23, 2017   doi: 10.1111/cch.12475   open full text
• How do caregivers understand and respond to unsettled infant behaviour in Vietnam? A qualitative study.
  L. Murray, T. Tran, V. V. Thang, L. Cass, J. Fisher.
  Child Care Health and Development. May 16, 2017
  Background Unsettled infant behaviours are a common source of concern for new parents and have been associated with perinatal common mental disorders amongst women in high‐income settings. There is little evidence about how unsettled infant behaviours are understood and managed in low and lower‐middle income countries. This study aimed to describe caregivers' understandings of, and responses to, unsettled infant behaviours in Vietnam and their family caregiving contexts. Methods Women who were mothers of infants aged 0–6 months were purposively recruited from two sites in Thua Thien Hue Province, Vietnam (one urban and one rural). An additional group of women who were grandmothers were recruited by snowball sampling. Data were collected in semi‐structured interviews about demographic information, infant feeding practices, descriptions of infant crying episodes, beliefs about why infants cry, settling strategies, infant sleeping arrangements and sources of advice on infant care. Translated interview transcripts were analysed thematically. Results Twenty‐four interviews were undertaken (21 with mothers and 3 with grandmothers). Five major themes emerged from the data after analysis: infant settling techniques, sources of information on unsettled infant behaviour, understandings of the causes of infant crying, the emotional responses of caregivers and the intergenerational household context. Infants were commonly cared for by people from multiple generations, particularly during the day. Infant settling was characterized by attending to infants immediately, breastfeeding and bed‐sharing with parents during the night. Most mothers received advice on caregiving from family members. Infant crying was attributed to hunger and loneliness, as well as traditional beliefs that the infant was being upset by ‘ghosts’ or becoming ‘hot’. Women described feeling anxious, frustrated and helpless in relation to unsettled behaviours amongst their infants. Conclusions Educational interventions on interpreting infant cues, infant sleep requirements and bed sharing may be appropriate in Vietnam if multiple generations are included and traditional beliefs about infant crying are addressed.

  May 16, 2017   doi: 10.1111/cch.12474   open full text
• Quality of life of primary caregivers of children with cerebral palsy: a comparison between mother and grandmother caregivers in Anhui province of China.
  J. Wu, J. Zhang, Y. Hong.
  Child Care Health and Development. May 11, 2017
  Background The aims of the study are to evaluate the quality of life of mother and grandmother primary caregivers of children with cerebral palsy (CP) and to compare the difference between these two groups of caregivers. Methods We recruited 125 mother and 52 grandmother primary caregivers of children with CP. All the primary caregivers were interviewed with the short‐form 36 (SF‐36) health survey version 2.0 and with researcher‐designed questionnaires for family background. As for the children, social‐demographic characteristics, medical history and the result of a physical examination performed by a paediatric specialist in neurological rehabilitation were also collected. Results Mother and grandmother caregivers scored lower than their counterparts in the general population in both summary scores. Grandmother caregivers had lower scores than mother caregivers in all eight domains and in the two summary scores, with all differences being statistically significant (P < 0.05), except for the domain of the mental component summary score (P = 0.618). The differences were found particularly remarkable in the domains of physical functioning, role physical, bodily pain and also the physical component summary score (P < 0.001). Conclusions The quality of life is significantly unsatisfactory in both mother and grandmother primary caregivers of children with CP; this research provides evidence for the need of the monitoring of these caregivers.

  May 11, 2017   doi: 10.1111/cch.12464   open full text
• The potential role of attitudes towards suicide between mental health status and suicidal ideation among Chinese children and adolescents.
  L. Tan, Q. H. Yang, J. L. Chen, H. X. Zou, T. S. Xia, Y. Liu.
  Child Care Health and Development. May 09, 2017
  Background The objective of this study was to investigate the contributions of mental health status and attitudes towards suicide on suicidal ideation in a sample of 6568 Chinese children and adolescents in China. Attitudes towards suicide were investigated as a possible moderator and mediator of the influence of mental health status on suicidal ideation. Methods Descriptive statistical analyses, Pearson correlation analyses and hierarchical regression analyses were adopted as methods of data analyses. Results Approximately 35.38% of children and adolescents in our study reported having suicidal ideation. Mental health status and attitudes towards suicide both had an independent effect on the severity of suicidal ideation. Results indicated that mental health status was positively associated with suicidal ideation, while attitudes towards suicide were negatively associated with suicidal ideation. Moderation analysis showed that the impact of mental health status on suicidal ideation was significantly greater among children and adolescents who reported favourable attitudes towards suicide. Attitudes towards suicide partially mediated the link between mental health status and the severity of suicidal ideation. Specifically, students who experienced poorer mental health status might be more likely to report significantly more favourable attitudes towards suicide, which in turn promote greater suicidal ideation. Conclusions These results have implications for the prevention of youth suicide, suggesting that mental health status and attitudes towards suicide could be important targets for prevention and intervention for children and adolescents at risk of suicidal ideation.

  May 09, 2017   doi: 10.1111/cch.12471   open full text
• Maternal care mediates the effects of nutrition and responsive stimulation interventions on young children's growth.
  N. Brown, J. E. Finch, J. Obradović, A. K. Yousafzai.
  Child Care Health and Development. May 07, 2017
  Background Undernutrition contributes to at least half the estimated six million annual childhood deaths worldwide. Furthermore, one in three children fails to meet their developmental potential because of risks including stunting, illness, under‐stimulation, poor responsive interactions and maternal depressive symptoms. Our study investigates the role of caregiving processes on children's height‐for‐age at 2 and 4 years. Methods The Pakistan Early Child Development Scale‐up study assessed the longitudinal effectiveness of early nutrition and responsive stimulation interventions on growth and development at 4 years of age. In total, 1302 children were followed up from birth to 4 years. We leveraged path analyses to explore potential mediators of early intervention effects on children's height‐for‐age at 4 years, including maternal depressive symptoms, mother–child interaction quality, diarrhoeal illness and height‐for‐age at 2 years. Results Our final model had excellent model fit (comparative fix index = 0.999, Tucker–Lewis index = 0.998, root mean square error of approximation = 0.008) and showed that mother–child interaction quality mediated the effects of both enhanced nutrition and responsive stimulation interventions on height‐for‐age at 4 years via its longitudinal stability from 2 years of age (β = 0.016, p = 0.005; β = 0.048, p < 0.001, respectively). Further, diarrhoeal illness mediated the effects of maternal depressive symptoms at 1 year post partum on children's height‐for‐age at 4 years via the longitudinal stability of height‐for‐age z‐score from 2 years of age onwards (β = −0.007, p = 0.019). Conclusions The quality of early caregiving experience mediated the association between both interventions and height‐for‐age. The effect of maternal depressive symptoms on growth was mediated by diarrhoeal illness. Programmatic approaches to child nutrition and growth must address all these potentially modifiable factors.

  May 07, 2017   doi: 10.1111/cch.12466   open full text
• ASQ‐3 scores are sensitive to small differences in age in a Peruvian infant population.
  K. C. Chong, V. L. Zhou, D. Tarazona, H. Tuesta, J. E. Velásquez‐Hurtado, R. Sadeghi, F. Llanos.
  Child Care Health and Development. May 07, 2017
  Objective The Ages and Stages Questionnaires Edition 3 (ASQ‐3) are a well‐validated international screen for developmental delays in young children. However, previous studies demonstrate variable scores between children eligible to take the same ASQ‐3 interval. This study aimed to determine a relationship between age and ASQ‐3 score for each screening interval. Methods This was a baseline exploratory cross‐sectional study of infants under 2 years old evaluated for the Peruvian social programme Cuna Más. Participants were included in Cuna Más if they lived in districts with fewer than 2000 inhabitants or 400 homes, indicating a predominantly rural population. The appropriate ASQ‐3 screening interval was administered to each subject. Subjects were divided into four 2‐week chronological subgroups based on age within each 2‐month screening window and aggregated across all 12 screening intervals. Fisher's exact test, analysis of variance and Bonferonni post hoc test were used to compare differences between age subgroups. Linear regression was performed to assess the relationship between ASQ‐3 score and both aggregated and disaggregated age subgroup. Results A total of 5850 Peruvian infants were evaluated in 2013. Mean age was 13 ± 6.6 months, 50.7% were male and mean maternal education was 6.6 ± 4.0 years; 34.8% infants were stunted, 7.8% were underweight, 0.9% were wasted and 2% had age adjusted greater than 35 days for prematurity for ASQ‐3 interval assignment. Mean total ASQ‐3 was 42.2 ± 8.2. The ASQ‐3 allocated 49.6% with suspected delay in one or more developmental areas. Before and after adjusting for wealth quintile, maternal education level, infant nutritional status and prematurity adjustment, age subgroup remained significantly associated with total ASQ‐3 score (β = 1.8, CI: 1.7–2.0, P < 0.001), sectional ASQ‐3 score (all P < 0.001) and inversely associated with one or more scores indicating suspected developmental delay (P < 0.001). Conclusions The ASQ‐3 may underestimate the sensitivity of child development to small differences in age in this population.

  May 07, 2017   doi: 10.1111/cch.12469   open full text
• Protecting children and families from tobacco and tobacco‐related NCDs in the Western Pacific: good practice examples from Malaysia, Philippines and Singapore.
  A. M. David, S. P. Mercado, J. D. Klein, M. s./o. K. Kaundan, H. N. Koong, E. Garcia.
  Child Care Health and Development. May 07, 2017
  Background Non‐communicable diseases (NCDs) are generally considered diseases of adulthood, but NCD risk factors like tobacco use often are taken up during childhood and adolescence, and second‐hand smoke exposure affects child survival and development. Methods At a regional meeting of the Asia Pacific Child and Family Health Alliance for Tobacco Control, members reviewed existing good practices of child‐focused tobacco control approaches using health promotion strategies. These interventions were implemented nationally in Malaysia, the Philippines and Singapore. Results Three good practice national examples were identified that focused on creating supportive tobacco‐free environments and upgrading cessation skills among paediatricians. These country examples highlight strategic areas to protect children and families from the harms of tobacco, as part of NCD prevention and control. Training paediatricians in brief cessation advice has enabled them to address tobacco‐using parents. Fully enforcing smoke‐free public areas has led to an increase in smoke‐free homes. The Tobacco Free Generation is a tobacco control ‘endgame’ strategy that taps into a social movement to deglamorize tobacco use and empower youth born in and after year 2000 to reject tobacco and nicotine addiction. Conclusion Tobacco control is pivotal in the fight against NCDs; health promotion strategies to protect children and youth from tobacco have a critical role to play in NCD prevention and control. Frontline health workers, including primary care paediatricians, need to step up and actively advocate for full implementation of the WHO Framework Convention on Tobacco Control, including tobacco tax increases and smoke‐free areas, while monitoring patients and their parents for tobacco use and second‐hand smoke exposure, preventing adolescent smoking uptake, and offering cessation support. A life‐course approach incorporating child‐focused efforts to prevent initiation of smoking and second‐hand smoke exposure with measures promoting cessation among parents will offer the greatest chance of overcoming future tobacco‐related NCD burden.

  May 07, 2017   doi: 10.1111/cch.12472   open full text
• Maternal experience raising girls with autism spectrum disorder: a qualitative study.
  N. Navot, A. G. Jorgenson, S. J. Webb.
  Child Care Health and Development. May 02, 2017
  Background A growing line of research has sought to characterize the different presentations of autism spectrum disorder (ASD) among boys and girls. Much less is known about maternal experience and mother–child relationship in children with ASD based on child gender. The present qualitative study aimed to investigate the mother–daughter relationship from the perspective of mothers who are raising girls with ASD with normal intelligence and functional verbal communication. Methods Eleven in‐depth interviews were conducted with mothers of girls with ASD, ages 10–19 years. Data were analysed in an interactive process commonly used in naturalistic inquiry. Results provide insight into the unique maternal experience of raising a daughter with ASD. Results Mothers reported a sense of exclusion from the neurotypical population and male‐dominant ASD population and transformation in relationship. Themes identified were skepticism and delayed diagnosis, disbelief from others, lack of information about girls with ASD, higher social demands in adolescence, puberty challenges around hygiene, disappointment about physical appearance, vulnerability in relationships and worries about future functioning. The mother–daughter relationship started with an early expectation of a close and intimate relationship that then underwent a transformation, which challenged maternal competence, reshaped expectations and created a different bond between mother and daughter. Conclusions The findings in this qualitative study highlight the impact of gender on the maternal experience of raising a daughter with ASD and contribute to a better understanding of the needs of both mothers and daughters. These results can help providers support the mother–daughter dyad by recognizing gender‐specific challenges.

  May 02, 2017   doi: 10.1111/cch.12470   open full text
• Measuring family‐centred practices of professionals in early intervention services in Taiwan.
  L.‐J. Kang, R. J. Palisano, R. J. Simeonsson, A.‐W. Hwang.
  Child Care Health and Development. April 23, 2017
  Background Family‐centred practices emphasize professional supports for forming partnerships with families in early intervention. The Measure of Processes of Care for Service Providers (MPOC‐SP) measures the perceptions of paediatric service providers in supporting children and families. This study aimed to establish reliability of the Chinese version of the MPOC‐SP (C‐MPOC‐SP) and to examine professional perceptions of family‐centred practices in relation to professional discipline and years of experience. Methods A convenience sample of 94 physical therapists, occupational therapists, speech‐language pathologists, social workers and early childhood educators completed the C‐MPOC‐SP. Thirty‐seven professionals completed the measure a second time within 2–4 weeks for test–retest reliability. Internal consistency and test–retest reliability were examined by Cronbach's α and intra‐class correlation coefficient. Comparisons were made across professional disciplines by multivariate analyses of variance followed by analyses of variance. Relationships between years of experience and ratings of family‐centred practices were examined by Pearson's correlation coefficients (r). Results Cronbach's α for items on each of the four scales of the C‐MPOC‐SP ranged from 0.80 to 0.92, indicating adequate internal consistency. Intra‐class correlation coefficient between the initial and repeat completion of the C‐MPOC‐SP for each scale ranged from 0.56 to 0.77, indicating adequate to excellent test–retest reliability. Mean ratings for the Communicating Specific Information were significantly higher for physical therapists, occupational therapists and speech‐language pathologists than for social workers (P = 0.001). The C‐MPOC‐SP scores were positively correlated with years of experience for all four scales (r = 0.23–0.38; P < 0.05). Conclusions This study established adequate internal consistency and adequate to excellent test–retest reliability of the C‐MPOC‐SP in measuring perceptions of family centeredness of early intervention service providers. Cross‐discipline differences were found in communicating specific information about the child. Higher perceptions of family centeredness were associated with more years of experience. The results support the utility of the C‐MPOC‐SP in professional education and programme evaluation of early intervention services in Taiwan.

  April 23, 2017   doi: 10.1111/cch.12463   open full text
• Stakeholders' views of the introduction of assistive technology in the classroom: How family‐centred is Australian practice for students with cerebral palsy?
  P. Karlsson, C. Johnston, K. Barker.
  Child Care Health and Development. April 17, 2017
  Background With family‐centred care widely recognized as a cornerstone for effective assistive technology service provision, the current study was undertaken to investigate to what extent such approaches were used by schools when assistive technology assessments and implementation occurred in the classroom. Method In this cross‐sectional study, we compare survey results from parents (n = 76), school staff (n = 33) and allied health professionals (n = 65) with experience in the use of high‐tech assistive technology. Demographic characteristics and the stakeholders' perceived helpfulness and frequency attending assessment and set‐up sessions were captured. To evaluate how family‐centred the assistive technology services were perceived to be, the parents filled out the Measure of Processes of Care for Caregivers, and the professionals completed the Measure of Processes of Care for Service Providers. Descriptive statistics and one‐way analysis of variance were used to conduct the data analysis. Results Findings show that parents are more involved during the assessment stage than during the implementation and that classroom teachers are often not involved in the initial stage. Speech pathologists in particular are seen to be to a great extent helpful when implementing assistive technology in the classroom. This study found that family‐centred service is not yet fully achieved in schools despite being endorsed in early intervention and disability services for over 20 years. No statistically significant differences were found with respect to school staff and allied health professionals' roles, their years of experience working with students with cerebral palsy and the scales in the Measure of Processes of Care for Service Providers. Conclusion To enhance the way technology is matched to the student and successfully implemented, classroom teachers need to be fully involved in the whole assistive technology process. The findings also point to the significance of parents' involvement, with the support of allied health professionals, in the process of selecting and implementing assistive technology in the classroom.

  April 17, 2017   doi: 10.1111/cch.12468   open full text
• Decision‐making and future planning for children with life‐limiting conditions: a qualitative systematic review and thematic synthesis.
  E. Popejoy, K. Pollock, K. Almack, J. C. Manning, B. Johnston.
  Child Care Health and Development. April 12, 2017
  Background In the last decade, the number of children with life‐limiting and life‐threatening conditions in England has almost doubled, and it is estimated that worldwide, there are 1.2 million children with palliative care needs. Families and professionals caring for children with life‐limiting conditions are likely to face a number of difficult treatment decisions and develop plans for future care over the course of the child's life, but little is known about the process by which these decisions and plans are made. Methods The purpose of this review is to synthesize findings from qualitative research that has investigated decision‐making and future planning for children with life‐limiting conditions. A systematic search of six online databases was conducted and identified 887 papers for review; five papers were selected for inclusion, using predefined criteria. Reference list searching and contacting authors identified a further four papers for inclusion. Results Results sections of the papers were coded and synthesized into themes. Nineteen descriptive themes were identified, and these were further synthesized into four analytical themes. Analytical themes were ‘decision factors’, ‘family factors’, ‘relational factors’ and ‘system factors’. Conclusions Review findings indicate that decision‐making and future planning is difficult and needs to be individualized for each family. However, deficits in understanding the dynamic, relational and contextual aspects of decision‐making remain and require further research.

  April 12, 2017   doi: 10.1111/cch.12461   open full text
• ‘Maybe I will give some help…. maybe not to help the eyes but different help’: an analysis of care and support of children with visual impairment in community settings in Malawi.
  M. Gladstone, M. McLinden, G. Douglas, E. Jolley, E. Schmidt, J. Chimoyo, H. Magombo, P. Lynch.
  Child Care Health and Development. April 09, 2017
  Background Visual impairment in children is common in low and middle‐income settings. Whilst visual impairment (VI) can impact on the development of children, many reach full potential with appropriate early intervention programmes. Although there is increased emphasis on early child development globally, it is not yet clear how to provide specific programmes for children with VI in low and middle‐income settings. This study aims to identify facilitators and barriers to the provision of a developmental stimulation programme for children with VI in rural and urban Malawi. Methods We undertook 6 focus groups, 10 home observations and 20 in‐depth interviews with carers of children with VI under 6 years in urban and rural Southern Malawi. We utilised topic guides relating to care, play, communication and feeding. Qualitative data were subject to thematic analysis that included placing themes within Bronfenbrenner's ecological framework. We established authenticity of themes through feedback from participants. Results We identified themes within Bronfenbrenner's framework at five levels: (1) blindness acting as a barrier to stimulation and communication, health and complex needs all affecting the individual child; (2) understanding of VI, ability to be responsive at the microsystem level of the carer; (3) support from other carers at microsystem level within a mesosystem; (4) support from other professionals (knowledge of, identification and management of children with VI, responsibilities and gender roles, environmental safety and prejudice, stigma and child protection all at the level of the exosystem. Discussion This study has revealed the requirements needed in order to produce meaningful and appropriate programmes to support nutrition, care and early stimulation for children with VI in this and similar African settings. This includes supporting carers to understand their child's developmental needs, how to better communicate with, feed and stimulate their child; offering advice sensitive to carers' responsibilities and professional training to better support carers and challenge community stigma.

  April 09, 2017   doi: 10.1111/cch.12462   open full text
• Developmental pathways in infants from 4 to 24 months.
  L. Valla, M. S. Birkeland, D. Hofoss, K. Slinning.
  Child Care Health and Development. April 07, 2017
  Background There has been limited epidemiological research describing population‐based samples regarding developmental pathways throughout infancy, and the research that exists has revealed substantial diversity. Identifying predictors for developmental pathways can inform early intervention services. Methods The Ages and Stages Questionnaire was used to measure communication, gross motor, fine motor, problem‐solving and personal–social skills longitudinally in a large, population‐based sample of 1555 infants recruited from well‐baby clinics in five municipalities in southeast Norway. We conducted latent class analyses to identify common pathways within the five developmental areas. Results Our results indicated that most classes of infants showed generally positive and stable normative developmental pathways. However, for communication and gross motor areas, more heterogeneity was found. For gross motor development, a class of 10% followed a U‐shaped curve. A class of 8% had a declining communication pathway and did not reach the level of the high stable communication class at 24 months. Low gestational age, low Apgar score, male sex, maternal depression symptoms, non‐Scandinavian maternal ethnicity and high maternal education significantly predict less beneficial communication pathways. Conclusion The results suggest that infants with low gestational age, low Apgar score, male sex and a mother with depression symptoms or non‐Scandinavian ethnicity may be at risk of developing less beneficial developmental pathways, especially within the communication area. Targeting these infants for surveillance and support might be protective against delayed development in several areas during a critical window of development.

  April 07, 2017   doi: 10.1111/cch.12467   open full text
• Development of a 22q11DS psycho‐educational programme: exploration of the views, concerns and educational needs of parents caring for children or adolescents with 22q11DS in relation to mental health issues.
  T. Alugo, H. Malone, A. Sheehan, I. Coyne, A. Lawlor, F. McNicholas.
  Child Care Health and Development. March 30, 2017
  Background 22q11.2 deletion syndrome (22q11DS) is a multisystem genetic condition with a broad phenotype. It is associated with a high prevalence of depression and anxiety during childhood and increased risk of schizophrenia in adulthood. Despite this, studies report that families may receive inadequate information of mental health (MH) risks at diagnosis. Therefore, this study investigated parents' experiences of caring for a child with 22q11DS, investigated their knowledge regarding the risk of MH problems and assessed the need for a psycho‐educational programme. Methods A qualitative design and purposeful sampling was utilized. Parents registered with the ‘22q11 Ireland’ support group, and parents listed on the cleft palate database in a children's hospital in Ireland were invited to participate. Focus groups were held with 22 parents. Data were thematically analysed using Burnard's method of analysis. Results Most parents had some knowledge of the relationship between 22q11DS and an increased risk of MH issues. Parents reported that MH information relating to 22q11DS was mainly obtained from 22q11DS conferences, the ‘22q11 Ireland’ support group and the Internet. Parents expressed a need for information to prevent or cope with their child's MH issues. Parents suggested that the following topics would be quite useful in a psycho‐educational programme. These included information on the early warning signs of MH issues and guidance on when and how to tell the child about the condition and how to manage the child or young person's anxiety, obsessive behaviour or hearing voices. Conclusions The findings indicated parental support for a psycho‐educational programme that would provide relevant, accurate and timely information on how to effectively care for a child with 22q11DS MH needs.

  March 30, 2017   doi: 10.1111/cch.12457   open full text
• Parents' early healthcare transition experiences with preterm and acutely ill infants: a scoping review.
  M. Ballantyne, T. Orava, S. Bernardo, A. C. McPherson, P. Church, D. Fehlings.
  Child Care Health and Development. March 30, 2017
  Background Parents undergo multiple transitions following the birth of an ill infant: their infant's illness‐health trajectory, neonatal intensive care unit hospitalization and transfers from one healthcare setting to another, while also transitioning to parenthood. The objective of this review was to map and synthesize evidence on the experiences and needs of parents of preterm or ill infants as they transition within and between healthcare settings following birth. Methods The scoping review followed Arskey and O′Malley's () framework, enhanced by Levac et al. (). Relevant studies were identified through a comprehensive search strategy of scientific and grey literature databases, online networks, Web of Science and citation lists of relevant articles. Inclusion criteria encompassed a focus on infants undergoing a healthcare transition, and the experiences and needs of parents during transition. Studies were appraised for design quality, and data relevant to parent experiences were extracted and underwent thematic analysis. Results A total of 7773 records were retrieved, 90 full texts reviewed and 11 articles synthesized that represented a total sample of 435 parents of preterm or ill infants. Parents reported on their experiences in response to their infant's transition within and between hospitals and across levels of neonatal intensive care unit, intermediate and community hospital care. Ten studies used qualitative research methods, while one employed quantitative survey methods. Four key themes were identified: that of parent distress throughout transition, parenting at a distance, sources of stress and sources of support. Parents' stress resulted from not being informed or involved in the transition decision, inadequate communication and perceived differences in cultures of care across healthcare settings. Conclusions Opportunities to improve parents' early transition experiences include enhanced engagement, communication, information‐sharing and shared decision‐making between health care providers and parents. Future areas of research should focus on early transition interventions to advance parent capacity, confidence and closeness as the primary nurturer.

  March 30, 2017   doi: 10.1111/cch.12458   open full text
• Family‐centred service: differences in what parents of children with cerebral palsy rate important.
  M. Terwiel, M. W. Alsem, R. C. Siebes, K. Bieleman, M. Verhoef, M. Ketelaar.
  Child Care Health and Development. March 22, 2017
  Background A family‐centred approach to services of children with disabilities is widely accepted as the foundational approach to service delivery in paediatric health care. The 56 items of the Measure of Processes of Care questionnaire (MPOC‐56) all reflect elements of family‐centred service. In this study, we investigated which elements of family‐centred service are rated important by parents of children with cerebral palsy by adding a question on importance to each item of the MPOC‐56 (MPOC‐56‐I). Methods In total, 175 parents of children with cerebral palsy completed the MPOC‐56‐I. For each MPOC item, parents were asked to rate the importance on a 5‐point scale ranging from 0 (not important at all) up to and including 4 (very important). We used Spearman's rank correlation coefficient to further explore the variation in parents' importance ratings. Results Parents' importance ratings of the MPOC‐56 items varied. The percentage of parents rating an item important (importance rating 3 or 4) varied between 43.8% and 96.8%. The percentage of parents rating an item unimportant (rating 0 or 1) varied between 0.0% and 20.3%, and the percentage of parents rating an item neutral (rating 2) varied between 3.0% and 36.0%. Most diverse importance ratings were found for five items concerning the provision of general information. Three correlations between these items and child and parent characteristics were found. Six items were rated important by almost all (≥95%) parents. These items concern elements of specific information about the child, co‐ordinated and comprehensive care for child and family and enabling and partnership. Conclusions Parents rate the importance of family‐centred services for their situation in various ways. These findings endorse that family‐centred services should recognize the uniqueness of families and should be tailored to what parents find important.

  March 22, 2017   doi: 10.1111/cch.12460   open full text
• Specific language impairment is associated with maternal and family factors.
  F. B. Diepeveen, P. Dommelen, A. M. Oudesluys‐Murphy, P. H. Verkerk.
  Child Care Health and Development. March 20, 2017
  Background This study aimed to identify risk factors associated with specific language impairment (SLI). Methods In a nested case–control design, 253 children attending special needs schools for severe speech and language difficulties in the Netherlands were matched for sex and date of birth with 253 children attending mainstream education. Data on perinatal, maternal and family issues were retrieved from well‐child care files registered shortly after birth. Results Children with SLI had younger mothers than children in the control group (mean 30 years 9 months vs. mean 31 years 9 months) (P = 0.02). Children with SLI were less frequently breastfed directly after birth (55% vs. 71%) (P = 0.0007) and were less frequently firstborns (33.3% vs. 46.2%) (P = 0.002). No statistically significant differences were found for any of the other risk factors. Conclusions A relationship was found between SLI and maternal age, being breastfed and place in the birth order. Perinatal risk factors do not seem to be strongly associated with SLI.

  March 20, 2017   doi: 10.1111/cch.12451   open full text
• Immunization of looked‐after children and young people: a review of the literature.
  S. Walton, H. Bedford.
  Child Care Health and Development. March 19, 2017
  Background Numbers of looked‐after children and young people (LACYP) in the UK have risen over the last seven years. Looked‐after children and young people should receive regular health assessments, including establishing immunization status and, if needed, developing a health plan to achieve full immunization. The Department for Education publish data on immunizations among LACYP to monitor both how well they are immunized and service performance. Methods A literature review was conducted using four databases (PubMed, Embase, Scopus and Web of Science) on immunization status of LACYP, factors affecting uptake and challenges to immunization, and interventions to improve immunization rates. Results Thirty‐two papers were identified, 16 of which were UK based. Looked‐after children and young people are less likely to be ‘up‐to‐date’ with their immunizations than children in the general population. Looked‐after children and young people are less likely to receive timely immunizations, and older LACYP are less likely to be ‘up‐to‐date’ than younger LACYP. Barriers to immunization include failure to attend health checks, absence from school and frequent placement moves. Unknown and discrepant immunization histories, name changes, sharing of information between organizations and obtaining consent for immunizations are also challenges. Conclusions In recent years, immunization of LACYP has been given a higher priority. However, the immunization figures produced by the Department for Education are problematic because of challenges in determining whether the child is ‘up‐to‐date’, and data are not comparable with the general population; ideally, this should be changed to correspond to routine immunization data. In the interim, for reporting purposes, the use of a tool to assist with determining a child's immunization status would be beneficial. When a child's immunization status is incomplete or unknown, Public Health England's algorithm for vaccination of individuals with uncertain or incomplete status should be used. Practice to improve immunization uptake amongst LACYP needs to be evaluated to develop evidence‐based recommendations.

  March 19, 2017   doi: 10.1111/cch.12452   open full text
• Rapid weight gain during infancy and early childhood is related to higher anthropometric measurements in preadolescence.
  H. Nanri, T. Shirasawa, H. Ochiai, S. Nomoto, H. Hoshino, A. Kokaze.
  Child Care Health and Development. March 16, 2017
  Background This study examined the relationship between rapid weight gain during infancy and/or early childhood and anthropometric measurements [body mass index (BMI), percent body fat (%BF), waist circumference (WC) and waist‐to‐height ratio (WHtR)] in preadolescence by sex. Methods Subjects were fourth‐grade school children (aged 9 to 10 years) from elementary schools in Ina‐town, Japan, in 2010. Measurements of height, weight, %BF and WC were conducted for each subject. We obtained data on height and weight of subjects at birth, age 1.5 years and age 3 years from the Maternal and Child Health handbook. Rapid weight gain was defined as a change in weight‐for‐age standard deviation score greater than 0.67 from birth to age 1.5 years (infancy) or from age 1.5 to 3 years (early childhood). Results All anthropometric variables (BMI, %BF, WC and WHtR) at age 9 to 10 years were significantly higher in the rapid weight gain during both infancy and early childhood period group than in the no rapid weight gain group, regardless of sex. When compared with the no rapid weight gain group, rapid weight gain during early childhood period had significantly higher BMI and WC in boys and BMI, %BF and WC in girls. Compared with the no rapid weight gain group, the rapid weight gain during infancy group had a significantly higher WC in boys and significantly higher BMI and WC in girls. Conclusion Rapid weight gain during both infancy and early childhood was related to higher anthropometric measurements, including WHtR, among Japanese preadolescents, regardless of sex. This study suggests that rapid weight gain during infancy and early childhood may be a risk factor for general/abdominal obesity later in life.

  March 16, 2017   doi: 10.1111/cch.12455   open full text
• Relative age effects in the Movement Assessment Battery for Children‐2: age banding and scoring errors.
  S. Veldhuizen, L. Rivard, J. Cairney.
  Child Care Health and Development. March 15, 2017
  Aim The Movement Assessment Battery for Children‐2 (MABC‐2) uses age‐grouped scoring, which will result in relative motor functioning being overestimated for some children and underestimated for others. In this paper, we measure these errors and discuss their consequences. Method We pool data from two validation studies to obtain a sample of 278 children assessed with the MABC‐2 (mean (SD) age: 5 years, 0 months (9.6 months); 142 female). We used regression to measure the association between standard score and relative age, and used these results to estimate misclassification rates at the MABC‐2's recommended thresholds. Results Movement Assessment Battery for Children‐2 scores were distributed as expected (mean (SD) = 10.4 (2.8)). We estimated that the standard score varied by 2.76 units (0.92 SDs) per year of relative age. Depending on threshold and age bandwidth, this implies overall misclassification rates from 9% to 23%. Interpretation Relative age differences in MABC‐2 scores led to substantial systematic error for young children. These errors can affect MABC‐2 validity, longitudinal stability and agreement with other tools, which may reduce the appropriateness of care offered to children. Scoring approaches that may reduce or eliminate these errors are outlined.

  March 15, 2017   doi: 10.1111/cch.12459   open full text
• Home and the social worlds beyond: exploring influences in the lives of children of mothers with intellectual disability.
  S. Collings, G. Llewellyn, R. Grace.
  Child Care Health and Development. March 10, 2017
  Background Mothers with intellectual disability are likely to raise their children in socially disadvantaged circumstances, and many face social isolation; however, the impact of a potentially restricted home context on children's social worlds has not been examined. This study was conducted to explore influences in the social worlds of children of mothers with intellectual disability from a child's perspective. Methods Seven children aged 7 to 11 years took part in at least two semi‐structured interviews over a year. Narrative accounts of each child's social interactions were analysed to ascertain if a pattern was present across the group. Results Home was found to influence the children's social interactions elsewhere by providing (or not) predictable routines and rules, and support from a significant adult other than a mother. Home environments were found to influence other social worlds by establishing a foundation for children's expectations about social interactions. Conclusions The social worlds of school‐aged children of mothers with intellectual disability are shaped by influences in the home that cannot be attributed exclusively to having a parent with intellectual disability. Significant adults provide an important support role and can be fulfilled by social service workers when a family‐centred approach is applied.

  March 10, 2017   doi: 10.1111/cch.12456   open full text
• Family‐centred care for children and young people with cerebral palsy: results from an Italian multicenter observational study.
  A. Molinaro, E. Fedrizzi, S. Calza, E. Pagliano, G. Jessica, E. Fazzi,.
  Child Care Health and Development. March 09, 2017
  Background Family‐centred care (FCC) is recognized as the model of best practice for the provision of services for children who have physical disabilities and their families. Objective To assess the overall perception of FCC provided in an Italian network of 17 rehabilitation services, as perceived by parents of children with cerebral palsy and professionals, and to explore whether children, families, service providers and service‐related characteristics influence parent satisfaction regarding service provision in an FCC practice. Methods The Measure of Processes of Care (MPOC‐20) for parents/caregivers and the Measure of Processes of Care for Service Providers (MPOC‐SP) for healthcare providers were used. For the purposes of the study, an ad hoc information form was developed to collect information concerning children, families, service providers and services. Results A total of 382 parents/caregivers and 269 healthcare providers completed the MPOC questionnaires. Parents and service providers both identified the domains for enabling partnerships and interpersonal sensitivity as a strength, while the domain relating to general information was always scored the lowest. An advanced maternal age, being a single parent, being unemployed and having lower socio‐economic status were factors identified as individually predictive of lower FCC scores on the MPOC‐20. Higher intensity treatment, inpatient services, primary healthcare settings and settings identified with limited financial resources and reduced space/time for each family were other variables significantly associated with less favourable MPOC‐20 ratings. Conclusions The perception of FCC provided was fairly positive, with some areas of improvement, such as the domain of provision of information. Professionals should, therefore, provide better communication and take more time in giving information and attention to parents. Potential sources of variation in parent perceptions of FCC based on family characteristics and the organization of services highlight the importance the need to support services through the provision of greater financial and human resources.

  March 09, 2017   doi: 10.1111/cch.12449   open full text
• Factors influencing uptake of measles, mumps and rubella (MMR) immunization in site‐dwelling Gypsy, Roma and Traveller (G&T) communities: a qualitative study of G&T parents' beliefs and experiences.
  P. Newton, D. M. Smith.
  Child Care Health and Development. March 07, 2017
  Background Increasing immunization in the Gypsy, Roma and Traveller (G&T) community is a key priority for improving health outcomes in this community. This study aimed to explore G&T parents: (1) beliefs about childhood immunization; (2) beliefs about the risks of immunization and non‐immunization; (3) perceived obstacles to, and facilitators of, immunization and (4) views on increasing immunization levels. Method A cross‐sectional, qualitative study was conducted comprising of five focus groups with 16 site‐dwelling G&T women with pre‐school aged children. Data were transcribed verbatim and analysed thematically. Results Five main themes were identified: Lay understandings of causation and risk; Timing of immunization; Children being perceived as vulnerable; The fit between lifestyle and healthcare provision; The impact of living with a high burden of disease. Conclusion Understanding of the risks and benefits of measles, mumps and rubella immunization did not differ significantly from the wider population or those promoted by the health service. The majority of barriers stemmed from living with the effects of long‐standing health inequalities, which posed further barriers to accessing immunization, and shaped beliefs about immunization. Factors facilitating uptake occurred where access to immunization services was made flexible, e.g. immunization on traveller sites.

  March 07, 2017   doi: 10.1111/cch.12453   open full text
• Fathers make a difference: positive relationships with mother and baby in relation to infant colic.
  C. P. Alexander, J. Zhu, I. M. Paul, K. H. Kjerulff.
  Child Care Health and Development. March 07, 2017
  Background Maternal psychological factors like depression, anxiety and stress have been associated with infant fussiness or colic. However, little research exists on whether positive factors such as social support and the happiness of the mother–partner relationship are associated with lower rates of infant fussiness or colic. Objectives We investigated the association between infant colic and three types of maternal support: general maternal social support (during pregnancy and post partum), the happiness of the mother–partner relationship (during pregnancy and post partum) and partner involvement in caring for the newborn. Methods Participants were 3006 women in the First Baby Study, a prospective study of the effect of mode of first delivery on subsequent childbearing. Women were interviewed by telephone during pregnancy and 1 month after first childbirth and asked about social support and if their baby had a variety of problems since birth, including ‘Colic – crying or fussiness three or more hours a day’. Multivariable logistic regression models were used to model the association between maternal support and infant colic, controlling for confounders, including maternal race or ethnicity, insurance, marital status, smoking, mode of delivery, maternal post‐partum depression, breastfeeding, other neonatal illnesses and newborn gestational age. Results Infant colic was reported by 11.6% of new mothers. High general maternal social support (in comparison with low), measured during pregnancy, was associated with lower reported infant colic (adjusted odds ratio (AOR), 0.55, 95% confidence interval (CI), 0.40–0.75) and measured post partum (AOR, 0.51, 95% CI, 0.39–0.67); high relationship happiness (in comparison with low), measured during pregnancy (AOR, 0.71, 95% CI, 0.54–0.93), and measured post partum (AOR, 0.22, 95% CI, 0.12–0.40); and high partner involvement with newborn care (in comparison with low) (AOR, 0.60, 95% CI, 0.44–0.81). Conclusion Higher levels of maternal social support during pregnancy and post partum are associated with lower rates of maternal reported infant colic.

  March 07, 2017   doi: 10.1111/cch.12445   open full text
• A study into the effectiveness of a postural care training programme aimed at improving knowledge, understanding and confidence in parents and school staff.
  S. Hotham, K. E. Hamilton‐West, E. Hutton, A. King, N. Abbott.
  Child Care Health and Development. March 05, 2017
  Background Parents and school staff lack knowledge and confidence when providing postural care to physically disabled children. This can act as a barrier to the successful implementation of therapy. To address this problem, we developed a novel training programme to improve knowledge and confidence in providing postural care and evaluate the impact of the training programme in parents and school staff. Methods The postural care training programme included three elements: a 2‐h interactive workshop facilitated by physiotherapists and occupational therapists, a follow‐up home/school visit and a follow‐up telephone call. The Understanding, Knowledge and Confidence in Providing Postural Care for Children with Disabilities questionnaire was utilized to evaluate the impact and includes subscales assessing knowledge and understanding, concerns and confidence in providing postural care. The Understanding, Knowledge and Confidence in Providing Postural Care for Children with Disabilities questionnaire was completed at baseline and 6 weeks later. The training programme was delivered to N = 75 parents and school staff. Of these, N = 65 completed both baseline and follow‐up measures and were used in the data analysis. Participants and therapists were also invited to provide further feedback on the overall training programme via interviews and focus groups. Results Paired samples t‐tests were used to determine statistically significant differences between baseline and follow‐up scores for each of the three subscales. Mean levels of understanding and knowledge and confidence improved (P < 0.001), while concerns decreased (P < 0.001). Qualitative data were collected via interviews and group discussions providing an in‐depth perspective on how participants experienced change. Discussion Results suggest improvement in knowledge, understanding and confidence in parents and school staff that care for children with significant physical postural care impairments.

  March 05, 2017   doi: 10.1111/cch.12444   open full text
• Tools assessment and diagnosis to infant colic: a systematic review.
  S. García Marqués, R. Chillón Martínez, S. González Zapata, M. Rebollo Salas, J. J. Jiménez Rejano.
  Child Care Health and Development. March 05, 2017
  Background Infant colic occurs between 10% and 40% of healthy born children in their first year of life. Its assessment is complex, and there are only a few instruments of appraisement and diagnosis. Methods Scientific articles located through a systematic review using the Pubmed, Scopus, Cochrane, PEDro, Dialnet, IME and Dialnet databases. Two researchers obtained data independently from relevant studies previously identified. Risk of bias was assessed according to the methods recommended by the Cochrane Collaboration, with reporting following the preferred reported items for systematic reviews and meta‐analyses guidelines and evaluating their methodological quality based on the EMPRO scale. Results Four tools were obtained for valuation of infant colic. Parental diary of infant cry and fuss behaviour, Crying Pattern Questionnaire, Infant Colic Scale and, lastly, a validity of the Turkish version of the Infant Colic Scale. Conclusions Analysis of the existing tools involves the need to design and validate new assessment scales for this clinical frame.

  March 05, 2017   doi: 10.1111/cch.12454   open full text
• Adaptation of MacArthur Communicative Development Inventory in rural Pakistan – useful tool for early childhood studies.
  M. A. Rasheed, G. Tabussum, Z. H. Habib, A. K. Yousafzai.
  Child Care Health and Development. March 03, 2017
  Background Given the significance of early language for later academic achievement, language development can be an important outcome measure in evaluation of early childhood intervention programmes. Language development may be challenging to assess in settings where trained personnel are hard to find; therefore, maternal report can be a reliable alternative measure. Aim The aim of this study was to adapt a maternal report measure, the MacArthur Communicative Development Inventory II‐Short Form, in the Sindhi language and to examine its psychometric properties as a measure of language outcome in 2‐year‐old children in rural Pakistan. Methods A three‐phase process was followed to produce a Sindhi adaptation of the tool comprising 100 words. The first phase was a review of the original 258 words through a focus group discussion with a team familiar with the context; the second phase was testing 258 words to compile a 100‐word list of easy, moderate and difficult words. The third phase was a pilot of the 100‐word list followed by administration in a larger intervention study population. Results On administration with 1381 children, concurrent validity with the Bayley Scale of Infant Development III using the Pearson's correlation test showed a moderate association for comprehension (r = 0.45, p = 0.01, n = 1381) and good association for expression (r = 0.51, p = 0.01, n = 1381). Internal consistency was high with alphas of 0.98 for comprehension items and 0.96 for expression items. Conclusion The authors conclude that the Sindhi adaptation of the MacArthur Communicative Development Inventory followed a feasible and rigorous methodology to create a reliable and sensitive tool to assess young children's language development for use in a child assessment battery for early childhood health, nutrition and development studies.

  March 03, 2017   doi: 10.1111/cch.12450   open full text
• Ask Me! self‐reported features of adolescents experiencing neglect or emotional maltreatment: a rapid systematic review.
  A. M. Naughton, L. E. Cowley, V. Tempest, S. A. Maguire, M. K. Mann, A. M. Kemp.
  Child Care Health and Development. February 26, 2017
  Background Neglect is often overlooked in adolescence, due in part to assumptions about autonomy and misinterpretation of behaviors being part of normal adolescent development. Emotional maltreatment (abuse or neglect) has a damaging effect throughout the lifespan, but is rarely recognized amongst adolescents. Our review aims to identify features that adolescents experiencing neglect and/ or emotional maltreatment report. Method A rapid review methodology searched 8 databases (1990‐2014), supplemented by hand searching journals, and references, identifying 2,568 abstracts. Two independent reviews were undertaken of 279 articles, by trained reviewers, using standardised critical appraisal. Eligible studies: primary studies of children aged 13‐17 years, with substantiated neglect and/ or emotional maltreatment, containing self‐reported features. Results 19 publications from 13 studies were included, demonstrating associations between both neglect and emotional maltreatment with internalising features (9 studies) including depression, post traumatic symptomatology and anxiety; emotional maltreatment was associated with suicidal ideation, while neglect was not (1 study); neglect was associated with alcohol related problems (3 studies), substance misuse (2 studies), delinquency for boys (1 study), teenage pregnancy (1 study), and general victimization for girls (1 study), while emotionally maltreated girls reported more externalising symptoms (1 study). Dating violence victimization was associated with neglect and emotional maltreatment (2 studies), while emotional abuse of boys, but not neglect, was associated with dating violence perpetration (1 study), and neither neglect nor emotional maltreatment had an association with low self‐esteem (2 studies). Neither neglect nor emotional maltreatment had an effect on school performance (1 study), but neglected boys showed greater school engagement than neglected girls (1 study). Conclusions If asked, neglected or emotionally maltreated adolescents describe significant difficulties with their mental health, social relationships, and alcohol or substance misuse. Practitioners working with youths who exhibit these features should recognize the detrimental impact of maltreatment at this developmental stage, and identify whether maltreatment is a contributory factor that should be addressed.

  February 26, 2017   doi: 10.1111/cch.12440   open full text
• Educators' experiences of managing students with ADHD: a qualitative study.
  D. A. Moore, A. E. Russell, S. Arnell, T. J. Ford.
  Child Care Health and Development. February 24, 2017
  Background The symptoms of attention‐deficit/hyperactivity disorder are associated with difficulty coping with the social, behavioural and academic components of school. Compared with medication and other non‐pharmacological treatment, there is less evidence relating to school‐based interventions to support children with ADHD. There is additionally an absence of any research focused on the experiences and practices of educators in the UK around how they work with children who are inattentive, impulsive and hyperactive. Methods Forty‐two educational practitioners from primary, secondary and alternate provision schools in the UK participated in focus groups or individual interviews that explored (1) their experiences of managing students with ADHD in the classroom and (2) factors that helped and hindered them in this endeavour. Transcripts were analysed using thematic analysis. Results Analysis identified six themes: broad strategies, student‐centred, inclusive strategies, labelling, medication and relationships. Participants' experiences of managing students with ADHD drew upon a wide range of strategies that typically involved responding to individual needs in an inclusive manner, so individuals with ADHD could access the classroom with their peers. Participants spoke about three factors that helped and hindered managing students with ADHD. Labelling of students with ADHD was reported, with the negative aspects of labelling, such as stigmatization, affecting the classroom. Educators reported mixed experiences regarding the helpfulness of medication; where helpful, it allowed the use of strategies in the classroom. Although students with ADHD were described as having rollercoaster relationships, positive relationships were considered key to the support of children with these difficulties. Conclusions This study suggests that factors such as attitudes towards ADHD, relationships experienced by students with ADHD and other treatments being delivered need to be carefully considered before strategies are put in place in the classroom. This study supports the need for further work on the implementation of evidence‐based school interventions for ADHD.

  February 24, 2017   doi: 10.1111/cch.12448   open full text
• Time use of parents raising children with severe or profound intellectual and multiple disabilities.
  J. Luijkx, A. A. J. Putten, C. Vlaskamp.
  Child Care Health and Development. February 03, 2017
  Background Raising children with severe or profound intellectual and multiple disabilities (PIMD) is expected to put extreme pressure on parental time use patterns. The aim of this study was to examine the total time use of mothers and fathers raising children with PIMD and compare it with the time use of parents of typically developing children. Method Twenty‐seven fathers and 30 mothers raising children with PIMD completed a time use diary on a mobile phone or tablet app, as did 66 fathers and 109 mothers of typically developing children. Independent t‐tests and Mann–Whitney tests were performed to compare mean time use. Results There are no differences in the time use of parents of children with PIMD on contracted time (paid work and educational activities) and necessary time (personal care, eating and drinking and sleeping) when compared with parents of typically developing children. There are significant differences between the parents of children with PIMD and the parents of typically developing children in terms of committed time (time for domestic work and the care and supervision of their children) and free time. The mothers of children with PIMD spend significantly less time on domestic work and more time on care and supervision than mothers of typically developing children. Conclusions This study shows that the parents of children with PIMD have to spend a significant amount of time on care tasks and have on average 1.5 h less free time per day than parents of typically developing children. This is a striking difference, because leisure time can substantially contribute to well‐being. Therefore, it is important not only to consider a child with PIMD's support needs but also to identify what parents need to continue their children's daily care and supervision.

  February 03, 2017   doi: 10.1111/cch.12446   open full text
• Experiences of parents of children with special needs at school entry: a mixed method approach.
  A. Siddiqua, M. Janus.
  Child Care Health and Development. January 20, 2017
  Background The transition from pre‐school to kindergarten can be complex for children who need special assistance due to mental or physical disabilities (children with ‘special needs’). We used a convergent mixed method approach to explore parents' experiences with service provision as their children transitioned to school. Methods Parents (including one grandparent) of 37 children aged 4 to 6 years completed measures assessing their perceptions of and satisfaction with services. Semi‐structured interviews were also conducted with 10 parents to understand their experience with services. Results Post transition, parents reported lower perceptions of services and decreased satisfaction than pre‐transition. The following themes emerged from the qualitative data: qualities of services and service providers, communication and information transfer, parent advocacy, uncertainty about services, and contrasts and contradictions in satisfaction. The qualitative findings indicate that parents were both satisfied and concerned with aspects of the post‐transition service provision. Conclusions While the quantitative results suggested that parents' experience with services became less positive after their children entered school, the qualitative findings illustrated the variability in parents' experiences and components of service provision that require improvements to facilitate a successful school entry.

  January 20, 2017   doi: 10.1111/cch.12443   open full text
• What do popular YouTubeTM videos say about vaccines?
  C. H. Basch, P. Zybert, R. Reeves, C. E. Basch.
  Child Care Health and Development. January 19, 2017
  Background The unregulated social network YouTubeTM has become an increasingly popular source of information on health topics such as vaccine safety. With a reach of over one billion users per month, the potential for misinformation is significant. Methods Using the keywords ‘vaccine safety’ and ‘vaccines and children’, 87 of the most widely viewed YouTubeTM videos were identified and analyzed for content, author status and view count. Results The range of view counts was 25 532 to 6 229 835, with a median of 62 075 views per video. Most videos (n = 74, 85.1%) were devoted exclusively to the topic of vaccination. The three most common sources of these YouTubeTM videos were consumers (27.6%), TV‐based or Internet‐based news (26.4%) and individual health professionals (25.3%). Top topics covered were autism causality (47.1% of videos), undisclosed or poorly understood risks (42.5%), adverse reactions (40.2%) and thimerosol or mercury in vaccines (36.8%). The majority of videos (65.5%) discouraged the use of vaccines. Conclusion Health professionals should be aware of the widely disseminated vaccination information available on the Internet and should appreciate its possible effect on the public.

  January 19, 2017   doi: 10.1111/cch.12442   open full text
• Associations between participation in family activities and adolescent school problems.
  S. S. Goldfarb, J. L. Locher, J. Preskitt, D. Becker, S. L. Davies, B. Sen.
  Child Care Health and Development. January 18, 2017
  Introduction Adolescent risk outcomes related to school issues are widespread, with about 20% parents reporting poor school engagement amongst their youth. Previous literature suggests that adolescents who report strong bonds with their parents are often identified as being less likely to engage in risky behaviours, such as substance use. The current study sought to examine the association between the frequencies of selected family activities and school problems amongst adolescents after adjustments for family connectedness and other characteristics. Methods Data were drawn from the National Longitudinal Survey of Youth, 1997. Of the 8984 youth interviewed, 3855 also had a sibling interviewed who met the selection criteria. School problem outcomes measured were suspension occurrence, poor grades and highest grade completed low for age. Independent variables of interest were self‐reported frequency of family dinner, fun and religious activities in a typical week. Multivariable logistic models were estimated for each outcome, and multivariable linear probability models were estimated adjusting for family fixed effects. Results Adjusting for family connectedness, there were significant associations between certain family activities and adolescent school problem measures. However, these results did not remain significant in models with family fixed effects, suggesting that associations could be driven by family‐level confounders. Discussion This study did not find strong evidence of a protective relationship between family activities and school problems. Therefore, it suggested that programme and policymakers be cautious in overstating the importance of family activities in preventing adolescent risk outcomes until true causal relationships can be determined.

  January 18, 2017   doi: 10.1111/cch.12434   open full text
• Children and young people's conceptualizations of depression: a systematic review and narrative meta‐synthesis.
  N. Georgakakou‐Koutsonikou, J. M. Williams.
  Child Care Health and Development. January 15, 2017
  Background There is an increasing research interest in conceptualizations of mental illness, examined in association with help‐seeking, stigma and treatment preferences. A recent focus on young people's concepts has been identified, with depression being one of the most examined conditions. Methods The purpose of this systematic review is to synthesize evidence on children and adolescents' conceptualizations of depression, adopting the model of illness representations. The review further aims to examine developmental trends, gender differences and the role of experience. A systematic review and narrative meta‐synthesis were conducted, reviewing 36 studies identified through a systematic search of six databases in March 2016. Results Thirty‐six quantitative and qualitative studies were included. Half of the young people are able to recognize depression, and recognition increases when symptoms are more severe (e.g. suicidality). Young people are able to name a variety of causes for depression. Mental health professionals are considered the appropriate source of help by half of the young people, followed by family and peers. However, stigma constitutes a major barrier to help‐seeking. There are developmental trends and gender differences in young people's conceptualization of depression, while experience with depression is associated with a broader conceptualization. Conclusions Young people's concepts of depression resemble aspects of adult conceptualizations, however are sometimes incomplete. Further research on younger children and clinical populations is needed. Research on young people's conceptualizations informs both clinical practice and mental health literacy interventions.

  January 15, 2017   doi: 10.1111/cch.12439   open full text
• Family‐oriented services in pediatric rehabilitation: a scoping review and framework to promote parent and family wellness.
  G. King, L. Williams, S. Hahn Goldberg.
  Child Care Health and Development. January 12, 2017
  Family‐oriented services are not as common as one would expect, given the widespread endorsement of family‐centred care, the role of parents in supporting optimal child outcomes, and legislation and literature indicating that parent outcomes are important in their own right. There are no published service delivery frameworks describing the scope of services that could be delivered to promote parent and family wellness. A scoping review was conducted to identify types of family‐oriented services for parents of children with physical disabilities and/or intellectual impairments. This information was then synthesized into a conceptual framework of services to inform service selection and design. A scoping review of the recent literature was performed to capture descriptions of services targeting parents/families of children with physical disabilities and/or intellectual impairments, published in a six‐year period (2009 to 2014). Six databases were searched and 557 retrieved articles were screened using inclusion and exclusion criteria. Thirty six relevant articles were identified. Based on descriptions of services in these articles, along with seminal articles describing the nature of desirable services, we propose a needs‐based and capacity‐enhancing framework outlining a continuum of family‐oriented services for parents of children with disabilities. The framework includes six types of services to meet parent/family needs, organized as a continuum from fundamental information/education services, to those supporting parents to deliver services to meet their child's needs, to a variety of services addressing parents' own needs (support groups, psychosocial services and service coordination). The framework provides pediatric rehabilitation service organizations with a way to consider different possible family‐oriented services. Implications include the particular importance of providing information resources, support groups and psychosocial services to meet parents' needs, enhance capacity and promote family wellness. There is also an opportunity to provide composite parent–child services to address the needs of both parents and children.

  January 12, 2017   doi: 10.1111/cch.12435   open full text
• How to define successful transition? An exploration of consensus indicators and outcomes in young adults with chronic conditions.
  J. N. T. Sattoe, S. R. Hilberink, A. Staa.
  Child Care Health and Development. January 10, 2017
  Background In this short report, we use data from a previous cohort study to explore the relationship between five out of eight consensus indicators for successful transition and patient‐reported outcomes in young adulthood. Methods Data came from a 6‐year cohort study that consisted of a survey among 518 young adults with various chronic conditions and a review of their electronic patient records. Associations between five indicators for successful transition and background variables and patient‐reported outcomes were explored with Spearman's r. Significant variables were included in stepwise (logistic) regression analyses with transition outcomes as dependent variables. Results The indicators relate to some extent to better healthcare‐related transition outcomes, but not to autonomy in participation. The explained variance of the models varied from 9.7% to 26.4%. The change in explained variance after adding indicators varied from 2% to 16%. Conclusions The challenge of translating the definition of transition into holistic indicators remains. The current consensus indicators are a good start, but there is more to transition than transfer.

  January 10, 2017   doi: 10.1111/cch.12436   open full text
• Parental influences on weight‐related health behaviors in western and eastern cultures.
  B. S. Niemeier, Y. P. Duan, B. R. Shang, J. Yang.
  Child Care Health and Development. January 10, 2017
  Background Excessive bodyweight contributes to a myriad of risk factors for chronic diseases, and multiple reports have demonstrated that parents influence the development of their children's behaviors that contribute to bodyweight. However, studies that include considerations for cultural influences are limited, and methodology that considers direct reports from young adults and their parents across cultures does not exist. Methods A sample of young adults (N = 327) and their parents in the U.S. and in China were recruited and completed a series of questionnaires in two cycles (2010 and 2014). With correlation and multiple regression analyses, parents’ characteristics, behaviors, and parental authority styles were examined and compared to weight‐related health behaviors and bodyweight of their young‐adult children. Additionally, similarities and differences of parental influences between the two cultures were explored. Results Parents’ body mass indexes (BMIs) and dietary behaviors were positively associated with those of their young adult children in the mixed‐culture sample (P < .001 for both). When controlling for gender, at high levels of authoritarian and permissive parental authority, the relationships between young adults' and their parents’ BMIs were negative for U.S. participants and positive for Chinese participants (P < .05 for both). Further, at high levels of authoritarian parenting, the relationship between young adults' and their parents’ dietary consumption behaviors was negative for U.S. participants and positive for Chinese participants (P < .001). Conclusions This study provides evidence that the development of life‐long health behaviors that contribute to BMI are significantly influenced by parents’ behaviors and parenting styles. Moreover, an interaction of parental characteristics and cultural norms is indicated.

  January 10, 2017   doi: 10.1111/cch.12438   open full text
• A narrative meta‐review of a series of systematic and meta‐analytic reviews on the intervention outcome for children with developmental co‐ordination disorder.
  M. Miyahara, M. Lagisz, S. Nakagawa, S. E. Henderson.
  Child Care Health and Development. December 30, 2016
  Background Systematic reviews and meta‐analyses are considered to be the ‘gold standards’ for synthesizing research evidence in particular areas of enquiry. However, such reviews are only useful if they themselves are conducted to a sufficiently high standard. The aim of this study was to conduct a narrative meta‐review of existing analyses of the effectiveness of interventions designed for children with developmental co‐ordination disorder (DCD). Methods A narrative meta‐review of systematic and meta‐analytic reviews aimed at evaluating the effectiveness of intervention for children with DCD was conducted on studies published between 1950 and 2014. We identified suitable reviews, using a modification of the Population, Intervention, Comparison, Outcome (PICO) system and evaluated their methodological quality using the Assessment of Multiple Systematic Reviews (AMSTAR). In addition, the consistency of the quality of evidence and classification of intervention approaches was assessed independently by two assessors. Results The literature search yielded a total of four appropriate reviews published in the selected time span. The Assessment of Multiple Systematic Reviews percentage quality scores assigned to each review ranged from 0% (low quality) to 55% (medium quality). Evaluation of the quality of evidence and classification of intervention approaches yielded a discrepancy rate of 25%. All reviews concluded that some kind of intervention was better than none at all. Conclusions Although the quality of the reviews progressively improved over the years, the shortcomings identified need to be addressed before concrete evidence regarding the best approach to intervention for children with DCD can be specified.

  December 30, 2016   doi: 10.1111/cch.12437   open full text
• Talking with young children about concussions: an exploratory study.
  E. Kroshus, D. Gillard, J. Haarbauer‐Krupa, R. E. Goldman, D. S. Bickham.
  Child Care Health and Development. December 25, 2016
  Background Concussion education for children early in their participation in organized sport may help shape lasting attitudes about concussion safety. However, existing programming and research focus on older ages. Methods Qualitative interviews about concussions were conducted with twenty children between the ages of six and eight. Structural, descriptive and pattern coding were used to organize the transcribed interviews and identify emergent themes. Results Eighteen of the participants indicated that they had heard of the word concussion, with 12 describing the injury as related to the brain or head. The most frequently described mechanisms of injury were impacts to the head or falls, and symptoms tended to be somatic, such as generalized pain. The most frequently endorsed strategy to avoid sustaining a concussion was to ‘follow the rules.’ Multiple participants referenced parents as an informal source of information about concussions. Conclusions While most participants demonstrated some awareness about concussions, there were clear knowledge gaps that can be addressed with developmentally appropriate concussion education programming. Consistent with their developmental stage, interventions targeted at children in this age range may be most successful if they use basic logic, concrete ideas, provide rules to be followed and engage parents in dissemination.

  December 25, 2016   doi: 10.1111/cch.12433   open full text
• Associations between mothers' active engagement with infants at 6 months and children's adjustment to school life at ages 5.5 and 11 years.
  T. Kato, T. Fujiwara, I. Kawachi.
  Child Care Health and Development. December 19, 2016
  Background In Japan, students' poor adjustment to school life such as school refusals has been recognized as a nation‐wide problem. In this study, we examined the link between the absence of mothers' active engagement with their infants at 6 months and children's risks of poor adjustment toward elementary school life at the ages of 5.5 and 11. Methods We used a Japanese national longitudinal survey (n = 43 132) with 11 years of follow‐up. Because of social patterning in how mothers engage with their infants, we employed propensity score matching analyses to control for confounding by socio‐economic and other factors. We matched mothers with active engagement and those without on various social and parental characteristics such as educational attainment and household income. Results and Conclusions Among matched pairs, we observed higher risks of poor adjustment to school life at both 5.5 and 11 years among Japanese children who lacked mothers' active engagement at 6 months. For example, the relative risk was 1.46 [95% confidence interval: 1.10, 1.94] for inability to get along with others in a group setting at the age of 5.5 years and 1.29 [1.10, 1.51] for inability to get along with teachers at the age of 11 years. Our findings corroborate previous findings, which emphasize the importance of providing an enriched environment for infants' social development and may indicate the need for an intervention for caregivers who lack appropriate nurturing skills.

  December 19, 2016   doi: 10.1111/cch.12432   open full text
• Predictors of developmental surveillance completion at six months of age in south western Sydney.
  B. J. Overs, S. Woolfenden, K. Williams, B. Jalaludin, E. L. Axelsson, C. Dissanayake, J. Descallar, S. Harvey, D. Beasley, E. Murphy, V. Eapen,.
  Child Care Health and Development. December 01, 2016
  Background While developmental surveillance programs promote early identification of child developmental problems, evidence has indicated suboptimal uptake. This study aimed to identify predictors of developmental surveillance completion at 6 months postpartum. Methods Questionnaires were administered to the parents of 510 infants who were born in south western Sydney, Australia over a 22‐month period. Attendance for developmental screening and completion of the Parents' Evaluation of Developmental Status (PEDS) at 6 months postpartum were modelled separately using multivariable logistic regression. Results Developmental surveillance attendance was predicted by higher levels of maternal education, annual income and being informed about checks. PEDS completion at 6 months of age was predicted by higher income and being informed, as well as being married, employed, speaking English at home, full‐term birth and the professional status of the practitioner completing the check. Conclusions Barriers to developmental surveillance included low socioeconomic status, linguistic diversity and possible gaps in parental knowledge and professional education. Developmental surveillance rates may be increased by the addition of targeted parental and professional support within current universal frameworks.

  December 01, 2016   doi: 10.1111/cch.12425   open full text
• Children with medical complexity: a scoping review of interventions to support caregiver stress.
  H. Edelstein, J. Schippke, S. Sheffe, S. Kingsnorth.
  Child Care Health and Development. November 29, 2016
  Background Caring for children with chronic and complex medical needs places extraordinary stress on parents and other family members. A scoping review was undertaken to identify and describe the full range of current interventions for reducing caregiver stress. Methods Applying a broad definition of caregiver stress, a systematic search of three scientific databases (CINAHL, Embase and Ovid Medline), a general internet search and hand searching of key peer‐reviewed articles were conducted. Inclusion criteria were as follows: (i) published in English between 2004–2016; (ii) focused on familial caregivers, defined as parents, siblings or extended family; (iii) targeted children/youth with medical complexity between the ages of 1–24 years; and (iv) described an intervention and impact on caregiver stress. Data on type of intervention, study design and methods, measures and overall findings were extracted. Results Forty‐nine studies were included from a list of 22 339 unique titles. Six domains of interventions were found: care coordination models (n = 23); respite care (n = 8); telemedicine (n = 5); peer and emotional support (n = 6); insurance and employment benefits (n = 4); and health and related supports (n = 3). Across studies, there was a wide variety of designs, outcomes and measures used. Conclusions Positive findings of reductions in caregiver stress were noted within an emerging body of evidence on effective interventions for families of children with medical complexity. A commonality across domains was a significant focus on streamlining services and reducing the burden of care related to varied pressures experienced, including time, finances, care needs and service access, among others. There was non‐conclusive evidence however around which of the six identified intervention domains or combination thereof are most effective for reducing stress. These promising findings demonstrate that stress reduction is possible with the right support and that multiple interventions may be effective in reducing burdens of care experienced by families of children with medical complexity.

  November 29, 2016   doi: 10.1111/cch.12430   open full text
• Leaving foster or residential care: a participatory study of care leavers' experiences of health and social care transitions.
  K. Liabo, C. McKenna, A. Ingold, H. Roberts.
  Child Care Health and Development. November 29, 2016
  Background Young people in residential or foster care experience multiple transitions around their 18th birthday without the long term and consistent support from their family of origin that most of their peers can expect. We report a mixed methods qualitative study of transitions across health and social care services for children leaving care, providing narratives of what young people described as positive, and what they and professionals think might be improved. Methods Data were collected in participatory meetings and individual interviews between young people and researchers (n = 24) and individual interviews with practitioners (n = 11). In addition to discussion and interview techniques, we used pictorial and other participatory methods. Interviews were coded by three members of the team and differences resolved with a fourth. Our analysis draws on thematic and framework approaches. Results Health was rarely at the top of any young person's agenda, although gaps in health care and exceptional care were both described. Housing, financial support and education took priority. Young people and professionals alike emphasized the importance of workers prepared to go the extra mile; of young people being able to contact professionals; and professionals being able to contact one another. Conclusions Policy and practice aspirations for care leavers recommend gradual change but transfer rather than transition continues to be described by care leavers. Our data support the need for transition as a long‐term process, with children and young people having early opportunities to prepare for citizenship.

  November 29, 2016   doi: 10.1111/cch.12426   open full text
• The early intervention message: perspectives of parents of children with autism spectrum disorder.
  A. Edwards, C. Brebner, P. McCormack, C. MacDougall.
  Child Care Health and Development. November 28, 2016
  Background There is strong evidence that early intervention (EI) can improve outcomes for children with autism spectrum disorder (ASD), and consequently, the importance of EI has been widely promoted to families of children with ASD. However, the perspectives of parents of children with ASD regarding the EI message have not been widely examined. Methods This study used qualitative methods to explore parental perspectives on the EI message. Semi‐structured interviews were undertaken with 14 participants from 12 family units to explore the perspectives of parents of children with ASD on the EI message. Thematic analysis was undertaken on the data. Results Three central themes were constructed following data analysis: (i) parents' initial perceptions of EI following their child's diagnosis with ASD; (ii) the consequences (both positive and negative) of the EI message; and (iii) parents' perspectives on life after EI. The results of this study indicated that parents were acutely aware of the importance of EI, and although this provided parents with hope immediately post‐diagnosis, it also placed pressure on parental decision‐making regarding which intervention approaches to access for their children with ASD. Conclusions The results of this study highlight the importance of carefully considering how health messages, specifically the importance of EI, are communicated to families of children with ASD. Furthermore, the findings of this study also highlight the need for allied health professionals to communicate openly with parents about the anticipated outcomes of EI programmes.

  November 28, 2016   doi: 10.1111/cch.12428   open full text
• A comparison of parent and childcare provider's attitudes and perceptions about preschoolers' physical activity and outdoor time.
  P. S. Tandon, B. E. Saelens, K. A. Copeland.
  Child Care Health and Development. November 28, 2016
  Background Young children depend on adult caregivers to provide opportunities for physical activity. Research has focused on barriers and facilitators to children's physical activity while in childcare, but parental influences remain largely unknown. This study examines parent's attitudes about preschoolers' physical activity and outdoor time, compares them with those of childcare providers and determines the association between parental attitudes and preschoolers' measured activity. Methods Parents and childcare providers from 30 childcare centres were surveyed regarding attitudes towards preschoolers' physical activity and outdoor time. Children's moderate‐to‐vigorous physical activity was determined by using 24‐h accelerometry. Parent and childcare providers' responses were compared. Mixed‐effect linear regression examined moderate‐to‐vigorous physical activity and sedentary time as outcomes with parental attitudes as predictors, family demographics as covariates and centre as a random effect. Results Three hundred eighty‐eight parents and 151 childcare providers participated. On average, children were 4.3 (0.7) years old. Parents and childcare providers both considered daily physical activity important for preschoolers, but providers rated the importance of daily outdoor time higher on a 10‐point scale (8.9 vs. 7.6, P < 0.001). More parents than providers believed that children would get sick by playing outside in the cold (25 vs. 11%, P < 0.05). Parents were more comfortable with their child playing outside at childcare compared with outside at home (8.9 vs. 6.9, P < 0.001). Lower income parents felt less comfortable than higher income parents with their child playing outside either near home or at childcare. Neither home nor total child activity levels were associated with most parental attitudes queried. Conclusions While parents and childcare providers value daily physical activity for children, some parents expressed discomfort about their young children engaging in outdoor play, especially around home and in cold weather. These findings highlight the importance of childcare‐based interventions to promote preschoolers' physical activity and outdoor play.

  November 28, 2016   doi: 10.1111/cch.12429   open full text
• Associated factors of behavioural problems in children at preschool age: the Hokkaido study on environment and children's health.
  M. Minatoya, S. Itoh, A. Araki, N. Tamura, K. Yamazaki, S. Nishihara, C. Miyashita, R. Kishi.
  Child Care Health and Development. November 20, 2016
  Background Finding associated factors with childhood behavioural problems as early as preschool age is important. Studies have revealed several factors including socioeconomic factors, which may vary among different cultural background and population. However, investigation in general Japanese population of preschool age has not been well demonstrated. Thus, the objective of this study was to examine associated factors of childhood behavioural problems using Strengths and Difficulties Questionnaire (SDQ) in a prospective birth cohort study. Methods Total 3813 SDQ were distributed between October 2014 and December 2015 to the subpopulation of prospective birth cohort study, the Hokkaido Study on Environment and Children's Health. The subpopulation consisted of participants who had reached age 5 and were born between April 2008 and December 2010. Baseline questionnaire filled at recruitment and birth record were used to obtain participant information. Children with total difficulties score ≧ 13 were defined as likelihood of behavioural problems. A total of 2553 children with valid answers were included into the analysis. The response rate was 67.1%. Results Number of children with likelihood of behavioural problems was 521 (20.4%). Boys showed more problematic scores than girls. Multivariate analysis found that maternal pre‐pregnancy BMI ≧ 30 kg/m2, primipara, maternal education lower than high school, family income during pregnancy < 3 million yen/year and boy gender were the factors associated with increased odds ratio of likelihood of child behavioural problems. Conclusions This study found that prenatal socioeconomic factors were associated with likelihood of child behavioural problems at preschool age in Japan.

  November 20, 2016   doi: 10.1111/cch.12424   open full text
• The meaning of participation for children in Malawi: insights from children and caregivers.
  F. Nelson, C. Masulani‐Mwale, E. Richards, S. Theobald, M. Gladstone.
  Child Care Health and Development. November 02, 2016
  Background Global rates of childhood disability are high and are estimated through tools that focus on impairment, functioning and activity. The International Classification of Functioning, Disability and Health has promoted a framework to define disability more broadly and to include participation. New outcome measures have now been created to assess participation of children with disabilities for use in research and clinical practice. In order to use these in other cultural contexts, the validity of concepts and tools developed should be evaluated prior to use. We aim to create a tool that would be relevant and valid to the cultural context of Malawi, but to do so, we first need to understand what participation means to children in Malawi. Aim The aim of this study is to explore what participation means for children (including those with and without disability) in rural Northern Malawi. Methods We used semi‐structured interviews, focus group discussions, participatory action research and direct observations. Sixty‐four participants were involved including children (8–18 years) with (14) and without disabilities (17), carers of children with (8) and without (6) disabilities, community members (14) and professionals/healthcare workers (5). Data analysis was carried out using the ‘framework’ approach. Results Activities reported by children, carers and community members fell within seven main themes or areas of participation. These include contribution to family life (chores and work), social activities (communicating and being with others), social activities (unstructured play), structured and organized activities, activities of daily living, education and schooling and entertainment (listening to and watching media). Conclusions This study provides concepts and ideas that may be utilized in developing a suitable measure of participation of children with disabilities for rural African settings. Many of the most important activities for all children relate to family and day‐to‐day social life.

  November 02, 2016   doi: 10.1111/cch.12422   open full text
• Peri‐radiographic guidelines for children with autism spectrum disorder: a nationwide survey in Sweden.
  B. Björkman, I. Gimbler Berglund, K. Enskär, M. Faresjö, K. Huus.
  Child Care Health and Development. November 02, 2016
  Objective This study aimed to investigate the prevalence of guidelines and routines used nationwide when children with autism spectrum disorder (ASD) are taken care of and examined in a radiology department during a peri‐radiographic process. Method A nationwide survey was compiled and distributed to 94 radiology departments throughout Sweden, i.e. those performing more than 100 000 radiographic examinations annually. The survey was designed as a web questionnaire with seven questions on possible guidelines and/or routines for the departments when preparing and taking care of children with ASD in conjunction with a radiographic procedure. The data were scrutinized, using descriptive statistics. Results In total, 86 radiology departments responded to the survey (response rate 92%). Of those departments, 40 did not examine children with ASD. None of the departments included in the study had existing guidelines underpinning the routines when preparing and performing radiographic examinations for children diagnosed with ASD. A few departments (n = 8) would set aside more time for the procedure if it were known in advance that the child to be examined had been diagnosed with ASD. Also, some departments (n = 7) had radiographers who were more experienced in the care of children who would be appointed to perform examinations for children with ASD. Conclusion It is suggested that guidelines should be developed in order to increase interaction in a supportive way and decrease anxiety during the peri‐radiographic process with children with ASD.

  November 02, 2016   doi: 10.1111/cch.12427   open full text
• Siblings of children with life‐limiting conditions: psychological adjustment and sibling relationships.
  J. M. Fullerton, V. Totsika, R. Hain, R. P. Hastings.
  Child Care Health and Development. November 01, 2016
  Background This study explored psychological adjustment and sibling relationships of siblings of children with life‐limiting conditions (LLCs), expanding on previous research by defining LLCs using a systematic classification of these conditions. Methods Thirty‐nine siblings participated, aged 3–16 years. Parents completed measures of siblings' emotional and behavioural difficulties, quality of life, sibling relationships and impact on families and siblings. Sibling and family adjustment and relationships were compared with population norms, where available, and to a matched comparison group of siblings of children with autistic spectrum disorder (ASD), as a comparable ‘high risk’ group. Results LLC siblings presented significantly higher levels of emotional and behavioural difficulties, and lower quality of life than population norms. Their difficulties were at levels comparable to siblings of children with ASD. A wider impact on the family was confirmed. Family socio‐economic position, time since diagnosis, employment and accessing hospice care were factors associated with better psychological adjustment. Conclusions Using a systematic classification of LLCs, the study supported earlier findings of increased levels of psychological difficulties in siblings of children with a LLC. The evidence is (i) highlighting the need to provide support to these siblings and their families, and (ii) that intervention approaches could be drawn from the ASD field.

  November 01, 2016   doi: 10.1111/cch.12421   open full text
• Birth interval and stunting in children under five years of age in Peru (1996–2014).
  M. Sobrino, C. Gutiérrez, J. Alarcón, M. Dávila, A. J. Cunha.
  Child Care Health and Development. November 01, 2016
  Background Examine the evolution of stunting in <5 years of age in Peru and its relationship with birth interval (BI), and associated factors from 1996 to 2014. Methods Data were extracted from the National Demographic and Health Survey of Peru (DHS) for the years 1996, 2000, 2005, 2010 and 2014 on children <5 years of age for stunting (height / age ≤ 2DS). The main independent variable of interest was BI dichotomized by interval between date of last and penultimate birth (≤24 months vs. >24 months) and others sociodemographic variables. Crude and adjusted odds ratios with 95% confidence intervals were estimated in logistic regression for the effect of BI and other variables on stunting by each survey year. Results Between 1996 and 2014, stunting declined in both BI groups: ≤24 months: 35.8% to 21.8%; >24 months: 29.5% to 14.3%. BI was associated with stunting after adjustment for other variables in each survey except 2005. Of the other factors, sex, birth order (fourth child or more), maternal education and poverty were independently associated with stunting in all survey years. Residence in rural areas and in Amazon forest and highland regions was associated with stunting 1996 and 2000. Maternal age was not independently associated with stunting. Conclusions While stunting showed a decreasing trend from 1996 to 2014, birth interval exceeding 24 months exerted a protective effect on stunting across the years surveyed. Poverty, low maternal education and high birth order were associated with stunting in all survey years.

  November 01, 2016   doi: 10.1111/cch.12420   open full text
• Developing tailored positive parenting messages for a clinic‐based communication programme.
  N. L. Weaver, T. L. Weaver, S. E. Nicks, K. A. Jupka, H. Sallee, H. Jacobsen, W. Henley, M. Jaques.
  Child Care Health and Development. October 25, 2016
  Background Health care providers fill a central role in the prevention of both child abuse and neglect (CA/N) and unintentional childhood injury. Health communication interventions hold promise for promoting attitudes and behaviours among parents that increase positive parenting practices, which may be linked to decreased rates of intentional and unintentional childhood injuries. This manuscript describes the development of ‘RISE Up’, an ambulatory clinic‐based childhood injury prevention programme that provides tailored, injury prevention print materials to parents of children ages 0–5. Methods Fifteen semi‐structured key informant interviews were conducted with clinic healthcare providers and staff to develop communication strategies and materials for caregivers. Cognitive response testing was then conducted with 20 caregivers of the priority population to assess all materials. Interviews were recorded, transcribed and analyzed using thematic coding methods. Results Formative research revealed that health care providers and caregivers were very responsive to messages and materials. Health care providers reported that abuse and neglect were particularly relevant to their patients and noted several benefits to implementing the RISE Up programme in a health care setting. Caregivers generally found messages on reducing the risks of injuries, as well as the graphics displayed in the RISE Up programme to be helpful. Conclusions Addressing the common determinants of both intentional and unintentional childhood injury through customized print materials may be a useful component of comprehensive prevention efforts to address childhood injury risk with greater impact. Providers and parents responded favourably to this communication strategy.

  October 25, 2016   doi: 10.1111/cch.12418   open full text
• Why chronically ill children face challenges in regular classrooms: perspectives from nursing teachers in Japan.
  Y. Seki, A. Kakinuma, T. Kuchii, K. Ohira.
  Child Care Health and Development. October 25, 2016
  Background Chronically ill children are increasingly expected to join their peers in regular classrooms. However, sometimes schools do not provide adequate assistance. This study explores nursing teachers' thoughts and experiences on integrating such students into regular classrooms in Japan. Methods We analysed 79 essays written by nursing teachers collectively titled ‘The challenges of having chronically ill children in regular classrooms’. We conducted a qualitative study using Kinoshita's Modified Grounded Theory Approach. Results Nursing teachers identified three main obstacles: insufficient resources to support chronically ill students, parents not playing a supporting role in aiding them at school and a regular classroom not being suitable for them. However, collaborating with the children's medical staff proved successful at integrating them into regular classrooms. Conclusions Given these obstacles, it seems very difficult for nursing teachers to lead the way toward establishing cooperative support systems for the children. Instructions from medical staff could empower teachers to set up such systems.

  October 25, 2016   doi: 10.1111/cch.12423   open full text
• Psychosocial problems of children whose parents visit the emergency department due to intimate partner violence, substance abuse or a suicide attempt.
  E. M. M. Hoytema van Konijnenburg, J. H. Lee, A. H. Teeuw, R. Lindeboom, S. N. Brilleslijper‐Kater, T. Sieswerda‐Hoogendoorn, J. B. Goudoever, R. J. L. Lindauer,.
  Child Care Health and Development. October 23, 2016
  Background High levels of maltreatment are found in children who are identified because their parents visit the emergency department due to partner violence, substance abuse or suicide attempt. However, it is unknown if these children experience psychosocial problems. This study aims to assess their levels of post‐traumatic stress, anxiety, depression, behavioural problems and health‐related quality of life. Methods A cross‐sectional study was conducted in six hospitals. All consecutive families of which a parent visited the emergency department due to partner violence, substance abuse or suicide attempt between 1 July 2012 and 1 March 2014 with children aged 1.5–17 years were approached for participation. Parents and children aged 8 years and older filled out questionnaires measuring post‐traumatic stress [13‐item version of Children's Revised Impact of Event Scale (CRIES‐13)], anxiety, depression (Revised Child Anxiety and Depression Scale), behavioural problems [Child Behavior Checklist (CBCL) and Youth Self‐Report (YSR)] and health‐related quality of life (PedsQL). Scores of participants were compared with reference data obtained in children in similar age ranges from representative Dutch community samples (CRIES‐13, Revised Child Anxiety and Depression Scale, PedsQL and CBCL) and to a normed cutoff score (CRIES‐13). Results Of 195 eligible families, 89 (46%) participated in the study. Participating children did not score different from community children, both on child‐reported and parent‐reported instruments. Standardized mean differences of total sum scores were 0 (CRIES‐13 and CBCL 1.5–5), 0.1 (YSR), 0.2 (CBCL 6–18) and −0.3 (PedsQL) and not statistically different from community children. Thirty‐five percent of the participating children scored above the cutoff score on the CRIES‐13, indicating post‐traumatic stress disorder, but this difference was not statistically significant from community children (mean difference 8%; 95% CI −4–22%). Conclusions We found no differences in psychosocial problems between children whose parents visited the emergency department due to partner violence, substance abuse or suicide attempt and children from community samples. Because 35% of the children scored in the range of post‐traumatic stress disorder, we advise healthcare providers to pay attention to post‐traumatic stress symptoms

  October 23, 2016   doi: 10.1111/cch.12419   open full text
• Improving participation outcomes and interventions in neurodisability: co‐designing future research.
  J. McAnuff, R. Brooks, C. Duff, M. Quinn, J. Marshall, N. Kolehmainen.
  Child Care Health and Development. October 21, 2016
  There is an urgent, agreed need to improve participation outcomes and interventions for children and young people with neurodisability. We worked together with service users and providers to design research into participation outcomes and interventions in neurodisability. We built on existing evidence about participation outcomes and interventions and the WHO International Classification of Functioning, Disability and Health. We: (1) specified seven participation outcome categories for measurement; (2) prioritized these for improvement: self‐care, friends and social, and physical activity ranked the highest; (3) identified 11 potential intervention categories for targeting the top priority, self‐care, through eight hypothesized change mechanisms and agreed for the interventions to be delivered as a ‘Menu of Interventions’ for personalized self‐care support; and (4) designed a before‐and‐after mixed methods feasibility study to evaluate the Menu with children and young people (0–12 years) and their parents and therapists.

  October 21, 2016   doi: 10.1111/cch.12414   open full text
• Participation of Australian Aboriginal and Torres Strait Islander families in a parent support programme: longitudinal associations between playgroup attendance and child, parent and community outcomes.
  K. E. Williams, D. Berthelsen, M. Viviani, J. M. Nicholson.
  Child Care Health and Development. October 13, 2016
  Background Playgroups are a relatively unique form of family support programme that is common in Australia which has high community acceptance and significant government investment. However, limited evidence exists regarding the effectiveness of playgroups to achieve better outcomes for children and their parents. This study describes patterns of playgroup participation for Aboriginal and Torres Strait Islander families with young children and examines the extent to which participation from birth to three years is associated with subsequent child, parent and community outcomes. Methods This study uses three years of longitudinal data for 622 Aboriginal and Torres Strait Islander children who were participants in the Longitudinal Study of Indigenous Children (LSIC). Longitudinal associations between playgroup attendance when children were age 2 and 3 years and outcome measures for child vocabulary, motor skills, behaviour problems, prosocial development, parent home learning engagement, resilience, advice‐seeking and health service use, and community trustworthiness were examined using path analysis. Results Rates of playgroup participation in this sample group were generally lower than for Australian children overall. Playgroup attendance when children were age 2 to 3 years was associated with higher parental engagement in home learning activities when children were aged 4 years which, in turn, was associated with stronger expressive vocabulary scores for children. Conclusion The findings from this study suggest that playgroup participation can enhance the home learning environments for Aboriginal and Torres Strait Islander children. Playgroups as a parent support programme hold strong potential to reach and engage families, particularly in areas of high geographic isolation, which can realize improved outcomes for children, parents and communities.

  October 13, 2016   doi: 10.1111/cch.12417   open full text
• Development of a screening tool enabling identification of infants and toddlers at risk of family abuse and neglect: a feasibility study from three South European countries.
  L. Ezpeleta, R. Pérez‐Robles, K. A. Fanti, V. Karveli, E. Katsimicha, G. Nikolaidis, M. Z. Hadjicharalambous, K. Hatzinikolaou.
  Child Care Health and Development. October 11, 2016
  Background Child abuse is a health and social problem, and few screening instruments are available for the detection of risk in primary health care. The aim was to develop a screening instrument to be used by professionals in the public health care sector, thus enabling the detection of infants and toddlers at risk of emotional and physical abuse and neglect, and to provide evidence for the feasibility of the instrument in Cyprus, Greece and Spain. Method A total of 50 health professionals from paediatric public health‐care centres in the three countries were involved in a three‐step process for guiding the development of the screening tool and its application. Results A nine‐item screening tool, consisting of items assessing relational emotional abuse, physical abuse and other risk factors, was developed. The screening tool was applied on a total of 219 families with 0 to 3‐year‐old children attending public health centres in the three countries. Clinicians reported that they agreed on the inclusion of the questions (86.4–100%) and that they found the questions to be useful for the clinical evaluation of the family (63.2–100%). Conclusion The screening tool shows considerable face validity and was reported feasible by an international set of clinicians.

  October 11, 2016   doi: 10.1111/cch.12416   open full text
• Use of the ages and stages questionnaire adapted for South Africa and Zambia.
  C. Hsiao, L. Richter, T. Makusha, B. Matafwali, A. Heerden, M. Mabaso.
  Child Care Health and Development. October 05, 2016
  Background There are few readily available, relatively easy to use and culturally adaptable developmental assessment tools for young children in southern Africa. The overarching aim of this study is to test the psychometric properties, contextual appropriateness and cut‐off scores across 21 age groups of the Ages and Stages Questionnaire Third Edition (Squires & Bricker, ) among a group of typically developing children in South Africa and Zambia through a combination of both caregiver‐report and direct observations, and to compare children's performance across sociodemographic variables. Methods The sample consisted of 853 children (50.5% Zambia, with 50.1% girls for Zambia and 50% girls for South Africa) aged 2 months to 60 months. Information on caregiver employment, education and household assets were also obtained. Results The psychometric properties of the ASQ‐3 in southern Africa are consistent with those found in the extant literature. Analysis of item difficulty at each age reveals adequate levels of difficulty for majority of the items, with exception of the problem solving domain where half of the items at 54 and 60 months have poor pass rates. Sociodemographic variables were significantly associated with children's performance: higher caregiver levels of education are associated with higher toddler scores on the personal–social domain and higher preschooler scores on the problem solving domain; children whose caregivers earn a salary have higher fine motor scores during toddlerhood and higher problem solving scores during preschool and children who attend preschools have higher gross motor scores during toddlerhood and higher fine motor scores during the preschool years. Conclusions Findings provide evidence to support the psychometric properties and feasibility of using the ASQ‐3 in both South Africa and Zambia through a combination of caregiver‐report and direct observations.

  October 05, 2016   doi: 10.1111/cch.12413   open full text
• Evaluating the Incredible Years Toddler Parenting Programme with parents of toddlers in disadvantaged (Flying Start) areas of Wales.
  J. Hutchings, N. Griffith, T. Bywater, M. E. Williams.
  Child Care Health and Development. October 05, 2016
  Background Early risk factors for poor child outcomes are well established, and some group parenting programmes have demonstrated good outcomes for children under 3 years of age. This randomized controlled trial evaluated the effectiveness of the Incredible Years® Toddler Parenting Programme with parents of 1‐year‐old and 2‐year‐old children recruited by staff in disadvantaged Flying Start areas across Wales. Methods Eighty‐nine families with a child aged between 12 and 36 months at baseline participated in a pragmatic community‐based trial of the programme in eight Flying Start areas. Outcomes were measured at baseline, 6 months and 12 months using measures of parental mental health, competence, child behaviour, child development, home environment and blinded‐observation of parent–child interactions. Results Significant intervention group improvements were found in parental mental well‐being and observed praise at 6 months. Significant improvements for the intervention group at 12 months included child development, home environment and parental depression. Conclusion The study provides preliminary evidence for programme attendance.

  October 05, 2016   doi: 10.1111/cch.12415   open full text
• A vocational rehabilitation intervention for young adults with physical disabilities: participants' perception of beneficial attributes.
  M. I. Bal, J. N. T. Sattoe, N. R. Schaardenburgh, M. C. S. G. Floothuis, M. E. Roebroeck, H. S. Miedema.
  Child Care Health and Development. October 05, 2016
  Background Finding and maintaining employment is a major challenge for young adults with physical disabilities and their work participation rate is lower than that of healthy peers. This paper is about a program that supports work participation amongst young adults with chronic physical disabilities. The study aims to explore their experienced barriers and facilitators for finding and maintaining employment after starting this program, the participant‐perceived beneficial attributes of the program and participants' recommendations for additional intervention components. Methods Semi‐structured interviews (n = 19) were held with former intervention participations. Interviews were recorded and transcribed ad verbatim. Themes were derived using the phenomenological approach. Results Physical functions and capacities, supervisor's attitude, self‐esteem and self‐efficacy and openness and assertiveness were experienced barriers and facilitators for finding and maintaining employment. Improvement of self‐promoting skills and disclosure skills through job interview‐training, increased self‐esteem or self‐efficacy through peer‐support, a suitable job through job placement, improvement of work ability through arrangement of adjusted work conditions and change of supervisor's attitude through education provided to the supervisor were perceived as beneficial attributes of the intervention. Respondents recommended to incorporate assertiveness and openness skills training into future intervention programs. Conclusions The findings suggest that programs supporting work participation should be designed to provide challenging, real‐world experiential opportunities that provide young adults with physical disabilities with new insights, self‐efficacy and life skills. Also, such programs should facilitate context centered learning. Former intervention participants, therefore, evaluated job‐interview training, sharing learning and social experiences with peers, job placement, arrangement of adjusted work conditions and education as beneficial attributes of the ‘At Work’ program. In addition, they recommended, to incorporate more training on assertiveness and disclosure. We advise professionals to include these beneficial attributes in similar interventions in other contexts.

  October 05, 2016   doi: 10.1111/cch.12407   open full text
• Identifying research priorities with nurses at a tertiary children's hospital in the United Kingdom.
  A. Williams, D. Sell, K. Oulton, N. Wilson, J. Wray, F. Gibson.
  Child Care Health and Development. October 04, 2016
  Aim The objective of this study was to undertake a research priority setting exercise with the aim of maximizing efficiency and impact in research activity undertaken by nurses at one children's tertiary healthcare institution by ensuring the clinical staff directly shaped a coherent, transparent and consensus driven nurse‐led research agenda. Background In Round 1, the research topics of 147 nurses were elicited using a modified nominal group technique as the consensus method. The number of participants in the 24 separate discussions ranged from 3 to 21, generating lists of between 6 and 23 topics. In Round 2, nurses from the clinical areas ranked topics of importance resulting in a set of four to five priorities. In Round 3, the divisional heads of nursing consulted with staff in all of their clinical areas to each finalize their five divisional priorities. The Nursing Research Working Group discussed and refined the divisions' priorities and voted on the final list to agree the top five research priorities for the organization. Results A total of 269 research topics were initially generated. Following three rounds of ranking and prioritizing, five priorities were agreed at Divisional level, and from these, the five top organizational priorities were selected. These were (i) understanding and improving all aspects of the patient journey through the hospital system; (ii) play; (iii) staff wellbeing, patient care and productivity; (iv) team work – linking to a more efficient service; and (v) supporting parents/parent pathway. Conclusions Divisional priorities have been disseminated widely to clinical teams to inform a patient‐specific nurse‐led research agenda. Organizational priorities agreed upon have been disseminated through management structures and processes to ensure engagement at all levels. A subgroup of the Nursing Research Working Group has been delegated to take this work forward so that the agreed priorities continue to contribute towards shaping nurse‐led research activity, thereby going some way to inform and embed an evidence‐based culture of inquiry.

  October 04, 2016   doi: 10.1111/cch.12340   open full text
• Age and gender differences in self‐control and its intergenerational transmission.
  L. Wang, C. Fan, T. Tao, W. Gao.
  Child Care Health and Development. October 02, 2016
  Background Few studies have been conducted in people of Asian descent that have reported to demonstrate the distinct developmental trends in good self‐control and poor control. To fill this gap, we conducted a national cross‐sectional survey among adolescents and young adults in China to further clarify the age and gender differences in self‐control from a dual‐systems perspective. Methods A total of 2910 adolescents (female, n = 1698) and their parents from five different provinces in China were surveyed using the Dual‐Modes of Self‐Control Scale (DMSC‐S) and the Parents' Perceived Self‐Control Scale. The mean age of the adolescent sample was 17.47 years (ranging from 12.50 to 25.42 years). Results Boys exhibited greater good self‐control than girls. Poor control increased between 12 and 17 years of age and declined thereafter; however, good self‐control increased over the entire study period. Both good self‐control and poor control in student participants were significantly associated with parents' perceived self‐control; moreover, the association between good self‐control and parental self‐control was mediated by SES. Conclusion The roles of age, gender, parental self‐control and SES varied in a dual‐systems model of self‐control: good self‐control and poor control. Implications of these results are discussed.

  October 02, 2016   doi: 10.1111/cch.12411   open full text
• Child behaviour problems and childhood illness: development of the Eczema Behaviour Checklist.
  A. E. Mitchell, A. Morawska, J. A. Fraser, K. Sillar.
  Child Care Health and Development. October 02, 2016
  Background/Objectives Children with atopic dermatitis are at increased risk of both general behaviour problems, and those specific to the condition and its treatment. This can hamper the ability of parents to carry out treatment and manage the condition effectively. To date, there is no published instrument available to assess child behaviour difficulties in the context of atopic dermatitis management. Our aim was to develop a reliable and valid instrument to assess atopic dermatitis‐specific child behaviour problems, and parents' self‐efficacy (confidence) for managing these behaviours. Methods The Eczema Behaviour Checklist (EBC) was developed as a 25‐item questionnaire to measure (i) extent of behaviour problems (EBC Extent scale), and (ii) parents' self‐efficacy for managing behaviour problems (EBC Confidence scale), in the context of child atopic dermatitis management. A community‐based sample of 292 parents completed the EBC, measures of general behaviour difficulties, self‐efficacy with atopic dermatitis management and use of dysfunctional parenting strategies. Results There was satisfactory internal consistency and construct validity for EBC Extent and Confidence scales. There was a negative correlation between atopic dermatitis‐specific behaviour problems and parents' self‐efficacy for dealing with behaviours (r = −.53, p < .001). Factor analyses revealed a three‐factor structure for both scales: (i) treatment‐related behaviours; (ii) symptom‐related behaviours; and (iii) behaviours related to impact of the illness. Variation in parents' self‐efficacy for managing their child's atopic dermatitis was explained by intensity of illness‐specific child behaviour problems and parents' self‐efficacy for dealing with the behaviours. Conclusions The new measure of atopic dermatitis‐specific child behaviour problems was a stronger predictor of parents' self‐efficacy for managing their child's condition than was the measure of general child behaviour difficulties. Results provide preliminary evidence of reliability and validity of the EBC, which has potential for use in clinical and research settings, and warrant further psychometric evaluation.

  October 02, 2016   doi: 10.1111/cch.12412   open full text
• Socio‐economics, food habits and the prevalence of childhood obesity in Spain.
  J. M. Gil, S. Takourabt.
  Child Care Health and Development. September 27, 2016
  Background In 2012, the prevalence of obesity and overweight statuses among children in Spain was 9% and 26%, respectively. Concerns about childhood obesity have increased over the past few years, as obesity developed during childhood can persist throughout an individual's lifetime (cohort effect). This study aims to develop a better understanding of the factors influencing the prevalence of obesity in Spain. Methods Microdata from the 2012 National Health Survey are used, and the methodological framework is based on the estimation of a sample selection model. Results Results suggest that the prevalence of obesity increases among children who live in households of a lower socio‐economic status and households in which parents are obese. Lower levels of childhood physical activity are positively related to the probability of being obese. Finally, there exists a positive relationship between children's body mass index and an inappropriate intake of fresh fruits, fish, pasta and rice, legumes, sweets and soft drinks. Conclusions The methodological framework used in this study is flexible enough to be used in traditional longitudinal studies. Children's and households' lifestyles play a pivotal role in the prevalence of obesity. Policies should be oriented toward changing lifestyles, which would require more multidisciplinary research in the future to reduce childhood obesity.

  September 27, 2016   doi: 10.1111/cch.12408   open full text
• Health‐related quality of life of young people with long‐term illnesses before and after transfer from child to adult healthcare.
  A. E. While, E. Heery, A. M. Sheehan, I. Coyne.
  Child Care Health and Development. September 27, 2016
  Background The numbers of children with long‐term illnesses surviving into adulthood and transferring from child to adult services has increased dramatically in the last 30 years. This study aimed to examine health‐related quality of life pre‐ and post‐transfer from child to adult healthcare for young people with three long‐term illnesses. Methods A total of 217 young people with cystic fibrosis, congenital heart defects or diabetes attending child and adult hospital services in Dublin, Ireland completed a questionnaire survey. Multiple linear regression was used to identify predictors of five dimensions of health‐related quality of life pre‐ and post‐transfer. Results Post‐transfer young people with congenital heart disease and diabetes reported significantly lower physical well‐being than their pre‐transfer counterparts. Pre‐transfer young people with cystic fibrosis reported significantly lower physical well‐being than those with diabetes, but there was no significant difference post‐transfer. Pre‐transfer females reported lower scores than males on the Psychological Well‐being and Autonomy and Parent Relation dimensions; however, these differences disappeared post‐transfer. Higher maternal overprotection scores were associated with significantly lower scores on the Psychological Well‐being, Autonomy and Parent Relation, and Social Support and Peers dimensions, regardless of transfer status. Conclusions Disease group, gender and maternal overprotection were predictors of health‐related quality of life pre‐ and post‐transfer from child to adult healthcare. Transition programmes should promote self‐management and discourage parental overprotection.

  September 27, 2016   doi: 10.1111/cch.12410   open full text
• Physical fitness in preschool children: association with sex, age and weight status.
  P. Á. Latorre Román, R. Moreno del Castillo, M. Lucena Zurita, J. Salas Sánchez, F. García‐Pinillos, D. Mora López.
  Child Care Health and Development. September 25, 2016
  Background Because fitness level is a potent biomarker of health from an early age, the improvements of physical fitness performance through the promotion of physical activity could be important for the health of preschool children, particularly in obesity prevention. Objective The purpose of this study is to determine the physical fitness in children aged 3–6 years, discriminating performance by sex, age and body mass index (BMI). Method A total of 3868 children from 3 to 6 years agreed voluntarily to participate. Demographic characteristics revealed that 1961 children were male (age: 55.71 ± 11.11 months old, BMI = 16.03 ± 1.93 kg/m2), and 1907 were female (age 56.16 ± 0.97 months old, BMI = 15.85 ± 1.89 kg/m2), and they were selected from 51 schools in southern Spain. Results Significant differences were found between sexes: boys showed a greater performance on cardio respiratory endurance, reaction time, strength and running speed. We found significant differences by sex in the different age groups (3, 4, 5 and 6 years old). Conclusions Sex differences in physical fitness are evident at an early age; in addition, the relationship between physical fitness and BMI is inconsistent in preschool children. The improvements of physical fitness performance and its association with physical activity could be important for the health of children, particularly in obesity prevention.

  September 25, 2016   doi: 10.1111/cch.12404   open full text
• Discrepancies between self‐ and adult‐perceptions of social competence in children with neuropsychiatric disorders.
  M. Vuori, I. Autti‐Rämö, N. Junttila, M. Vauras, A. Tuulio‐Henriksson.
  Child Care Health and Development. September 19, 2016
  Background The present study examines discrepancies between self‐ and adult‐perceptions of social competence in children with attention deficit‐hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and possible co‐morbid disruptive behaviour disorders (DBD). Method Self‐reported questionnaires were collected from multiple informants at the baseline of a multi‐systemic family intervention programme for children (aged 5–12) with ADHD, ASD and possible co‐morbid DBD. In total, out of the 154 families eligible for the study, information was received concerning children from 124 families (children n = 121; mothers n = 117; fathers n = 86; teachers n = 97). In addition to this, a comparison community sample of 318 school‐aged children (approximately 10 years old) was utilized to examine the perceptions of children's social competence across intervention and population groups in more detail. Results Children's self‐perceptions in the prosocial dimension of social competence (i.e. cooperating skills, empathy) did not differ between the intervention and comparison groups. Interestingly, the children in the intervention sample expressed more impulsivity and disruptiveness – the antisocial dimension of social competence – when compared with the children in the comparison sample. Adult ratings demonstrated that mothers, fathers and teachers reported decreased prosocial behaviour and increased antisocial behaviour across overall dimensions and sub‐dimensions when compared with adults' ratings of elementary school children. Informant discrepancies between self‐ratings and adult ratings across intervention groups yielded significant effect sizes (eta‐squared) across all domains of social competence ranging from .09 to .25. Conclusion Children's positive self‐ratings of social competence relative to adult ratings increased within intervention sample when compared with population sample. The intervention sample children appeared to acknowledge their social competence deficits, yet self‐perceptions were inflated relative to adult ratings when focusing on peer relationship difficulties, particularly, aggression to peers.

  September 19, 2016   doi: 10.1111/cch.12406   open full text
• Feasibility of the Participatory Experience Survey and the Setting Affordances Survey for use in evaluation of programmes serving youth with intellectual and developmental disabilities.
  K. Liljenquist, W. Coster, J. Kramer, Z. Rossetti.
  Child Care Health and Development. September 15, 2016
  Background Participation by youth with disabilities in recreational activities has been shown to promote the development of important skills needed for transition to adulthood. The Participatory Experience Survey (PES) and the Setting Affordances Survey (SAS) were developed for use by recreational programmes serving youth with significant intellectual and developmental disabilities (SIDD) to assess participant experiences and ensure that participants are afforded optimal opportunities to develop these skills. This paper presents a feasibility evaluation to determine the appropriateness of the PES and the SAS for use in a programme evaluation context. Method The PES and the SAS were used to evaluate a programme serving youth with SIDD in the greater northwest region of the United States. Three recreational activities were evaluated: an art project, trip to a zoo and a track practice. Programme volunteers used the SAS to assess opportunities and affordances offered within each activity. The PES was then given to 10 young people in each activity to capture their experiences. It was hypothesized that each setting would afford different experiences and developmental opportunities because of the differing nature of the activities. Results The PES and SAS were found to be feasible for conducting a programme evaluation. All three settings offered varying types of experiences and affordances. Notably, as measured by the SAS, opportunity for skill development was greater in more structured activities; the zoo had the fewest opportunities for skill development and the art project had the most skill development opportunities. Youth answered ‘no’ most often to ‘asking for help’ and ‘helping a kid’, suggesting changes to offer more opportunities to develop these skills would be beneficial in all three activities. Conclusion These new instruments offer programmes a means to more fully include young people with disabilities during programme evaluations, leading to better‐structured, more supportive programmes.

  September 15, 2016   doi: 10.1111/cch.12402   open full text
• Time trends of technology mediated communication with friends among bullied and not bullied children in four Nordic countries between 2001 and 2010.
  Y. Bjereld, K. Daneback, P. Löfstedt, T. Bjarnason, J. Tynjälä, R. Välimaa, M. Petzold.
  Child Care Health and Development. September 13, 2016
  Background Friends are important in childhood and adolescence, especially to bullied children. Technology mediated communication (TMC) could be used both to develop and maintain friendship. The present study examined (1) trends in the use of TMC with friends between 2001 and 2010; (2) possible differences between bullied and not bullied children and (3) differences between children with few close friends and children with several close friends. Methods Data were obtained from three waves of the serial cross‐sectional Health Behaviour in School‐Aged Children survey conducted in Denmark, Finland, Iceland and Sweden during 2001/2002, 2005/2006 and 2009/2010. The total sample consisted of 65 953 children aged 11, 13 and 15. Results Two trends were observed. The first trend showed an increased use of TMC in all countries. Children that were not bullied and/or had several close friends had increased their use of TMC with friends from 2001 to 2010. The second trend was applicable only for bullied children with few close friends; they had not as other children increased their use of TMC and thus remained at the same levels as in 2001/2002. Conclusions Bullied children with few close friends were excluded from communication forums that usually allow children to maintain and develop friendships. This is a concern because friends are important during childhood and adolescence, especially for bullied children.

  September 13, 2016   doi: 10.1111/cch.12409   open full text
• Transition from paediatric to adult care: what makes it easier for parents?
  J. ‐C. Suris, J. ‐P. Larbre, M. Hofer, M. Hauschild, Y. Barrense‐Dias, A. Berchtold, C. Akre.
  Child Care Health and Development. September 13, 2016
  Objective To assess differences between parents of adolescents with chronic illness (CI) going through a self‐reported easy or difficult transfer. Methods Seventy‐two parents of CI youths who had already transferred to adult care were divided according to whether they considered that the transfer had been easy (n = 45) or difficult (n = 27). We performed a bivariate analysis comparing both groups and variables with a significance level < .1 were included in a logistic regression. Results are presented as adjusted odds ratio (aOR). Results Over one third of parents (27/72) reported a difficult transfer. At the multivariate level, higher socioeconomic status (aOR: 7.74), parents feeling ready for transfer (aOR: 6.54) and a good coordination between teams (aOR: 7.66) were associated with an easy transfer. Conclusions An easy transfer for parents is associated with feeling ready and considering that the coordination between teams is good. Health providers should consider these requisites for a successful transfer.

  September 13, 2016   doi: 10.1111/cch.12405   open full text
• The impact of autism services on mothers' psychological wellbeing.
  S. Hodgetts, D. McConnell, L. Zwaigenbaum, D. Nicholas.
  Child Care Health and Development. September 12, 2016
  Background Families with a child diagnosed with autism spectrum disorder (ASD) often utilize a variety of professional services. The provision of these services has many potential benefits for families; however, these services also place demands on parents, particularly mothers, to access, navigate and participate. Little is known about how involvement with these services and service systems influences the psychological wellbeing of mothers of children diagnosed with ASD. We examined the relationship between professional services and psychological wellbeing for mothers of children diagnosed with ASD. Methods Mothers (n = 119) of children (mean child age 10.1 years; range 2–24 years) diagnosed with ASD anonymously completed a comprehensive survey. The survey included data related to maternal psychological wellbeing, professional services received and perceptions of these services, and child, mother and household characteristics. Results Regression analyses revealed that maternal psychological wellbeing was positively associated with the perceived continuity of services, and negatively associated with the number of professionals involved. Child and maternal age, and household income were also statistically significant predictors of maternal psychological wellbeing. Conclusions The study findings draw attention to the potentially negative impact of systems‐level challenges, especially fragmentation of services, on maternal psychological wellbeing, despite positive front‐line services. In particular, our data suggest that psychological wellbeing among mothers of children with ASD may vary more as a function of service system variables than practitioner‐level or child‐level variables.

  September 12, 2016   doi: 10.1111/cch.12398   open full text
• Cross‐cultural validity of the German version of the Pediatric Evaluation of Disability Inventory (PEDI‐G)—a Rasch model application.
  C. Schulze, J. Page, M. Lilja, A. Kottorp.
  Child Care Health and Development. September 04, 2016
  Aim The aim of this study was to evaluate the cross‐cultural validity of the German version of the Pediatric Evaluation of Disability Inventory (PEDI‐G) when used in Austria, Germany and Switzerland. Method A total of 118 girls and 144 boys participated in this study; 198 of the children (75.6%) had a developmental disability and 64 (24.4%) were without a known disability. The mean age was four years (range 11 months to 10 years and six months, SD 1.91). Item goodness of fit, differential item functioning (DIF) and differential test functioning (DTF) were evaluated by use of a Rasch model. Results Twenty‐four (11.6%) out of 206 items of the Functional Skills Scale and one (5%) out of 20 items of the Caregiver Assistance Scale demonstrated misfit according to the Rasch model. Thirty‐four (16.5%) out of 206 items of the Functional Skills Scale and no item from the Caregiver Assistance Scale demonstrated DIF. Almost half (46%) of the items demonstrating misfit also demonstrated DIF, indicating an association between them. The DIF by country only demonstrated a minimal impact on the person measures of the PEDI‐G. Interpretation Even though some items did not meet the statistical and clinical criteria set, the PEDI‐G can be used, on a preliminary basis as a valid tool to measure activities of daily living of children with and without a disability in these countries. Further larger studies are needed to evaluate more psychometric item properties of the PEDI‐G in relation to context.

  September 04, 2016   doi: 10.1111/cch.12401   open full text
• Low‐income mothers' feeding goals predict observed home mealtime and child feeding practices.
  M. H. Pesch, A. L. Miller, D. P. Appugliese, N. Kaciroti, K. L. Rosenblum, J. C. Lumeng.
  Child Care Health and Development. August 24, 2016
  Background Mothers' goals are important for health behavior change, and engagement in child obesity interventions. It is unknown if maternal feeding goals are associated with observed home mealtime or feeding practices. The objective of this study was to examine the association of four common feeding goals (restrict junk food, promote fruit or vegetable intake, promote autonomy in eating and prevent obesity) with mothers' observed home mealtime and feeding practices. Methods Low‐income mothers (N = 265) of children (mean child age 70.8 months) participated in a semi‐structured interview about child feeding. A coding scheme was developed and reliably applied to identify mothers' feeding goals from transcripts. Mothers' observed home mealtime and feeding practices were reliably coded from home mealtimes and a laboratory eating protocol. Mothers completed a questionnaire and reported demographics. Participant weights and heights were obtained. Regression models were used to test the association of each feeding goal with observed maternal practices, controlling for covariates. Results The goal of restricting junk food was associated with the child always eating at a table (OR 2.87, 95% CI (1.39–5.96) p = 0.005), but not with the mother restricting junk food. The goal of promoting fruit or vegetable intake was associated with observationally promoting vegetables (OR 1.41, 95% CI (1.09–1.84), p = 0.01). The goals of promoting autonomy and preventing obesity were not associated with any observed maternal home mealtime or feeding practices. Conclusions While mothers' goals to restrict junk food and promote fruit or vegetable intake were associated with observed home mealtime and feeding practices, promoting autonomy and preventing obesity were not. Increased understanding of why low‐income mothers may not translate certain feeding goals into practices may inform childhood obesity interventions.

  August 24, 2016   doi: 10.1111/cch.12396   open full text
• Investigating offering of vegetables by caregivers of preschool age children.
  C. E Holley, C. Farrow, E. Haycraft.
  Child Care Health and Development. August 24, 2016
  Background Research into the methods which caregivers use to encourage children to eat vegetables is limited, with minimal evidence about what the barriers are to offering these foods. Vegetable consumption in children is typically low, and so gaining information on these factors is vital in order to develop further caregiver‐centred interventions to increase children's vegetable consumption. This study aimed to investigate the methods caregivers use to offer vegetables to preschool aged children, as well as the factors which influence whether and how caregivers present vegetables to their children. Method Seventeen caregivers with a preschool aged child participated in focus groups to assess these questions. Results Thematic analysis indicated that caregivers use a range of methods to offer their children vegetables, with these methods falling into three broad categories: behavioural/active methods, passive methods and food manipulations. Influences on caregiver offering which emerged from the focus groups formed four categories: information, cost, parent factors and child factors. Conclusions Together with large‐scale quantitative data, this information can be used to shape future interventions aiming to increase children's vegetable intake as well as to tailor advice given to caregivers striving to achieve a healthful diet for their children.

  August 24, 2016   doi: 10.1111/cch.12400   open full text
• Children and young people's views on access to a web‐based application to support personal management of long‐term conditions: a qualitative study.
  K. Huby, V. Swallow, T. Smith, I. Carolan.
  Child Care Health and Development. August 24, 2016
  Background An exploration of children and young people's views on a proposed web‐based application to support personal management of chronic kidney disease at home is important for developing resources that meet their needs and preferences. Methods As part of a wider study to develop and evaluate a web‐based information and support application for parents managing their child's chronic kidney disease, qualitative interviews were conducted with 26 children and young people aged 5–17 years. Interviews explored their views on content of a proposed child and young person‐appropriate application to support personal management of their condition. Data were analysed by using framework technique and self‐efficacy theory. Results One overarching theme of Access and three subthemes (information, accessibility and normalization) were identified. Information needed to be clear and accurate, age appropriate and secure. Access to Wi‐Fi was essential to utilize information and retain contact with peers. For some, it was important to feel ‘normal’ and so they would choose not to access any care information when outside of the hospital as this reduced their ability to feel normal. Conclusion Developing a web‐based application that meets children and young peoples' information and support needs will maximize its utility and enhance the effectiveness of home‐based clinical caregiving, therefore contributing to improved outcomes for patients.

  August 24, 2016   doi: 10.1111/cch.12394   open full text
• HIV‐associated neurodevelopmental delay: prevalence, predictors and persistence in relation to antiretroviral therapy initiation and viral suppression.
  R. Strehlau, L. Kuhn, E. J. Abrams, A. Coovadia.
  Child Care Health and Development. August 22, 2016
  Context HIV infection in infancy may influence the developing brain, leading to adverse neurodevelopmental consequences. Objective We aim to describe neurodevelopmental characteristics of a cohort of HIV‐infected infants and young children prior to antiretroviral therapy (ART) initiation and after achieving viral suppression. Methods As part of the Neverest 2 trial, 195 HIV‐infected children under 2 years of age were assessed using the Ages and Stages Questionnaire (ASQ) prior to ART initiation and at subsequent age‐appropriate time points after ART had been started. The ASQ is a simple screening questionnaire used to identify children at risk of neurodevelopmental delays. Questionnaires completed by the parent/caregiver assess neurodevelopmental functioning in five domains: communication, gross motor, fine motor, problem solving and personal–social. Results Median age pre‐ART was 8.8 months (range 2.2–24.9) and 53.9% were male. Mean time to viral suppression was 9.4 months (range 5.9–14.5). Compared with pre‐ART better outcomes were reported at time of viral suppression with a lower proportion of children failing the gross motor (31.5% vs. 13%, p = 0.0002), fine motor (21.3% vs. 10.2%, p = 0.017), problem solving (26.9% vs. 9.3%, p = 0.0003) and personal–social (19.6% vs. 7.4%, p = 0.019) domains. However, there was no change in the communication domain (14.8% vs. 12.0%, p = 0.6072). Conclusion Although achieving viral suppression on ART resulted in significant improvements in markers of neurodevelopmental function of young HIV‐infected children, potential neurodevelopmental delays still persisted in a large proportion. Further interventions are needed to limit potential disabilities and maximize developmental outcomes.

  August 22, 2016   doi: 10.1111/cch.12399   open full text
• Timing of menarche in girls adopted from China: a cohort study.
  P. Hayes, T. X. Tan.
  Child Care Health and Development. August 21, 2016
  Background Girls adopted internationally from some states have been found to have high rates of early puberty, including early menarche. Explanations for the link between international adoption and early puberty include post‐adoption catch‐up growth triggering puberty, and under‐recorded age. Methods We compared menarcheal age in a cohort of 814 girls adopted from China into North America against menarcheal ages in girls in China. Adoptive parents provided survey data on their daughters′ weight in 2005 and on menarcheal status and age at menarche in 2011. Results Estimated median age at menarche for adopted Chinese girls is 12.37 years (95% CI: 11.84–13.00 years). Estimated prevalence of menarcheal age ≤10.00 years for adopted girls is 3%. These findings are similar to published findings on non‐adopted Chinese girls. The distribution of menarche of adopted girls and non‐adopted girls at the estimated incidence rates P3–P97 are also similar. Among the 609 girls whose parents reported on their weight shortly after adoption, 148 (24.3%) were −2SD or more below the median weight in the WHO weight‐for‐age tables. The proportion of these girls who had attained menarche was not statistically different from other girls. Conclusions For girls adopted from China, the age of menarche, the percentage of girls attaining menarche <10 years and the distribution of menarcheal age are all similar to Chinese girls growing up in China.

  August 21, 2016   doi: 10.1111/cch.12393   open full text
• Classifying sensory profiles of children in the general population.
  L. M. Little, E. Dean, S. D. Tomchek, W. Dunn.
  Child Care Health and Development. August 21, 2016
  Background The aim of this study was to subtype groups of children in a community sample with and without developmental conditions, based on sensory processing patterns. Methods We used latent profile analysis to determine the number of sensory subtypes in a sample of n = 1132 children aged 3–14 years with typical development and developmental conditions, including autism spectrum disorder (ASD), attention‐deficit hyperactivity disorder and learning disabilities. Results A five‐subtype solution was found to best characterize the sample, which differed on overall degree and differential presentation of sensory processing patterns. Children with and without developmental conditions presented across subtypes, and one subtype was significantly younger in age than others (P < 0.05). Conclusions Our results show that sensory subtypes include both children with typical development and those with developmental conditions. Sensory subtypes have previously been investigated in ASD only, and our results suggest that similar sensory subtypes are present in a sample reflective of the general population of children including those largely with typical development. Elevated scores on sensory processing patterns are not unique to ASD but rather are reflections of children's abilities to respond to environmental demands.

  August 21, 2016   doi: 10.1111/cch.12391   open full text
• Early childhood development: impact of national human development, family poverty, parenting practices and access to early childhood education.
  T. D. Tran, S. Luchters, J. Fisher.
  Child Care Health and Development. August 17, 2016
  Background This study was to describe and quantify the relationships among family poverty, parents' caregiving practices, access to education and the development of children living in low‐ and middle‐income countries (LAMIC). Methods We conducted a secondary analysis of data collected in UNICEF's Multiple Indicator Cluster Surveys (MICS). Early childhood development was assessed in four domains: language‐cognitive, physical, socio‐emotional and approaches to learning. Countries were classified into three groups on the basis of the Human Development Index (HDI). Results Overall, data from 97 731 children aged 36 to 59 months from 35 LAMIC were included in the after analyses. The mean child development scale score was 4.93 out of a maximum score of 10 (95%CI 4.90 to 4.97) in low‐HDI countries and 7.08 (95%CI 7.05 to 7.12) in high‐HDI countries. Family poverty was associated with lower child development scores in all countries. The total indirect effect of family poverty on child development score via attending early childhood education, care for the child at home and use of harsh punishments at home was −0.13 SD (77.8% of the total effect) in low‐HDI countries, −0.09 SD (23.8% of the total effect) in medium‐HDI countries and −0.02 SD (6.9% of the total effect) in high‐HDI countries. Conclusions Children in the most disadvantaged position in their societies and children living in low‐HDI countries are at the greatest risk of failing to reach their developmental potential. Optimizing care for child development at home is essential to reduce the adverse effects of poverty on children's early development and subsequent life.

  August 17, 2016   doi: 10.1111/cch.12395   open full text
• A qualitative investigation of recovery after femoral fracture in Rett syndrome.
  T. Horne, H. Leonard, K. Stannage, J. Downs.
  Child Care Health and Development. August 11, 2016
  Background Children with severe disability often develop osteoporosis and have an increased risk of fracture. In Rett syndrome, the prevalence of fracture is four times greater than in the general population, and the femur is commonly affected. This study used qualitative methods to investigate the regaining of mobility within 12 months following femoral fracture in Rett syndrome and parent caregiver experiences. Methods Caregivers (n = 14) of cases registered with the Australian Rett Syndrome Database with a daughter with Rett syndrome were recruited if their daughter sustained a femoral fracture between 2009 and 2014. Median (interquartile range) age at fracture was 11 years and 4 months (8 years and 8 months to 22 years and 3 months). Qualitative methods were used to investigate parent/caregiver experiences and their daughter's recovery following fracture. Themes in the interview data were identified with thematic analysis. Results Operative management was chosen for those walking independently and non‐operative management for most of the remaining. All who walked independently and one of the four who required assistance recovered pre‐operative walking skills within 6 months. Themes identified by caregivers related to the complexities of pain recognition, the caregiver emotional journey and later rebuilding of relationships with service providers. Conclusions Those who walked with assistance were vulnerable to loss of this skill. Difficulties in pain recognition increased time to diagnose fracture, and the acute episode was associated with heightened caregiver stress. Service providers can use family‐centred practice models to support the strengthening of family functioning following this acute event that is surprisingly common in those with severe disability.

  August 11, 2016   doi: 10.1111/cch.12392   open full text
• The effects of caregiver and household HIV on child development: a community‐based longitudinal study of young children.
  L. Sherr, S. Skeen, I. S. Hensels, M. Tomlinson, A. Macedo.
  Child Care Health and Development. August 11, 2016
  Objective Many studies that document child outcomes in the context of parental HIV – which has been established as a risk factor for child development – focus on older children/adolescents. Studies also concentrate on the status of the primary caregiver, not other household members who might be infected. Design This study examined the effects of caregiver and household HIV on child development (4–13 years) in South Africa and Malawi (2011–2014). Methods Data were gathered from 989 children and their primary caregivers at baseline and repeated at 12–15 months follow‐up (86.5% follow‐up rate). Only caregivers of a single child and caregiver/child dyads without missing data were included, providing a sample of 808 dyads for analysis. Children were divided into three groups according to caregiver‐reported HIV burden: having an HIV‐positive primary caregiver (19.8%), having HIV in the household (14.2%) or no HIV (66%). Results The HIV burden was positively associated with an array of negative child outcomes, often mediated by caregiver depression levels. Family HIV burden at baseline affected child behavioural problems at follow‐up indirectly through carer depression (B = 0.02; CI = 0.003, 0.06). Internalizing (B = 0.02; CI = 0.002, 0.05) and externalizing problems at follow‐up (B = 0.01; CI = 0.0002, 0.03) were also indirectly affected by family HIV burden through caregiver depression. Conclusions The data suggest that family HIV can affect child development, emphasizing the important role of depression in the pathway to such an effect. Community‐based interventions directed at alleviating parental depression in the presence of HIV may help to interrupt the cycle of family HIV and adverse child outcomes.

  August 11, 2016   doi: 10.1111/cch.12387   open full text
• Positional plagiocephaly reduces parental adherence to SIDS Guidelines and inundates the health system.
  A. Martiniuk, J. Jacob, N. Faruqui, W. Yu.
  Child Care Health and Development. August 09, 2016
  Background This study sought to better understand parent, grandparent and clinician views of prevention, treatment and costs of plagiocephaly. Methods A qualitative study was conducted using focus groups and semi‐structured interviews. A grounded theory approach was taken to build theories from the qualitative data collected. A subjectivist epistemological orientation was taken under the paradigm of positivism. Results Ninety‐one parents, 6 grandparents and 24 clinicians were recruited from the community as well as primary and tertiary care clinics. Plagiocephaly worried most parents because it could permanently affect their child's ‘looks’ and some thought it would affect a child's development. Parents were ‘willing to do anything’ to prevent plagiocephaly including using products or sleeping positions that are contraindicated under sudden infant death syndrome guidelines. Parents found the care pathway convoluted and inconsistent messages were given from different health providers. For clinicians, the high prevalence of flat head is ‘clogging up their patient pool’, taking up time they used to spend with children with more severe conditions. Conclusion There is a need to re‐emphasize sudden infant death syndrome guidelines for families when they present with an infant with plagiocephaly. Stronger messaging regarding the lack of safety of current pillows marketed to prevent flat head may be useful to decrease their use. Increasing education for all health professionals including general practitioners, allied health and complementary health providers and standardizing assessment and referral criteria may allow the majority of diagnosis and treatment of positional plagiocephaly to occur at points of first contact (e.g. general practitioners, community nurse) and may prevent further burden on the health care system.

  August 09, 2016   doi: 10.1111/cch.12386   open full text
• Fundamental literature and hot topics on rural left‐behind children in China: a bibliometric analysis.
  L. Wang, Y. Wei, Y. Ma, T. Wang.
  Child Care Health and Development. August 08, 2016
  Background Recently, the literature on rural left‐behind children in China has rapidly grown. However, no comprehensive review of the status of knowledge on the issue exists. Methods A co‐cited network map of 327 studies (covering 1998 through 2014) drawn from the Chinese Social Studies Citation Index database was analysed. Results Using visualization software, the results identified three fundamental studies on the issue and four hot topics: interventions, deviant behaviours, mental health and family childrearing strategies. The analysis found that knowledge on this topic could be furthered by (1) focusing on protective factors and (2) integrating disciplines by standardizing concepts and measures. Conclusions These study's results are an important reference for the development of theories, practices and policies regarding rural left‐behind children in China.

  August 08, 2016   doi: 10.1111/cch.12390   open full text
• School performance for children with cleft lip and palate: a population‐based study.
  J. C. Bell, C. Raynes‐Greenow, R. Turner, C. Bower, A. Dodson, W. Nicholls, N. Nassar.
  Child Care Health and Development. August 08, 2016
  Background Educational attainment is important in shaping young people's life prospects. To investigate whether being born with orofacial cleft (OFC) affects school performance, we compared school test results between children born with and without OFC. Methods Using record‐linked datasets, we conducted a population‐based cohort study of children liveborn in Western Australia 1980–2010 with a diagnosis of OFC on the Register of Developmental Anomalies, and a random sample of 6603 children born without OFC. We compared odds ratios for meeting national minimum standards in five domains (reading, numeracy, writing, spelling, grammar and punctuation), and adjusted OR (aOR) for children with cleft lip only (CLO), cleft lip and palate (CL + P) and cleft palate only (CPO) for each domain. Results Results from two testing programs (WALNA and NAPLAN) were available for 3238 (89%) children expected to participate. Most met the national minimum standards. Compared with children without OFC, children with CPO were less likely to meet minimum standards for NAPLAN reading (aOR 0.57 [95%CI 0.34, 0.96]) grammar and punctuation (aOR 0.49 [95%CI 0.32, 0.76]), WALNA writing (aOR 0.66 [95%CI 0.47, 0.92]), and WALNA and NAPLAN numeracy (aOR 0.64 [95%CI 0.43, 0.95] and aOR 0.47 [95%CI 0.28, 0.82]), respectively. Children with CL + P had significantly lower odds for reaching the spelling standard in NAPLAN tests (aOR 0.52 [95%CI 0.29, 0.94]). Children with CLO had similar odds for reaching all minimum standards. Conclusion Children born with OFC, particularly children with CPO, should be monitored to identify learning difficulties early, to enable intervention to maximize school attainment.

  August 08, 2016   doi: 10.1111/cch.12388   open full text
• Subjective sleep measures for adolescents: a systematic review.
  X. Ji, J. Liu.
  Child Care Health and Development. August 06, 2016
  Background Sleep disturbances in adolescents have received significant attention because of their high prevalence and the negative health outcomes. Relative to objective measures, subjective sleep instruments have been the most practical tools used to identify sleep problems and assess responses to interventions in research and clinical settings. This systematic review aims to examine the psychometric properties of subjective measures that are used to assess sleep quality and disturbances among adolescents, identify the strength and limitation of each measurement and inform recommendations for practice. Methods PubMed, Embase and PsycInfo were searched from 2000 through May 2016. The reference lists of important articles were included if they met the inclusion criteria. The available measures were evaluated and classified as positive, intermediate or poor according to the quality criteria for health status questionnaires. Results Thirteen self‐reported or parent‐reported sleep measures met the inclusion criteria. Of the measurements reviewed, six were generic instruments assessing overall sleep quality and disturbances; five were dimension‐specific instruments measuring daytime sleepiness, sleep insufficiency and sleep hygiene; and two were condition‐specific instruments for insomnia. None of the subjective sleep measures for adolescents has a psychometric profile with all essential measurement properties. Specifically, the generic sleep measurements capture multiple dimensions but face issues of participant burden and compatibility. Among the domain‐specific tools, the Cleveland Adolescent Sleepiness Questionnaire and the Chronic Sleep Reduction Questionnaire have achieved good psychometric merits but need further evaluation for responsiveness. Likewise, essential measurement properties of condition‐specific tools for insomnia have yet to be established. Conclusions Because of the limited evidence, no definite recommendations can be made at this point. However, each available measurement has its own uniqueness and strength despite the limitations. Future research on measurement development and evaluation for adolescent sleep is needed to ensure the relevance and suitability to different stages of adolescence and social contexts.

  August 06, 2016   doi: 10.1111/cch.12376   open full text
• Monitoring children's health and well‐being by indicators and index: apples and oranges or fruit salad?
  L. Köhler.
  Child Care Health and Development. August 06, 2016
  The use of indicators is a fast and widely spread way to monitor groups of children's health and well‐being. Indicators are useful in research; but they are also important tools for planners and politicians. Although they are constructed to simplify reality, in many reports they still offer a complex and confusing picture, not least by their sheer numbers. Although they are constructed to simplify reality, in many reports, they still offer a complex and confusing picture, not least by their sheer numbers. Therefore, there is an increasing demand for even further simplifications, where the indicators are combined into single summary numbers, composite indices. At the same time, as a composite index summarizes a complex and sometimes elusive process, making it more accessible for advocacy and political interventions, the combining of very dissimilar components makes the results difficult to interpret and use. There is an obvious dilemma between the need for rigour and evidence, the research orientation, and the wish for a simple and summarizing overview of the findings, the policy orientation. Models have been created to form indicator sets, either by combining them by simple addition or by weighting them or by just leaving them as separate indicators. Most index systems in operation use an equal weighting system after standardization, once the components have been selected. Examples of these models are described as well as their pros and cons, and a summary of suitable ways of handling the problems of indicators and composite indices is offered. Some surveys have taken the best from different approaches, presenting the results as a summary index for the great picture, as subindices for the various domains of child health and as separate indicators for the detailed study of the basic components. A Swedish Child Health Index is presented as an example of such a solution.

  August 06, 2016   doi: 10.1111/cch.12373   open full text
• A scoping review examining physical activity measurement and levels in the first 2 years of life.
  A. Prioreschi, L. K. Micklesfield.
  Child Care Health and Development. August 04, 2016
  Background The first few years of life have been identified as a critical stage in the development of activity behaviours, which have been shown to track into later life. This scoping review aims to assess the literature reporting on physical activity levels in the first 2 years of life in order to answer two main questions: (i) how is physical activity measured in this age group? and (ii) how active are infants and toddlers in the first 2 years of life? Methods A search strategy was employed using PubMed with restrictions only on age and language. After applying exclusion criteria, 20 papers were included in the results. Results Seventeen studies used some form of objective assessment of physical activity (accelerometers, actometers, direct observation, doubly labelled water or a metabolic chamber); while the remaining three relied on subjective assessments (parent reported questionnaires or interviews, and activity diaries). Nine studies exclusively assessed infants (<12 months), and five exclusively assessed toddlers (>12 months). Only six studies reported physical activity levels and patterns specifically; most included studies measured activity as a covariate or correlate. Therefore, much of the reported data was difficult to assess, as results were vague or incompletely described. Where data were reported sufficiently for analysis, results were equally conflicted regarding whether toddlers were meeting recommended physical activity guidelines. Conclusions This scoping review re‐iterates the fact that more studies need to be conducted, which focus primarily on measuring and reporting physical activity levels and patterns in this age group in a comprehensive and standardized way, so that more informed guidelines can be devised and interventions can be designed and implemented where necessary.

  August 04, 2016   doi: 10.1111/cch.12382   open full text
• Material hardship and children's social‐emotional development: Testing mitigating effects of Child Development Accounts in a randomized experiment.
  J. Huang, Y. Kim, M. Sherraden.
  Child Care Health and Development. August 04, 2016
  Background Research has established a negative association between household material hardship and children's mental health. This study examines whether Child Development Accounts (CDAs), an economic intervention that encourages families to accumulate assets for children's long‐term development, mitigate the association between material hardship and children's social‐emotional development. Methods Researchers conducted a randomized experiment of CDAs in Oklahoma, USA, with a probability sample (N = 7328) of all infants born in two 3‐month periods in 2007. After agreeing to participate in the experiment, caregivers of 2704 infants completed a baseline survey and were assigned randomly to the treatment (n = 1358) or control group (n = 1346). The intervention exposed the treatment group to a CDA, which consisted of an Oklahoma 529 College Savings Plan account, financial incentives and financial information. Results Material hardship has a negative association with the social‐emotional development of children around the age of 4 years. Estimates from regression analysis indicate that CDAs mitigate about 50% of the negative association between material hardship and children's social‐emotional development. Conclusions Although they do not provide direct support for consumption in households experiencing material hardship, CDAs may improve child development by influencing parenting practices and parents' expectations for their children. We discuss the implications of using asset‐building programmes to improve child development.

  August 04, 2016   doi: 10.1111/cch.12385   open full text
• Social participation of teenagers and young adults with developmental co‐ordination disorder and strategies that could help them: results from a scoping review.
  M. Gagnon‐Roy, E. Jasmin, C. Camden.
  Child Care Health and Development. August 01, 2016
  Background The impact of developmental co‐ordination disorder (DCD) on teenagers' and young adults' participation is not well documented. This article aims to synthesize the current knowledge on social participation, which is the performance of an individual in realizing his or her daily activities and social roles within its life environment. Strategies and interventions to support youths (15–25 years old) with DCD were also synthesized. Methods A scoping review interrogating three databases and using ‘snowballing techniques’ was performed to identify both scientific and grey literature published between 2004 and 2014. Over 1000 documents were screened and 57 were read in full; 28 met inclusion criteria. A charting form based on 12 life habits described in the disability creation process and developed by two reviewers was used to extract data and report the results. Results All life habits were reported to be affected for teenagers and young adults with DCD, with education and interpersonal relationships being the most frequently discussed. During adolescence and adulthood, new tasks and subsequent difficulties emerge, such as driving. Mental health difficulties emerged as a key theme. Few strategies and interventions were described to support social participation of youths with DCD. Conclusion Many life habits are challenging for youths with DCD, but few evidence‐based strategies and interventions have been designed to help them to increase their social participation.

  August 01, 2016   doi: 10.1111/cch.12389   open full text
• Development and face validity of a cerebral visual impairment motor questionnaire for children with cerebral palsy.
  M. Salavati, A. Waninge, E.A.A. Rameckers, J. Steen, W.P. Krijnen, C.P. Schans, B. Steenbergen.
  Child Care Health and Development. August 01, 2016
  Aim The objectives of this study were (i) to develop two cerebral visual impairment motor questionnaires (CVI‐MQ's) for children with cerebral palsy (CP): one for children with Gross Motor Function Classification System (GMFCS) levels I, II and III and one for children with GMFCS levels IV and V; (ii) to describe their face validity and usability; and (iii) to determine their sensitivity and specificity. Backgrounds The initial versions of the two CVI‐MQ's were developed based on literature. Subsequently, the Delphi method was used in two groups of experts, one familiar with CVI and one not familiar with CVI, in order to gain consensus about face validity and usability. The sensitivity and specificity of the CVI‐MQ's were subsequently assessed in 82 children with CP with (n = 39) and without CVI (n = 43). With the receiver operating curve the cut‐off scores were determined to detect possible presence or absence of CVI in children with CP. Results Both questionnaires showed very good face validity (percentage agreement above 96%) and good usability (percentage agreement 95%) for practical use. The CVI‐MQ version for GMFCS levels I, II and III had a sensitivity of 1.00 and specificity of 0.96, with a cut‐off score of 12 points or higher, and the version for GMFCS levels IV and V had a sensitivity of 0.97 and a specificity of 0.98, with a cut‐off score of eight points or higher. Conclusion The CVI‐MQ is able to identify at‐risk children with CP for the probability of having CVI.

  August 01, 2016   doi: 10.1111/cch.12377   open full text
• Does somatosensation change with age in children and adolescents? A systematic review.
  S. Taylor, B. McLean, T. Falkmer, L. Carey, S. Girdler, C. Elliott, E. Blair.
  Child Care Health and Development. July 28, 2016
  Background Somatosensory modalities, such as touch, proprioception and haptic ability, greatly influence the achievement of developmental milestones for children. Describing somatosensory impairment, natural variability and typical or expected developmental changes across age groups will help establish frameworks for intervention in clinical populations. This systematic review aimed to determine how different somatosensory modalities develop across childhood into adolescence to use as a point of reference for children at risk of somatosensory impairment. Methods Searches of five electronic databases were undertaken through EBSCO‐host (MEDLINE, CINAHL, PsycINFO, SPORTDiscus and ERIC) for studies measuring at least one somatosensory modality in typically developing individuals between birth and 18 years and analysed by age. Characteristics of studies were collected including country of origin, sample size, demographics and outcome measure used. Quality assessment and data extraction were performed by two independent reviewers. Results Twenty three cross‐sectional studies were included from a total of 188 articles retrieved: 8 examined aspects of touch, 5 proprioception and 10 haptic ability. Variability of study designs and variation in assessment tools precluded any formal meta‐analysis. Conclusions Somatosensation matures through childhood into adolescence; however, the present review found the pattern of somatosensory development varied depending on the assessment tool used and the aspect of somatosensation being measured, making it difficult to describe typical performance. There is a need for comprehensive assessment batteries to measure the somatosensation, including touch, proprioception and haptic ability, of children at risk of somatosensory impairment to aid in the development of effective interventions.

  July 28, 2016   doi: 10.1111/cch.12375   open full text
• Coping strategies used by children and adolescents born with esophageal atresia – a focus group study obtaining the child and parent perspective.
  M. Dellenmark‐Blom, J. E. Chaplin, L. Jönsson, V. Gatzinsky, J. H. Quitmann, K. Abrahamsson.
  Child Care Health and Development. July 28, 2016
  Background Esophageal atresia (EA) is a rare malformation, which requires surgical treatment. Survival rates today reach 95%, but EA remains a significant cause of chronic morbidity with increased risk of psychosocial problems and impaired health‐related quality of life (HRQOL). No study of coping strategies of children with EA has been reported in the literature to date, but increased knowledge could lead to improved outcomes and better HRQOL. Methods Standardized focus groups with children with EA and their parents were conducted to identify issues related to health care needs and HRQOL, with group members relating their coping experiences. Identified coping statements were content analysed using a card sorting procedure and descriptive statistics. Results Thirty families (18 children 8–17 years; 32 parents of children with EA 2–17 years) participated in 10 focus groups. A total of 590 coping statements were recorded. Nine coping strategies were identified: problem solving (n = 116), avoidance (n = 95), recognizing responsibility (n = 71), confronting (n = 70), seeking social support (n = 63), positive reappraisal (n = 58), emotional expression (n = 46), acceptance (n = 40) and distancing (n = 31). Nine situational contexts were identified: nutritional intake (n = 227), communication of one's health condition (n = 78), self‐perception when experiencing troublesome symptoms (n = 59), appearance of body or scar(s) (n = 57), physical activities like sport and play (n = 43), sleep (n = 34), hospital care (n = 33), stigmatization and social exclusion (n = 30) and medication intake (n = 29). Conclusions Focus group methodology contributed to an increased understanding of disease‐specific coping processes among children and adolescence with EA. Findings illustrate that they use several coping strategies, some of which they seem to adopt at early age and use in disease‐related contexts of physical, social and emotional character. Such coping may influence health and HRQOL in children with EA. In view of the importance of establishing good coping strategies early in life, health care professionals should integrate coping aspects into care management. Future studies are warranted.

  July 28, 2016   doi: 10.1111/cch.12372   open full text
• Does caregiver participation in decision making within child welfare agencies influence children's primary and mental health care service use?
  M. P. Jolles, R. Wells.
  Child Care Health and Development. July 28, 2016
  Background Many children in contact with child welfare agencies do not receive needed health services. These agencies have used participatory decision making (PDM) practices as a way to increase families' use of recommended services. However, we lack evidence of whether caregiver participation in PDM increases children's use of health services. This study uses a national sample of children involved with child welfare to compare their health service use between those children serve through a PDM practice and those who did not experience it. Methods Cross‐sectional analyses using the 2009–2010 National Survey of Child and Adolescent Well‐Being. Propensity score analysis accounted for observed selection bias. PDM practice was measured as whether the caregiver was included in decision‐making during service planning meetings. Health service use was measured as child's receipt of any primary or mental health care services in the past year. Primary health care need was measured using standardized measures and caseworker report. The sample was comprised of children ages 2–17 with primary or mental health needs in contact with a child welfare agency. Results In the unmatched sample of 1,358 children, 14% were served through a PDM service practice, and 12% had a primary health care and 37% a mental health need. Families served through PDM were also reported by caseworkers as more cooperative during the child welfare investigation, and with fewer reports of domestic violence and agency re‐referrals (P < 0.05). Analyses using matched samples showed that for primary health care, 59% of PDM children received services compared with 40% for non‐PDM children (P = 0.004). Group differences were not significant for mental health services. Conclusions Lower‐risk families were more likely to be served through PDM which was positively associated with child use of primary health services. Inclusion of caregivers in decision making may not be sufficient to overcome barriers to children's mental health service use.

  July 28, 2016   doi: 10.1111/cch.12384   open full text
• Parents' voices: ‘why and how we advocate’. A meta‐synthesis of parents' experiences of advocating for their child with autism spectrum disorder.
  K. Boshoff, D. Gibbs, R. L. Phillips, L. Wiles, L. Porter.
  Child Care Health and Development. July 22, 2016
  Parenting a child with autism spectrum disorder (ASD) can be stressful, and accessing services can add to this stress. Self‐efficacy, agency and advocacy are important for parents when accessing and using services. To develop insight into parental advocacy, a meta‐synthesis was undertaken to consolidate the literature focussing on parents' experiences of advocating for their child with ASD. A qualitative meta‐synthesis was conducted. Fifteen databases were systematically searched by using key terms related to ASD, children, parents/carers, advocacy and qualitative studies. Twenty‐four studies were identified and appraised using an adapted version of the Critical Appraisal Skills Programme tool. Data were synthesized into themes through the steps of review, meta‐aggregation, integration and interpretation. Two overarching concepts emerged, illustrating both the challenging nature of advocacy and the associated personal and societal benefits. These two concepts are supported by eight themes: a life‐long, all‐encompassing challenge; advocacy as a parental coping strategy; advocacy involving working to create a future; balancing roles and needs; isolation versus support; personal impacts of advocacy; benefits of advocacy; and the barriers to advocacy. The experience of advocacy for parents with a child with ASD is complex and intensive, presenting both personal and societal benefits, as well as challenges for parents. In supporting individuals with ASD and family well‐being, service providers need to have an understanding of the advocating role of parents and ensure that opportunities exist for their voices to be heard during service delivery.

  July 22, 2016   doi: 10.1111/cch.12383   open full text
• Attention‐deficit/hyperactivity disorder casts a long shadow: findings from a population‐based study of adult women with self‐reported ADHD.
  E. Fuller‐Thomson, D. A. Lewis, S. K. Agbeyaka.
  Child Care Health and Development. July 20, 2016
  Background To develop a sociodemographic and health profile of women with self‐reported attention deficit/hyperactivity disorder (ADHD) in comparison to women without. Methods Chi‐square tests and logistic regression analyses were conducted on data from the nationally representative Canadian Community Health Survey‐Mental Health (2012) comparing 107 women aged 20 to 39 years (inclusive) with ADHD to 3801 without ADHD. Depression, generalized anxiety disorder and substance abuse were measured using the WHO‐CIDI. Results Women with ADHD had triple the prevalence of insomnia, chronic pain, suicidal ideation, childhood sexual abuse and generalized anxiety disorder and double the prevalence of substance abuse, current smoking, depressive disorders, severe poverty and childhood physical abuse in comparison with women without ADHD (all P < 0.001). Even after adjustments for age, race, education and income, women with ADHD had substantially higher odds of a wide range of problems. Conclusion Our results suggest that women with ADHD are particularly vulnerable to early adversities, health and mental health problems.

  July 20, 2016   doi: 10.1111/cch.12380   open full text
• Parenting children with intellectual disabilities in Malawi: the impact that reaches beyond coping?
  C. Masulani‐Mwale, D. Mathanga, D. Silungwe, F. Kauye, M. Gladstone.
  Child Care Health and Development. July 15, 2016
  Background Rates of disability are high in resource poor settings with 85% of children with disabilities living in these settings. Long‐term caregiving for disabled children is associated with fatigue, financial difficulties, parenting distress and other psychological issues. While such parents of children have repeatedly highlighted their feelings of discrimination, stigma and exclusion, leading to mental health issues, there is little research from the developing world addressing these issues. Research objectives This study aims to explore psychological experiences of parents caring for children with intellectual disabilities; understand their mechanisms of coping and their psychosocial needs in Malawi. Methodology This study used a qualitative phenomenological design. We purposively sampled parents who had children diagnosed with intellectual disability from two clinics in two cities in Malawi. Between January 2015 and March 2015, we conducted 10 focus group discussions and four in‐depth interviews. All ethical study procedures were carefully followed. All interviews were tape‐recorded, transcribed and translated from vernacular to English. Thematic approach of data analysis was adopted to understand the data. Findings Caring for intellectually disabled children comes with a number of challenges. Parents have limited access to services for their children let alone for their own psychological issues; they experience stigma and discrimination, have mental health issues resulting from the caring role, have suicidal ideas and in some cases have even been coerced by neighbours to kill their disabled child. To manage these issues, most parents cope through their spirituality. Discussion and recommendation Apart from suicide and filicide, the findings of this study are similar to those performed in other countries. It is recommended that parents' psychological issues be managed concurrently when providing services for their children. There is also a need to develop psychosocial training interventions to address the needs of the parents of these children.

  July 15, 2016   doi: 10.1111/cch.12368   open full text
• Use of electronic health records by child primary healthcare providers in Europe.
  Z. Grossman, S. Torso, D. Esso, J. H. H. Ehrich, P. Altorjai, A. Mazur, C. Wyder, A. M. Neves, H. J. Dornbusch, E. Jaeger Roman, A. Santucci, A. Hadjipanayis.
  Child Care Health and Development. July 10, 2016
  Background There is limited data on the use and functionality level of electronic health records (EHRs) supporting primary child health care in Europe. Our objective was to determine European primary child healthcare providers' use of EHRs, and functionality level of the systems used. Methods European primary care paediatricians, paediatric subspecialists and family doctors were invited by European Academy of Paediatrics Research in Ambulatory Setting Network (EAPRASnet) country coordinators to complete a web‐based survey on the use of EHRs and the systems' functionalities. Binomial logistic analysis has been used to evaluate the effect of specialty and type of practice on the use of EHRs. Results The survey was completed by 679 child primary healthcare providers (response rate 53%). Five hundred and fifty four responses coming from 10 predominant countries were taken for further analysis. EHR use by respondents varied widely between countries, all electronic type use ranging between 7% and 97%. There was no significant difference in EHR use between group practice and solo practitioners, or between family doctors and primary care paediatricians. History and physical examination can be properly recorded by respondents in most countries. However, growth chart plotting capacity in some countries ranges between 22% and 50%. Vaccination recording capacity varies between 50% and 100%, and data exchange capacity with immunization databases is mostly limited, ranging between 0% and 54%. Conclusions There is marked heterogeneity in the use and functionalities of EHRs used among child primary child healthcare providers in Europe. More importantly, lack of critical paediatric supportive functionalities like growth tracking and vaccination status has been documented in some countries. There is a need to explore the reasons for these findings, and to develop a cross European paediatric EHR standards.

  July 10, 2016   doi: 10.1111/cch.12374   open full text
• Adapting the Bayley Scales of infant and toddler development in Ethiopia: evaluation of reliability and validity.
  C. Hanlon, G. Medhin, B. Worku, M. Tomlinson, A. Alem, M. Dewey, M. Prince.
  Child Care Health and Development. July 06, 2016
  Background There is a need for valid and reliable observational measures of early child development in low‐income and middle‐income country settings. Methods The aims of the study were to adapt the Bayley Scales of Infant Development (Bayley III) for a rural Ethiopian setting and evaluate reliability and validity. The study was carried out between January 2008 and January 2009 in the Butajira demographic surveillance site, south central Ethiopia. The Bayley III was adapted to be socioculturally appropriate for a rural Ethiopian context. Nurses and high school graduates were trained in administration of the measure for 10 days. Inter‐rater reliability was evaluated (n = 60). Content, construct and convergent validity was then examined on a population‐based cohort of children at the ages of 30 (n = 440) and 42 months (n = 456). Mokken scale analysis was used to determine the scalability of items in unidimensional, hierarchical sub‐scales. The mean score was compared by age of child and by stunting status (less than −2 z scores below the standard height‐for‐age). Results The intra‐class correlations between raters were above 0.90 for all sub‐scales of the child development measure. Some scale items were not contextually relevant and showed poor scalability. However, the majority of items scaled onto the existing sub‐scales of the international measure to form adequate‐to‐strong hierarchical scales with good internal consistency (Cronbach's α above 0.70 except for gross motor and expressive language sub‐scales). Item‐scale coefficients were good. The mean score of all sub‐scales was significantly higher in the older group of children (33.02 higher total score; P < 0.001) and in the children who were stunted (total Bayley score 2.58 (95% confidence interval 0.07 to 5.10) points lower at 30 months and 3.87 (1.94 to 5.81) points lower at 42 months. Conclusions An adapted version of an international, observational measure of child development was found to be reliable, valid and feasible in a rural Ethiopian setting.

  July 06, 2016   doi: 10.1111/cch.12371   open full text
• Validation of a rapid neurodevelopmental assessment tool for 10‐ to 16‐year‐old young adolescents in Bangladesh.
  H. Muslima, N. Z. Khan, A. B. Shilpi, D. Begum, M. Parveen, H. McConachie, G. L. Darmstadt.
  Child Care Health and Development. June 30, 2016
  Objective To validate a Rapid Neurodevelopmental Assessment (RNDA) tool for use by child health professionals to determine neurodevelopmental impairments (NDIs) in young adolescents aged 10–16 years in Bangladesh. Study design In a convenience sample of community children (n = 47), inter‐rater reliability was determined between four testers, and concurrent validity was determined by simultaneous administration of an intelligence quotient (IQ) test (Wechsler Intelligence Scale for Children, Revised) by a child psychologist. Results Inter‐rater reliability was excellent between the testers on the 47 children administered the RNDA (kappa = 1.00). Significantly lower IQ scores were obtained in those identified with ‘any (>1) NDI’ (n = 34) compared with those with no NDI (n = 13) on Verbal IQ (P‐value < 0.0001), Performance IQ (P‐value < 0.0001) and Full‐scale IQ (P‐value < 0.0001) scores on the Wechsler Intelligence Scale for Children, Revised. Conclusion The RNDA shows promise as a tool for use by child health professionals for identifying NDIs in young adolescents aged 10–16 years. A larger study sample is needed to determine its usefulness for identification of some impairments not found in the study population, i.e. gross motor, fine motor, hearing and seizures.

  June 30, 2016   doi: 10.1111/cch.12362   open full text
• The awareness of primary caregivers in South Africa of the human rights of their children with intellectual disabilities.
  K. Huus, S. Dada, J. Bornman, F. Lygnegård.
  Child Care Health and Development. June 30, 2016
  Background Besides the right to freedom, human rights can be seen as a basic requirement also for the maintenance of human dignity and the opportunity to thrive – particularly in the case of children with disabilities. It is imperative to explore primary caregivers' awareness of the human rights of their children with intellectual disabilities in view of the role they may play in either facilitating or restricting these rights. This paper explores the awareness of 219 primary caregivers of the human rights of their children with intellectual disabilities. Method A descriptive survey design was used with a custom‐designed questionnaire that employed a deductive content analysis based on the articles of the United Nations Convention on the Rights of a Child. Comparisons were drawn between the awareness of primary caregivers from urban and those from rural areas. Results The majority (85.5%) of participants agreed that their child with intellectual disability had rights. Three broad kinds of right were mentioned (in descending order): provision rights, protection rights and participation rights. Participants from both urban and rural areas mentioned education (a provision right) most frequently. However, participants from urban areas were more aware of the different rights that existed than were their counterparts from rural areas. Conclusion Primary caregivers in both rural and urban areas are aware of the rights of their children with disabilities, although there are significant differences between them.

  June 30, 2016   doi: 10.1111/cch.12358   open full text
• Subjective well‐being amongst migrant children in China: unravelling the roles of social support and identity integration.
  S. Ni, C. H.‐K. Chui, X. Ji, L. Jordan, C. L.‐W. Chan.
  Child Care Health and Development. June 27, 2016
  Background Migrant children refer to rural children who accompany one or both parents to urban area. Empirical evidence showed that compared with their urban counterparts, migrant children had poorer developmental, emotional and psychological health. Method A sample of 1306 migrant children were recruited to examine the characteristics of migrant children and investigate the effects of identity integration, support and socioeconomic factors (e.g. age, gender, type of school, family socioeconomic status, city type) on their subjective wellbeing. Results Children with higher levels of identity integration, social support, family socioeconomic status, who attended public school and who lived in the third‐tiered city of Weihai demonstrated better subjective wellbeing. Social support remained a strong predictor for subjective wellbeing, despite a significant mediating effect of identity integration. Conclusions These results highlight the need for policymakers and practitioners alike to address individual factors pertaining to psychological adjustments, as well as social determinants of subjective wellbeing in the context of migration.

  June 27, 2016   doi: 10.1111/cch.12370   open full text
• The reliability and validity of a child and adolescent participation in decision‐making questionnaire.
  L. O'Hare, O. Santin, K. Winter, C. McGuinness.
  Child Care Health and Development. June 26, 2016
  Background There is a growing impetus across the research, policy and practice communities for children and young people to participate in decisions that affect their lives. Furthermore, there is a dearth of general instruments that measure children and young people's views on their participation in decision‐making. This paper presents the reliability and validity of the Child and Adolescent Participation in Decision‐Making Questionnaire (CAP‐DMQ) and specifically looks at a population of looked‐after children, where a lack of participation in decision‐making is an acute issue. Methods The participants were 151 looked after children and adolescents between 10–23 years of age who completed the 10 item CAP‐DMQ. Of the participants 113 were in receipt of an advocacy service that had an aim of increasing participation in decision‐making with the remaining participants not having received this service. Results The results showed that the CAP‐DMQ had good reliability (Cronbach's alpha = 0.94) and showed promising uni‐dimensional construct validity through an exploratory factor analysis. The items in the CAP‐DMQ also demonstrated good content validity by overlapping with prominent models of child and adolescent participation (Lundy 2007) and decision‐making (Halpern 2014). A regression analysis showed that age and gender were not significant predictors of CAP‐DMQ scores but receipt of advocacy was a significant predictor of scores (effect size d = 0.88), thus showing appropriate discriminant criterion validity. Conclusion Overall, the CAP‐DMQ showed good reliability and validity. Therefore, the measure has excellent promise for theoretical investigation in the area of child and adolescent participation in decision‐making and equally shows empirical promise for use as a measure in evaluating services, which have increasing the participation of children and adolescents in decision‐making as an intended outcome.

  June 26, 2016   doi: 10.1111/cch.12369   open full text
• Visual–motor integration performance in children with severe specific language impairment.
  K. Nicola, P. Watter.
  Child Care Health and Development. June 12, 2016
  Background This study investigated (1) the visual–motor integration (VMI) performance of children with severe specific language impairment (SLI), and any effect of age, gender, socio‐economic status and concomitant speech impairment; and (2) the relationship between language and VMI performance. It is hypothesized that children with severe SLI would present with VMI problems irrespective of gender and socio‐economic status; however, VMI deficits will be more pronounced in younger children and those with concomitant speech impairment. Furthermore, it is hypothesized that there will be a relationship between VMI and language performance, particularly in receptive scores. Methods Children enrolled between 2000 and 2008 in a school dedicated to children with severe speech‐language impairments were included, if they met the criteria for severe SLI with or without concomitant speech impairment which was verified by a government organization. Results from all initial standardized language and VMI assessments found during a retrospective review of chart files were included. Results The final study group included 100 children (males = 76), from 4 to 14 years of age with mean language scores at least 2SD below the mean. For VMI performance, 52% of the children scored below −1SD, with 25% of the total group scoring more than 1.5SD below the mean. Age, gender and the addition of a speech impairment did not impact on VMI performance; however, children living in disadvantaged suburbs scored significantly better than children residing in advantaged suburbs. Receptive language scores of the Clinical Evaluation of Language Fundamentals was the only score associated with and able to predict VMI performance. Conclusions A small subgroup of children with severe SLI will also have poor VMI skills. The best predictor of poor VMI is receptive language scores on the Clinical Evaluation of Language Fundamentals. Children with poor receptive language performance may benefit from VMI assessment and multidisciplinary management.

  June 12, 2016   doi: 10.1111/cch.12365   open full text
• Health‐related impairments in young children with ADHD: a community‐based study.
  E. Sciberras, M. Bisset, P. Hazell, J. M. Nicholson, V. Anderson, K. Lycett, B. Jongeling, D. Efron.
  Child Care Health and Development. June 12, 2016
  Background We aimed to examine health‐related impairments in young children with attention‐deficit/hyperactivity disorder (ADHD) and non‐ADHD controls and explore differences in children with ADHD by gender, ADHD subtype and mental health co‐morbidity status. Methods Children with ADHD (n = 177) and controls (n = 212) aged 6–8 years were recruited across 43 schools in Melbourne, Australia following a screening (Conners 3 ADHD Index) and case confirmation procedure (Diagnostic Interview Schedule for Children IV). Direct and blinded assessments of height and weight were used to calculate body mass index z‐score and to identify overweight/obesity. Parents reported on child global health, sleep problems and physical injuries. Unadjusted and adjusted (socio‐demographic factors and co‐morbidities) logistic and linear regression were conducted to compare health‐related impairments between (1) children with and without ADHD; (2) boys and girls with ADHD; (3) children with ADHD‐inattentive and ADHD‐combined types; and (4) children with ADHD by internalizing and externalizing disorder status. Results Children with ADHD had poorer global health than controls when adjusted for socio‐demographic characteristics (OR: 2.0; 95% CI 1.1, 3.9); however, this attenuated after adjusting for co‐morbidities. In adjusted analyses, children with ADHD had increased odds of moderate/large sleep problems (OR: 3.1; 95% CI 1.4, 6.8), compared with controls. There were no differences between children with and without ADHD in terms of physical injuries or overweight/obesity. Findings were similar when excluding children taking ADHD medication, and health‐related impairments did not differ between boys and girls with ADHD. Children with ADHD‐combined type had higher BMI z‐scores than controls in adjusted analyses (P = 0.04). Children with ADHD and co‐occurring internalizing and externalizing co‐morbidities were particularly vulnerable to health‐related impairments. Conclusion Young children with ADHD experience a number of health‐related impairments, which are exacerbated by the presence of internalizing and externalizing co‐morbidities. Clinicians should consider the broader health of children with ADHD in clinical consultations.

  June 12, 2016   doi: 10.1111/cch.12363   open full text
• Associations between recurrent musculoskeletal pain and visits to the family doctor (GP) and specialist multi‐professional team in 74 Norwegian youth with cerebral palsy.
  K. Ramstad, R. Jahnsen, T. H. Diseth.
  Child Care Health and Development. June 09, 2016
  Background Musculoskeletal pain in cerebral palsy (CP) is common, but probably undertreated. The aim of the study was to explore if recurrent musculoskeletal pain (RMP) related to the CP condition was associated with visits to the family doctor [general practitioner (GP)] and specialist habilitation centre in youth with CP. Methods Seventy‐four youth with CP (mean age 16.5 years, 40 boys) from the same geographical area were assessed by clinical examination, semi‐structured interview on pain (adolescent and parent together), the two questions on pain from the Child Health Questionnaire (parents only) and a structured interview on health care services. Gross Motor Function Classification System was level I 39%, level II 23%, level III 8% and levels IV and V 30%. Results Thirty‐five participants (47%) had visited their GP last year, and 49 (66%) had visited the specialist habilitation centre. The presence of RMP (n = 58; 78%) was not significantly associated with having visited the GP or the specialist habilitation centre. Still, in participants with RMP, increasing pain severity was associated with having visited the GP. Rest, massage, change of position and oral drugs were the most common measures taken to relieve RMP. Three adolescents with RMP did not take any measures to relieve pain. Conclusion Youth with RMP do take measures to relieve pain, but usually not in the direction of consulting the health care services available unless the pain is severe. Both youth with CP and their caregivers should be encouraged to discuss RMP with their professional network of care.

  June 09, 2016   doi: 10.1111/cch.12366   open full text
• Is a family‐centred initiative a family‐centred service? A case of a Conductive Education setting for children with cerebral palsy.
  R. Schenker, S. Parush, P. Rosenbaum, A. Rigbi, A. Yochman.
  Child Care Health and Development. June 09, 2016
  Background From the moment a child is diagnosed as having cerebral palsy, families have to cope on a daily basis with the multifaceted challenges of life‐long disability management. Family‐centred service is embraced as a ‘best practice’ model because of accumulating evidence supporting its positive influence on parents and children's outcomes. Nevertheless, research comparing parent and provider perspectives on family‐centred practices of educational service providers in education settings is scarce. The aims of this study were to compare the extent to which parents and conductors experience the service delivery in Tsad Kadima, the Association for Conductive Education in Israel, as being family‐centred, as well as comparing parents’ perception of different educational settings as being family‐centred. Methods Measurements of family‐centeredness, the Israeli Measure of Processes of Care for families (MPOC‐20) and for service providers (MPOC‐SP), were administrated to 38 teacher conductors and 83 families of children with cerebral palsy (aged 1–14), from different conductive educational settings. Results Parents and conductors perceive Conductive Education service as being highly family centred in most domains, rating respectful and supportive care the highest and providing general information the lowest, thus indicating an area where improvements should be made. Parents perceived the service they receive to be more family‐centred than conductor's perception about their own activities. In addition, educational setting (day care, pre‐school and school) was found to be associated with parent's scores. Conclusions The current study, which is the first to examine family‐centred service provision in a conductive special education setting, from the perspectives of both parents and conductors, provides significant evidence for high‐quality services in these settings.

  June 09, 2016   doi: 10.1111/cch.12354   open full text
• The association between adverse childhood experiences (ACEs) and suicide attempts in a population‐based study.
  E. Fuller‐Thomson, S. L. Baird, R. Dhrodia, S. Brennenstuhl.
  Child Care Health and Development. June 09, 2016
  Objectives To further our understanding of the relationship between Adverse Childhood Experiences (ACEs) and suicidal behaviour, this study investigates the association between three types of ACEs and lifetime suicide attempts, while considering potential gender‐specific and mediating effects. Methods Data were obtained from the 2012 Canadian Community Health Survey‐Mental Health (CCHS‐MH), a cross‐sectional, population‐based survey comprised of respondents aged 18 or older who provided self‐reported data on past experiences of suicide attempts, as well as childhood sexual abuse (CSA), childhood physical abuse (CPA) and parental domestic violence (PDV) (n = 22 559). After testing for ACE by gender interactions, we estimated the odds of lifetime suicide attempts for each ACE and then investigated whether depression, anxiety, substance abuse and chronic pain acted as mediators of the relationship. Results The odds of suicide attempts are significantly higher among those with a history of CPA (OR = 3.29; 99.9% CI 2.33–4.64), CSA (OR = 4.42; 99.9% CI 3.14–6.23) or PDV (OR = 2.52; 99.9% CI 1.69–3.76), when ACEs are mutually adjusted. There is little evidence that gender acts as a moderator; however, depression, anxiety, substance abuse and chronic pain appear to partially mediate the associations. Depression alone accounts for about a quarter of the associations with CSA and CPA. Conclusions Mental health factors and chronic pain appear only to partially mediate relationships between ACEs and lifetime suicide attempts. Future research should look at other pathways with the goal of developing multi‐level interventions.

  June 09, 2016   doi: 10.1111/cch.12351   open full text
• Reliability and validity of the Spanish version of the Children's Sleep Habits Questionnaire (CSHQ‐SP) in school‐age children.
  L. Lucas‐de la Cruz, V. Martínez‐Vizcaino, C. Álvarez‐Bueno, N. Arias‐Palencia, M. Sánchez‐López, B. Notario‐Pacheco.
  Child Care Health and Development. June 08, 2016
  Background Sleep disorders in schoolchildren are a common problem worldwide, and when are not adequately diagnosed and treated, their negative impact on daytime functioning may be significant. The aim of this study was to evaluate the psychometric properties of the Spanish version of the Children's Sleep Habits Questionnaire (CSHQ). Methods Participants were 286 school‐aged children from a community‐based sample, aged 4 to 7 years. The sleep behaviour was evaluated using the CSHQ and actigraphy (ActiSleep monitor). The CSHQ was adapted to the Spanish language. The internal consistency of the questionnaire and the test–retest reliability between scores at baseline and three‐weeks‐later were estimated. Associations between CSHQ items and accelerometer sleep quality indicators were used as indicators of concurrent validity. Results Cronbach's alpha coefficients for the subscales ranged from 0.60 to 0.81, and 0.81 for the full scale; the intraclass correlation coefficients ranged from 0.56 to 0.81. A moderate correlation was observed in sleep latency and awakenings measurements using both parents' reported sleep habits (CSHQ‐SP) and sleep quality indicators (ActiSleep). Conclusions The CSHQ‐SP has demonstrated adequate psychometric properties, and it serves as a useful instrument for clinical and research setting.

  June 08, 2016   doi: 10.1111/cch.12357   open full text
• Reliability of the German version of the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC).
  A. Fink, B. Gebhard, S. Erdwiens, L. Haddenhorst, S. Nowak.
  Child Care Health and Development. June 08, 2016
  Background The introduction of the International Classification of Functioning, Disabilities and Health of the World Health Organization in 2001 made social participation a major rehabilitation outcome and the ultimate goal of rehabilitation services. There is no available instrument to measure the youth participation in leisure activities apart from asking the youth themselves. The goal of this study was to present a German version of the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC). Methods The CAPE/PAC questionnaire was translated into German, a cultural adaptation process was designed and a reliability study was conducted. One hundred and fifty‐two youths with and without disabilities, with a mean age of 15.2 years (standard deviation 1.7), participated in the study. The participants completed CAPE and PAC twice within 4 weeks. Reliability was examined by intraclass correlation coefficients, standard error of measurement, smallest detectable change and Cronbach's alpha. Results The absolute values of participation differ between the typically developed youth group and those with impairments; the reliability of the CAPE/PAC is comparable in both groups. Intraclass correlation coefficients ranged from 0.43 to 0.74 for the CAPE and from 0.71 to 0.83 for the PAC in all participants. The alpha values for internal consistency ranged from 0.42 to 0.82 for the CAPE and from 0.65 to 0.92 for the PAC. Conclusions The German version of the PAC showed satisfactory reliability; however, reliability was not satisfactory for all scores of the CAPE, but comparable with versions in other languages. The need for newly developed participation measurements requires further discussion.

  June 08, 2016   doi: 10.1111/cch.12360   open full text
• Validity and reliability of a pictorial instrument for assessing perceived motor competence in Portuguese children.
  V. P. Lopes, L. M. Barnett, L. Saraiva, C. Gonçalves, S. J. Bowe, G. Abbott, L. P. Rodrigues.
  Child Care Health and Development. June 07, 2016
  Background It is important to assess young children's perceived Fundamental Movement Skill (FMS) competence in order to examine the role of perceived FMS competence in motivation toward physical activity. Children's perceptions of motor competence may vary according to the culture/country of origin; therefore, it is also important to measure perceptions in different cultural contexts. The purpose was to assess the face validity, internal consistency, test–retest reliability and construct validity of the 12 FMS items in the Pictorial Scale for Perceived Movement Skill Competence for Young Children (PMSC) in a Portuguese sample. Methods Two hundred one Portuguese children (girls, n = 112), 5 to 10 years of age (7.6 ± 1.4), participated. All children completed the PMSC once. Ordinal alpha assessed internal consistency. A random subsamples (n = 47) were reassessed one week later to determine test–retest reliability with Bland–Altman method. Children were asked questions after the second administration to determine face validity. Construct validity was assessed on the whole sample with a Bayesian Structural Equation Modelling (BSEM) approach. The hypothesized theoretical model used the 12 items and two hypothesized factors: object control and locomotor skills. Results The majority of children correctly identified the skills and could understand most of the pictures. Test–retest reliability analysis was good, with an agreement ration between 0.99 and 1.02. Ordinal alpha values ranged from acceptable (object control 0.73, locomotor 0.68) to good (all FMS 0.81). The hypothesized BSEM model had an adequate fit. Conclusions The PMSC can be used to investigate perceptions of children's FMS competence. This instrument can also be satisfactorily used among Portuguese children.

  June 07, 2016   doi: 10.1111/cch.12359   open full text
• Children referred for evaluation for ADHD: comorbidity profiles and characteristics associated with a positive diagnosis.
  D. Efron, H. Bryson, K. Lycett, E. Sciberras.
  Child Care Health and Development. June 07, 2016
  Background The symptoms of attention‐deficit/hyperactivity disorder (ADHD) are non‐specific, and a range of possible causes and comorbidities need to be considered in children referred for assessment. Objective To examine the factors associated with ADHD diagnosis following multidisciplinary assessment. Methods Children underwent multidisciplinary evaluation including parent and teacher questionnaires; semi‐structured interview to screen for internalizing and externalizing diagnoses; paediatric, psychology and special education assessments; and case conference. Predictors of ADHD diagnosis were examined in univariable and multivariable logistic regression models. Results Data from 190 assessments (82% male, mean age 6.8 years) were included. ADHD was diagnosed in 132 (70%) cases, of which 77% had one or more comorbidities. In children not diagnosed with ADHD, 60% had one or more alternate diagnosis made. Teacher‐reported ADHD symptom severity and learning difficulties were the strongest predictors of ADHD diagnosis. The pattern of comorbid/alternative diagnoses was similar between those diagnosed with ADHD and those not diagnosed with ADHD. Conclusions Direct report from teachers is the most critical element of the clinical dataset for the evaluation for ADHD. These findings emphasize the importance of cross‐situational impairment to ADHD diagnosis. The frequency and similarity of diagnoses in both groups highlight the overlapping nature of childhood developmental disorders, and the importance of evaluating for comorbid disorders regardless of the primary diagnosis.

  June 07, 2016   doi: 10.1111/cch.12364   open full text
• Comparisons in childhood obesity and cardiometabolic risk factors among urban Saudi Arab adolescents in 2008 and 2013.
  N.M. Al‐Daghri, N.J. Aljohani, O.S. Al‐Attas, Y. Al‐Saleh, A.M. Alnaami, S. Sabico, O.E. Amer, M. Alharbi, S. Kumar, M.S. Alokail.
  Child Care Health and Development. June 07, 2016
  Background We aimed to compare the prevalence of childhood obesity and other cardiometabolic risk factors from two independent cohorts (2008 and 2013) in Riyadh, Saudi Arabia. Methods A total of 4549 adolescents aged 12–18 years [2454 boys, 2095 girls], taken from two independent cohorts, 5 years apart (2008 and 2013), were included. Anthropometrics were measured, and fasting blood samples were taken to ascertain glucose and lipid profile. Results The overall prevalence of obesity was significantly higher in 2013 [15.3 (95% confidence interval 13.7–16.9)] than 2008 [12.6 (11.3–13.9)] (P = 0.012). Stratified by sex, the prevalence of obesity among boys was significantly higher in 2013 than 2008 [2008 = 12.0 (10.3–13.7) versus 2013 = 17.4 (15.1–19.7); P < 0.001]. The age groups 13 and 15 years had a significantly higher mean triglycerides in 2013 than 2008 (P‐values 0.003 and <0.001, respectively) and lower mean HDL‐cholesterol also in the 13 years old age group (P < 0.001). Conclusions The prevalence of childhood obesity in Saudi Arabia has increased in particular age groups (13–15 years) during a 5‐year span. Special attention is warranted in these vulnerable age groups, particularly in boys, as cardiometabolic risk factors appear to worsen.

  June 07, 2016   doi: 10.1111/cch.12361   open full text
• Experiences and perspectives of children attending a weight loss camp in China: a qualitative study.
  X. Li, X. Zhou, T. Hesketh.
  Child Care Health and Development. June 07, 2016
  Background Modernisation, urbanisation and the globalisation of food markets have exposed Chinese children to an obesogenic environment. With the dramatic increase in the prevalence of overweight and obesity among Chinese children, there are now over 2000 weight loss camps for children. The aim of this study was to investigate how one typical weight loss camp operates and to explore the experiences and perceptions of children attending the camp. Methods This study utilised ethnographic techniques and semi‐structured interviews with children attending a 28‐day summer weight loss camp in Hangzhou, China. All children attending at the time of the study were included. Field notes were taken, and interviews with children were recorded, transcribed and analysed into themes. Results Nine boys and 10 girls aged 7–18 years with a body mass index ranging from 21 to 37 kg/m2 were interviewed. The weight loss programme combined dietary restriction (<350 calories/meal) and a daily schedule of 8 h of exercise in outdoor temperatures of around 40 °C. Field observation and interviews showed that the regime was distressing for all the children who suffered hunger and exhaustion leading to crying, squabbling, fighting and desperate phone calls to parents. All felt their weight loss could not be sustained. Conclusions The extreme conditions and total absence of health and nutrition education at the camp were of great concern. Parents should be aware of the potential dangers and long‐term ineffectiveness of such interventions. At the very least, these camps must be subject to regulation.

  June 07, 2016   doi: 10.1111/cch.12353   open full text
• Siblings of children with complex care needs: their perspectives and experiences of participating in everyday life.
  R. L. Woodgate, M. Edwards, J. D. Ripat, G. Rempel, S. F. Johnson.
  Child Care Health and Development. May 19, 2016
  Background Participating in everyday life is essential to the healthy development and emotional well‐being of children. However, little is known about siblings of children with complex care needs (CCN), and their perspectives and experiences of participating in everyday life. The aim of this paper is to present research findings that add to our understanding of how siblings of children with CCN view and experience participation in everyday life. Methods To arrive at a detailed and accurate understanding of the siblings' perspectives and experiences, we used the qualitative research design of ethnography. Sixteen siblings (seven brothers, nine sisters) of children with CCN were recruited. The siblings ranged in age between 7 and 25 years, with a mean age of 14 years. All siblings took part in opened‐ended interviews and completed ecomaps to describe how they participate. Five siblings also took part in the photovoice method. Analysis involved several iterative steps, congruent with ethnography. Results Four main themes emerged as follows: (1) participation is about being part of a group; (2) it feels good; (3) I love my sibling but…; and (4) promoting participation. Siblings of children with CCN identified challenges to participation and also described ways that they participate that relate to the care of their sibling. Conclusions Siblings prioritized the relationship with their sisters and brothers with CCN in their life, and a great deal of their participation was chosen with their sibling in mind. Sibling‐to‐sibling relationships were distinct and meaningful and, as a result, participation was always done mindfully and with the family needs at the forefront. Nonetheless, clinicians caring for children with CCN must keep in mind the challenges that siblings of children with CCN experience and provide strategies to siblings that will help to promote their participation in everyday life.

  May 19, 2016   doi: 10.1111/cch.12345   open full text
• Treatment with botulinum toxin in children with cerebral palsy: a qualitative study of parents' experiences.
  K. Lorin, A. Forsberg.
  Child Care Health and Development. May 19, 2016
  Background In children with cerebral palsy everyday movements such as walking, standing and using one's hands can be difficult to perform because of spasticity. Botulinum neurotoxin type A (BoNT‐A) are often used to reduce spasticity. The aim of this study was to describe how parents of children with cerebral palsy experienced the child's treatment with BoNT‐A, how the child was affected by the treatment and how spasticity affected the child. Methods A qualitative study in which 15 parents of children (6–13 years old) with cerebral palsy were interviewed about their experiences of the BoNT‐A treatment. The children had received several BoNT‐A treatments. An interview guide was used with topics: the child's functions before and after the treatment, the outcomes of the treatment and how they valued the BoNT‐A treatment. Content analysis was used to analyse the interviews. Results The analyses resulted in two themes: ‘When softness comes and goes’ and ‘Both want and do not want’. The reduction of spasticity – softness – was described to promote motor functions, and facilitate the next step in motor development. The children were described as being more active out of their own initiative and having a happier mood. Spasticity, described as stiffness, was described to make walking more strenuous as well as interfering with activities. The BoNT‐A injection procedure was perceived as troublesome and painful for the child, and sometimes traumatic for both children and parents. Conclusions Treatment with BoNT‐A was described as facilitating motor development and activity. The children's and the parents' negative experiences of the injection procedure should be addressed.

  May 19, 2016   doi: 10.1111/cch.12350   open full text
• Movement Assessment of Children (MAC): validity, reliability, stability and sensitivity to change in typically developing children.
  L. S. Chandler, L. Terhorst, J. C. Rogers, M. B. Holm.
  Child Care Health and Development. May 15, 2016
  Aim The purpose of this study was to establish the validity, reliability, stability and sensitivity to change of the family‐centred Movement Assessment of Children (MAC) in typically developing infants/toddlers from 2 months (1 month 16 days) to 2 years (24 months 15 days) of age. Background Assessment of infant/toddler motor development is critical so that infants and toddlers who are at‐risk for developmental delay or whose functional motor development is delayed can be monitored and receive therapy to improve their developmental outcomes. Infants/toddlers are thought to be more responsive during the MAC assessment because parents and siblings participate and elicit responses. Methods Two hundred seventy six children and 405 assessments contributed to the establishment of age‐related parameters for typically developing infants and toddlers on the MAC. The MAC assesses three core domains of functional movement (head control, upper extremities and hands, pelvis and lower extremities), and generates a core total score. Four explanatory domains serve to alert examiners to factors that may impact atypical development (general observations, special senses, primitive reflexes/reactions, muscle tone). Construct validity of functional motor development was examined using the relationship between incremental increases in scores and increases in participants' ages. Subsamples were used to establish inter‐rater reliability, test–retest reliability, stability and sensitivity to change. Results Construct validity was established and inter‐rater reliability ICCs for the core items and core total ranged from 0.83 to 0.99. Percent agreement for the explanatory items ranged from 0.72 to 0.96. Stability within age grouping was consistent from baseline to 6 months post‐baseline, and sensitivity to change from baseline to 6 months was significant for all core items and the total score. Conclusion The MAC has proven to be a well‐constructed assessment of infant and toddler functional motor development. It is a family‐centred and efficient tool that can be used to assess and follow‐up of infants and toddlers from 2 months to 2 years.

  May 15, 2016   doi: 10.1111/cch.12348   open full text
• Assent for children's participation in research: why it matters and making it meaningful.
  K. Oulton, F. Gibson, D. Sell, A. Williams, L. Pratt, J. Wray.
  Child Care Health and Development. May 02, 2016
  Background There are gaps in the existing evidence base about assent, with conflicting and unhelpful views prevalent. We contend that appropriate assent is a valuable process that has important consequences for children's/young people's participation in research. Furthermore, there is a need for a model to support researchers in making decisions about who to assent and how to do this is a meaningful way. Methods We undertook a scoping review of the literature to assess the body of opinion on assent in research with children/young people. An anonymous online survey was conducted to gather views from the wider community undertaking research with children/young people. We also sought to gather examples of current and effective practice that could be shared beyond the level of a single institution and our own experience. Survey participants included 48 health professionals with varied levels of experience, all actively involved in research with children. Results Published work, the findings from the online survey and our knowledge as experienced researchers in the field have confirmed four domains that should be considered in order for assent to be meaningful and individualized: child‐related factors, family dynamics, study design and complexity and researcher and organizational factors. Mapping these domains onto the three paradigm cases for decision‐making around children and young people's assent/consent as recommended by the Nuffield Council on Bioethics has resulted in a model that will aid researchers in understanding the relationship between assent and consent and help them make decisions about when assent is appropriate. Conclusions The debate about assent needs to move away from terminology, definition and legal issues. It should focus instead on practical ways of supporting researchers to work in partnership with children, thus ensuring a more informed, voluntary and more robust and longer lasting commitment to research.

  May 02, 2016   doi: 10.1111/cch.12344   open full text
• Questioning assent: how are children's views included as families make decisions about clinical trials?
  L. Madden, V. Shilling, K. Woolfall, E. Sowden, R. L. Smyth, P. R. Williamson, B. Young.
  Child Care Health and Development. May 02, 2016
  Background Assent is used to take children's wishes into account when they are invited into clinical trials, but the concept has attracted considerable criticism. We investigated children's accounts of decision‐making with the aim of informing practice in supporting children when invited to join a clinical trial. Methods We audio‐recorded qualitative, semi‐structured interviews with 22 children aged 8–16 years about being invited to take part in a clinical trial. Most children were interviewed with their parents. Analysis of the transcribed interviews examined the content of participants' accounts thematically, whilst also drawing on principles of discourse analysis, which examines how individuals use talk to achieve certain effects or social practices. Results It was not possible to separate children's knowledge of the clinical trial, or their decision‐making processes from that of their parents, with parents taking a substantial mediating role in producing their children's decisions. Decision‐making gradually unfolded across time and events and was interwoven within the family context, rather than happening in one moment or in the clinical setting. Whilst children valued their parents' role, a case study of child–parent disagreement indicated how children can struggle to be heard. Conclusions Decisions happen within a process of family dynamics, in contrast to ideas of assent that isolate it from this context. Parents have a substantial role in children's decisions, and thus how families come to provide consent. Reflecting this we argue that assent practices need to focus on supporting parents to support their children in learning and deliberating about trials. However, this needs to be accompanied by practitioners being alert to the possibility of divergence in child and parent views and enabling children's perspectives to be heard.

  May 02, 2016   doi: 10.1111/cch.12347   open full text
• Comparison of parental estimate of developmental age with measured IQ in children with neurodevelopmental disorders.
  S. Chandler, P. Howlin, E. Simonoff, J. Kennedy, G. Baird.
  Child Care Health and Development. April 28, 2016
  Background Formal IQ tests are an important part of the diagnostic and needs‐based assessment process for children with neurodevelopmental disorders. However, resources for such assessments are not always available. It has been suggested that parental estimates of their child's developmental age could serve as a proxy IQ when formal measures are unavailable. Method Parental estimates of their child's developmental age were converted to a developmental quotient (DQ) in 197 children with Autism Spectrum Disorder (ASD) aged 4–9 years, and 108 children with ADHD and intellectual disability (ADHD + ID) aged 7–15 years. Formal IQ assessments were then conducted. Parents completed the Social Communication Questionnaire ((SCQ), a measure of autism symptomatology) and a demographic questionnaire. Results In the ASD sample, 58% of parent estimates were within 15 points (i.e. one standard deviation) of the child's measured IQ score. Lower measured IQ and lower SCQ total score predicted higher parental accuracy. In the ADHD + ID sample, 74% of parental estimates were within 15 points of measured IQ. In this group, higher child IQ predicted greater parental accuracy. Parents in the ADHD + ID group were more likely to overestimate children's ability level than parents in the ASD group. Conclusions In this study, the majority of parents of children with ADHD and ID were able to estimate their child's intellectual ability level with some accuracy. Parents of children with ASD were less accurate, but this may be because these parents were focussing more on children's level of adaptive functioning, which is known to be typically lower than cognitive ability in ASD.

  April 28, 2016   doi: 10.1111/cch.12346   open full text
• Issues around childhood disclosure of HIV status – findings from a qualitative study in West Bengal, India.
  A. Das, R. Detels, M. Javanbakht, S. Panda.
  Child Care Health and Development. April 27, 2016
  Introduction Informing the children living with HIV (CLH) about their disease (disclosure) is important from the perspective of disease treatment and overall psychosocial development. There are no published studies that qualitatively explored HIV disclosure‐related issues among CLH in India. Our aim was to provide insights into the perceptions of informal caregivers of CLH regarding childhood disclosure. Methods Children were defined as those aged <16 years. In‐depth interviews were conducted with 34 primary caregivers of CLH aged 8 to 15 years old who were residing in West Bengal, India. The participants were recruited with the help of a community‐based organization that provides need‐based services to people living with HIV. Results We obtained caregivers' perspectives on the motivators and barriers of childhood disclosure. Health benefits such as medication adherence emerged as an important motivator, while distress caused by disclosure and potential for stigma were identified as barriers. Health care providers were the preferred disclosers for most caregivers, followed by the caregivers themselves. Some caregivers wanted their child to learn about his/her HIV status by him/herself. There was no consensus among the caregivers about the ideal age for disclosure. Many preferred to wait until the child attained maturity or was of marriageable age. Discussion Disclosure of HIV status to children is an emotional issue, both for the caregiver and the child. Like most low‐or middle‐income countries, no standardized, age‐appropriate disclosure guidelines exist in India. Our findings advocate adoption of a multi‐faceted approach, including increased availability of social and familial support, for childhood HIV disclosure.

  April 27, 2016   doi: 10.1111/cch.12338   open full text
• Parents' perceptions of the services provided to children with cerebral palsy in the transition from preschool rehabilitation to school‐based services.
  M. W. Alsem, M. Verhoef, J. W. Gorter, L. C. M. Langezaal, J. M. A. Visser‐Meily, M. Ketelaar.
  Child Care Health and Development. April 26, 2016
  Aim To describe the course of parents' perceptions of the family centredness of rehabilitation services provided to their children with cerebral palsy (CP) before and after the transition from preschool to school‐based services. Background Parents of 59 children with CP aged 2.5 to 4.5 years filled in the 56‐item Measure of Processes of Care (MPOC‐56) on three occasions pre (2) and post (1) transition to school‐based services. Friedman tests were used to describe changes in parents' perceptions over time. Mann–Whitney U tests were used to describe differences in course of parents' perceptions between regular school and special school or day care. Results Parents' perceptions of preschool services were stable between the ages of 2.5 and 3.5 years, with a decline after transition on four of the five domains of the MPOC (P < 0.05). The domain providing general information was scored lowest (median at baseline 3.56, IQR 2.39) compared with the four other MPOC domains, but remained stable over time. No differences in course of parental perceptions were found for school type. Conclusion The transition from preschool to school‐based services for children with CP is associated with a decrease in parents' perception of family centredness independent of the type of school. The transition in services has a negative impact on perceived family‐centred practices.

  April 26, 2016   doi: 10.1111/cch.12341   open full text
• You never transition alone! Exploring the experiences of youth with chronic health conditions, parents and healthcare providers on self‐management.
  T. Nguyen, D. Henderson, D. Stewart, O. Hlyva, Z. Punthakee, J. W. Gorter.
  Child Care Health and Development. April 22, 2016
  Background Recent evidence suggests that fostering strategies to enable youth with chronic health conditions to work towards gradual self‐management of their health is key in successful transition to adult healthcare. To date, there is limited research on self‐management promotion for youth. The purpose of this study is to explore self‐management from the perspectives of youth, parents and healthcare providers in transition to adult healthcare. Methods Part of a larger longitudinal transition (TRACE‐2009–2013) study, interpretive phenomenology was used to explore the meaning of the lived experiences and perceptions of youth, parents, and healthcare providers about transition to adult healthcare. Purposeful sampling was utilized to select youth with a range of chronic health conditions from the TRACE cohort (spanning 20 diagnoses including developmental disabilities and chronic conditions), their parents and healthcare providers. Results The emerging three themes were: increasing independence of youth; parents as safety nets and healthcare providers as enablers and collaborators. The findings indicate that the experiences of transitioning youth, parents and service providers are interconnected and interdependent. Conclusions Results support a dynamic and developmentally appropriate approach when working with transitioning youth and parents in practice. As youth depend on parents and healthcare providers for support in taking charge of their own health, parents and healthcare providers must work together to enable youth for self‐management. At a policy level, adequate funding, institutional support and accreditation incentives are recommended to allow for designated time for healthcare providers to foster self‐management skills in transitioning youth and parents.

  April 22, 2016   doi: 10.1111/cch.12334   open full text
• Parental educational level and psychological positive health and health complaints in Spanish children and adolescents.
  C. Padilla‐Moledo, J. R. Ruiz, J. Castro‐Piñero.
  Child Care Health and Development. April 20, 2016
  Background Interest on the impact of socioeconomic differences on youth's health is growing. The aim of the present study was to examine the association of parental educational level with psychological positive health and health complaints in Spanish children and adolescents. Methods Parental educational level, psychological positive health indicators (perceived health status, life satisfaction, quality of family relationships, quality of peer relationships and academic performance) and health complaint index (headache, stomach ache, backache, feeling low, irritability or bad temper, feeling nervous, difficulties getting to sleep, feeling dizzy) were self‐reported using the Health Behavior in School‐aged Children questionnaire in 685 (366 boys and 319 girls) children and adolescents. Results Children reporting parents with non‐university studies (father, mother or both) had significantly higher odd ratio of having lower academic performance, lower life satisfaction, perceiving their health status as otherwise (vs. excellent) and having health complaints sometime than their counterparts reporting parents with university studies (father, mother or both). Conclusion Current results provide evidence that children having parents with a university degree (father, mother or both) are more likely to have higher psychological positive health and lower health complaints than children reporting parents with non‐university studies. This is particularly important for the welfare policy that must pay attention for implementing programs for helping population to access to university studies by their impact on youth health.

  April 20, 2016   doi: 10.1111/cch.12342   open full text
• Play distraction versus pharmacological treatment to reduce anxiety levels in children undergoing day surgery: a randomized controlled non‐inferiority trial.
  N. Al‐Yateem, M. Brenner, A. A. Shorrab, C. Docherty.
  Child Care Health and Development. April 14, 2016
  Background Perioperative experience can be one of the most distressful experiences in a child's life if not managed properly by healthcare professionals. Its consequences can extend well beyond surgery and recovery into the child's future life. Healthcare professionals have a responsibility to decrease the anxiety associated with this experience, improve the child's and the parent's experience and prevent negative consequences. This has traditionally been performed through pharmacological treatment which might have negative side effects. More developmentally appropriate distraction methods are currently being trialled globally to augment the evidence that supports their use as a similarly efficient alternative. Objectives The aim of this study was to explore the efficiency of storytelling, pictures and colouring activities as an anxiolytic intervention in comparison to the traditional pharmacological premedication technique in a non‐inferiority study. Study design A randomized non‐inferiority controlled trial was carried out in 168 children scheduled for day surgery. Children's perioperative anxiety was assessed by a trained anaesthetist using the modified Yale Preoperative Assessment Scale and by parents using the State‐Trait Anxiety Inventory for Children. Children's vital signs were also collected preoperatively during the induction period and during the recovery period. Results The primary endpoint, which is non‐inferiority in terms of anxiety as per Yale Preoperative Assessment Scale survey between play distraction and preoperative medication, was met [average score 10.95 vs. 10.94, respectively, 95% confidence interval (−0.35; 0.37); P = 0.941]. Moreover, anxiety scores of both the intervention and the control group were quite comparable as per STAIC survey [20.90 vs. 20.73, respectively, 95% confidence interval (−0.52; 0.88); P = 0.708] and in terms of vital signs. Conclusion The results indicate that the distraction technique employed can be considered as an efficient alternative to traditional pharmacological premedication for children undergoing day surgery.

  April 14, 2016   doi: 10.1111/cch.12343   open full text
• Rates of detection of developmental problems at the 18‐month well‐baby visit by family physicians' using four evidence‐based screening tools compared to usual care: a randomized controlled trial.
  R. E. Thomas, W. Spragins, G. Mazloum, M. Cronkhite, G. Maru.
  Child Care Health and Development. April 08, 2016
  Background Early and regular developmental screening can improve children's development through early intervention but is insufficiently used. Most developmental problems are readily evident at the 18‐month well‐baby visit. This trial's purpose is to: (1) compare identification rates of developmental problems by GPs/family physicians using four evidence‐based tools with non‐evidence based screening, and (2) ascertain whether the four tools can be completed in 10‐min pre‐visit on a computer. Methods We compared two approaches to early identification via random assignment of 54 families to either: ‘usual care’ (informal judgment including ad‐hoc milestones, n = 25); or (2) ‘Evidence‐based’ care (use of four validated, accurate screening tools, n = 29), including: the Parents' Evaluation of Developmental Status (PEDS), the PEDS‐Developmental Milestones (PEDS‐DM), the Modified Checklist for Autism in Toddlers (M‐CHAT) and PHQ9 (maternal depression). Results In the ‘usual care’ group four (16%) and in the evidence‐based tools group 18 (62%) were identified as having a possible developmental problem. In the evidence‐based tools group three infants were to be recalled at 24 months for language checks (no specialist referrals made). In the ‘usual care’ group four problems were identified: one child was referred for speech therapy, two to return to check language at 24 months and a mother to discuss depression. All forms were completed on‐line within 10 min. Conclusions Despite higher early detection rates in the evidence‐based care group, there were no differences in referral rates between evidence‐based and usual‐care groups. This suggests that clinicians: (1) override evidence‐based screening results with informal judgment; and/or (2) need assistance understanding test results and making referrals. Possible solutions are improve the quality of information obtained from the screening process, improved training of physicians, improved support for individual practices and acceptance by the regional health authority for overall responsibility for screening and creation of a comprehensive network.

  April 08, 2016   doi: 10.1111/cch.12333   open full text
• Obesity leads to declines in motor skills across childhood.
  J. Cheng, P. East, E. Blanco, E. Kang Sim, M. Castillo, B. Lozoff, S. Gahagan.
  Child Care Health and Development. April 05, 2016
  Background Poor motor skills have been consistently linked with a higher body weight in childhood, but the causal direction of this association is not fully understood. This study investigated the temporal ordering between children's motor skills and weight status at 5 and 10 years. Methods Participants were 668 children (54% male) who were studied from infancy as part of an iron deficiency anaemia preventive trial and follow‐up study in Santiago, Chile. All were healthy, full‐term and weighing 3 kg or more at birth. Cross‐lagged panel modelling was conducted to understand the temporal precedence between children's weight status and motor proficiency. Analyses also examined differences in gross and fine motor skills among healthy weight, overweight, and obese children. Results A higher BMI at 5 years contributed to declines in motor proficiency from 5 to 10 years. There was no support for the reverse, that is, poor motor skills at 5 years did not predict increases in relative weight from 5 to 10 years. Obesity at 5 years also predicted declines in motor proficiency. When compared with normal weight children, obese children had significantly poorer total and gross motor skills at both 5 and 10 years. Overweight children had poorer total and gross motor skills at 10 years only. The differences in total and gross motor skills among normal weight, overweight and obese children appear to increase with age. There were small differences in fine motor skill between obese and non‐obese children at 5 years only. Conclusions Obesity preceded declines in motor skills and not the reverse. Study findings suggest that early childhood obesity intervention efforts might help prevent declines in motor proficiency that, in turn, may positively impact children's physical activity and overall fitness levels.

  April 05, 2016   doi: 10.1111/cch.12336   open full text
• Early introduction of palliative care and advanced care planning for children with complex chronic medical conditions: a pilot study.
  D. B. Liberman, E. Song, L. M. Radbill, P. K. Pham, S. F. Derrington.
  Child Care Health and Development. March 29, 2016
  Background Children with complex chronic medical conditions benefit from early introduction of palliative care services and advanced care planning for symptom management and to support quality of life and medical decision‐making. This study evaluated whether introducing palliative care during primary care appointments (1) was feasible; (2) increased access and improved knowledge of palliative care; and (3) facilitated advanced care planning. Methods Pilot study of a multi‐modal intervention including targeted education for primary care providers (PCPs), an informational packet for families and presence of a palliative care team member in the outpatient clinic. PCPs completed pre‐ and post‐surveys assessing experience, knowledge and comfort with palliative care. Enrolled families received an information packet; a subset also met a palliative care team member. All families were encouraged to make an appointment with the palliative care team, during which the team assessed palliative care needs and goals of care. Upon study completion, the investigators assessed family and PCP satisfaction and collected feedback on project feasibility. Results Twenty families were enrolled and received the information packet; 15 met a palliative care team member. Of the 17 participating families who were reached and completed a post‐study survey, 11 families had never heard of palliative care and 13 were unaware that the palliative care team existed. Most families perceived palliative care information as ‘very helpful’ and ‘very important’. All would recommend palliative care team services to others. Nine families followed up with the palliative care team, but none was prepared to complete an advanced care plan. PCPs reported lack of training in communicating bad news and conducting goals of care discussions. However, they felt increasingly comfortable introducing palliative care to families and supported program continuation. Conclusions Initiating palliative care services in the outpatient primary care setting is logistically challenging but increases access to palliative care for children with complex chronic medical conditions and improves palliative care knowledge and comfort for PCPs.

  March 29, 2016   doi: 10.1111/cch.12332   open full text
• Assessment of the needs of mothers and primary healthcare providers to support early childhood development in Egypt: a qualitative study.
  O. Elgibaly, M. M. Aziz.
  Child Care Health and Development. March 22, 2016
  Background The early childhood period is considered the most important developmental phase in an individual's lifespan. However, it is not addressed in the Egyptian health system. We aimed to explore mothers' and healthcare providers' perceptions about early childhood development (ECD) and identify their needs to support ECD in Egypt. Methods Focus group discussions with 79 mothers of children younger than 2 years old from different socio‐economic backgrounds and residing in urban and rural areas and 26 primary healthcare providers were used to collect data. Emerging themes and subthemes were identified from the data analysis. Results Urban and rural mothers in Egypt of all educational levels are not well prepared to support their children's early development, especially the cognitive and emotional aspects. Limited sources of information about ECD, the large families of rural women and an absence of developmental health services and family support were the most important factors that led to a neglect of mother–child communication and stimulation. Conclusion Raising community awareness and training primary healthcare providers to counsel mothers about ECD are important prerequisites for supporting ECD in Egypt. Rural and first‐time mothers would be the most valuable starting point.

  March 22, 2016   doi: 10.1111/cch.12337   open full text
• Maternal perception of weight status in first‐born Australian toddlers aged 12–16 months – the NOURISH and SAIDI cohorts.
  R. Byrne, A. Magarey, L. Daniels.
  Child Care Health and Development. March 21, 2016
  Background The preference amongst parents for heavier infants is in contrast to obesity prevention efforts worldwide. Parents are poor at identifying overweight in older children, but few studies have investigated maternal perception of weight status amongst toddlers and none in the Australian setting. Methods Mothers (n = 290) completed a self‐administered questionnaire at child age 12–16 months, defining their child's weight status as underweight, normal weight, somewhat overweight or very overweight. Weight‐for‐length z‐score was derived from measured weight and length, and children categorized as underweight, normal weight, at risk overweight or obese (WHO standards). Objective classification was compared with maternal perception of weight status. Mean weight‐for‐length z‐score was compared across categories of maternal perception using one‐way ANOVA. Multinomial logistic regression was used to determine child or maternal characteristics associated with inaccurate weight perception. Results Most children (83%) were perceived as normal weight. Twenty nine were described as underweight, although none were. Sixty‐six children were at risk of overweight, but 57 of these perceived as normal weight. Of the 14 children who were overweight, only 4 were identified as somewhat overweight by their mother. Compared with mothers who could accurately classify their normal weight child, mothers who were older had higher odds of perceiving their normal weight child as underweight, while mothers with higher body mass index had slightly higher odds of describing their overweight/at risk child as normal weight. Conclusion The leaner but healthy weight toddler was perceived as underweight, while only the heaviest children were recognized as overweight. Mothers unable to accurately identify children at risk are unlikely to act to prevent further excess weight gain. Practitioners can lead a shift in attitudes towards weight in infants and young children, promoting routine growth monitoring and adequate but not rapid weight gain.

  March 21, 2016   doi: 10.1111/cch.12335   open full text
• “I think they're all basically the same”: parents' perceptions of human papilloma virus (HPV) vaccine compared with other adolescent vaccines.
  A. Ogunbajo, C. E. Hansen, A. L. North, E. Okoloko, L. M. Niccolai.
  Child Care Health and Development. March 15, 2016
  Background Human papillomavirus (HPV) vaccination is recommended for routine administration at ages 11–12 years. However, uptake is lower than for other vaccines that are also routinely recommended for adolescents (MCV4 and Tdap). Understanding parental perceptions of HPV vaccine compared with other vaccines may help to inform strategies to increase uptake. Methods Parents and caregivers (n = 45) of adolescents ages 10–18 years from a low‐income, ethnic minority population participated in a qualitative study. Interviews were transcribed verbatim and coded for emergent themes. Results Many participants perceived the HPV vaccine to be similar to other routine vaccines. Noted similarities included the vaccines' ability to prevent disease, similar methods of administration and belief in health care providers' recommendation. Some parents noted the greater benefit of HPV vaccine in preventing cancer, which was viewed as a serious disease. Parents also noted the different mode of transmission (sexual) for HPV, which evoked mixed opinions. Conclusion Overall, most participants viewed the HPV vaccine in a positive light and similar to other adolescent vaccines with the added benefit of cancer prevention. Strategies that treat all three vaccines equally such as presenting them similarly as a ‘bundle’ to parents or considering policy initiatives such as school entry requirements might help increase raise coverage for HPV vaccine.

  March 15, 2016   doi: 10.1111/cch.12331   open full text
• Preventing childhood obesity in early care and education settings: lessons from two intervention studies.
  S. E. Benjamin Neelon, T. Østbye, D. Hales, A. Vaughn, D. S. Ward.
  Child Care Health and Development. March 14, 2016
  Background Obesity prevention in young children is a public health priority. In the USA, nearly 10% of children less than 5 years of age are obese, and most attend some form of out‐of‐home child care. While a number of interventions have been conducted in early care and education settings, few have targeted the youngest children in care or the less formal types of child care like family child care homes. Additionally, only two previous studies provided recommendations to help inform future interventions. Methods This paper presents lessons learned from two distinct intervention studies in early care and education settings to help guide researchers and public health professionals interested in implementing and evaluating similar interventions. We highlight two studies: one targeting children ages 4 to 24 months in child care centres and the other intervening in children 18 months to 4 years in family child care homes. We include lessons from our pilot studies and the ongoing larger trials. Results To date, our experiences suggest that an intervention should have a firm basis in behaviour change theory; an advisory group should help evaluate intervention materials and plan for delivery; and realistic recruitment goals should recognize economic challenges of the business of child care. A flexible data collection approach and realistic sample size calculations are needed because of high rates of child (and sometimes facility) turnover. An intervention that is relatively easy to implement is more likely to appeal to a wide variety of early care and education providers. Conclusions Interventions to prevent obesity in early care and education have the potential to reach large numbers of children. It is important to consider the unique features and similarities of centres and family child care homes and take advantage of lessons learned from current studies in order to develop effective, evidence‐based interventions.

  March 14, 2016   doi: 10.1111/cch.12329   open full text
• Choosing foods for infants: a qualitative study of the factors that influence mothers.
  R. Boak, M. Virgo‐Milton, A. Hoare, A. Silva, L. Gibbs, L. Gold, M. Gussy, H. Calache, M. Smith, E. Waters.
  Child Care Health and Development. March 03, 2016
  Background Examining the experiences of parents making food choices for infants is important because ultimately this influences what infants eat. Infancy is a critical period when food preferences and eating behaviour begin to develop, shaping dietary patterns, growth and health outcomes. There is limited evidence regarding what or why foods are chosen for infants. Objective To describe the experiences of mothers making food choices for their infant children. Methods Semi‐structured interviews with 32 Australian mothers of infants aged four to 15 months from a range of socioeconomic backgrounds. An inductive thematic analysis through a process of constant comparison was conducted on transcribed interviews. Results Mothers described many ideas and circumstances which influenced food choices they made for infants. Themes were developed which encapsulate how the wider environment and individual circumstances combine to result in the food choices made for infants. Beliefs, values, norms and knowledge were a central influence on choices. Cost, quality and availabilities of various foods were also key factors. Related to this, and combined with inherent factors such as perishability and infant acceptability, fresh fruits and vegetables were often singled out as an easy or difficult choice. Influences of time, parents' capacities, social connections and different information sources were clearly apparent. Finally infants' own preferences and how parents helped infants with learning to eat were also key influences on food choices. Conclusions Choosing foods for infants is a complex social practice. An ecological framework depicting the multiple influences on what people eat and sociological theory on food choice regarding the role of ‘social structure’ and ‘human agency’ are both applicable to the process of choosing foods for infants. Equity issues may be key regarding the degree to which mothers can choose particular foods for infants (e.g. choosing foods which promote health).

  March 03, 2016   doi: 10.1111/cch.12323   open full text
• No widening socioeconomic gap within a general decline in Swedish breastfeeding.
  M. Magnusson, D. Lagerberg, T. Wallby.
  Child Care Health and Development. February 25, 2016
  Aim To study potential socioeconomic differences within the general decline in breastfeeding over time. Methods Data was collected for 51 415 infants born 2004–2010 from the databases of statistics of the Preventive Child Health Care Services in Uppsala and Orebro counties in Sweden and socioeconomic indicators from Swedish national registers. Breastfeeding data (breastfed/not breastfed) from 1 week, 4 months and 6 months of age were used as the main outcome variables. Educational level of the mother was defined as the highest level on a three‐grade scale, low, medium and high. Family type was defined as whether the mother was single or married/cohabiting. Family disposable income was divided into quartiles where quartile 1 included the 25% children in families with the lowest incomes. Analyses were conducted by logistic regression models using the methodology of generalized estimating equations (GEE). An exchangeable correlation structure was used to control for the dependence among infants with the same mother. Results Breastfeeding rate in Sweden has declined gradually since the late 1990s. The results indicated that overall breastfeeding rates over the study period were influenced by socioeconomic status in a gradient manner but no widening socioeconomic gap was detected. Rather the interaction analyses showed a narrowing socioeconomic gap over the study period between high and low educational level and single versus cohabiting mothers at 4 months. The narrowing socioeconomic gap between the educational level categories was also detectable at 6 months. Conclusion No increase in socioeconomic gap was detected within the general decline in Swedish breastfeeding. However, there are reasons to maintain and strengthen the overall breastfeeding supportive measures including extended support for vulnerable groups.

  February 25, 2016   doi: 10.1111/cch.12327   open full text
• Assessment of home hazards for childhood injuries in an urban population in New Delhi.
  G. G. Parmeswaran, M. Kalaivani, S. K. Gupta, A. K. Goswami, B. Nongkynrih.
  Child Care Health and Development. February 19, 2016
  Background Childhood injuries, especially the unintentional category of injuries, occur most commonly in the environment inside a child's home. The primary objective of the present study was to assess the presence of home hazards for childhood injuries in households in an urban resettlement colony in New Delhi. Methods A community‐based cross‐sectional study was carried out in an urban resettlement colony in Delhi. A hazards assessment tool was used to check the presence of hazards in the houses. Results A total of 225 households were included. It was seen that121 (53.7%) had a cooking stove within the reach of the child, and 190 (84.3%) had the gas pipe within reach. Fire hazard was seen in 84% of houses. About 78% of households did not have locked storage for chemicals. Conclusion The study revealed a significant burden of hazards for childhood injuries within their own homes, thus emphasizing the need for injury prevention interventions to reduce the number of hazards.

  February 19, 2016   doi: 10.1111/cch.12328   open full text
• Inhibited attachment behaviour and disinhibited social engagement behaviour as relevant concepts in referred home reared children.
  F. Y. Scheper, M. E. Abrahamse, C. S. Jonkman, C. Schuengel, R. J. L. Lindauer, A. L. C. Vries, T. A. H. Doreleijers, L. M. C. Jansen.
  Child Care Health and Development. February 18, 2016
  Background Disorders of attachment and social engagement have mainly been studied in children, reared in institutions and foster care. There are few studies amongst home reared children living with biological parents. The aim of this study was to test the clinical significance of inhibited attachment behaviour and disinhibited social engagement behaviour in young home reared children, referred for treatment of emotional and behavioural problems, compared with young children in treatment foster care. Methods The Disturbances of Attachment Interview, Maltreatment Classification System, the Child Behaviour Checklist and Parenting Stress Index were used in 141 referred home reared children and 59 referred foster children, aged 2.0–7.9 years (M = 4.7, SE = 1.3), 71% boys. Results Inhibited attachment behaviour was less prevalent in the referred home reared group (9%) than in the foster care group (27%). Disinhibited social engagement behaviour was found in 42% of the home reared group, similar to the foster care group. Inhibited attachment behaviour and disinhibited social engagement behaviour were not associated with child maltreatment. More inhibited attachment behaviour was associated with clinical levels of child internalizing and externalizing behaviour in the home reared group, not in the foster care group. In both groups, more disinhibited social engagement behaviour was associated with clinical levels of externalizing behaviour and with more parenting stress. Conclusions Even without evident links to maltreatment, results of this study suggest clinical significance of inhibited attachment behaviour and disinhibited social engagement behaviour in young home reared children referred for treatment of emotional and behavioural problems.

  February 18, 2016   doi: 10.1111/cch.12319   open full text
• Children's experiences about a structured assessment of health‐related quality of life during a patient encounter.
  C. Petersson, K. Huus, K. Åkesson, K. Enskär.
  Child Care Health and Development. February 17, 2016
  Background It has been stated that care for children with chronic health conditions tends to focus on condition‐specific issues rather than how these children experience their health and everyday life functioning. Aim The aim of this study was to explore children's experiences about a structured assessment of health‐related quality of life applied during a patient encounter. Methods Prior to the start of the study, a clinical intervention based on the questionnaire DISABKIDS Chronic Generic Measure (DCGM‐37) was performed. A qualitative explorative design was chosen, and 25 children between 10–17 years of age were interviewed after the consultation at four different paediatric outpatient clinics. Data were analysed according to qualitative content analysis. Results The results were twofold: children experienced that the assessment was providing them with insights about their health, which motivated them to make lifestyle changes. When outcomes were discussed and requested, the children felt encouraged. Conclusions The use of an assessment of health‐related quality of life may promote insights about health and encourage children with chronic health conditions to discuss their outcomes with healthcare professionals.

  February 17, 2016   doi: 10.1111/cch.12324   open full text
• Determining prevalence of maltreatment among children in the kingdom of Saudi Arabia.
  M. A. Al‐Eissa, H. N. Saleheen, S. AlMadani, F. S. AlBuhairan, A. Weber, J. D. Fluke, M. Almuneef, K. L. Casillas.
  Child Care Health and Development. February 15, 2016
  Purpose The aim of this study is to find out the overall prevalence rates for the major forms of abuse among adolescents in the Kingdom of Saudi Arabia and the differences in prevalence by age, gender and living arrangement. Methods The cross‐sectional study was conducted in secondary high schools in five of the 13 main regions of Kingdom of Saudi Arabia during 2012. Through a multistage stratified sampling technique, a sample (n = 16 939) of adolescents (15‐19 years) were identified and invited to participate. The ISPCAN Child Abuse Screening Tool ‐ Child was used for data collection. The previous year's occurrence of violence exposure, psychological, physical and sexual abuse, and neglect were assessed. Results Nearly 90% of the adolescents were between 16 and 18 years of age, and over 80% were cared for by both of their biological parents. Annual prevalence of various forms of abuse in the year before the 2012 assessment ranged between 0.10 and 0.65, with the lowest rate for sexual abuse and the highest for psychological abuse. Significantly, greater rates of all forms of abuse/exposure were found when participants lived with their mother or father only (versus with both), and even greater rates for all when they lived with their biological parent and a step‐parent. Rates for violence exposure, psychological abuse and neglect were significantly greater for girls, and rate of sexual abuse was greater for boys. Conclusions More attention should be given to the effect of adolescent maltreatment particularly among girls. In addition, sexual abuse prevention programme should be targeted among boys.

  February 15, 2016   doi: 10.1111/cch.12325   open full text
• About my Child: measuring ‘Complexity’ in neurodisability. Evidence of reliability and validity.
  A. M. Ritzema, L. M. Lach, P. Rosenbaum, D. Nicholas.
  Child Care Health and Development. February 10, 2016
  Background About my Child, 26‐item version (AMC‐26) was developed as a measure of child health ‘complexity’ and has been proposed as a tool for understanding the functional needs of children and the priorities of families. Methods The current study investigated the reliability and validity of AMC‐26 with a sample of caregivers of children with neurodevelopmental disorders (NDD; n = 258) who completed AMC‐26 as part of a larger study on parenting children with NDD. A subsample of children from the larger study (n = 49) were assessed using standardized measures of cognitive and adaptive functioning. Results Factor analysis revealed that a four‐component model explained 51.12% of the variance. Cronbach's alpha was calculated for each of the four factors and for the scale as a whole, and ranged from 0.75 to 0.85, suggesting a high level of internal consistency. Construct validity was tested through comparisons with the results of standardized measures of child functioning. Predicted relationships for factors one, two and three were statistically significant and in the expected directions. Predictions for factor four were partially supported. AMC‐26 was also expected to serve as an indicator of caregiver distress. Drawing on a sample of caregivers from the larger study (n = 251) the model was found to be significant and explained 23% of the variance in caregiver depressive symptoms (R2 = .053, F (1, 249) = 14.06, P < .001). Conclusions Based on these observations, the authors contend that AMC‐26 may be used by clinicians and researchers as a tool to capture child function and child health complexity. Such a measure may help elucidate the relationships between child complexity and family well‐being. This is an important avenue for further investigation.

  February 10, 2016   doi: 10.1111/cch.12326   open full text
• Developmental status of preschool children receiving cART: a descriptive cohort study.
  J. Potterton, N. Hilburn, R. Strehlau.
  Child Care Health and Development. February 02, 2016
  Background HIV is known to cause neurodevelopmental problems in infants and young children. The impact of HIV on the development of preschool‐age children has been less well described. Method The study was conducted at an urban paediatric HIV clinic in Johannesburg, South Africa. A sample of convenience was used. Sixty‐eight medically stable children between the ages of 3 and 5 years were assessed with the Griffiths Scales of Mental Development. Children were excluded from the study if they had severe HIV encephalopathy, which made it impossible for them to participate in the items on the Griffiths Scales of Mental Development. Results The children had started combination antiretroviral treatment (cART) at a mean age of 8.1 months. The majority of the children were virologically suppressed and did not present with wasting or stunting. Severe overall developmental delay (z‐scores < −2SD) was detected in 55.88% of children. Developmental facets related to speech, cognition and perception were the most severely affected. Personal–social development was the least affected with only 13.4% of the children demonstrating severe delay. Conclusion Despite having early access to cART, children infected with HIV are still at risk for severe developmental delay across a number of facets. Very early initiation of cART may help alleviate this problem. All preschool children infected with HIV should have routine developmental screening.

  February 02, 2016   doi: 10.1111/cch.12321   open full text
• Caregiver perceptions of childhood weight: demographic moderators and correlates.
  D. Miller, W. Johnson, M. Miller, J. Miller, A. R. Sutin.
  Child Care Health and Development. January 28, 2016
  Background To examine whether ethnicity moderates the association between caregiver characteristics and perceptions of childhood weight and whether these perceptions are associated with their child's obesity status. Methods Caregivers recruited from paediatricians' offices (n = 453) completed a survey about childhood health; nurses weighed and measured the children. Caregivers reported their own weight and height, demographic information about their family and made ratings of healthy weight for children in general and for their own child in particular. Results African American caregivers were more likely to view heavier girls as healthier, but this association held only for lower income families or caregivers with higher body mass index. Hispanic caregivers were more likely to misperceive their own child's weight if either the caregiver or the child had a higher body mass index. Parents who perceived heavier weight as healthier or misperceived their own child's weight were more likely to have a child with obesity. This latter association held regardless of ethnicity. Conclusion The association between ethnicity and perceptions of healthy childhood weight are complex. The relation between caregivers' perceptions of healthy weight and their own child's obesity status, however, was similar regardless of ethnicity.

  January 28, 2016   doi: 10.1111/cch.12318   open full text
• The relationship between parental attitudes and behaviours in the context of paediatric chronic pain.
  T. Jaaniste, N. Jia, T. Lang, E. M. Goodison‐Farnsworth, M. McCormick, D. Anderson.
  Child Care Health and Development. January 14, 2016
  Background Within the context of paediatric chronic pain, parental attitudes are of particular importance given that they have the potential to impact on how parents respond to their child. The current study was designed to assess whether parental attitudes, such as parental confidence and beliefs in their child's ability to function in spite of pain, and parental catastrophising about their child's pain, are associated with parental pain‐related behaviours known to be associated with poor child outcomes, such as protectiveness and high levels of monitoring. Methods Participants were 138 child–parent dyads recruited from a tertiary chronic pain clinic. Patients were aged 8‐ to 17‐years. Prior to the initial clinic appointment, parents completed validated measures of parental pain catastrophising and parental responses to their child's pain. Patients completed measures of functional disability and pain intensity. Results Parents who reported lower confidence in their child's ability to cope with the pain engaged in significantly more protective, monitoring and distracting behaviours, even when controlling for the child's recent level of functioning. They also took more days off work due to their child's pain. Parents who catastrophised more about their child's pain engaged in significantly more protective and monitoring behaviours, even when controlling for the child's recent level of functioning. Conclusions Parental behaviours in response to their child's pain are significantly related to parental confidence in their child's coping and parental pain‐related catastrophising. Clinical interventions may benefit from addressing parental attitudes, especially their confidence in their child's ability to function.

  January 14, 2016   doi: 10.1111/cch.12312   open full text
• Associations between early alcohol and tobacco use and prolonged time to puberty in boys.
  E. M. Davis, J. D. Peck, B. M. Peck, H. B. Kaplan.
  Child Care Health and Development. May 27, 2014
  Background Previous research has demonstrated a relationship between prepubertal alcohol and tobacco use and delayed pubertal characteristics in girls. Although, laboratory research indicates that alcohol and tobacco use inhibits sexual maturation in male rats, human research in this area is lacking. To address this question among boys, we conducted a study to explore the association between early use of alcohol and tobacco and time to development of secondary sexual characteristics. Methods The study population included 3199 boys interviewed between the ages of 11 and 21. Participants reported the ages at which they first experienced body hair growth, deepening of the voice and facial hair growth. Early alcohol and tobacco use were defined as first use preceding the age of pubertal development among those reporting regular consumption patterns. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazard models. Results Early alcohol use was associated with longer time to body hair growth (HR 0.77; 95% CI 0.69–0.87), voice changes (HR 0.72; 95% CI 0.64–0.82) and facial hair growth (HR 0.77; 95% CI 0.68–0.86), after adjusting for tobacco use and age at interview. Tobacco use was not independently associated with the puberty indicators after controlling for alcohol use and age at interview. Conclusions Our findings are consistent with the hypothesis that alcohol may inhibit puberty onset in boys, an association that has been previously observed among young girls. Thus, alcohol may be an exposure deserving more scrutiny as a disruptor to normal pubertal development.

  May 27, 2014   doi: 10.1111/cch.12160   open full text
• Maternal and child health nurses' self‐perceived confidence in dealing with child behaviour problems.
  A. Sarkadi, A. Gulenc, H. Hiscock.
  Child Care Health and Development. May 25, 2014
  Background Addressing behaviour problems in children is increasingly becoming part of routine care. The question therefore arises as to which workforce members are best suited to deliver structured interventions and what skill sets they might need apart from knowledge of the specific parenting programme offered. Objectives To assess maternal and child health (MCH) nurses' self‐perceived confidence in dealing with child behaviour problems. Design Cross‐sectional questionnaire study. Data collection occurred prior to cluster randomization in the Families in Mind trial. Setting MCH clinics in nine local government areas in greater Melbourne, in 2010. Participants All MCH nurses in the nine areas were invited to participate, 153 (79%) completed the survey. Main outcomes measures Nurses' comfort, competency, attitudes and perceived difficulties in dealing with child behaviour problems. Results The majority of nurses (63%) viewed it as their role to deal with, rather than refer, child behaviour problems and felt that the task was rewarding (86%). They believed that parenting advice should be offered universally, rather than only to families with severe problems (94%). Nurses felt rather comfortable and competent to broach and discuss child behaviour problems without need for prior parental request, but somewhat less comfortable and competent to manage child behaviour problems or to make a difference. Experienced nurses (>10 years in practice) felt more comfortable and competent. Nurses described that the major challenge in their dealing with child behaviour problems was parental denial or resistance (60%). Conclusions MCH nurses are at the frontline of preventive medical services for families with young children where behaviour problems are a common concern. Because managing young children's behaviour problems primarily occurs through adult behaviour change, techniques addressing parent denial and non‐compliance, such as motivational interviewing and empowerment should be a part of MCH nurses' skill sets.

  May 25, 2014   doi: 10.1111/cch.12150   open full text
• The Incredible Years Parent–Toddler Programme and parental language: a randomised controlled trial.
  N. Gridley, J. Hutchings, H. Baker‐Henningham.
  Child Care Health and Development. May 19, 2014
  Background Parental language is associated with children's later language development. Parenting programmes, based on social learning theory, enhance a range of parenting behaviours, yet there is limited evidence for their effect on parental language. Aim To assess the benefits of a behavioural‐based parenting programme, which features components of language and communication, to enhance parental language. Method Parents of toddlers, aged 12 to 36 months, were recruited from eight Flying Start early intervention centres across Wales. Participants were randomised 2:1 either to a parenting programme (n = 60) or to a wait‐list control group (n = 29). Researchers were blind to participant allocation throughout the trial. Fifteen‐minute video‐recorded observations of parents and children interacting during free‐play, both at a pre‐intervention and at 6‐month follow‐up, provided the data for the study. Five observed measures of parental language were assessed; quantity and variety, encouraging, critical, child‐led and parent led interactions. Intervention The Incredible Years Parent–Toddler Programme (IYPTP) is a 12‐week group‐based behavioural intervention that teaches effective relationship and behavioural management skills including social, emotional and persistence coaching to enable parents to better support their children's development. Results Of 89 dyads that completed pre‐intervention assessments 81 (54 intervention and 27 control) met the criteria for the current study. Intention to treat analysis indicated that child‐led language interactions significantly benefited from the intervention [regression coefficient (B) = −1.44, 95% confidence intervals (CI) = −2.59 to −0.29, P = 0.015, effect size (ES) = 0.47] and a positive trend for encouraging language in favour of the intervention sample was evident. Per‐protocol sample analysis replicated these findings with encouraging language reaching statistical significance (B = 1.07, 95% CI = 0.11 to 2.03, P = 0.03, ES = 0.52). No further benefits were evident. Conclusions The IYPTP has limited evidence as an effective programme for enhancing some aspects of parental language.

  May 19, 2014   doi: 10.1111/cch.12153   open full text
• Distributed expertise: qualitative study of a British network of multidisciplinary teams supporting parents of children with chronic kidney disease.
  V. Swallow, T. Smith, N. J. A. Webb, L. Wirz, L. Qizalbash, E. Brennan, A. Birch, M. D. Sinha, L. Krischock, J. Voort, D. King, H. Lambert, D. V. Milford, L. Crowther, M. Saleem, A. Lunn, J. Williams.
  Child Care Health and Development. May 14, 2014
  Background Long‐term childhood conditions are often managed by hospital‐based multidisciplinary teams (MDTs) of professionals with discipline specific expertise of a condition, in partnership with parents. However, little evidence exists on professional–parent interactions in this context. An exploration of professionals' accounts of the way they individually and collectively teach parents to manage their child's clinical care at home is, therefore, important for meeting parents' needs, informing policy and educating novice professionals. Using chronic kidney disease as an exemplar this paper reports on one aspect of a study of interactions between professionals and parents in a network of 12 children's kidney units in Britain. Methods We conducted semi‐structured, qualitative interviews with a convenience sample of 112 professionals (clinical‐psychologists, dietitians, doctors, nurses, pharmacists, play‐workers, therapists and social workers), exploring accounts of their parent‐educative activity. We analysed data using framework and the concept of distributed expertise. Results Four themes emerged that related to the way expertise was distributed within and across teams: (i) recognizing each other's' expertise, (ii) sharing expertise within the MDT, (iii) language interpretation, and (iv) acting as brokers. Two different professional identifications were also seen to co‐exist within MDTs, with participants using the term ‘we’ both as the intra‐professional ‘we’ (relating to the professional identity) when describing expertise within a disciplinary group (for example: ‘As dietitians we aim to give tailored advice to optimize children's growth’), and the inter‐professional ‘we’ (a ‘team‐identification’), when discussing expertise within the team (for example: ‘We work as a team and make sure we're all happy with every aspect of their training before they go home’). Conclusions This study highlights the dual identifications implicit in ‘being professional’ in this context (to the team and to one's profession) as well as the unique role that each member of a team contributes to children's care. Our methodology and results have the potential to be transferred to teams managing other conditions.

  May 14, 2014   doi: 10.1111/cch.12141   open full text
• Life satisfaction, coping, self‐esteem and suicide ideation in Chinese adolescents: a school‐based study.
  Y‐S. Yao, W‐W. Chang, Y‐L. Jin, Y. Chen, L‐P. He, L. Zhang.
  Child Care Health and Development. May 13, 2014
  Purpose To determine the prevalence and associated risk factors of suicidal ideation (SI) among junior, senior high and college school students. Methods A total of 5249 students in Anhui Province of China participated in a self‐administered anonymous survey. Results Females were more likely to report SI than males (32.1% vs. 20.6%). Using binary logistic regression analysis, we found that being female, passive coping, lower family satisfaction, lower school satisfaction, lower living environment satisfaction and higher self‐esteem were associated with an increased risk of SI. Conclusions This study suggested that SI was common among Chinese adolescents. Being female, high score of passive coping, lower family satisfaction, lower school satisfaction, lower living environment satisfaction and higher self‐esteem were significantly associated with an increased risk of SI. There is an urgent need to take effective measures reducing the rate of SI among adolescents through collaboration among families, schools and society.

  May 13, 2014   doi: 10.1111/cch.12142   open full text
• Overcoming barriers to effective early parenting interventions for attention‐deficit hyperactivity disorder (ADHD): parent and practitioner views.
  E. Smith, J. Koerting, S. Latter, M. M. Knowles, D. C. McCann, M. Thompson, E. J. Sonuga‐Barke.
  Child Care Health and Development. May 12, 2014
  Background The importance of early intervention approaches for the treatment of attention‐deficit hyperactivity disorder (ADHD) has been increasingly acknowledged. Parenting programmes (PPs) are recommended for use with preschool children with ADHD. However, low ‘take‐up’ and high ‘drop‐out’ rates compromise the effectiveness of such programmes within the community. Methods This qualitative study examined the views of 25 parents and 18 practitioners regarding currently available PPs for preschool children with ADHD‐type problems in the UK. Semi‐structured interviews were undertaken to identify both barriers and facilitators associated with programme access, programme effectiveness, and continued engagement. Results and conclusions Many of the themes mirrored previous accounts relating to generic PPs for disruptive behaviour problems. There were also a number of ADHD‐specific themes. Enhancing parental motivation to change parenting practice and providing an intervention that addresses the parents' own needs (e.g. in relation to self‐confidence, depression or parental ADHD), in addition to those of the child, were considered of particular importance. Comparisons between the views of parents and practitioners highlighted a need to increase awareness of parental psychological barriers among practitioners and for better programme advertising generally. Clinical implications and specific recommendations drawn from these findings are discussed and presented.

  May 12, 2014   doi: 10.1111/cch.12146   open full text
• The association between stunting and psychosocial development among preschool children: a study using the South African Birth to Twenty cohort data.
  D. Casale, C. Desmond, L. Richter.
  Child Care Health and Development. May 08, 2014
  Background A large literature in developing countries finds a strong association between stunting in early childhood and educational attainment and/or cognitive performance among children of school‐going age. We contribute to the literature on the effects of stunting in childhood by exploring the links between linear growth retardation and measures of development among preschool‐aged children. Methods We analyse the association between stunting (height‐for‐age z‐score <−2) at age 2 years and children's scores on the Vineland Social Maturity Scale (VSMS) at age 4 years, a measure of social competence or ‘daily living skills’, and the Revised‐Denver Prescreening Developmental Questionnaire (R‐DPDQ) at age 5 years, a test which places greater emphasis on cognitive functioning. The sample is drawn from the Birth to Twenty cohort study, a prospective dataset of children born in 1990 in urban South Africa. We conduct multivariate regression analysis controlling for socio‐economic status, various child‐specific characteristics, home environment and caregiver inputs. Results No significant association between stunting and children's performance on the VSMS, but a large and significant association with the R‐DPDQ scores, was found. A disaggregated analysis of the various components of the scores suggests that children with low height‐for‐age at 2 years do not fall behind in terms of daily living skills or social maturity, but do substantially worse on measures capturing higher order fine motor skills and cognitive functioning. Conclusions Stunting in early childhood is strongly related to impaired cognitive functioning in children of preschool age, but does not seem to affect social maturity, at least as measured by the VSMS. These relationships between stunting at 2 years and psychosocial development at 4 and 5 years hold with extensive controls for socio‐economic status, home environment, caregiver inputs and child characteristics included in the multivariate analysis.

  May 08, 2014   doi: 10.1111/cch.12143   open full text
• Exposure of children with developmental delay to social determinants of poor health: cross‐sectional case record review study.
  E. Emerson, P. Brigham.
  Child Care Health and Development. May 06, 2014
  Background Research on child development in general has highlighted the importance that the family environment plays in mediating the pathway between exposure to low socio‐economic position (SEP) and child well‐being. While child developmental models in intellectual disability have highlighted the interplay between social context, family environment and child development, little empirical work has attempted to formally evaluate the evidence in support of specific mediating pathways between low SEP and child outcomes. Methods Secondary analysis of cross‐sectional confidentialized needs analysis data collected in three Primary Care Trusts in England covering a total population of 1.25 million people. Case record reviews were undertaken for 46 023 households, 2236 (4.9%) of which contained a child in the target age range with developmental delay. Results Children with developmental delay, when compared with their non‐disabled peers, were at significantly increased risk of poorer health outcomes and of being exposed to a wide range of social determinants of poor health. Controlling for between‐group differences in exposure to social determinants of poor health reduced the risk of developmental delay being associated with poorer health outcomes by 45% for behaviour problems and 89% for risk of significant harm. For children with developmental delay, parenting difficulties appears to play a particularly significant role in partially mediating the effects of low SEP. Conclusions The findings of the present study point to the potential effectiveness of family‐focused early intervention to prevent the emergence and escalation of behavioural difficulties and health problems in children with developmental delay.

  May 06, 2014   doi: 10.1111/cch.12144   open full text
• What do parents need to enhance participation of their school‐aged child with a physical disability? A cross‐sectional study in the Netherlands.
  B. Piškur, A. J. H. M. Beurskens, M. J. Jongmans, M. Ketelaar, R. J. E. M. Smeets.
  Child Care Health and Development. May 06, 2014
  Background The aim was to provide an overview of the number, domains and priority of needs as expressed by parents in supporting participation of their school‐aged child with a physical disability. Additionally, this study investigated whether the number of needs within each domain is related to the child's gross motor function level, parent's perceived own general health, family socio‐economic status and family type. Method A cross‐sectional study with a total of 146 participants (84.9% mothers) who completed a survey including the Family Needs Inventory – Paediatric Rehabilitation, the Gross Motor Function Classification System Family Report Questionnaire, the General Health Questionnaire and a demographic questionnaire. A need has been operationalized as ‘a family's, parent's or other family member's expressed desire for information, services and supports related to their family’. Descriptive statistics and correlation analysis were applied. Results Parents (n = 146; response rate 27%) varied in the number of expressed needs (range 0–124; mean = 35.9; median = 30; SD = 25.6). Highest mean percentage scores were found for the domains ‘Laws, regulations and fees’ (36%), ‘Leisure time’ (35.6%) and ‘Aids, adaptations, facilities and resources’ (33.8%). Seven single needs were expressed by 50% or more of the parents. All domains of needs showed a positive correlation with perceived parental general health. The domains ‘Laws, regulations and fees’, ‘Day care & school’, ‘Emotional and mental support’ and ‘Raising my child’ correlated negatively with family socio‐economic status; and child's gross motor function level correlated positively with the domains ‘Aids, adaptations, facilities and resources’, ‘Practical support at home’ and ‘Leisure time’. Conclusions As parents have a major influence on participation of children with a physical disability, meeting their individual needs should become an objective for service providers and policy makers. Family‐centred service might be more effective by putting a greater emphasis on changing the environment.

  May 06, 2014   doi: 10.1111/cch.12145   open full text
• Prevalence and risk factors for stunting and severe stunting among children under three years old in mid‐western rural areas of China.
  Y. Jiang, X. Su, C. Wang, L. Zhang, X. Zhang, L. Wang, Y. Cui.
  Child Care Health and Development. May 06, 2014
  Background Adequate nutrition is needed to ensure optimum growth and development of infants and young children. Although the national economy has developed rapidly during recent decades in China, malnutrition continues to be a major public health problem. The aim of the present study was undertaken to assess the prevalence and risk factors associated with stunting and severe stunting under 3 years old in mid‐western rural areas in China. Methods A community‐based cross‐sectional survey was carried out in 84 villages in mid‐western provinces of China in 2010. A total of 1260 children were selected for nutritional assessment in terms of stunting and severe stunting using the new World Health Organization growth standards. Hierarchical logistic regression was used to examine the risk factors for adverse nutritional status. Results The prevalence of stunting and severe stunting was 27.0% and 13.2% respectively. Hierarchical logistic regression analysis showed that the risk factors for stunted children were province of residence, caregiver's education, child's gender, low birthweight and duration of exclusive breastfeeding (<6 months). The risk factors for severe stunting in children aged 0–36 months were province of residence, caregiver's education and child's gender. Conclusions These results indicate that malnutrition is still a major public health problem among children under 3 years old. The government should implement appropriate nutritional intervention strategies to help reduce the prevalence of malnutrition in children.

  May 06, 2014   doi: 10.1111/cch.12148   open full text
• Living in transition – experiences of health and well‐being and the needs of adolescents with cerebral palsy.
  E. Björquist, E. Nordmark, I. Hallström.
  Child Care Health and Development. May 06, 2014
  Background Transition to adulthood for adolescents in general is a multifaceted process, and for adolescents with cerebral palsy (CP) it also involves transition from child‐ to adult‐oriented support. CP entails a variety and combination of disabilities, which in association with external factors may make the transition to adult health services difficult. The aim of this study was to gain a deeper understanding of how adolescents with CP experience their own health, well‐being and need of support during their transition to adulthood. Methods An inductive qualitative approach was used based on interviews with 12 adolescents with CP aged 17–18 years and living in Sweden. Manifest and latent content analysis was used for the analysis of data. Results The results are described in the main theme ‘Living in transition and looking forward to being an adult, but not feeling ready yet and being in need of further support’. Five subthemes highlight the adolescents' experiences of belonging to a family, of the importance of friends and love, of managing daily activities, being surrounded by support and having hopes for the future. Conclusions Interviews with adolescents with CP provide valuable information for the planning of transition programmes and for the support of adolescents with disabilities who are in the transition to adult living. According to the adolescents in this study, the support should be flexible and not be fixed to biological age. Personal, individualized information and support was desired by the adolescents in order to be able to manage their own transition. One option to facilitate transition is the stepping‐stone of being close to parents or staff members during the first phase, after leaving the parental home.

  May 06, 2014   doi: 10.1111/cch.12151   open full text
• Why the (dis)agreement? Family context and child–parent perspectives on health‐related quality of life and psychological problems in paediatric asthma.
  N. Silva, C. Crespo, C. Carona, M. Bullinger, M. C. Canavarro.
  Child Care Health and Development. May 05, 2014
  Background Children's health‐related quality of life (HrQoL) and psychological problems are important outcomes to consider in clinical decision making in paediatric asthma. However, children's and parents' reports often differ. The present study aimed to examine the levels of agreement/disagreement between children's and parents' reports of HrQoL and psychological problems and to identify socio‐demographic, clinical and family variables associated with the extent and direction of (dis)agreement. Methods The sample comprised 279 dyads of Portuguese children with asthma who were between 8 and 18 years of age (M = 12.13; SD = 2.56) and one of their parents. The participants completed self‐ and proxy‐reported questionnaires on paediatric generic HrQoL (KIDSCREEN‐10), chronic‐generic HrQoL (DISABKIDS‐37) and psychological problems (Strengths and Difficulties Questionnaire). Children's and parents' perceptions of family relationships were measured with the Family Environment Scale and the caregiving burden was assessed using the Revised Burden Measure. Results The child–parent agreement on reported HrQoL and psychological problems was poor to moderate (intraclass correlation coefficients between 0.32 and 0.47). The rates of child–parent discrepancies ranged between 52.7% (psychological problems) and 68.8% (generic HrQoL), with 50.5% and 31.5% of the parents reporting worse generic and chronic‐generic HrQoL, respectively, and 33.3% reporting more psychological problems than their children. The extent and direction of disagreement were better explained by family factors than by socio‐demographic and clinical variables: a greater caregiving burden was associated with increased discrepancies in both directions and children's and parents' perceptions of less positive family relationships were associated with discrepancies in different directions. Conclusions Routine assessment of paediatric HrQoL and psychological problems in healthcare and research contexts should include self‐ and parent‐reported data as complementary sources of information, and also consider the family context. The additional cost of conducting a more in‐depth assessment of paediatric adaptation outcomes can be offset through more efficient allocation of health resources.

  May 05, 2014   doi: 10.1111/cch.12147   open full text
• Childhood psychosocial development and fatal injuries in Gauteng, South Africa.
  K. Pretorius, A. Van Niekerk.
  Child Care Health and Development. April 15, 2014
  Background In South Africa, injuries are the third leading cause of death and disability. Children are especially susceptible to unintentional injuries, especially pedestrian injuries, burns and drowning. Injury risk is informed by children's exposure to adverse environmental circumstances, and individual capacities dependent on developmental maturity. Boys are at greater risk than girls. This study investigates the incidence of fatal childhood injuries as well as sex differences across psychosocial development stages. Methods Data on fatal injuries in Gauteng, South Africa's most populous province, were obtained from the National Injury Mortality Surveillance System. The analysis drew on Erikson's psychosocial theory of development which was used to create meaningful age groups. Age‐specific population data from the 2011 Census were used to calculate rates, and significant differences were determined through the generation of risk ratios and confidence intervals. Results There were 5404 fatal injuries among children in Gauteng from 2008 to 2011. The average age of victims was 8.9 years, and the majority male (65.6%). In infancy, the mortality rates for all injuries and non‐traffic unintentional injuries were significantly higher than for the other age groups. Burns were the most common cause of death in infancy and early childhood. Pedestrian injuries accounted for a third of mortality in preschool and school age, and homicide rates were significantly higher in adolescence than in the other developmental stages. For injuries in general, boys had significantly higher mortality rates than girls in all age groups except preschool. The only instance where the mortality rate for girls was significantly higher than for boys was for adolescent ingestion poisoning suicides. Conclusions The exposure to environmental and social risks is differentially moderated with maturing age and levels of autonomy. The sex of the child also informs risk. The nature of these risks is important when considering child injury prevention strategies.

  April 15, 2014   doi: 10.1111/cch.12140   open full text
• Attention‐deficit hyperactivity disorder (ADHD): an updated review of the essential facts.
  J. Tarver, D. Daley, K. Sayal.
  Child Care Health and Development. April 13, 2014
  Attention‐deficit hyperactivity disorder (ADHD) is a complex disorder that can affect individuals across the lifespan. It is associated with substantial heterogeneity in terms of aetiology, clinical presentation and treatment outcome and is the subject of extensive research. Because of this, it can be difficult for clinicians to stay up to date with the most relevant findings and know how best to respond to parents' questions and concerns about the disorder and interventions. This is a narrative review that aims to summarize key findings from recent research into ADHD and its treatment that clinicians can share with families in order to increase their knowledge about ADHD and intervention options. ADHD develops as a result of complex interplay between interdependent genetic and non‐genetic factors. The disorder is associated with substantial impairments in functioning and poor long‐term outcomes. Pharmacological and non‐pharmacological treatment options are available for symptom management and to improve function, but functioning outcomes often fail to normalize in children with ADHD. Despite extensive advances in understanding this complex disorder, it is clear that there is still a long way to go. In particular, we address the need for future non‐pharmacological interventions to be more specifically targeted for ADHD symptoms and its commonly associated functioning deficits in order to ensure the best long‐term outcomes for children with ADHD.

  April 13, 2014   doi: 10.1111/cch.12139   open full text
• From parent to ‘peer facilitator’: a qualitative study of a peer‐led parenting programme.
  S. Thomson, D. Michelson, C. Day.
  Child Care Health and Development. March 28, 2014
  Background Peer‐led interventions are increasingly common in community health settings. Although peer‐led approaches have proven benefits for service users, relatively little is known about the process and outcomes of participation for peer leaders. This study investigated experiences of parents who had participated as ‘peer facilitators’ in Empowering Parents, Empowering Communities (EPEC), a peer‐led programme designed to improve access to evidence‐based parenting support in socially disadvantaged communities. Method A qualitative cross‐sectional design was used. Semi‐structured interviews were conducted with 14 peer facilitators and scrutinized using thematic analysis. Results Peer facilitators developed their knowledge and skills through personal experience of receiving parenting support, participation in formal training and supervised practice, access to an intervention manual, and peer modelling. Peer facilitators described positive changes in their own families, confidence and social status. Transformative personal gains reinforced peer facilitators' role commitment and contributed to a cohesive ‘family’ identity among EPEC staff and service users. Peer facilitators' enthusiasm, openness and mutual identification with families were seen as critical to EPEC's effectiveness and sustainability. Peer facilitators also found the training emotionally and intellectually demanding. There were particular difficulties around logistical issues (e.g. finding convenient supervision times), managing psychosocial complexity and child safeguarding. Conclusions The successful delivery and sustained implementation of peer‐led interventions requires careful attention to the personal qualities and support of peer leaders. Based on the findings of this study, support should include training, access to intervention manuals, regular and responsive supervision, and logistical/administrative assistance. Further research is required to elaborate and extend these findings to other peer‐led programmes.

  March 28, 2014   doi: 10.1111/cch.12132   open full text
• Mothers' work–family conflict and enrichment: associations with parenting quality and couple relationship.
  A. R. Cooklin, E. Westrupp, L. Strazdins, R. Giallo, A. Martin, J. M. Nicholson.
  Child Care Health and Development. March 26, 2014
  Background Employment participation of mothers of young children has steadily increased in developed nations. Combining work and family roles can create conflicts with family life, but can also bring enrichment. Work–family conflict and enrichment experienced by mothers may also impact children's home environments via parenting behaviour and the couple relationship, particularly in the early years of parenting when the care demands for young children is high. Methods In order to examine these associations, while adjusting for a wide range of known covariates of parenting and relationship quality, regression models using survey data from 2151 working mothers of 4‐ to 5‐year‐old children are reported. Results/Conclusion Results provided partial support for the predicted independent relationships between work–family conflict, enrichment and indicators of the quality of parenting and the couple relationship.

  March 26, 2014   doi: 10.1111/cch.12137   open full text
• Assessing severity of illness and outcomes of treatment in children with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME): a systematic review of patient‐reported outcome measures (PROMs).
  K. L. Haywood, S. M. Collin, E. Crawley.
  Child Care Health and Development. March 24, 2014
  Chronic Fatigue Syndrome or Myalgic Encephalomyelitis (CFS/ME) in children is characterized by persistent or recurrent debilitating fatigue which results in a substantial reduction in activity. There is a growing interest in the use of questionnaires, or patient‐reported outcome measures (PROMs), to assess how patients function and feel in relation to their health and associated healthcare. However, guidance for PROM selection for children with CFS/ME does not exist. We reviewed the quality and acceptability of PROMs used with children with CFS/ME to inform recommendations for practice. We conducted a systematic review of PROMs completed by children with CFS/ME. The quality of the evaluative studies and the reviewed measures were assessed against recommended criteria using an appraisal framework and the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) checklist. We sought evidence of measurement (reliability, validity, responsiveness, interpretability, data quality) and practical properties (acceptability, relevance, feasibility). Sixteen articles were included in the review, providing evidence of reliability and/or validity for 13 PROMs. Of these, five were child‐specific (one health‐related quality‐of‐life; four emotional well‐being) and eight were not (four emotional well‐being, three fatigue‐specific; and one generic). All measures had limited evidence of measurement properties and no evidence of practical properties. Recommendations for patient‐reported assessment are difficult to make because of limited evidence of the quality and acceptability of PROMs for children with CFS/ME. The appraisal method highlighted significant methodological and quality issues which must be addressed in future research. There is a lack of qualitative evidence describing the outcomes of healthcare that are important to children with CFS/ME, and the relevance or appropriateness of available measures. Future PROM development and evaluation in this group must seek to involve children collaboratively to ensure that the outcomes that children care about are assessed in an acceptable way.

  March 24, 2014   doi: 10.1111/cch.12135   open full text
• Notifications for child safeguarding from an acute hospital in response to presentations to healthcare by parents.
  A. Gonzalez‐Izquierdo, A. Ward, P. Smith, C. Walford, J. Begent, Y. Ioannou, R. Gilbert.
  Child Care Health and Development. March 18, 2014
  Background  Consideration of child safeguarding is routine within maternity services but less common in other health services for adults. We audited notifications for child safeguarding from an acute general hospital where the policy includes questioning adults presenting with violence, mental health problems or drug or alcohol misuse to any department within the hospital about children at home and notifying to the local authority children's social care services if there are safeguarding concerns. Methods  Cross‐sectional audit of notifications for child safeguarding, including abuse, neglect or victimization, from all departments in one hospital to the local authority children's social care department during 12 months (2010/11). Results  Of 681 notifications (57 per month), 40% (270/681) were triggered by parents' presentation to acute hospital services. Of these, 37% (100/270; 12 teenage mothers) presented for maternity care and 60% (162/270; 8 teenage parents) presented to the emergency department (ED). Of the 60% (411/681) of notifications prompted by children presenting for healthcare, most originated from the ED (358/411; 87%): two‐thirds of these presented with injury (250/358; 70%). Conclusion  Given a policy to ask adults about children at home, a substantial proportion of children notified for child safeguarding were recognized through presentations to acute healthcare by their parents. Further research and development of this policy needs to ensure that questioning results in effective interventions for the children and their parents.

  March 18, 2014   doi: 10.1111/cch.12134   open full text
• Teachers' perceptions about children's movement and learning in early childhood education programmes.
  J. S. Gehris, R. A. Gooze, R. C. Whitaker.
  Child Care Health and Development. March 07, 2014
  Background Efforts to improve the academic skills of preschool‐aged children have resulted in approaches that tend to limit children's movement. However, movement experiences have long been considered important to children's learning and have received increased attention because of the obesity epidemic. Early childhood educators are important sources of information about if and how to promote learning and school readiness through movement, but little effort has been made to understand teachers' views on this topic. Methods We conducted six focus groups with 37 teachers from a Head Start programme with centres in three cities in eastern Pennsylvania. We inquired about: (1) how movement influences children's learning; (2) what types of movement experiences are most beneficial for children; (3) what settings best support children's movement; and (4) challenges related to children's movement. To identify key themes from the focus groups, transcripts were analysed using an inductive method of coding. Results Teachers' views were expressed in four major themes. First, young children have an innate need to move, and teachers respond to this need by using movement experiences to prepare children to learn and to teach academic concepts and spatial awareness. However, teachers wanted more training in these areas. Second, movement prepares children for school and for life by building children's confidence and social skills. Third, teachers and children benefit from moving together because it motivates children and promotes teacher–child relationships. Finally, moving outdoors promotes learning by engaging children's senses and promoting community interaction. Conclusions More training may be required to help early childhood educators use movement experiences to teach academic concepts and improve children's spatial awareness. Future interventions could examine the impacts on children's movement and learning of having teachers move with children during outdoor free play and including more natural features in the design of outdoor play areas.

  March 07, 2014   doi: 10.1111/cch.12136   open full text
• An intervention to preschool children for reducing screen time: a randomized controlled trial.
  G. Yilmaz, N. Demirli Caylan, C. D. Karacan.
  Child Care Health and Development. February 26, 2014
  Background  Screen time, defined as time spent watching television, DVDs, or videos or playing computer or video games, has been related to serious health consequences in children, such as impaired language acquisition, violent behaviour, tobacco smoking and obesity. Our aim was to determine if a simple intervention aimed at preschool‐aged children, applied at the health maintenance visits, in the primary care setting, would be effective in reducing screen time. Methods  We used a two group randomized controlled trial design. Two‐ to 6‐year‐old children and their parents were randomly assigned to receive an intervention to reduce their screen time, BMI and parental report of aggressive behaviour. At the end of the intervention we made home visits at 2, 6 and 9 months and the parents completed questionnaire. Results  Parents in the intervention group reported less screen time and less aggressive behaviour than those in the control group but there were no differences in BMI z scores. Conclusions  This study shows that a preschool‐based intervention can lead to reductions in young children's television/video viewing.

  February 26, 2014   doi: 10.1111/cch.12133   open full text
• Self‐reported behaviour problems and sibling relationship quality by siblings of children with autism spectrum disorder.
  R. P. Hastings, M. A. Petalas.
  Child Care Health and Development. January 27, 2014
  Background There are few published research studies in which siblings of children with autism spectrum disorder (ASD) provide self‐reports about their own behavioural and emotional problems and their sibling relationships. Reliance on parent reports may lead to incomplete conclusions about the experiences of siblings themselves. Methods Siblings 7–17 years and their mothers from 94 families of children with ASD were recruited. Mothers reported on family demographics, the behavioural and emotional problems of their child with ASD, and on their own symptoms of depression. Siblings reported on their relationship with their brother or sister with ASD, and siblings 11+ years of age also self‐reported on their behavioural and emotional problems. Results Compared with normative British data, siblings reported very slightly elevated levels of behavioural and emotional problems. However, none of the mean differences were statistically significant and all group differences were associated with small or very small effect sizes – the largest being for peer problems (effect size = 0.31). Regression analysis was used to explore family systems relationships, with sibling self‐reports predicted by the behaviour problems scores for the child with ASD and by maternal depression. Maternal depression did not emerge as a predictor of siblings' self‐reported sibling relationships or their behavioural and emotional problems. Higher levels of behaviour problems in the child with ASD predicted decreased warmth/closeness and increased conflict in the sibling relationship. Conclusions These data support the general findings of recent research in that there was little indication of clinically meaningful elevations in behavioural and emotional problems in siblings of children with ASD. Although further research replication is required, there was some indication that sibling relationships may be at risk where the child with ASD has significant behaviour problems.

  January 27, 2014   doi: 10.1111/cch.12131   open full text
• Relationship among attention‐deficit hyperactivity disorder, dietary behaviours and obesity.
  E. J. Kim, H. J. Kwon, M. Ha, M. H. Lim, S. Y. Oh, J. H. Kim, S. J. Yoo, K. C. Paik.
  Child Care Health and Development. January 20, 2014
  Background Attention‐deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood and can be associated with obesity. The aim of this study was to reveal the connection between ADHD symptoms, food habits and obesity. Methods We examined 12 350 children (6010 boys, 6340 girls) from 27 elementary schools in Cheonan, the Republic of Korea. The study subjects were 5‐ to 13‐year‐old children (9.4 ± 1.7 years). Parents completed the DuPaul ADHD Rating Scale. Food habits were measured by a questionnaire adapted from the Korea Youth Risk Behavior Web‐based Survey and a validated mini‐dietary assessment tool. The full set of hypothesized associations was tested using covariance structural modelling. Results The prevalence of ADHD was 7.6% and that of obesity was 4.5% in our study population. The data was well fit by the model. ADHD was associated with body mass index (BMI; standardized β = 0.086, P < 0.001). Bulimic dietary behaviours was related to BMI (standardized β = 0.548, P < 0.001). Socio‐economic status was associated with BMI (standardized β = −0.017, P = 0.027). Conclusion Our analysis suggested that ADHD was a risk factor for obesity through dietary behavioural change and socio‐economic status.

  January 20, 2014   doi: 10.1111/cch.12129   open full text
• Best practice principles for management of children with developmental coordination disorder (DCD): results of a scoping review.
  C. Camden, B. Wilson, A. Kirby, D. Sugden, C. Missiuna.
  Child Care Health and Development. January 06, 2014
  Background Developmental coordination disorder (DCD) is a prevalent health condition that is frequently unrecognized despite the substantial evidence that has accumulated regarding how it affects children's health, education and skills. Most literature focuses on measurement of impairment and description of intervention approaches for individual children; little is known about the principles that should guide best practice and service delivery for children with DCD as a population. The purpose of this study was to identify these principles. Methods A scoping review was used to ‘map’ the information available to inform intervention and service delivery. Scholarly and grey literature written in English was identified in six databases, using a combination of keywords (e.g. guidelines, management, models and DCD); a ‘snow‐balling’ technique was also used in Canada and the UK to access clinical protocols used in publicly funded health care systems. Over 500 documents were screened: 31 met inclusion criteria as they outlined practice principles for children with DCD as a population. Data regarding best practices were independently extracted by two reviewers and then compared with achieve consistency and consensus. Results Two over‐arching themes emerged, with five principles: (1) Organizing services to efficiently meet the comprehensive needs of children (e.g. Increasing awareness of DCD and coordination; Implementing clearly defined pathways; Using a graduated/staged approach); (2) Working collaboratively to offer evidence‐based services (e.g. Integration of child and family views; Evidence‐based interventions fostering function, participation and prevention). Conclusion Numerous documents support each of the principles, reflecting agreement across studies about recommended organization of services. While these principles may apply to many populations of children with disabilities, this review highlights how essential these principles are in DCD. Researchers, managers, clinicians, community partners and families are encouraged to work together in designing, implementing and evaluating interventions that reflect these principles.

  January 06, 2014   doi: 10.1111/cch.12128   open full text
• Is breastfeeding in infancy predictive of child mental well‐being and protective against obesity at 9 years of age?
  D. Reynolds, E. Hennessy, E. Polek.
  Child Care Health and Development. December 19, 2013
  Background Preventing child mental health problems and child obesity have been recognized as public health priorities. The aim of the present study was to examine whether being breastfed (at all or exclusively) in infancy was a predictor of mental well‐being and protective against risk of obesity at age 9. Methods Cross‐sectional data from a large, nationally representative cohort study in the Republic of Ireland was used (n = 8357). Data on breastfeeding were retrospectively recalled. Child mental well‐being was assessed using a parent‐completed Strengths and Difficulties Questionnaire (SDQ). Child's height and weight were measured using scientifically calibrated instruments. Results Logistic regression analyses indicated that, after controlling for a wide range of potential confounding variables, being breastfed in infancy was associated with a 26% (P < 0.05) reduction in the risk of an abnormal SDQ score at 9 years. Being breastfed remained a significant predictor of child mental well‐being when child obesity was controlled for, indicating that being breastfed, independent of child obesity, is a predictor of child mental well‐being. The results of a second logistic regression indicated that, after controlling for a wide range of potential confounding variables, being breastfed for between 11 and 25 weeks was associated with a 36% (P < 0.05) reduction in the risk of obesity at 9 years, while being breastfed for 26 weeks or longer was associated with a 48% (P < 0.01) reduction in the risk of obesity at 9 years. Conclusions Breastfeeding in infancy may protect against both poor mental well‐being and obesity in childhood.

  December 19, 2013   doi: 10.1111/cch.12126   open full text
• Weight status is associated with cross‐sectional trajectories of motor co‐ordination across childhood.
  V. P. Lopes, D. F. Stodden, L. P. Rodrigues.
  Child Care Health and Development. December 19, 2013
  Background Research indicates the development of motor co‐ordination (MC) may be an important contributing factor to positive or negative weight trajectories across childhood. Objectives To analyse cross‐sectional associations between MC and weight status in children (boys n = 3344 – girls n = 3281), aged 6–11 years and assess overweight/obese risk across different ages. Methods Body mass index (BMI) was calculated [body mass (kg)/height (m2)]. MC was evaluated using the Körperkoordination Test für Kinder (KTK) and a motor quotient (MQ) was calculated. MQ distribution data were split into tertiles. The effect of age, sex and MQ tertiles on BMI and MC was tested with a factorial anova. A logistic regression also was performed to calculate odd ratios (OR) for being overweight/obese at each age. Results Children with higher MQ demonstrated lower BMI levels (F(2,6224) = 222.09; P < 0.001). Differences in BMI among MQ tertiles became larger across age (F(10,6224) = 4.53; P < 0.001). The OR of being overweight/obese in both sexes within the lowest MQ tertile increased in each age group from 6 to 11 years. Specifically, OR increased from 2.26 to 27.77 and from 1.87 to 6.81 in boys and girls respectively. Conclusions Children with low levels of MC have a higher risk of being overweight/obese and this risk increases with age.

  December 19, 2013   doi: 10.1111/cch.12127   open full text
• Inter‐organizational partnership for children with medical complexity: the integrated complex care model.
  S. Kingsnorth, A. Lacombe‐Duncan, K. Keilty, C. Bruce‐Barrett, E. Cohen.
  Child Care Health and Development. November 28, 2013
  Background Integrated care has important implications for children with medical complexity (CMC) who rely on care and service delivery involving multiple providers in different places over time. Most studies describing complex care programmes focus on the effectiveness of care co‐ordination rather than the process of system integration. This pilot study explores the implementation process of the Integrated Complex Care Model: a voluntary partnership between acute, rehabilitative and community care aimed at system integration through a key worker model to improve care co‐ordination for CMC. Methods This descriptive study used qualitative analyses and syntheses to explore the process of inter‐organizational collaboration under ‘real‐life’ circumstances. Multiple methods and sources of data were gathered to support triangulation in understanding of enablers and barriers to model implementation. Forty hours of meeting minutes and administrative databases housing patient records were reviewed. Baseline demographic information was available for 23 families, including child health‐related quality of life and healthcare utilization. A subset of 12 parental caregivers and 21 additional key informants participated in individual interviews or focus groups. Findings are presented using King and Meyer's description of system integration and care co‐ordination. Results Model enablers included dedication, timing, leadership and electronic care plan use/communication among key workers, families and health providers. Barriers included assumptions about partner organizations, differing organizational structures and client information systems, constrained project resources and limited engagement of primary care. Parents perceived an electronic care plan as a facilitator of timely and effective care for CMC across multiple settings. Conclusions At a systems level, the integrated model fostered collaboration between partner organizations. At a family level, development of inter‐organizational management structures and communication platforms; provision of adequate resourcing; and increased engagement of primary care may enable high level organizational integration aimed at improved care co‐ordination for CMC.

  November 28, 2013   doi: 10.1111/cch.12122   open full text
• A systematic review of instruments for assessment of capacity in activities of daily living in children with developmental co‐ordination disorder.
  B. W. Linde, J. J. Netten, E. Otten, K. Postema, R. H. Geuze, M. M. Schoemaker.
  Child Care Health and Development. November 28, 2013
  Children with developmental co‐ordination disorder (DCD) face evident motor difficulties in activities of daily living (ADL). Assessment of their capacity in ADL is essential for diagnosis and intervention, in order to limit the daily consequences of the disorder. The aim of this study is to systematically review potential instruments for standardized and objective assessment of children's capacity in ADL, suited for children with DCD. As a first step, databases of MEDLINE, EMBASE, CINAHL and PsycINFO were searched to identify studies that described instruments with potential for assessment of capacity in ADL. Second, instruments were included for review when two independent reviewers agreed that the instruments (1) are standardized and objective; (2) assess at activity level and comprise items that reflect ADL; and (3) are applicable to school‐aged children that can move independently. Out of 1507 publications, 66 publications were selected, describing 39 instruments. Seven of these instruments were found to fulfil the criteria and were included for review: the Bruininks‐Oseretsky Test of Motor Performance‐2 (BOT2); the Do‐Eat (Do‐Eat); the Movement Assessment Battery for Children‐2 (MABC2); the school‐Assessment of Motor and Process Skills (schoolAMPS); the Tuffts Assessment of Motor Performance (TAMP); the Test of Gross Motor Development (TGMD); and the Functional Independence Measure for Children (WeeFIM). As a third step, for the included instruments, suitability for children with DCD was discussed based on the ADL comprised, ecological validity and other psychometric properties. We concluded that current instruments do not provide comprehensive and ecologically valid assessment of capacity in ADL as required for children with DCD.

  November 28, 2013   doi: 10.1111/cch.12124   open full text
• Parents of children with neurogenic bowel dysfunction: their experiences of using transanal irrigation with their child.
  C. Sanders, L. Bray, C. Driver, V. Harris.
  Child Care Health and Development. November 22, 2013
  Background Neurogenic bowel dysfunction in children is a lifelong condition often resulting in the need for active bowel management programmes, such as transanal irrigation. Parents are central in the decision‐making process to initiate and carry out treatments until such a time their child becomes independent. Minimal research has focussed on examining parents' experiences of undertaking transanal irrigation with their child. This study aimed to explore parents' experiences of learning about and using irrigation with their child and how parents motivated their children to become independent. Methods Semi‐structured telephone interviews were conducted with parents with experience of using transanal irrigation with their child. Interviews were undertaken by a parent researcher. Data were analysed using qualitative content analysis. Results Eighteen telephone interviews (16 mothers, 1 father and 1 carer) were conducted. Parents shared how they had negotiated getting started and using transanal irrigation with their child. They discussed a sense of success derived from their confidence in using and mastering irrigation, the process of making decisions to continue or stop using irrigation and how they motivated themselves and their child to continue with the irrigation regime. Challenges included minimizing their child's distress during the irrigation procedure and how they negotiated and moved towards their child becoming independent. Conclusion Despite the emotional difficulty parents experienced as a result of the invasive nature of transanal irrigation most parents reported an improvement in their child's faecal continence which positively impacted on the child and family's lives. The child's physical ability and emotional readiness to develop independent irrigation skills in the future concerned some parents. The experiences shared by parents in this study has the capacity to inform transanal irrigation nursing and medical care.

  November 22, 2013   doi: 10.1111/cch.12117   open full text
• The RICHE taxonomy – an innovative means of classification of child health research.
  D. Alexander, A. Bourek, J. Kilroe, M. Rigby, A. Staines.
  Child Care Health and Development. November 22, 2013
  Background Research outputs increase inexorably. Health is now a required element in all policies of the European Union. There is a need for a system that helps to navigate the vast body of children's health research, identify pertinent research institutions, discover ongoing and recently funded research projects and identify gaps where there is little knowledge. Methods The European Commission funded the Research Inventory of Child Health in Europe (RICHE) project through the Framework 7 Programme, to identify gaps in child health research in Europe. A necessary first step was to identify and index current research, for which a website repository was created. As a basis for this task, an innovative taxonomy was necessary to encompass the many arenas of children's health and development, including subjects outside the traditional areas of children's health. Drawing inspiration from existing taxonomies, library systems and other forms of classification, a multi‐axial approach was selected as the best way to encompass the many influences on children's health. Six axes were identified and their contents defined. All of the axes can be viewed and searched independently, as well as in relation to each other. The axes encompass factors and service areas that impact on children, including health, education, justice, the environment and others. This has created a system that is consistent and impartial, but adaptable to an enormous variety of uses. Results The taxonomy has been tested and validated by a number of well‐respected academics, researchers and practitioners across Europe. It forms the basis of an intuitive and accessible database. This allows research knowledge to be easily identified and for networking to take place. Conclusions The RICHE taxonomy facilitates retrieval of knowledge – ongoing research as well as findings – in order to inform researchers and policy makers who wish to include children's health as an element of new policy.

  November 22, 2013   doi: 10.1111/cch.12119   open full text
• Family‐centred music therapy to promote social engagement in young children with severe autism spectrum disorder: a randomized controlled study.
  G. A. Thompson, K. S. McFerran, C. Gold.
  Child Care Health and Development. November 22, 2013
  Background Limited capacity for social engagement is a core feature of autism spectrum disorder (ASD), often evident early in the child's development. While these skills are difficult to train, there is some evidence that active involvement in music‐making provides unique opportunities for social interaction between participants. Family‐centred music therapy (FCMT) endeavours to support social engagement between child and parent within active music‐making, yet the extent of benefits provided is unknown. Aim This study investigated the impacts of FCMT on social engagement abilities. Methods Twenty‐three children (36–60 months) with severe ASD received either 16 weeks of FCMT in addition to their early intervention programmes (n = 12), or their early intervention programme only (n = 11). Change in social engagement was measured with standardized parent‐report assessments, parent interviews and clinician observation. Results Intention‐to‐treat analysis for the Vineland Social Emotional Early Childhood Scale indicated a significant effect in favour of FCMT. Thematic qualitative analysis of the parent interviews showed that the parent–child relationship grew stronger. Conclusion FCMT improves social interactions in the home and community and the parent–child relationship, but not language skills or general social responsiveness. This study provides preliminary support for the use of FCMT to promote social engagement in children with severe ASD.

  November 22, 2013   doi: 10.1111/cch.12121   open full text
• Use of the Measure of Processes of Care (MPOC‐20) to evaluate health service delivery for children with cerebral palsy and their families in Jordan: validation of Arabic‐translated version (AR‐MPOC‐20).
  M. Saleh, N. A. Almasri.
  Child Care Health and Development. November 08, 2013
  Background Family‐centred service (FCS) is widely accepted now as best practice in paediatric rehabilitation. The Measure of Processes of Care‐20 items set (MPOC‐20) is a valid and reliable self‐report measure of parents' perceptions of the extent to which health services are family‐centred. Arabic‐translated and validated version of the MPOC‐20 (AR‐MPOC‐20) is used to examine Jordanian families' perception of service providers' caregiving behaviours as they receive rehabilitation services for their children with cerebral palsy (CP). Methods Parents of 114 children with CP who are receiving services at different settings in Jordan were interviewed using the AR‐MPOC‐20. Participating children aged 4.1 ± 4.4 years, 53.5% were males. Children varied across gross motor functional classification system (GMFCS). Parents were mostly mothers (76.3%), with at least high school education (71.9%). Results Factor analyses of the AR‐MPOC‐20 yielded a five‐factor solution with items loaded differently from the original measure. All items correlated best and significantly with their own Arabic scale score (rs: 0.91–0.26, P < 0.01). Internal consistency values of AR‐MPOC‐20 scales were acceptable (Cronbach's α: 0.69–0.82). Scale ‘Providing Written Information’ has the lowest average score (1.9 ± 1.6), while scale ‘Respectful & Coordinated Care’ has the highest average score (5.2 ± 1.5). Conclusion The AR‐MPOC‐20 is found to be a valid and reliable measure for use with Arabic‐Jordanian families of children with CP. FCS is not yet well implemented in Jordan, with parents reporting more need for information about their children's health and available services. Service providers are encouraged to apply FCS in paediatric rehabilitation, and giving more attention to effective communication and information exchange with families. AR‐MPOC‐20 is recommended for use for program evaluation.

  November 08, 2013   doi: 10.1111/cch.12116   open full text
• Young children with cerebral palsy: families self‐reported equipment needs and out‐of‐pocket expenditure.
  H. Bourke‐Taylor, C. Cotter, R. Stephan.
  Child Care Health and Development. August 18, 2013
  Background Costs to families raising a child with cerebral palsy and complex needs are direct and indirect. This study investigated the self‐reported real‐life costs, equipment needs, and associated characteristics of children who had the highest equipment and care needs. Method The purposive sample (n = 29) were families with a child with cerebral palsy: gross motor function levels 5 (n = 20), level 4 (n = 5), level 3 (n = 4); complex communication needs (n = 21); medical needs (n = 14); hearing impairment (n = 5) and visual impairment (n = 9). Participants completed a specifically designed survey that included the Assistance to Participate Scale. Equipment and technology purchases were recorded in the areas of positioning, mobility, transport, home modifications, communication, splinting and orthoses, self‐care, technology, communication devices, medical, adapted toys/leisure items and privately hired babysitters/carers. Descriptive and inferential statistics were used to analyse the data. Results Families had purchased up to 25 items within the areas described. The highest median number of items were recorded for positioning (15 items), mobility devices (9 items) and adapted toys/leisure items (9 items). Median costs were highest for home modifications (AUD$23 000), transport (AUD$15 000), splints and orthoses (AUD$3145), paid carers (AUD$3080), equipment for toileting/dressing/bathing (AUD$2900) and technical/medical items ($2380). Children who needed more parental assistance to participate in play and recreation also required significantly more equipment overall for positioning, communication, self‐care and toys/leisure. Conclusions The equipment needs of young children with complex disability are extensive and out‐of‐pocket expenses and parental time to support participation in play/recreation excessive. Substantial financial support to offset costs are crucial to better support families in this life situation.

  August 18, 2013   doi: 10.1111/cch.12098   open full text
• Low hepatitis B vaccine response in children with Down syndrome from Brazil.
  R. Nisihara, R. S. De Bem, P. H. R. Negreiros, S. R. R. Utiyama, N. P. Oliveira, H. Amarante.
  Child Care Health and Development. August 18, 2013
  Background It has been reported that vaccination against hepatitis B is less effective among people with Down syndrome than in the general population. We aimed to evaluate the rate of seroconversion to hepatitis B vaccine in children with Down syndrome from Brazil. Methods A total of 120 people with Down syndrome were included. All of them received the vaccine at intervals of 0, 30 and 180 days and serum samples were tested for the presence of antibodies to the hepatitis B surface antigen (anti‐HBs) 30 days after the last dose. Results In the studied group, 58.3% (70/120) were male and 41.7% (50/120) female, with the median age of 5 years (range 2–15 years). Fifty‐eight of 120 (48.3%) developed anti‐HBs after vaccination. No association was found between gender and/or age and vaccine response. Conclusions The low rate of seroconversion in response to hepatitis B vaccine suggests that all patients with Down syndrome immunized against hepatitis B should be followed and monitored by clinicians.

  August 18, 2013   doi: 10.1111/cch.12099   open full text
• Snapshots reflecting the lives of siblings of children with autism spectrum disorders.
  A. Latta, T. Rampton, J. Rosemann, M. Peterson, B. Mandleco, T. Dyches, S. Roper.
  Child Care Health and Development. August 18, 2013
  Background Past research focused on the effects of raising a child with autism spectrum disorder on families. However, most research examined parents' perspectives rather than siblings' perspectives. Therefore, the purpose of this qualitative descriptive design was to use photo elicitation to capture perspectives of siblings living with a child with autism spectrum disorder. Methods Fourteen siblings (nine male) of 13 children with autism spectrum disorder received disposable cameras with 24–27 colour exposures, and were asked to photograph what was important to them within 2 weeks. After developing snapshots, investigators interviewed siblings about their photographs, and used open, axial and selective coding to determine photograph categories and subcategories. Results Two major categories were found: people (family members, non‐family members) and non‐people (personal items/objects, animals, buildings, scenery). Interviews about photographs reflected experiences siblings had with people/non‐people in the snapshots and their normal everyday activities. Most photographs revealed family life and activities any sibling would experience whether or not they lived in a family raising a child with autism spectrum disorder. Conclusions Photo elicitation facilitates communication between children and health‐care professionals, and provides information about living with a child with autism spectrum disorder from the sibling's perspective. This information contributes to our knowledge base and allows development of specific intervention plans for siblings of these children.

  August 18, 2013   doi: 10.1111/cch.12100   open full text
• Prevalence and associated factors of emotional and behavioural problems in Chinese school adolescents: a cross‐sectional survey.
  J‐N. Wang, L. Liu, L. Wang.
  Child Care Health and Development. August 18, 2013
  Background Emotional and behavioural problems are key health issues in adolescence. The aim of this study was to evaluate the prevalence of emotional and behavioural problems in Chinese school adolescents and to explore associated factors. Methods This cross‐sectional study was conducted during the period of November/December 2009. A questionnaire including the Strengths and Difficulties Questionnaire (SDQ) self‐reported version, and the characteristics of child (age, gender, only child and study pressure), parents (parent–adolescent relationship and parental expectations) and families (living area, family structure, socio‐economic status and negative life events) was distributed to our study population. A total of 5220 Chinese adolescents (aged 11–18) from 30 public schools in Liaoning province completed the questionnaire. Multivariate logistic analysis was used to explore the factors associated with emotional and behavioural problems. Results The average problem score was 11.28 (SD = 5.86) and the 10.7% scored above the cut‐off for emotional and behavioural problems. Factors that increased the risk of having emotional and behavioural problems were: poor parent–adolescent relationship, experiencing more negative life events, older age, having study pressure, living in rural areas, boys and lower parental expectations. Conclusions The prevalence of emotional and behavioural problems among Chinese adolescents was lower level compared with those reported in other countries. We found parent–adolescent relationship, negative life events and age to be the strongest contributing factors of emotional and behavioural problems.

  August 18, 2013   doi: 10.1111/cch.12101   open full text
• Body mass index (BMI)‐for‐age and health‐related quality of life (HRQOL) among high school students in Tehran.
  S. Jalali‐Farahani, Y. S. Chin, P. Amiri, M. N. Mohd Taib.
  Child Care Health and Development. August 18, 2013
  Background The study aimed to determine the association between body mass index (BMI)‐for‐age and health‐related quality of life (HRQOL) among high school students in Tehran. Methods A total of 465 high school students (227 girls and 238 boys) and their parents were participated in this cross‐sectional study. Body weight and height of the students were measured. For assessing HRQOL, both adolescent self‐report and parent proxy‐report of the Persian version of Pediatric Quality of Life Inventory (PedsQL™4.0) questionnaire were completed by adolescents and their parents respectively. Results The prevalence of overweight and obesity (38.5%) was higher than severe thinness and thinness (2.8%). Mean of adolescent self‐reported and parent proxy‐reported HRQOL total score were 80.26 ± 12.07 and 81.30 ± 14.08 respectively. In terms of HRQOL subscale scores, the highest subscale score of HRQOL was reported in social functioning (87.27 ± 14.40) and the lowest score was reported in emotional functioning (69.83 ± 18.69). Based on adolescent self‐report, adolescent boys had significantly higher mean score for total and all subscale scores of HRQOL compared with girls (P < 0.05). BMI‐for‐age was inversely correlated to adolescent self‐reported HRQOL total score (r = −0.25, P < 0.05). Based on adolescents self‐report, HRQOL total score was significantly different by body weight status (F = 16.16, P < 0.05). Normal weight adolescents had significantly higher HRQOL total score compared with overweight (mean difference: 7.32; P < 0.05) and obese adolescents (mean difference: 9.10, P < 0.05). The HRQOL total score was not significantly different between normal weight and underweight adolescents (mean difference: 1.65, P = 0.96). However, based on parent proxy‐reports, HRQOL total score was not significantly different by body weight status (F = 2.64, P = 0.059). Conclusion More than one‐third of adolescents were overweight and obese. BMI‐for‐age was inversely correlated to adolescent self‐reported HRQOL. Based on adolescents' perspective, overweight and obese adolescents had poorer HRQOL compared with normal weight adolescents. Intervention studies are needed to improve the HRQOL of overweight and obese adolescents in Tehran.

  August 18, 2013   doi: 10.1111/cch.12103   open full text
• Parents’ experiences with physical and occupational therapy for their young child with cerebral palsy: a mixed studies review.
  A. J. A. Kruijsen‐Terpstra, M. Ketelaar, H. Boeije, M. J. Jongmans, J. W. Gorter, J. Verheijden, E. Lindeman, O. Verschuren.
  Child Care Health and Development. August 13, 2013
  Understanding the experiences of parents with their child's intervention might help meet the needs of parents and, subsequently get them engaged in their child's intervention. As parents’ early beliefs regarding their child's intervention has consequences for treatment participation, it is important to understand these parental perspectives. The aim of this mixed studies review was to give an overview of the experiences and related factors of parents of young children (0–5 years of age) with cerebral palsy in relation to the physical and/or occupational therapy of their child in a rehabilitation setting. The literature was searched systematically for qualitative and quantitative studies published between January 1990 and July 2011. Inclusion criteria were (1) the study population consisted of parents of children with cerebral palsy, with at least 25% of children under the age of five; (2) children had received physical and/or occupational therapy in a rehabilitation setting; and (3) the experiences of the parents with their child's therapy were addressed. Data were synthesized with the framework synthesis method resulting in a conceptual framework describing the factors that are related to the parents’ experiences with their child's interventions. A total of 13 studies (eight qualitative and five quantitative) were included and evaluated. Parents expressed various aspects in context, process and outcomes when asked about their experiences with their child's intervention. They had different needs over time and needed time to build a collaborative relationship with their child's therapists. The proposed framework acknowledges the various aspects in context, process and outcomes that parents reported when asked about their experiences. Knowing this, the importance of the broader context of the child in a family should be acknowledged; realizing the impact that the demands of daily life, supports and resources provided to parents, attitudes in the community and culture have on parental experiences.

  August 13, 2013   doi: 10.1111/cch.12097   open full text
• Experiences of housing insecurity among participants of an early childhood intervention programme.
  H. Turnbull, K. Loptson, N. Muhajarine.
  Child Care Health and Development. August 05, 2013
  Objectives To understand the barriers to programme success among high‐needs families in KidsFirst, an early childhood intervention programme. Methods Using a qualitative approach, a secondary analysis was performed using the qualitative data set (111 interviews and focus groups with 242 participants) from the KidsFirst programme evaluation. Data analysis was conducted to identify common experiences among high‐needs families in the programme and barriers to programme success. Results Participants identified housing insecurity as a major factor impeding programme delivery, retention and successful outcomes. Housing insecurity was shown to create or exacerbate ongoing crises among high‐needs families. Only after housing insecurity was addressed were families able to benefit from the KidsFirst programme. Conclusions The findings of this research suggest that until baseline material security is established for high‐needs families, early childhood development (ECD) interventions will be limited in meeting their objectives. In order to have the most effect for those living in poverty, helping families to achieve basic material security, including secure housing, should precede the targeted provision of psychosocial ECD supports. This finding has implications for how ECD intervention programmes could more effectively be designed and whom they should target.

  August 05, 2013   doi: 10.1111/cch.12091   open full text
• Undernutrition in children with profound intellectual and multiple disabilities (PIMD): its prevalence and influence on quality of life.
  C. Holenweg‐Gross, C. J. Newman, M. Faouzi, I. Poirot‐Hodgkinson, C. Bérard, E. Roulet‐Perez.
  Child Care Health and Development. August 01, 2013
  Background To estimate the prevalence of undernutrition among children with profound intellectual and multiple disabilities (PIMD) and to explore its influence on quality of life. Methods Seventy‐two children with PIMD (47 male; 25 female; age range 2 to 15 years 4 months; mean age 8.6, SD 3.6) underwent an anthropometric assessment, including body weight, triceps skinfold thickness, segmental measures and recumbent length. Undernutrition was determined using tricipital skinfold percentile and z‐scores of weight‐for‐height and height‐for‐age. The quality of life of each child was evaluated using the QUALIN questionnaire adapted for profoundly disabled children. Results Twenty‐five children (34.7%) were undernourished and seven (9.7%) were obese. Among undernourished children only eight (32 %) were receiving food supplements and two (8%) had a gastrostomy, of which one was still on a refeeding programme. On multivariate analysis, undernutrition was one of the independent predictors of lower quality of life. Conclusion Undernutrition remains a matter of concern in children with PIMD. There is a need to better train professionals in systematically assessing the nutritional status of profoundly disabled children in order to start nutritional management when necessary.

  August 01, 2013   doi: 10.1111/cch.12085   open full text
• The role of fathers in child feeding: perceived responsibility and predictors of participation.
  K. M. Mallan, M. Nothard, K. Thorpe, J. M. Nicholson, A. Wilson, P. A. Scuffham, L. A. Daniels.
  Child Care Health and Development. July 31, 2013
  Background The role of fathers in shaping their child's eating behaviour and weight status through their involvement in child feeding has rarely been studied. This study aims to describe fathers' perceived responsibility for child feeding, and to identify predictors of how frequently fathers eat meals with their child. Methods Four hundred and thirty‐six Australian fathers (M age = 37 years, SD = 6 years; 34% university educated) of a 2–5‐year‐old child (M age = 3.5 years, SD = 0.9 years; 53% boys) were recruited via contact with mothers enrolled in existing research projects or a university staff and student email list. Data were collected from fathers via a self‐report questionnaire. Descriptive and hierarchical linear regression analyses were conducted. Results The majority of fathers reported that the family often/mostly ate meals together (79%). Many fathers perceived that they were responsible at least half of the time for feeding their child in terms of organizing meals (42%); amount offered (50%) and deciding if their child eats the ‘right kind of foods’ (60%). Time spent in paid employment was inversely associated with how frequently fathers ate meals with their child (β = −0.23, P < 0.001); however, both higher perceived responsibility for child feeding (β = 0.16, P < 0.004) and a more involved and positive attitude toward their role as a father (β = 0.20, P < 0.001) were positively related to how often they ate meals with their child, adjusting for a range of paternal and child covariates, including time spent in paid employment. Conclusions Fathers from a broad range of educational backgrounds appear willing to participate in research studies on child feeding. Most fathers were engaged and involved in family meals and child feeding. This suggests that fathers, like mothers, should be viewed as potential agents for the implementation of positive feeding practices within the family.

  July 31, 2013   doi: 10.1111/cch.12088   open full text
• The School Function Assessment: identifying levels of participation and demonstrating progress for pupils with acquired brain injuries in a residential rehabilitation setting.
  S. West, C. Dunford, M. J. Mayston, R. Forsyth.
  Child Care Health and Development. July 31, 2013
  Background Delivering and monitoring residential rehabilitation services for pupils with acquired brain injuries (ABI) is challenging because of variability in aetiology, age and pre‐morbid characteristics. Therapists and educators in this residential rehabilitation setting identified the need for a comprehensive tool which would capture the pupils' ability to participate in typical, everyday, school‐based functional activities. This study aimed to explore the ability of the School Function Assessment (SFA) to identify levels of participation in school‐based functional tasks and demonstrate progress for pupils with an ABI in a residential rehabilitation setting. Methods The SFA was conducted on admission and discharge for pupils with ABI receiving residential rehabilitation between January 2007 and October 2011. Data analysis used Kruskal–Wallis to determine between‐group differences in age, time post injury and weeks in rehabilitation. Linear mixed effects modelling was used to establish differences between admission and discharge scores. Case vignettes demonstrated how the SFA was used with individual pupils. Results Seventy pupils were identified (31 traumatic brain injury; 29 non‐traumatic and 10 anoxic) 42 boys and 28 girls whose age at injury was 4.5–17.2 years (median 12.8). The SFA demonstrated that 54/70 pupils had made progress with their ability to participate in school activities. Significant differences were found between admission and discharge SFA scores for participation, physical and cognitive assistance and adaptation and activity performance (P < 0.05). There was wide variability between individual profiles reflecting the heterogeneity of ABI. Conclusions The SFA determined levels of participation in school‐based functional tasks for these residential pupils with an ABI and demonstrated progress both at the group and individual level in this residential rehabilitation setting. It identified the amount of support a pupil would need when they return to their local school and their strengths and needs in relation to participation in physical and cognitive school‐based functional activities.

  July 31, 2013   doi: 10.1111/cch.12089   open full text
• Social determinants of parent–child interaction in the UK.
  R. Brocklebank, H. Bedford, L. J. Griffiths.
  Child Care Health and Development. July 31, 2013
  Background Children are shaped in part by their environment and one rich in communication is therefore beneficial. Activities such as play and reading have long lasting positive effects on development. This study examined the social and demographic characteristics of mothers who play with, read to and tell stories to their child, using data from the UK‐wide Millennium Cohort Study (MCS). Methods The study included 14 034 mothers of singleton 5‐year‐old children. Using data from the first and third sweeps of the MCS, we examined how often mothers engaged with their child in playing, reading and telling stories, according to their social and demographic characteristics: ethnicity, socio‐economic status, highest academic qualification, lone mother status, age at birth of cohort child, number of children and employment status. Adjusted logistic regression analyses were conducted using Stata. Results When their children were 5 years old, 22% of mothers reported playing, 51% reading and 13% telling stories everyday. Indian, Pakistani, Bangladeshi and Black mothers were significantly less likely to play with their child at least weekly compared with White mothers. The same applied to lone mothers compared with those living with a partner. Mothers with academic qualifications lower than degree level were less likely to read at least once weekly. Compared with mothers who worked full‐time, those who worked part‐time, were ‘on‐leave’ or unemployed, were more likely to play with, and read to, their child at least weekly. Mothers with more than one child were significantly less likely to engage at least weekly in any of the three activities studied. Conclusions We found significant inequalities in the frequency of playing, reading and telling stories according to sociodemographic characteristics. This information is important to be able to target more effectively vulnerable children using established public health initiatives, like ‘Bookstart’ and ‘Surestart’, aimed at promoting play, reading and story telling.

  July 31, 2013   doi: 10.1111/cch.12090   open full text
• Family resources for families of children with cerebral palsy in Jordan: psychometric properties of the Arabic‐Family Resources Scale.
  N. A. Almasri, M. Saleh, C. J. Dunst.
  Child Care Health and Development. July 30, 2013
  Background Resource‐based, family‐centred practices are associated with better health, emotional, and social well‐being of children with disabilities. The adequacy of resources available for families of children with disabilities in Middle Eastern countries has not been described adequately in part because of lack of measures that are culturally adapted to be used in Arabic countries. Therefore, this study aims to (1) to evaluate the psychometric properties of the Arabic‐Family Resource Scale (A‐FRS) on a sample of families of children cerebral palsy (CP); (2) examine the adequacy of family resources as perceived by parents of children with CP in Jordan; and (3) examine the influence of child and family demographic variables on how parents report resources available to their families. Method A cross‐section design was applied. One‐hundred fifteen parents of children with CP with mean age 4.6 years (SD = 4.4) and their parents participated in the study. Research assistants interviewed the participants to complete the A‐FRS, and family and child demographic questionnaire, and determined the Gross Motor Function Classification System level of children. Results The principal axis factoring of the A‐FRS yielded a six‐factor solution that accounted for 67.39% of the variance and that is different than the factor structure reported by the developers of the FRS. Cronbach's coefficient alpha of the total score of family resources was 0.86 indicating a good internal consistency and the test–retest reliability for the total scale score was r = 0.92 (P = 0.000) indicating excellent test–retest reliability. Child health and family income were significantly associated with the total score of the A‐FRS. Conclusions The A‐FRS is a valid and reliable measure of family resources for Jordanian families of children with CP. Service providers are encouraged to use A‐FRS with families to plan resource‐based interventions in which family resources are mobilized to meet family needs.

  July 30, 2013   doi: 10.1111/cch.12087   open full text
• Paternal ADHD symptoms and child conduct problems: is father involvement always beneficial?
  A. M. Romirowsky, A. Chronis‐Tuscano.
  Child Care Health and Development. July 30, 2013
  Background Maternal psychopathology robustly predicts poor developmental and treatment outcomes for children with attention‐deficit/hyperactivity disorder (ADHD). Despite the high heritability of ADHD, few studies have examined associations between paternal ADHD symptoms and child adjustment, and none have also considered degree of paternal involvement in childrearing. Identification of modifiable risk factors for child conduct problems is particularly important in this population given the serious adverse outcomes resulting from this comorbidity. Methods This cross‐sectional study examined the extent to which paternal involvement in childrearing moderated the association between paternal ADHD symptoms and child conduct problems among 37 children with ADHD and their biological fathers. Results Neither paternal ADHD symptoms nor involvement was independently associated with child conduct problems. However, the interaction between paternal ADHD symptoms and involvement was significant, such that paternal ADHD symptoms were positively associated with child conduct problems only when fathers were highly involved in childrearing. Conclusions The presence of adult ADHD symptoms may determine whether father involvement in childrearing has a positive or detrimental influence on comorbid child conduct problems.

  July 30, 2013   doi: 10.1111/cch.12092   open full text
• Assessment of family needs in children with physical disabilities: development of a family needs inventory.
  M. W. Alsem, R. C. Siebes, J. W. Gorter, M. J. Jongmans, B. G. J. Nijhuis, M. Ketelaar.
  Child Care Health and Development. July 30, 2013
  Background Valid tools to assess family needs for children with physical disabilities are needed to help tune paediatric rehabilitation care processes to individual needs of these families. To create such a family needs inventory, needs of families of children with a physical disability (age 0–18 years) were identified. We examined differences in the number and type of needs listed by families when asked for by means of an interview compared with using an inventory. Methods Forty‐nine families of children with a wide variety of physical disabilities (mean age 7.7 years; SD 4.6) participated in semi‐structured interviews, focusing on family needs. They also checked an inventory of 99 items (based on a previously conducted literature review), regarding their family needs. In addition, individual interviews with healthcare professionals, and panel meetings with healthcare professionals and parents were held to further identify relevant family needs for the inventory. Results The individual parent and healthcare professional interviews raised 41 needs that were not included in the original inventory of 99 items. Moreover, the panel meetings raised a further 49 needs. After restructuring and reformulating several items, a 187‐item Family Needs Inventory – Paediatric Rehabilitation (FNI‐PR) was created. The parent interviews revealed significantly less family needs (mean number of needs = 10.8; SD = 6.0) compared with using the inventory (mean number of needs = 31.7; SD = 19.7) (P < 0.0001). Most expressed family needs were related to both general and specific information concerning the child's development and treatment, aids and information about legislation and to rules relating to compensation of costs. Conclusion Based on responses of parents and healthcare professionals the FNI‐PR has been developed, a comprehensive inventory for family needs that can be used in paediatric rehabilitation. An inventory checked by parents resulted in more family needs than a single open‐ended question. The inventory may facilitate the implementation of family‐centred care.

  July 30, 2013   doi: 10.1111/cch.12093   open full text
• Exploring young patients' perspectives on rehabilitation care: methods and challenges of organizing focus groups for children and adolescents.
  M. Krol, H. Sixma, J. Meerdink, H. Wiersma, J. Rademakers.
  Child Care Health and Development. July 30, 2013
  Background In research on quality of care, the experiences of children and (pre)adolescents are usually assessed by asking their parents. However, these young patients may have preferences of their own, and their experiences do not necessarily concur with those of their parents. Therefore, our research aimed to give young patients an opportunity to speak up for themselves. Methods Focus group meetings and online focus groups were organized for two age groups (8–11 and 12–15 years) of young patients from two Dutch rehabilitation centres, with the use of a tailored interview technique. The feasibility and applicability of both types of focus groups were assessed. Results For both types of focus groups, recruitment proved a major problem. The focus group meetings with (pre)adolescents proved both feasible and applicable in obtaining information regarding the preferences and experiences towards rehabilitation care. Regarding children's meetings, there were mixed results. The setting suited most of them, but some were more anxious. In general, online focus groups were less successful than expected for both age groups. Conclusions Possibilities for enhancing the recruitment rate should be considered, as the low participation rates limited generalizability of focus group results. The tailored design proved useful for obtaining relevant input from (pre)adolescents through meetings, but, especially for children, repeated meetings or other locations (e.g. at home) could be considered. This may make participants more at ease. For both age groups, the online focus groups proved far less useful, in terms of participation.

  July 30, 2013   doi: 10.1111/cch.12095   open full text
• The importance of identity and empowerment to teenagers with developmental co‐ordination disorder.
  R. P. Lingam, C. Novak, A. Emond, J. E. Coad.
  Child Care Health and Development. June 18, 2013
  Aims The aim of the current study was to gain an understanding of the experiences and aspirations of young people living with Developmental Coordination Disorder (DCD) in their own words. Methods Eleven young people aged 11–16 years with a prior diagnosis of DCD were identified from child health records of two participating NHS trusts. The sample included seven boys and four girls, from different socio‐economic backgrounds living in different parts of one large urban area in England. In depth one‐to‐one semi‐structured interviews and subsequent follow‐up small group interviews were carried out with the young people. Interviews were enhanced using participatory arts‐based techniques. All interviews were recorded verbatim and transcribed. Narrative data were analysed using Lindseth's interpretive phenomenology. Results The central theme of ‘We're all different’ described how the young person saw themselves and encompassed the formation of identity. Subthemes illustrated the attitude of the young people to their day to day lives, their difficulties and strategies used by the young people to overcome these difficulties in school and at home. The attitude of the school to difference, the presence of bullying, the accepting nature of the class, teachers and peers were vitally important. Areas of life that encouraged a positive sense of identity and worth included being part of a social network that gave the young people a sense of belonging, potentially one that valued differences as well as similarities. Conclusion The current work highlights the need for services to adopt a model of DCD where the young person talks about what they can do and considers strategies of overcoming their difficulties. This has implications for education and future intervention strategies that focus on fostering psychological resilience and educational coping strategies rather than simply attempting to improve motor skills.

  June 18, 2013   doi: 10.1111/cch.12082   open full text
• ‘I could never do that before’: effectiveness of a tailored Internet support intervention to increase the social participation of youth with disabilities.
  P. Raghavendra, L. Newman, E. Grace, D. Wood.
  Child Care Health and Development. June 13, 2013
  Background Youth use the Internet for a variety of purposes including social networking. Youth with disabilities are limited in their social networks and friendships with peers. The aim was to investigate the effectiveness of tailored one‐on‐one support strategies designed to facilitate social participation of youth with disabilities through the use of the Internet for social networking. Methods Eighteen youth aged 10–18 years with cerebral palsy, physical disability or acquired brain injury received support, training and assistive technology at their home to learn to use the Internet for building social networks. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS) were used to evaluate objective changes in performance and satisfaction. Interviews with the youth identified subjective changes they experienced through participation in the programme and to determine whether and how the intervention influenced their social participation. Results Youth showed an increase in performance and satisfaction with performance on identified goals concerning social networking on the COPM; Paired T‐test showed that these differences were statistically significant at P < 0.001. GAS T‐scores demonstrated successful outcomes (>50) for 78% of the youth. Interviews showed that youth were positive about the benefits of hands‐on training at home leading to increased use of the Internet for social networking. Conclusions The Internet could be a viable method to facilitate social participation for youth with disabilities. Youth identified the benefits of one‐to‐one support at home and training of the family compared with typical group training at school. Despite its success with this group of youth, the time and effort intensive nature of this approach may limit the viability of such programmes. Further longitudinal research should investigate whether Internet use is sustained post intervention, and to identify the factors that best support ongoing successful and safe use.

  June 13, 2013   doi: 10.1111/cch.12048   open full text
• The Assistance to Participate Scale to measure play and leisure support for children with developmental disability: update following Rasch analysis.
  H. Bourke‐Taylor, J. F. Pallant.
  Child Care Health and Development. June 13, 2013
  Background The Assistance to Participate Scale (APS) was designed to measure the primary carer's estimate of the amount of assistance that their school‐aged child with a disability requires to participate in play and leisure activities. Previous research suggests that the 8‐item APS has good internal consistency. The construct validity of the scale is supported by strong correlations with instruments measuring similar constructs and discrimination between groups of children with developmental disability, based on extent of need for caregiver assistance. Aim The aim of this current study was to undertake further evaluation of the psychometric properties of the APS using Rasch analysis. Method Rasch analysis was conducted using the RUMM2030 program to assess the APS items in terms of their overall fit to the Rasch model, individual item fit, response format, targeting and dimensionality. Results Rasch analysis showed good fit to the model, with no misfitting items and good internal consistency (PSI = 0.85). There was no differential item functioning across mothers' age, education level or child's age. Dimensionality testing supported the combination of all items to create a total score. Most items showed disordered thresholds, suggesting some inconsistencies in the way respondents used the response scale options. Conclusions The APS has been subjected to substantial psychometric testing during development and evaluation, revealing a sound, brief and easy‐to‐use scale. The APS has a number of potential clinical and research uses measuring the amount of additional assistance that children require from their primary care giver to participate in play activities.

  June 13, 2013   doi: 10.1111/cch.12047   open full text
• School participation, supports and barriers of students with and without disabilities.
  W. Coster, M. Law, G. Bedell, K. Liljenquist, Y.‐C. Kao, M. Khetani, R. Teplicky.
  Child Care Health and Development. June 13, 2013
  Background We compared school participation patterns of students ages 5–17 with and without disabilities and examined whether features of the school environment were perceived to help or hinder their participation. Methods Parents (n = 576) residing in the USA and Canada completed the Participation and Environment Measure for Children and Youth (PEM‐CY) via the internet. Results Parents of students with disabilities reported that their children participated less frequently in school clubs and organizations and getting together with peers outside the classroom and that they were less involved in all school activities. Parents of students with disabilities also were significantly more likely to report that features of the environment hindered school participation and that resources needed to support their child's participation were not adequate. Conclusions Parents of students with disabilities report that their children are participating less in important school‐related activities. Barriers limiting school participation include features of the physical and social environment as well as limited resources.

  June 13, 2013   doi: 10.1111/cch.12046   open full text
• Engagement in family activities: a quantitative, comparative study of children with profound intellectual and multiple disabilities and children with typical development.
  A. K. Axelsson, M. Granlund, J. Wilder.
  Child Care Health and Development. June 13, 2013
  Background Participation is known to be of great importance for children's development and emotional well‐being as well as for their families. In the International Classification of Functioning, Disability and Health – Children and Youth version participation is defined as a person's ‘involvement in a life situation’. Engagement is closely related to involvement and can be seen as expressions of involvement or degree of involvement within a situation. This study focuses on children's engagement in family activities; one group of families with a child with profound intellectual and multiple disabilities (PIMD) and one group of families with children with typical development (TD) were compared. Methods A descriptive study using questionnaires. Analyses were mainly performed by using Mann–Whitney U‐test and Spearman's rank correlation test. Results Engagement in family activities differed in the two groups of children. The children with PIMD had a lower level of engagement in most family activities even though the activities that engaged the children to a higher or lesser extent were the same in both groups. Child engagement was found to correlate with family characteristics mostly in the children with TD and in the children with PIMD only negative correlations occurred. In the children with PIMD child engagement correlated with cognition in a high number of listed family activities and the children had a low engagement in routines in spite of these being frequently occurring activities. Conclusions Level of engagement in family activities in the group of children with PIMD was lower compared with that in the group of children with TD. Families with a child with PIMD spend much time and effort to adapt family living patterns to the child's functioning.

  June 13, 2013   doi: 10.1111/cch.12044   open full text
• The youth report version of the Child and Adolescent Scale of Participation (CASP): assessment of psychometric properties and comparison with parent report.
  J. McDougall, G. Bedell, V. Wright.
  Child Care Health and Development. June 13, 2013
  Objective The Child and Adolescent Scale of Participation (CASP) parent report is a brief and valid measure for use with children and youth with chronic conditions/disabilities that has been shown to have good coverage at the chapter level of the ‘Activities and Participation’ component of the International Classification of Functioning, Disability and Health. The purpose of this research was to assess the psychometric properties of a CASP youth self‐report version, to further validate the parent report, and to compare parent and youth reports of youths' activity and participation. Methods Baseline data from a longitudinal study examining predictors of changes in quality of life for youth with chronic conditions/disabilities were used. CASP data were collected on 409 youth aged 11–17 with various conditions/disabilities using youth and parent reports. Internal consistency and factor structure were examined for both versions using Cronbach's alpha and exploratory factor analyses. Inter‐rater agreement and magnitude of differences between youth and parent report were evaluated using intraclass correlation coefficients and paired t‐tests respectively. Gender, age and condition/disability group differences in youth report CASP scores were examined using independent t‐tests or analyses of variance. Results Strong internal consistency and internal structure validity was demonstrated for the CASP youth and parent report. The youth report factor structure was similar to the parent report in this and other studies. Youth reported their activity/participation to be significantly higher than did their parents. Significant differences in CASP scores were found among condition/disability groups. Conclusions Findings show that, from a psychometric standpoint, the youth version of the CASP is a promising new self‐report measure of activity and participation. As youth perceive their activity and participation levels differently than their parents, it is important to collect data from both sources to obtain a more comprehensive understanding of this aspect of youths' lives.

  June 13, 2013   doi: 10.1111/cch.12050   open full text
• The Questionnaire of Young People's Participation (QYPP): a new measure of participation frequency for disabled young people.
  C. Tuffrey, B. J. Bateman, A. C. Colver.
  Child Care Health and Development. June 13, 2013
  Introduction The concept of participation was introduced by the World Health Organisation in the International Classification of Functioning, Disability and Health, 2001. Instruments to measure participation have been developed for children and adults, but none specifically for adolescents. Adolescence is a life stage with distinct patterns of participation, and previous research has shown that young people with disabilities have poorer participation than the general population. The aim of this study was to develop a measure of participation frequency, covering all major domains, for young people with cerebral palsy (CP). CP was chosen as an exemplar because it is a significant cause of disability in young people, with affected individuals experiencing a range of different impairments of varying severity. Methods A pool of 88 items was developed using the published literature, existing measures and qualitative data from young people. The item pool was revised following expert review by 17 experts. Cognitive interviews on the items were carried out with 12 young people and 12 carers; field‐testing was then undertaken with 107 young people with CP aged 13–21 years, and 540 young people from the general population to enable item reduction and to examine reliability and construct validity. Results The content review resulted in a 92‐item draft questionnaire, content validity index of 93%. Cognitive interviews led to further wording changes. Following field‐testing, the questionnaire was shortened to 45 items. Known‐groups validity was demonstrated by correlation with impairment severity. Test–retest reliability was satisfactory for all domains. Internal consistency varied between domains. Conclusion This is the first instrument developed specifically to measure frequency of participation across multiple domains for young people with disability. Use of the questionnaire in research and clinical work will enable its properties to be better understood and its generalizability to wider groups to be clearer.

  June 13, 2013   doi: 10.1111/cch.12060   open full text
• Community participation patterns among preschool‐aged children who have received Part C early intervention services.
  M. Khetani, J. E. Graham, C. Alvord.
  Child Care Health and Development. June 13, 2013
  Background We examined activity‐specific patterns and child, family and environmental correlates of participation restriction in nine community‐based activities among preschoolers with disabilities who have received Part C early intervention services. Methods Data were gathered from a subsample of 1509 caregivers whose children (mean age = 67.7 months) had enrolled in the National Early Intervention Longitudinal Study (NEILS) and completed a 40‐min computerized telephone interview or 12‐page mailed survey. Data were analysed on cases with complete data on the variables of interest. Bivariate relationships were examined between variables, including patterns of co‐reporting participation difficulties for pairs of community activities. Results Caregivers were more than twice as likely to report difficulty in one activity (20%) than difficulties in 2–3, 4–5, or 6–9 activities. Co‐reporting paired difficulties was strong for activities pertaining to neighbourhood outings but less conclusive for community‐sponsored activities and recreation and leisure activities. Our data show strong and positive associations between child functional limitations in mobility, toileting, feeding, speech, safety awareness, and friendships and participation difficulty in 7–9 activities. Lower household income was associated with participation difficulty in 7 out of 9 activities and difficulty managing problematic behaviour was strongly associated with participation difficulty in all 9 activities. Each of the three environmental variables (limited access to social support, transportation and respite) was associated with participation restrictions in all nine activities. Conclusion Results provide practitioners with detailed descriptive knowledge about modifiable factors related to the child, family and environment for promoting young children's community participation, as well information to support development of a comprehensive assessment tool for research and intervention planning to promote community participation for children enrolled in early intervention.

  June 13, 2013   doi: 10.1111/cch.12045   open full text
• Construct validity of the FOCUS© (Focus on the Outcomes of Communication Under Six): a communicative participation outcome measure for preschool children.
  K. Washington, N. Thomas‐Stonell, B. Oddson, S. McLeod, G. Warr‐Leeper, B. Robertson, P. Rosenbaum.
  Child Care Health and Development. June 13, 2013
  Objective The aim of this study was to establish the construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS©). This measure is reflective of concepts in the International Classification of Functioning Disability and Health – Children and Youth framework. It was developed to capture ‘real‐world’ changes (e.g. communicative participation) in preschoolers' communication following speech‐language intervention. Method A pre–post design was used. Fifty‐two parents of 3‐ to 6‐year‐old preschoolers attending speech‐language therapy were included as participants. Speech‐language therapists provided individual and/or group intervention to preschoolers. Intervention targeted: articulation/phonology, voice/resonance, expressive/receptive language, play, and use of augmentative devices. Construct validity for communicative participation was assessed using pre‐intervention and post‐intervention parent interviews using the FOCUS© and the communication and socialization domains of the Vineland Adaptive Behavior Scales‐II (VABS‐II). Results Significant associations were found between the FOCUS©, measuring communicative participation, and the VABS‐II domains for: (i) pre‐intervention scores in communication (r = 0.53, P < 0.001; 95% CI 0.30–0.70) and socialization (r = 0.67, P < 0.001; 95% CI 0.48–0.80); (ii) change scores over‐time in communication (r = 0.45, P < 0.001; 95% CI 0.201–0.65) and socialization (r = 0.39, P = 0.002; 95% CI 0.13–0.60); and (iii) scores at post‐intervention for communication (r = 0.53, P < 0.001; 95% CI 0.30–0.70) and for socialization (r = 0.37, P = 0.003; 95% CI 0.11–0.50). Conclusions The study provided evidence on construct validity of the FOCUS© for evaluating real‐world changes in communication. We believe that the FOCUS© is a useful measure of communicative participation.

  June 13, 2013   doi: 10.1111/cch.12043   open full text
• Measuring communicative participation using the FOCUS©: Focus on the Outcomes of Communication Under Six.
  N. Thomas‐Stonell, K. Washington, B. Oddson, B. Robertson, P. Rosenbaum.
  Child Care Health and Development. June 13, 2013
  Background The FOCUS© is a new outcome tool for use by both parents and clinicians that measures changes in the communicative participation skills of preschool children. Changes in communicative participation skills as measured by the FOCUS were compared across three groups of children: those with speech impairments only (SI), those with language impairments only (LI) and those with both speech and language impairments (S/LI). Methods Participating families (n = 112, 75 male children) were recruited through 13 Canadian organizations. Children ranged from 10 months to 6 years 0 months (mean = 2.11 years; SD = 1.18 years) and attended speech‐language intervention. Parents completed the FOCUS at the start and end of treatment. There were 23 children in the SI group, 62 children in the LI group and 27 children in the S/LI group. The average amount of the children's therapy varied from 7 to 10 h. Results The FOCUS captures changes in communicative participation for children with a range of communication disorder types and severities. All three groups of children made clinically important improvements according to their FOCUS scores (MCID ≥ 16 points). The FOCUS captured improvements in intelligibility, independent communication, play and socialization. Conclusions The FOCUS measured positive changes in communicative participation skills for all three groups of children after 7–10 h of speech‐language therapy. An outcome measure that targets only specific speech and language skills would miss many of the important social function changes associated with speech‐language treatment.

  June 13, 2013   doi: 10.1111/cch.12049   open full text
• Social support provided to caregivers of children with cerebral palsy.
  L. I. Pfeifer, D. B. R. Silva, P. B. Lopes, T. S. Matsukura, J. L. F. Santos, M. P. P. Pinto.
  Child Care Health and Development. June 04, 2013
  Objective To describe the perception of caregivers of children with cerebral palsy (CP) concerning social support received and to verify how the characteristics of the children (i.e. type of CP and severity of motor impairment) and those of their caregivers (i.e. age, level of education, occupation, income and number of children) are significantly related to this perception. Method A total of 50 children with CP aged between 3 and 12 years and their respective caregivers participated in this study. Children were grouped in terms of type of CP and according to the severity of motor impairment through the Gross Motor Function Classification System (GMFCS). The Social Support Questionnaire (SSQ) was used to evaluate the perception of caregivers concerning the social support they receive (number of people offering support – SSQ‐N index, and level of satisfaction concerning such support – SSQ‐S index). Results The caregivers reported receiving support from a mean of 1.67 people. Core and extended family members (i.e. husband, mother, siblings) and friends are the most common providers of support. In regard to level of satisfaction, caregivers considered the support they received to be positive, obtaining a mean of 5.52 out of a total of six points. Children's and caregivers' characteristics were not significantly related to the SSQ‐N and SSQ‐S indexes. Conclusion Family members are the caregivers' primary source of social support and caregivers reported being satisfied with the support they received.

  June 04, 2013   doi: 10.1111/cch.12077   open full text
• The validity and reliability of the Finnish Family Empowerment Scale (FES): a survey of parents with small children.
  M. Vuorenmaa, N. Halme, P. Åstedt‐Kurki, M. Kaunonen, M.‐L. Perälä.
  Child Care Health and Development. June 04, 2013
  Background The Family Empowerment Scale (FES) is a widely used instrument which measures the parents' own sense of their empowerment at the level of the family, service system and community. It was originally developed for parents of children with emotional disabilities. Aim The aims of this study were to evaluate the validity and reliability of the Finnish FES and to examine its responsiveness in measuring the empowerment of parents with small children. Methods and participants The English FES was translated into Finnish using back translation and modified so as to be generic and convenient for all families. The construct, convergent, discriminant and concurrent validities, reliability and responsiveness of the Finnish FES were examined. Participants (n = 955) were the parents of children aged 0–9 years who had been selected using stratified random sampling. Results Confirmatory factor analysis proved that the Finnish FES had three subscales based on the original FES. Convergent and discriminant validities confirmed and supported the same construct. The relationship between parents' participation and empowerment was tested for concurrent validity. As in previous FES studies, the participating parents were more empowered, which supported the concurrent validity. The reliability of the Finnish FES proved acceptable for both parents. The Finnish FES could also discriminate the responses of the parents. Participation in the activities organized by the family service system influenced parents' perceptions of empowerment more than did their background characteristics. Conclusions The Finnish FES is a valid and reliable instrument and it is suitable for measuring the empowerment of parents. However, it is necessary to consider how the FES would identify in the best way the parents who perhaps need some help.

  June 04, 2013   doi: 10.1111/cch.12081   open full text
• Early parental physical punishment and emotional and behavioural outcomes in preschool children.
  S. Scott, J. Lewsey, L. Thompson, P. Wilson.
  Child Care Health and Development. June 03, 2013
  Objective To determine whether there is an association between being smacked by your main caregiver in the first two years and emotional and behavioural problems at age four. Methods Design: Secondary analysis of data from the Growing Up in Scotland Prospective Study (GUS). Setting: Scotland, UK. Participants: GUS birth cohort children, whose main caregiver had no concerns about their behaviour at 22 months. Exposure: Ever smacked by main caregiver in first 22 months, as measured by caregiver self‐report at 22 months. Main Outcome: Emotional and behavioural problems as measured by parental assessment and the Strengths and Difficulties Questionnaire (SDQ) at 46 months. Results Preschool children exposed to main caregiver smacking in the first two years were twice as likely to have emotional and behavioural problems as measured by parental assessment [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.9–3.2; absolute risk reduction (ARR) 17.8%, 95% CI 12.1–23.5] and SDQ (OR 2.5, 95% CI 1.7–3.7; ARR 7.5%, 95% CI 3.7–11.5), as children never smacked by their main caregiver. The association remained significant after adjusting for child age and sex, caregiver age, sex, ethnicity, educational attainment and mental health status, sibling number, structural family transitions and socioeconomic status (adj. OR 2.4, 95% CI 1.8–3.2 for parental assessment and adj. OR 2.2, 95% CI 1.4–3.5 for SDQ). Conclusions Parental use of physical punishment in the first two years may be a modifiable risk factor for emotional and behavioural difficulties in preschool children.

  June 03, 2013   doi: 10.1111/cch.12061   open full text
• Associations of family meal frequency with family meal habits and meal preparation characteristics among families of youth with type 1 diabetes.
  M. L. Kornides, T. R. Nansel, V. Quick, D. L. Haynie, L. M. Lipsky, L. M. B. Laffel, S. N. Mehta.
  Child Care Health and Development. June 03, 2013
  Background While benefits of family mealtimes, such as improved dietary quality and increased family communication, have been well‐documented in the general population, less is known about family meal habits that contribute to more frequent family meals in youth with type 1 diabetes. Methods This cross‐sectional study surveyed 282 youth ages 8–18 years with type 1 diabetes and their parents on measures regarding diabetes‐related and dietary behaviours. T‐tests determined significant differences in youth's diet quality, adherence to diabetes management and glycaemic control between those with and without regular family meals (defined as ≥5 meals per week). Logistic regression analyses determined unadjusted and adjusted associations of age, socio‐demographics, family meal habits, and family meal preparation characteristics with regular family meals. Results 57% of parents reported having regular family meals. Families with regular family meals had significantly better diet quality as measured by the Healthy Eating Index (P < 0.05) and the NRF9.3 (P < 0.01), and adherence to diabetes management (P < 0.001); the difference in glycaemic control approached statistical significance (P = 0.06). Priority placed on, pleasant atmosphere and greater structure around family meals were each associated with regular family meals (P < 0.05). Meals prepared at home were positively associated with regular family meals, while convenience and fast foods were negatively associated (P < 0.05). Families in which at least one parent worked part‐time or stayed at home were significantly more likely to have regular family meals than families in which both parents worked full‐time (P < 0.05). In the multivariate logistic regression model, greater parental priority given to family mealtimes (P < 0.001) and more home‐prepared meals (P < 0.001) predicted occurrence of regular family meals; adjusting for parent work status and other family meal habits. Conclusions Strategies for promoting families meals should not only highlight the benefits of family meals, but also facilitate parents' skills for and barriers to home‐prepared meals.

  June 03, 2013   doi: 10.1111/cch.12078   open full text
• Parents of children with physical disabilities – perceived health in parents related to the child's sleep problems and need for attention at night.
  E. Mörelius, H. Hemmingsson.
  Child Care Health and Development. June 03, 2013
  Background Approximately half of all children with moderate to severe physical disabilities have persistent sleep problems and many of these children need parental attention at night. Aim To study whether sleep problems and need for night‐time attention among children with physical disabilities are associated with perceived parental health, headache, psychological exhaustion, pain due to heavy lifting, night‐time wakefulness and disrupted sleep. Methods We asked parents of 377 children with physical disabilities aged 1–16 years to complete a questionnaire about their own health. The children all lived at home with both parents. Results Both parents reported poor health, psychological exhaustion, more night‐time wakefulness and disrupted sleep when the child had sleep problems (P < 0.05). Mothers also reported more headache when the child had sleep problems (P = 0.001). Both parents reported more night‐time wakefulness and disrupted sleep when the child needed night‐time attention (P < 0.01). In general, mothers reported significantly poorer health, more night‐time wakefulness, disrupted sleep, headache and psychological exhaustion than fathers (P < 0.001). Conclusions Sleep problems need to be acknowledged within the paediatric setting in order to prevent psychological exhaustion and poor health in mothers and fathers of children with physical disabilities.

  June 03, 2013   doi: 10.1111/cch.12079   open full text
• Invented fairy tales in groups with onco‐haematological children.
  G. Margherita, M. L. Martino, F. Recano, F. Camera.
  Child Care Health and Development. May 14, 2013
  Background The impact of an onco‐haematological illness for children is a traumatic event that opens to pain, hospitalizations and interrupts the continuity of daily life. It is difficult for the child to make meaning, to share the pain or ask a question related to the illness because, often, the parents or doctors cannot find a way to communicate in a suitable way for the child who remains in a situation of ‘unspoken’, where, fear, anxiety and pain cannot find a space to express. Methods The present research‐intervention uses the methodology of invented fairy tales in groups with onco‐haematological children, in the hospital, in order to explore the organization of the meanings at the base of the tales co‐constructed by the participants underlying weaknesses and strengths of the invented fairy tales in groups intervention. The invented fairy tales in groups is used as a tool, such as a play, to express, share and support the experience of the illness of children. Forty‐nine children participated to the invented fairy tales in groups in an onco‐haematological hospital. Within a quali‐quantitative framework we performed a thematic analysis of elementary context, cluster analysis, on the fairy tales considered as a unique narrative corpus of the thought of the group. Results The analysis shows four thematic clusters: fantasy as search for a meaning, 29.71%, the group as a space for illusions, 27.90%, the illness as a family problem, 25.72%, anchoring reality, 16.67%. The results highlighted three main carriers of sense: the representation of illness/the relational world/the representation of the institution. Conclusions The use of invented‐fairy‐tales groups allowed the onco‐haematological children to tell and share the experience of illness through a different way, which let them express symbolically their pain. The invented fairy tale in groups becomes a mediator of psychic processes which offer new solutions while improving interpersonal relationships/communication between the participants in group.

  May 14, 2013   doi: 10.1111/cch.12076   open full text
• Goal setting with mothers in child development services.
  S. Forsingdal, W. St John, V. Miller, A. Harvey, P. Wearne.
  Child Care Health and Development. May 13, 2013
  Aim The aim of this grounded theory study was to explore mothers' perspectives of the processes of collaborative goal setting in multidisciplinary child development services involving follow‐up home therapy. Methods Semi‐structured interviews were conducted in South East Queensland, Australia with 14 mothers of children aged 3–6 years who were accessing multidisciplinary child development services. Interviews were focussed around the process of goal setting. Results A grounded theory of Maternal Roles in Goal Setting (The M‐RIGS Model) was developed from analysis of data. Mothers assumed Dependent, Active Participator and Collaborator roles when engaging with the therapist in goal‐setting processes. These roles were characterized by the mother's level of dependence on the therapist and insight into their child's needs and therapy processes. Goal Factors, Parent Factors and Therapist Factors influenced and added complexity to the goal‐setting process. Conclusion The M‐RIGS Model highlights that mothers take on a range of roles in the goal‐setting process. Although family‐centred practice encourages negotiation and collaborative goal setting, parents may not always be ready to take on highly collaborative roles. Better understanding of parent roles, goal‐setting processes and influencing factors will inform better engagement with families accessing multidisciplinary child development services.

  May 13, 2013   doi: 10.1111/cch.12075   open full text
• Social communicative variation in 1–3‐year‐olds with severe visual impairment.
  N. J. Dale, V. Tadić, P. Sonksen.
  Child Care Health and Development. May 12, 2013
  Background Although the social communicative domain is recognized as being at risk in young children with visual impairment (VI), few tools are available for identifying those most at risk or the aspects that are most vulnerable. Methods A standard parent interview – Social Communication Interview for young children with visual impairment (SOCI‐VI), was developed and tested with 55 parents of 17 profoundly, 15 severely VI and 23 normally sighted children; mean age 22 months (range 10–40 months). The 35‐item SOCI‐VI 35 showed adequate inter‐rater and test–retest reliability (P < 0.001). Results Thirteen of 35 items discriminated within and between the vision groups (anova P 0.008). The group with profound VI scored significantly lower than the Sighted group on the reduced 13 item SOCI‐VI 13 (t‐test P 0.002), the disparity being greatest for items exploring joint attention. The reduced SOCI‐VI 13 showed adequate internal consistency (Cronbach alpha > 0.75) and concurrent validity with the Vineland adaptation questionnaire within a randomized VI subgroup (r 0.8, P < 0.01). Conclusions The study reveals trends in early social communicative development in the young VI population and provides preliminary reliability and validity testing for future research within a clinical context.

  May 12, 2013   doi: 10.1111/cch.12065   open full text
• Why go online when you have pain? A qualitative analysis of teenagers’ use of the Internet for pain management advice.
  E. M. Henderson, E. Keogh, C. Eccleston.
  Child Care Health and Development. May 12, 2013
  Background Adolescents are routinely recognized as native to online technologies. However, we know from previous research that this familiarity does not often translate into its use for help‐seeking around health. We designed this study to examine the experience of adolescents in using the Internet to access pain management information, specifically why some adolescents may be reluctant to use these resources. Methods Twenty‐six healthy, school attending, adolescents aged between 14 and 17 years old were recruited to a qualitative study of focus groups. Seventeen participants were female and nine were male. Participation was limited to those who self‐selected as frequent users of the Internet, but who were loath to use it as a resource for health information as we wished to explore reasons for non‐use. All data were thematically analysed. Results Most participants reported using the Internet to seek health information at least once. Experiences with online content were typically negative and drawn on only when all other sources of information and pain coping were exhausted. Three themes emerged, Drivers of Internet use, Barriers, and Anxiety around use. Adolescent health websites were reported to be confusing, anxiety provoking and hard to negotiate. The Internet was judged to be less accessible than other forms of pain and health coping information. Secondary themes related to topic embarrassment, the strive for independence and reassurance, preferred information source failure, curiosity, website design, availability of OTC analgesics, effort, fear‐provoking narratives, mistrust of quality of online content and pain‐related anxiety. Conclusions Counter to many positive reports of the health benefits of Internet use during information seeking, its value is questionable to some adolescents. Typical experience was anxiety provoking, unlikely to yield helpful results, and wasteful comparative to off‐line resources for pain.

  May 12, 2013   doi: 10.1111/cch.12072   open full text
• Developing web‐based Triple P ‘Positive Parenting Programme’ for families of children with asthma.
  S.‐A. Clarke, R. Calam, A. Morawska, M. Sanders.
  Child Care Health and Development. May 12, 2013
  Background We examined the feasibility of self‐directed Triple P ‘Positive Parenting Programme’ for optimizing parents' management of childhood asthma and behaviour. Methods Eligible families were invited to access asthma‐specific web‐based Triple P as part of a preliminary randomized controlled study. Results Initial study information and introductory website pages received considerable interest but intervention uptake was poor with high rates of attrition. Conclusions Although parents of children with asthma show willingness to access web‐based parenting support, further work is necessary to develop engaging websites and determine barriers to uptake, and adherence to online parenting interventions with this population.

  May 12, 2013   doi: 10.1111/cch.12073   open full text
• Speech, communication and use of augmentative communication in young people with cerebral palsy: The SH&PE population study.
  H. Cockerill, D. Elbourne, E. Allen, D. Scrutton, E. Will, A. McNee, C. Fairhurst, G. Baird.
  Child Care Health and Development. May 09, 2013
  Background Communication is frequently impaired in young people (YP) with bilateral cerebral palsy (CP). Important factors include motoric speech problems (dysarthria) and intellectual disability. Augmentative and Alternative Communication (AAC) techniques are often employed. The aim was to describe the speech problems in bilateral CP, factors associated with speech problems, current AAC provision and use, and to explore the views of both the parent/carer and young person about communication. Methods A total population of children with bilateral CP (n = 346) from four consecutive years of births (1989–1992 inclusive) with onset of CP before 15 months were reassessed at age 16–18 years. Motor skills and speech were directly assessed and both parent/carer and the young person asked about communication and satisfaction with it. Results Sixty had died, eight had other conditions, 243 consented and speech was assessed in 224 of whom 141 (63%) had impaired speech. Fifty‐two (23% of total YP) were mainly intelligible to unfamiliar people, 22 (10%) were mostly unintelligible to unfamiliar people, 67 (30%) were mostly or wholly unintelligible even to familiar adults. However, 89% of parent/carers said that they could communicate 1:1 with their young person. Of the 128 YP who could independently complete the questions, 107 (83.6%) were happy with their communication, nine (7%) neither happy nor unhappy and 12 (9.4%) unhappy. A total of 72 of 224 (32%) were provided with one or more types of AAC but in a significant number (75% of 52 recorded) AAC was not used at home, only in school. Factors associated with speech impairment were severity of physical impairment, as measured by Gross Motor Function Scale level and manipulation in the best hand, intellectual disability and current epilepsy. Conclusions In a population representative group of YP, aged 16–18 years, with bilateral CP, 63% had impaired speech of varying severity, most had been provided with AAC but few used it at home for communication.

  May 09, 2013   doi: 10.1111/cch.12066   open full text
• What do parents know about their children's comprehension of emotions? Accuracy of parental estimates in a community sample of pre‐schoolers.
  S. B. Kårstad, Ø. Kvello, L. Wichstrøm, T. S. Berg‐Nielsen.
  Child Care Health and Development. April 22, 2013
  Background Parents' ability to correctly perceive their child's skills has implications for how the child develops. In some studies, parents have shown to overestimate their child's abilities in areas such as IQ, memory and language. Emotion Comprehension (EC) is a skill central to children's emotion regulation, initially learned from their parents. In this cross‐sectional study we first tested children's EC and then asked parents to estimate the child's performance. Thus, a measure of accuracy between child performance and parents' estimates was obtained. Subsequently, we obtained information on child and parent factors that might predict parents' accuracy in estimating their child's EC. Methods Child EC and parental accuracy of estimation was tested by studying a community sample of 882 4‐year‐olds who completed the Test of Emotion Comprehension (TEC). The parents were instructed to guess their children's responses on the TEC. Predictors of parental accuracy of estimation were child actual performance on the TEC, child language comprehension, observed parent–child interaction, the education level of the parent, and child mental health. Results Ninety‐one per cent of the parents overestimated their children's EC. On average, parents estimated that their 4‐year‐old children would display the level of EC corresponding to a 7‐year‐old. Accuracy of parental estimation was predicted by child high performance on the TEC, child advanced language comprehension, and more optimal parent–child interaction. Conclusion Parents' ability to estimate the level of their child's EC was characterized by a substantial overestimation. The more competent the child, and the more sensitive and structuring the parent was interacting with the child, the more accurate the parent was in the estimation of their child's EC.

  April 22, 2013   doi: 10.1111/cch.12071   open full text
• Children's strategies to handle cancer: a video ethnography of imaginal coping.
  C. Rindstedt.
  Child Care Health and Development. April 18, 2013
  Background This article explores how children use fantasy, play, and coping (imaginal coping) in order to handle chronic illness. Imaginal coping, as a theoretical construct, is defined as the use of imagination to deal with the hardships of illness. The overarching aim has been to investigate the various ways in which categories of staff members (doctors, nurses, play therapists, and hospital clowns) and parents support children in their coping. Focus has thus been on collaborative or interactive aspects of playful coping. Method A large proportion of the data collected consists of 93 h of video‐recorded interactions between children, parents and staff. The collection of data involved fieldwork carried out with the use of a video ethnographic method, making it possible thereby to analyse and work with data in greater detail. For more than one year, five children with leukaemia were followed as each made their regular visits to a children's cancer clinic in a children's hospital in Sweden. Results Collaborative storytelling, humorous treatment practices, playful rituals, as well as role‐reversal play, were all types of events involving staff–child collaboration and creative improvisation. Conclusions Staff, along with parents, played a significant role in the coping process. In various ways, the staff members helped the parents to respond to their children in ways adaptive for coping. It can be seen that imaginal coping is a highly interactional business. In this study it is shown that parents socialize coping; this is sometimes undertaken explicitly, for example, through coaching (in the form of instructions or suggestions) and teaching. But often it is achieved through modelling or intent participation, with the child observing staff members' treatment practices.

  April 18, 2013   doi: 10.1111/cch.12064   open full text
• Cross‐sectional survey of daily junk food consumption, irregular eating, mental and physical health and parenting style of British secondary school children.
  J. Zahra, T. Ford, D. Jodrell.
  Child Care Health and Development. April 18, 2013
  Background Previous research has established that poor diets and eating patterns are associated with numerous adverse health outcomes. This study explored the relationships between two specific eating behaviours (daily junk food consumption and irregular eating) and self‐reported physical and mental health of secondary school children, and their association with perceived parenting and child health. Methods 10 645 participants aged between 12 and 16 completed measures of junk food consumption, irregular eating, parental style, and mental and physical health through the use of an online survey implemented within 30 schools in a large British city. Results 2.9% of the sample reported never eating regularly and while 17.2% reported daily consumption of junk food. Young people who reported eating irregularly and consuming junk food daily were at a significantly greater risk of poorer mental (OR 5.41, 95% confidence interval 4.03–7.25 and 2.75, 95% confidence interval 1.99–3.78) and physical health (OR 4.56, 95% confidence interval 3.56–5.85 and 2.00, 95% confidence interval 1.63–2.47). Authoritative parenting was associated with healthier eating behaviours, and better mental and physical health in comparison to other parenting styles. Discussion A worrying proportion of secondary school children report unhealthy eating behaviours, particularly daily consumption of junk food, which may be associated with poorer mental and physical health. Parenting style may influence dietary habits. Interventions to improve diet may be more beneficial if also they address parenting strategies and issues related to mental and physical health.

  April 18, 2013   doi: 10.1111/cch.12068   open full text
• Reliability and validity of the Parent Efficacy for Child Healthy Weight Behaviour (PECHWB) scale.
  F. Palmer, M. C. Davis.
  Child Care Health and Development. April 18, 2013
  Background Interventions for childhood overweight and obesity that target parents as the agents of change by increasing parent self‐efficacy for facilitating their child's healthy weight behaviours require a reliable and valid tool to measure parent self‐efficacy before and after interventions. Nelson and Davis developed the Parent Efficacy for Child Healthy Weight Behaviour (PECHWB) scale with good preliminary evidence of reliability and validity. The aim of this research was to provide further psychometric evidence from an independent Australian sample. Methods Data were provided by a convenience sample of 261 primary caregivers of children aged 4–17 years via an online survey. PECHWB scores were correlated with scores on other self‐report measures of parenting efficacy and 2‐ to 4‐week test–retest reliability of the PECHWB was assessed. Results The results of the study confirmed the four‐factor structure of the PECHWB (Fat and Sugar, Sedentary Behaviours, Physical Activity, and Fruit and Vegetables) and provided strong evidence of internal consistency and test–retest reliability, as well as good evidence of convergent validity. Conclusion Future research should investigate the properties of the PECHWB in a sample of parents of overweight or obese children, including measures of child weight and actual child healthy weight behaviours to provide evidence of the concurrent and predictive validity of PECHWB scores.

  April 18, 2013   doi: 10.1111/cch.12069   open full text
• Family ecology of young children with cerebral palsy.
  A. LaForme Fiss, L. A. Chiarello, D. Bartlett, R. J. Palisano, L. Jeffries, N. Almasri, H‐J. Chang.
  Child Care Health and Development. April 17, 2013
  Background Family ecology in early childhood may influence children's activity and participation in daily life. The aim of this study was to describe family functioning, family expectations of their children, family support to their children, and supports for families of young children with cerebral palsy (CP) based on children's gross motor function level. Methods Participants were 398 children with CP (mean age = 44.9 months) and their parents residing in the USA and Canada. Parents completed four measures of family ecology, the Family Environment Scale (FES), Family Expectations of Child (FEC), Family Support to Child (FSC) and Family Support Scale (FSS). Results The median scores on the FES indicated average to high family functioning and the median score on the FSS indicated that families had helpful family supports. On average, parents reported high expectations of their children on the FEC and strong support to their children on the FSC. On the FES, higher levels of achievement orientation were reported by parents of children in Gross Motor Function Classification System (GMFCS) level II than parents of children in level I, and higher levels of control were reported by parents of children in level I than parents of children in level IV. On the FEC, parents of children with limited gross motor function (level V) reported lower expectations than parents of children at all other levels. Conclusions Family ecology, including family strengths, expectations, interests, supports and resources, should be discussed when providing interventions and supports for young children with CP and their families.

  April 17, 2013   doi: 10.1111/cch.12062   open full text
• Sleep‐related factors: associations with poor attention and depressive symptoms.
  J. E. Lehto, L. Uusitalo‐Malmivaara.
  Child Care Health and Development. April 17, 2013
  Background Sleep duration is known to be associated with depression and attention deficits in children, though the majority of studies have focused on adolescents. Attention problems and depressive symptoms related to sleep factors have not been studied simultaneously in the non‐clinical child population before. Methods Sleep quantity, adverse bedtime behaviour, daytime sleepiness, poor attention and symptoms of depression were assessed using self‐report measures. The participants were 11 years old (n = 439). Results Short sleep duration during the school week is related to poor attention and high depression. It is not a significant predictor of low attention and high depression symptoms in logistic regression analyses. Instead, adverse bedtime behaviour and daytime sleepiness predict them highly significantly. Conclusions Short sleep duration is related to poor attention and depressive symptoms as suggested by previous work. However, the significant role of other sleep‐related factors calls for further research.

  April 17, 2013   doi: 10.1111/cch.12063   open full text
• Relationships between academic performance, SES school type and perceptual‐motor skills in first grade South African learners: NW‐CHILD study.
  A. E. Pienaar, R. Barhorst, J. W. R. Twisk.
  Child Care Health and Development. April 16, 2013
  Background Perceptual‐motor skills contribute to a variety of basic learning skills associated with normal academic success. This study aimed to determine the relationship between academic performance and perceptual‐motor skills in first grade South African learners and whether low SES (socio‐economic status) school type plays a role in such a relationship. Methods This cross‐sectional study of the baseline measurements of the NW‐CHILD longitudinal study included a stratified random sample of first grade learners (n = 812; 418 boys and 394 boys), with a mean age of 6.78 years ± 0.49 living in the North West Province (NW) of South Africa. The Beery‐Buktenica Developmental Test of Visual‐Motor Integration‐4 (VMI) was used to assess visual‐motor integration, visual perception and hand control while the Bruininks Oseretsky Test of Motor Proficiency, short form (BOT2‐SF) assessed overall motor proficiency. Academic performance in math, reading and writing was assessed with the Mastery of Basic Learning Areas Questionnaire. Linear mixed models analysis was performed with spss to determine possible differences between the different VMI and BOT2‐SF standard scores in different math, reading and writing mastery categories ranging from no mastery to outstanding mastery. A multinomial multilevel logistic regression analysis was performed to assess the relationship between a clustered score of academic performance and the different determinants. Results A strong relationship was established between academic performance and VMI, visual perception, hand control and motor proficiency with a significant relationship between a clustered academic performance score, visual‐motor integration and visual perception. A negative association was established between low SES school types on academic performance, with a common perceptual motor foundation shared by all basic learning areas. Conclusion Visual‐motor integration, visual perception, hand control and motor proficiency are closely related to basic academic skills required in the first formal school year, especially among learners in low SES type schools.

  April 16, 2013   doi: 10.1111/cch.12059   open full text
• Parental education and physical activity in pre‐school children.
  S. Vale, N. Ricardo, L. Soares‐Miranda, R. Santos, C. Moreira, J. Mota.
  Child Care Health and Development. April 15, 2013
  Background The purpose of this study was to objectively assess pre‐school children's total physical activity (TPA) patterns and compliance with guidelines and to examine differences relative to parental education. Methods The sample consisted on 509 healthy pre‐school children, aged 3–6 years recruited from kindergartens located in the metropolitan area of Porto, Portugal. The PA was assessed for 7 consecutive days by accelerometry. For TPA, we followed the guidelines of the National Association for Sport and Physical Education (NASPE) (children who spent at least >120 min per day in active play). For TPA, we calculated the proportion of children who spent at least >120 min per day in active play and moderate‐to‐vigorous physical activity (MVPA), we calculated the proportion of children who spent at least >60 min per day in active play. Parental education was analysed according to the Portuguese education system. Results Children with parents in the highest education level were less active than children from low and middle education level (P ≤ 0.001) in all patterns of PA (week and weekend). Regarding TPA during the week we found that the majority of children from low and middle parental education meet the NASPE guidelines. On the other hand, more than half the children from high parental education did not meet these recommendations (P ≤ 0.001) and MVPA recommendations (P ≤ 0.05). In both recommendations, children from low parental education were twice more likely to meet the recommendations compared with children belonging to high parental education. Conclusion Parent education was negatively associated with children's daily physical activity patterns and compliance with guidelines.

  April 15, 2013   doi: 10.1111/cch.12041   open full text
• Trends and patterns of under‐5 vaccination in Nigeria, 1990–2008: what manner of progress?
  B. A. Ushie, O. A. Fayehun, D. B. Ugal.
  Child Care Health and Development. April 09, 2013
  Background Despite efforts towards reducing childhood morbidity and mortality, Nigeria ranks among countries with the highest rates of vaccine‐preventable diseases including tuberculosis, poliomyelitis, measles, diphtheria, pertussis and tetanus. These efforts include regular rounds of immunization days and routine exercises. The government of Nigeria periodically undertakes National Demographic and Health (NDH) surveys, which tap information on various health indices including vaccination coverage. Limited studies have used the NDHS data to examine the trends in vaccination coverage for the assessment of successes or failures of the immunization efforts. Methods This study used four NDH Surveys datasets between 1990 and 2008, which generated child health information including the proportion that had had any or all basic childhood vaccines. A combined total of 44 071 (weighted) children were involved in the study. The trend and pattern of vaccination over 18 years were examined while selected factors were regressed to obtain predictors of child vaccinations in Nigeria. Results The most recent survey (2008) reported more complete vaccination apart from 1990, which was said to be inaccurate. In all surveys, children from mothers with higher education, who were delivered in hospitals, lived in urban areas, and whose mothers work outside the home had significantly higher proportions of completed basic vaccination. A lower level of childhood vaccination is observed in the northern parts, while higher rates are observed in the southern parts. More complete vaccination coverage was reported in the 1990 survey, followed by 2008, 1999 and 2003. In addition, children from mothers with higher levels of education, who were delivered in hospitals, who lived in urban areas, and whose mothers work outside the home had significantly higher proportions of completed basic vaccination. Conclusion Much more work needs to be done if more children are to be covered and thus reduce vaccine‐preventable diseases.

  April 09, 2013   doi: 10.1111/cch.12055   open full text
• Adolescent inhalant use and executive cognitive functioning.
  K. D. Scott, A. A. Scott.
  Child Care Health and Development. April 03, 2013
  Background This study investigates the association between inhalant use and executive cognitive functioning (ECF) and processing speed (PS) in 754 adjudicated poly‐substance users on a series of neuropsychological tests. Poly‐substance users who used inhalants (PSI = 262) and poly‐substance users who did not use inhalants (PSO = 492) neuropsychological tests scores were compared. Hispanic Americans comprised 72% of the participants; European Americans, African Americans and Asian Americans comprised 28% of the participants. Methods Standardized neuropsychological tests were used to assess ECF and PS. Psychosocial and substance abuse standardized surveys were used to assess drug use severity and psychosocial problems associated with substance use. Results Multiple Analysis of Covariance shows that PSI users who used inhalants performed worse on ECF and PS measures in comparison to non‐inhalant poly‐substance users (PSO). PSI users were younger, used more drugs and had more psychiatric admissions than PSO users. Conclusion PSI users initiate substances at a younger age and experienced more ECF and PS deficits, and behavioural problems in comparison to PSO users. The results of this study suggest that PS has direct effect on ECF and psychosocial outcomes in PSI users.

  April 03, 2013   doi: 10.1111/cch.12052   open full text
• Infant temperament and childhood psychiatric disorder: longitudinal study.
  K. Sayal, J. Heron, B. Maughan, R. Rowe, P. Ramchandani.
  Child Care Health and Development. April 03, 2013
  Background Temperamental characteristics emerge early in life and can shape children's development, adjustment and behaviour. We aimed to investigate the association between early infant temperament and later childhood psychiatric disorder in a community sample. Methods This prospective, population‐based study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC). In a sample of 7318 children, we investigated whether temperamental characteristics assessed at the ages of 6 months and 24 months are associated with an independent diagnosis of psychiatric disorder ascertained at age 7 years. Results After adjusting for confounders, temperamental characteristics assessed at 6 and 24 months of age were associated with psychiatric disorder at age 7 years. In particular, intensity of emotional reaction at age 6 months was associated with later disorder (adjusted odds ratio = 1.56; 95% confidence interval 1.19, 2.04; P = 0.002). These associations were stronger in girls and in those children with high levels of intensity at both 6 and 24 months of age. Conclusions Temperamental characteristics involving high levels of emotional intensity within the first year of life are longitudinally associated with psychiatric disorder in mid‐childhood, suggesting that the roots of psychiatric disorder may, in some cases, lie very early in life.

  April 03, 2013   doi: 10.1111/cch.12054   open full text
• Identifying infants at high‐risk for second‐hand smoke exposure.
  S. S. Hawkins, L. Berkman.
  Child Care Health and Development. April 02, 2013
  Background To examine the social determinants of infant smoke exposure and whether these associations vary by mothers' smoking status and number of children in the household. Methods There were 135 278 mothers from 28 states who participated in the Pregnancy Risk Assessment Monitoring System from 2000 to 2003. Results Overall 9.9% of mothers reported that her infant was in the same room as someone smoking for 1 or more hours per day. Among smoking households, infants with 1 or 2+ siblings were 25% and 59% more likely to be exposed to 1+ hours of second‐hand smoke daily, respectively, than infants with no siblings. Conclusion Infants only a few months old are being exposed to second‐hand smoke, particularly infants whose mother smokes and infants with siblings, indicating the importance of surveillance even for this young age group.

  April 02, 2013   doi: 10.1111/cch.12058   open full text
• The importance of family functioning, mental health and social and emotional well‐being on child oral health.
  A. M. N. Renzaho, A. Silva‐Sanigorski.
  Child Care Health and Development. March 31, 2013
  Objective To examine the strength of associations between child oral health and aspects of the home environment (child behaviour, parental psychological distress and family functioning) in a large sample of 1‐ to 12‐year‐old Australian children. Methods The current study used data from the 2006 Victorian Child Health and Wellbeing Study. Data were obtained on 4590 primary carers. Measures of the family environment included the level of family functioning, parental psychological distress, child's emotion and behavioural problems and the family structure. Results The odds of children having good oral health status were lower with increasing parental psychological distress and poor family functioning across all age groups, and lower with increasing child mental health or conduct problems among children aged 4 years or older. Socioeconomic factors were also related to child oral health status, but this was significant only among children aged 4–7 years, with the odds of children having good oral health status 68% higher in households with a yearly income ≥AUD$ 60 000 compared with households with income <$20 000 (P < 0.05). Conclusion In order to address inequities in the experience of poor oral health, solutions that encompass social, economic and psychosocial dimensions will be required. Integrating intervention strategies that promote oral, healthy family functioning and the mental health of parents and children into existing systems reaching vulnerable community members may improve child oral health outcomes and reduce the unequal distribution of oral disease across the social gradient.

  March 31, 2013   doi: 10.1111/cch.12053   open full text
• A qualitative study exploring the psychosocial value of weekend camping experiences for children and adolescents with complex heart defects.
  P. P. Desai, L. J. Sutton, M. D. Staley, D. W. Hannon.
  Child Care Health and Development. March 31, 2013
  Background Children living with complex heart defects (CHD) are likely to have ongoing social, emotional, physical, and health concerns, and are in need of additional psychosocial support. Summer camps can provide therapeutic benefits. Little research exists regarding the value of shorter camping experiences from the perspectives of children with CHD. The aim of our study was to explore what children and adolescents with CHD considered meaningful when attending a therapeutic camping weekend in the company of peers with similar medical diagnoses. Methods Engaging a phenomenological approach we used participant generated photography and reflective semi‐structured interviews to explore participants' lived experience and value derived from their weekend camping experiences. The study was completed with thirteen participants ranging in age from 9 to 16 years. Interviews were recorded and transcribed verbatim. Data were analysed using Van Manen's guidelines. Results Three themes reflecting the camp experiences were generated from the data. Meaningful experiences spanned three outcomes which had some overlapping influences: (i) Developing relationships and feeling accepted by peers and counsellors at camp; (ii) Enjoying and learning during the weekend; and (iii) Experiencing the natural and human‐built therapeutic environmental features of camp. The camping programme features, inputs, and processes as identified by the participants in contributing to these outcomes are described. Conclusion This qualitative study showed that children living with complex CHD valued the opportunity for participating in weekend camping experiences in the company of peers with similar heart defects. Findings contribute to a better understanding of what programme features and processes were considered meaningful. Given the scarcity of resources to devote to such social support activities, the findings may help professionals to plan effective interventions to maximize benefits during a shorter camping experience.

  March 31, 2013   doi: 10.1111/cch.12056   open full text
• Who gets help for pre‐school communication problems? Data from a prospective community study.
  J. Skeat, M. Wake, O. C. Ukoumunne, P. Eadie, L. Bretherton, S. Reilly.
  Child Care Health and Development. March 22, 2013
  Objective Pre‐school communication problems are common, with implications for school readiness and educational achievement. Help is available from a variety of community healthcare providers. This study examined the extent to which help is received, and the predictors of service receipt. Design and setting Prospective community study, in Melbourne, Victoria. Participants and method At age 4 years, we assessed the speech, receptive and expressive language and fluency of 1607 children and gave feedback to their parents. At age 5 years, 983 families provided data on service use for communication problems between and 4 and 5 years. We compared service use between participants with and without impairment, and used logistic regression to estimate the strength of association between potential predictors (gender, socio‐economic status, maternal education, English‐speaking background status, family history of speech and language problems and parent concern) and service use (binary outcome). Results Data were available for both communication status and service use for 753 children. Only 44.9% of the 196 children with communication impairment received help from a professional. Furthermore, 7% of the 557 that did not meet criteria for communication impairment nevertheless received help from a professional. Parent concern was the strongest predictor of service use (adjusted odds ratio = 9.0; 95% CI: 5.6–14.8). Conclusions Both over‐ and under‐servicing for communication problems were evident. This study shows that accessing help for communication problems requires more than simply informing parents about the problem and having services available; there is a need for systematic support to get the right children to services.

  March 22, 2013   doi: 10.1111/cch.12032   open full text
• Lifestyle correlates of self‐reported sleep duration among Saudi adolescents: a multicentre school‐based cross‐sectional study.
  H. M. Al‐Hazzaa, A. O. Musaiger, N. A. Abahussain, H. I. Al‐Sobayel, D. M. Qahwaji.
  Child Care Health and Development. March 22, 2013
  Background Lifestyle factors are important determinants of adequate sleep among adolescents. However, findings on sleep duration relative to lifestyle factors are conflicting. Therefore, this study examined the association of self‐reported sleep duration with physical activity, sedentary behaviours and dietary habits among Saudi adolescents. Methods A multicentre school‐based cross‐sectional study was conducted in three major cities in Saudi Arabia. The sample included 2868 secondary‐school students (51.9% girls) aged 15–19 years, randomly selected using a multistage stratified cluster sampling technique. In addition to anthropometric measurements, sleep duration, physical activity, sedentary behaviours and dietary habits were assessed using self‐reported questionnaire. Results Several lifestyle factors were associated with sleep duration in adolescents. While controlling for some potential confounders, the findings showed that high screen time [>5 h/day; adjusted odds ratio (aOR) = 1.505, 95% confidence interval (CI) = 1.180–1.920, P = 0.001] and low (aOR = 1.290, 95% CI = 1.064–1.566, P = 0.010) to medium (aOR = 1.316, 95% CI = 1.075–1.611, P = 0.008) physical activity levels were significantly related to daily sleep of 8 h or longer. Furthermore, having low intake of breakfast (<3 day/week compared with 5 days or more per week) decreased the odd of having adequate sleep duration by a factor of 0.795 (95% CI = 0.667–0.947, P < 0.010). Conclusions Short sleep duration (<8 h/day) among Saudi adolescents 15–19 year olds was significantly associated with several lifestyle factors. Intervention programs aiming for improving sleeping habits among adolescents need to consider such potential association of lifestyle variables with sleep duration.

  March 22, 2013   doi: 10.1111/cch.12051   open full text
• Exploring risk for abuse of children with chronic conditions or disabilities – parent's perceptions of stressors and the role of professionals.
  B. Svensson, U.‐B. Eriksson, S. Janson.
  Child Care Health and Development. March 05, 2013
  Background Children with chronic conditions or disabilities are at an increased risk for abuse. High level of parental stress has been identified as possible trigger for abuse, were a combination of several factors are of importance, as lack of social support and limited resources in the neighbourhood. Suggestions for preventive measures have merely focused on parenting strategies and targeted intervention programmes. So far, little attention has been paid on how the risk for abuse might relate to parent's perceptions of stressors and the role of professionals. The purpose of the current study was therefore to explore risk factors for abuse with focus on both parent–child and parent–professional relationships. Method Semi‐structured in‐depth interviews with 15 parents of children with chronic conditions or disability were collected and analysed according to qualitative content analysis. Findings Three major themes were found that could be seen as risk factors for child abuse: (1) Emotional demands in precarious situations between parent and child. (2) Gradual shift in responsibility from professionals to parents concerning access to and co‐ordination of service and support. (3) Emotionally closed environment between professionals and parents and taboo on talking about abuse. The gradual shift in responsibility had emotional implications, which could reinforce parental stress and thereby also indirect increase the risk of child abuse. The gradual shift in responsibility also seemed to generate an emotionally closed environment and reinforce the taboo on talking about abuse, which in turn hindered preventive measures. Conclusions In the light of parent's perceptions of stressors and the role of professionals the findings indicate that abuse against children with chronic conditions or disability is not only a family matter, but also depending on qualities in service, professional support and social norms. The result pinpoints three challenges for preventive measures, all with emotional implications, parental strategies, organizational efforts and cultural awareness.

  March 05, 2013   doi: 10.1111/cch.12030   open full text
• Update on the Child's Challenging Behaviour Scale following evaluation using Rasch analysis.
  H. M. Bourke‐Taylor, J. F. Pallant, M. Law.
  Child Care Health and Development. March 05, 2013
  Background The Child's Challenging Behaviour Scale (CCBS) was designed to measure a mother's rating of her child's challenging behaviours. The CCBS was initially developed for mothers of school‐aged children with developmental disability and has previously been shown to have good psychometric properties using classical test theory techniques. The aim of this study was to use Rasch analysis to fully evaluate all aspects of the scale, including response format, item fit, dimensionality and targeting. Methods The sample consisted of 152 mothers of a school‐aged child (aged 5–18 years) with a disability. Mothers were recruited via websites and mail‐out newsletters through not‐for‐profit organizations that supported families with disabilities. Respondents completed a survey which included the 11 items of the CCBS. Rasch analysis was conducted on these responses using the RUMM2030 package. Results Rasch analysis of the CCBS revealed serious threshold disordering for nine of the 11 items, suggesting problems with the 5‐point response format used for the scale. The neutral midpoint of the response format was subsequently removed to create a 4‐point scale. High levels of local dependency were detected among two pairs of items, resulting in the removal of two items (item 7 and item 1). The final nine‐item version of the scale (CCBS Version 2) was unidimensional, well targeted, showed good fit to the Rasch model, and strong internal consistency. Conclusions To achieve fit to the Rasch model it was necessary to make two modifications to the CCBS scale. The resulting nine‐item scale with a 4‐point response format showed excellent psychometric properties, supporting its internal validity.

  March 05, 2013   doi: 10.1111/cch.12035   open full text
• Measures of participation outcomes related to hand use for 2‐ to 12‐year‐old children with disabilities: a systematic review.
  C‐W. Chien, S. Rodger, J. Copley, C. McLaren.
  Child Care Health and Development. March 05, 2013
  Many interventions have been used to improve children's hand‐related impairments or hand skill performance in functional activities so as to promote life participation. There is thus a need to have suitable instruments assessing children's participation in life situations that specifically require hand use in order to support and evaluate such interventions. This systematic review investigated the availability of potential instruments that can be used to assess children's participation specifically in life situations requiring hand use. Clinical utility and evidence for psychometric properties were also sourced. Database searches initially identified measures that were used to evaluate participation of children aged 2–12 years, involved self‐ or proxy report or interview administration and had generic application for a range of disabilities/diagnoses. These measures were further evaluated to determine if they fulfilled the above inclusion criteria and contained at least 60% of the items involving hand use. Further searches for psychometric evidence were undertaken for the eligible measures. Fourteen measures were identified and nine met the inclusion criteria. However, none of these measures, except for the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES), contained all items related to hand use. Most of the included measures had limited psychometric properties. Only the Children's Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC), the School Function Assessment‐Participation section (SFA‐P) and the Children Participation Questionnaire (CPQ) revealed sufficient evidence of validity and reliability. The findings suggest a need for adapting existing participation measures or developing new ones that specifically assess participation in life situations requiring hand use to support interventions.

  March 05, 2013   doi: 10.1111/cch.12037   open full text
• Factors predicting distress among parents/caregivers of children with neurological disease and home enteral nutrition.
  C. Pedrón‐Giner, C. Calderón, C. Martínez‐Costa, S. Borraz Gracia, L. Gómez‐López.
  Child Care Health and Development. March 05, 2013
  Background & aims Caregivers of children with chronic diseases included in a home enteral nutrition (HEN) programme are at risk of experiencing a feeling of burden, high level of anxiety and psychological distress. The aims of this study were: first, to examine the prevalence of symptoms of anxiety–depression in caregivers of children with neurological diseases requiring HEN by gastrostomy tube (GT); second, to compare the characteristics of caregivers with high or low risk of exhibiting symptoms of anxiety–depression; and third, to investigate possible associations to child disease severity and nutrition support mode. Methods A cross‐sectional observational study was performed in 58 caregivers of children (31 boys, aged 0.3–18 years) with neurological diseases and GT feeding. The characteristics of caregivers with high or low risk of presenting symptoms of anxiety–depression were compared regarding the following variables: socio‐demographic characteristics, the primary caregiver's intrapsychic factors, anthropometric parameters of the child, length of HEN, type of nutrients delivered by GT and infusion regime. Results All primary caregivers were mothers. Fifty‐three per cent of them showed high risk of exhibiting symptoms of anxiety–depression. Mothers with high or low risk of presenting symptoms of anxiety–depression were comparable in age and family socio‐economic status. They were also similar in terms of age, anthropometric conditions and length of HEN in their children.No differences were found between the two groups of mothers according to the level of the child's motor function impairment, type of nutrients delivered by GT and infusion regime. Higher levels of psychological distress and perception of burden overload were found in mothers with high risk of exhibiting symptoms of anxiety–depression. Conclusions This study found a high prevalence of symptoms of anxiety–depression, perception of burden overload and psychological distress in caregivers of children with HEN. Thus, greater practical and emotional support is required for these families.

  March 05, 2013   doi: 10.1111/cch.12038   open full text
• How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention‐deficit/hyperactivity disorder.
  C. Nussey, N. Pistrang, T. Murphy.
  Child Care Health and Development. March 05, 2013
  Tourette syndrome (TS) and attention‐deficit/hyperactivity disorder (ADHD) are common neurodevelopmental disorders that often co‐occur. They are both stigmatized and misunderstood conditions. This review critically appraises studies examining interventions using psychoeducational approaches in TS and ADHD. Studies examining the impact of providing educational information (or diagnostic label) about TS and ADHD to parents, teachers and peers (child and adult) were identified by searching relevant electronic databases, reference lists and citations, and consulting colleagues. Twenty‐two studies were identified, 20 of which involved teachers or peers. The studies indicate that providing educational information increases knowledge, positive attitudes and behaviours towards individuals with TS and ADHD. Provision of a diagnostic label alone appears insufficient. Parental education may improve treatment enrolment and adherence. While the findings are encouraging, there are a number of gaps in the literature. These include the effects of giving information to parents, whether changes are maintained over time, or are generalizable to the population. Studies are needed to investigate the optimal way to present educational information in everyday contexts in order to improve the lives of those with TS and ADHD.

  March 05, 2013   doi: 10.1111/cch.12039   open full text
• Community‐based healthcare costs for children born low birthweight, preterm and/or small for gestational age: data from the Longitudinal Study of Australian Children.
  E. M. Westrupp, N. Lucas, F. K. Mensah, L. Gold, M. Wake, J. M Nicholson.
  Child Care Health and Development. March 05, 2013
  Aim Children born low birthweight, preterm and/or small for gestational age (SGA) sustain substantially increased costs for hospital‐based health care and additional educational support in the first few years of life. This is the first study internationally to investigate costs beyond hospital care, to community‐based health care and prescription medicines across early and middle childhood with actual cost data, and to examine these costs according to the severity of perinatal risk. Method In the prospective Longitudinal Study of Australian Children, we followed two cohorts of children from age of 0 to 5 years (no increased perinatal risk, n = 3973; mild risk, n = 442; and moderate‐to‐high risk, n = 297), and from age of 4 to 9 years (no increased perinatal risk, n = 3629; mild risk, n = 465; and moderate‐to‐high risk, n = 361). Children were defined as mild risk if born 32–36 weeks, with birthweight 1500–2499 g, and/or SGA (<5–9th percentile), and moderate‐to‐high risk if born <32 weeks, birthweight <1500 g and/or extremely SGA (<5th percentile). Federal government expenditure (2011 $AUD) on healthcare attendances and prescription medication from birth to 9 years were calculated via data linkage to the Australian Medicare records. Results Mean costs per child were A$362 higher (95% CI $156; 568) from 0 to 5 years and A$306 higher (95% CI $137; 475) from 4 to 9 years, for children with any compared with no increased perinatal risk (P < 0.001). At the population level, an additional A$32m was spent per year for children 0–9 years with any relative to no increased perinatal risk. Conclusions Perinatal risk is a major public health issue conferring considerable additional expense to community‐based health care, most marked in the first year of life but persisting up to at least 10 years. Even without additionally considering burden, these findings add to the urgency of identifying effective mechanisms to reduce perinatal risk across its full spectrum.

  March 05, 2013   doi: 10.1111/cch.12040   open full text
• Prevalence of undetected developmental delays in Iranian children.
  F. Sajedi, R. Vameghi, A. Kraskian Mujembari.
  Child Care Health and Development. March 05, 2013
  Background Regarding the short‐ and long‐term benefits of early intervention for childhood developmental disorders, this study was carried out to determine the prevalence of undetected developmental delays by the standardized form of the Persian version of the Ages and Stages Questionnaires (ASQ) in Iranian children. Methods This was a cross‐sectional study. The study was carried out on 11 000, 4‐ to 60‐month‐old children; in 19 age groups, in 41 selected cities throughout the country. Ninety physicians were invited from each of the selected cities to Tehran in groups, and trained about the ASQ scoring, during a 2‐day workshop. The questionnaires were completed at healthcare settings by parents of children who were apparently normal (lacking any gross developmental disorders) under the supervision of the physicians who consequently scored each child. The response rate was 95% (10 516 parents). Results Among the 10 516 children studied, 5035 (47.87%) were girls. The average percentage of children delayed in the communication, gross motor, fine motor, problem‐solving and social‐personal domains was 3.87%, 4.04%, 4.31%, 4.15% and 3.69%, respectively, when considering the Iranian cut‐off points. In the 19 age‐domain groups, most frequently in the personal‐social and fine motor domains (in terms of domains), and also most frequently at 36 and 48 months of age (in terms of age ranges), girls showed significantly higher scores than boys. Boys showed significantly higher scores in two age‐domain groups (gross motor domain at 20 and 22 months of age). Conclusions The prevalence of undetected developmental delays in Iranian children screened by the ASQ questionnaires ranged from 3.69% to 4.31% in different developmental domains.

  March 05, 2013   doi: 10.1111/cch.12042   open full text
• A home‐based intervention using augmentative and alternative communication (AAC) techniques in rural Kenya: what are the caregivers' experiences?
  J. K. Gona, C. R. Newton, S. Hartley, K. Bunning.
  Child Care Health and Development. March 03, 2013
  Background Caring for a child with complex communication needs associated with a developmental condition frequently adds stress to the caregiver. Furthermore, professional assistance is scarce in low‐income rural settings. For such children speech is frequently unachievable. Augmentative and alternative communication provides options for supplementing or replacing speech with other techniques. The current study aimed to examine the experiences of caregivers in Kenya before and after a home‐based intervention using augmentative and alternative communication techniques with children with complex communication needs. Methods Caregivers were interviewed pre‐ and post‐intervention. The interviews were digitally recorded, transcribed and translated into English. Content analysis was applied through the stages of text familiarization and topic organization. Emergent themes and their sub‐themes were identified and labelled. Connections between themes were established and interpretations made. The procedure was completed by a second researcher independently. Conflicting ideas were jointly discussed until consensus was achieved. Results Four themes emerged from the data: communication process; struggle; normality; and supernatural power. Before intervention, the caregivers acknowledged their expertise in communications with the child, while also revealing their sense of isolation, burden and pain. Normality was present as a source of comparison and also an aspirational goal. Post‐intervention more positive language was used to describe the child. There was an ‘opening up’ of communication that recognized the child's strengths and some social support systems were re‐established. The power of the supernatural was recognized before and after intervention. Conclusion Caring of a child with complex communication needs presents many challenges. A home‐based intervention using augmentative and alternative communication techniques appears to have been a catalyst for some positive transformations in the caregivers' experiences, although it is not possible to attribute this change to any one aspect. The potentials of the home‐based intervention would benefit from further investigation on a larger scale.

  March 03, 2013   doi: 10.1111/cch.12031   open full text
• Paediatricians' decision making about prescribing stimulant medications for children with attention‐deficit/hyperactivity disorder.
  S‐J. Chow, E. Sciberras, L. H. Gillam, J. Green, D. Efron.
  Child Care Health and Development. February 27, 2013
  Background Attention‐deficit/hyperactivity disorder (ADHD) is now the most common reason for a child to present to a paediatrician in Australia. Stimulant medications are commonly prescribed for children with ADHD, to reduce symptoms and improve function. In this study we investigated the factors that influence paediatricians' decisions about prescribing stimulant medications. Method In‐depth, semi‐structured interviews were conducted with paediatricians (n = 13) who were purposively recruited so as to sample a broad demographic of paediatricians working in diverse clinical settings. Paediatricians were recruited from public outpatient and private paediatrician clinics in Victoria, Australia. The interviews were audio‐recorded and transcribed verbatim for thematic analysis. Paediatricians also completed a questionnaire describing their demographic and practice characteristics. Results Our findings showed that the decision to prescribe is a dynamic process involving two key domains: (1) weighing up clinical factors; and (2) interacting with parents and the patient along the journey to prescribing. Five themes relating to this process emerged from data analysis: comprehensive assessments that include history, examination and information from others; influencing factors such as functional impairment and social inclusion; previous success; facilitating parental understanding including addressing myths and parental confusion; and decision‐making model. Conclusions Paediatricians' decisions to prescribe stimulant medications are influenced by multiple factors that operate concurrently and interdependently. Paediatricians do not make decisions about prescribing in isolation; rather, they actively involve parents, teachers and patients, to arrive at a collective, well‐informed decision.

  February 27, 2013   doi: 10.1111/cch.12036   open full text
• Twenty years of research shows UK child development team provision still varies widely for children with disability.
  J. R. Parr, N. Jolleff, L. Gray, J. Gibbs, J. Williams, H. McConachie.
  Child Care Health and Development. February 21, 2013
  Objectives To identify how services provided by child development teams (CDTs) have changed over 20 years. To what extent have major government initiatives aiming to improve the lives of children with disability and their families been implemented by teams? Design Survey sent to every UK CDT in 2009/2010; comparison with data gathered in 1988 and 1999. Results Ninety‐four per cent (225/240) of CDTs responded; data on 242 teams were available from 1999 and 125 teams from 1988. Despite policy recommendations advocating the value of interdisciplinary team working, there was a decline in numbers of professionals working within the CDT multidisciplinary team. One‐third of all teams reported a reduction in their funding over the last 5 years. However, specialist clinics provided increased. Teams reported patchy adoption of national initiatives designed to improve provision. Transition services were underdeveloped. Conclusions This comprehensive survey of UK CDT service provision, as well as national studies of the healthcare experience of families with a disabled child, shows that improvements in provision are required.

  February 21, 2013   doi: 10.1111/cch.12025   open full text
• Rehabilitation service utilization in children and youth with cerebral palsy.
  A. Majnemer, K. Shikako‐Thomas, L. Lach, M. Shevell, M. Law, N. Schmitz, C. Poulin,.
  Child Care Health and Development. January 30, 2013
  Aim To describe the pattern of use of rehabilitation services in children and adolescents with cerebral palsy (CP), and to identify factors associated with use. Methods In this study, parents of 91 school‐age children and 167 adolescents with CP completed a questionnaire regarding educational and rehabilitation resources received within the last 6 months. Rehabilitation services included occupational therapy (OT), physical therapy (PT), speech language pathology (SLP), psychology and special education. Demographic characteristics were documented and developmental and functional status was assessed. Relationships between service utilization and sociodemographic factors, functioning and school setting were determined. Results Over half of children (53.2%) and adolescents (57.5%) were in regular schools; however, 41% of these required special education resources. The remainder (42.5–46.8%) was in special schools. The majority of children (84.6%) were receiving at least one rehabilitation service although this decreased (68.1%) in adolescence. PT and OT were most common and services were provided predominantly in the school setting. Services were primarily weekly direct interventions at school age, with weekly interventions or consultations most common for adolescents. Younger age was associated with service receipt at school age only. Children with greater motor limitations, lower IQ and greater activity limitations were more likely to receive OT, PT, SLP or special education. Children in segregated schools were significantly more likely to receive rehabilitation services, when compared with children in regular schools. Conclusions The majority of children and youth received one or more services. Individuals with greater motor or cognitive challenges were more likely to receive a range of school‐based services from rehabilitation specialists. When compared with children of school age, adolescents were less likely to receive services and when provided, services were more likely to be consultative. Services may need to be more optimally organized through childhood to enhance benefits to children with CP across activity limitation profiles.

  January 30, 2013   doi: 10.1111/cch.12026   open full text
• Housing, income inequality and child injury mortality in Europe: a cross‐sectional study.
  M. Sengoelge, M. Hasselberg, D. Ormandy, L. Laflamme.
  Child Care Health and Development. January 30, 2013
  Background Child poverty rates are compared throughout Europe to monitor how countries are caring for their children. Child poverty reduction measures need to consider the importance of safe living environments for all children. In this study we investigate how European country‐level economic disparity and housing conditions relate to one another, and whether they differentially correlate with child injury mortality. Methods We used an ecological, cross‐sectional study design of 26 European countries of which 20 high‐income and 6 upper‐middle‐income. Compositional characteristics of the home and its surroundings were extracted from the 2006 European Union Income Social Inclusion and Living Conditions Database (n = 203 000). Mortality data of children aged 1–14 years were derived from the World Health Organization Mortality Database. The main outcome measure was age standardized cause‐specific injury mortality rates analysed by income inequality and housing and neighbourhood conditions. Results Nine measures of housing and neighbourhood conditions highly differentiating European households at country level were clustered into three dimensions, labelled respectively housing, neighbourhood and economic household strain. Income inequality significantly and positively correlated with housing strain (r = 0.62, P = 0.001) and household economic strain (r = 0.42, P = 0.009) but not significantly with neighbourhood strain (r = 0.34, P = 0.087). Child injury mortality rates correlated strongly with both country‐level income inequality and housing strain, with very small age‐specific differences. Conclusions In the European context housing, neighbourhood and household economic strains worsened with increasing levels of income inequality. Child injury mortality rates are strongly and positively associated with both income inequality and housing strain, suggesting that housing material conditions could play a role in the association between income inequality and child health.

  January 30, 2013   doi: 10.1111/cch.12027   open full text
• Maternal postnatal mental health and later emotional–behavioural development of children: the mediating role of parenting behaviour.
  R. Giallo, A. Cooklin, C. Wade, F. D'Esposito, J. M. Nicholson.
  Child Care Health and Development. January 30, 2013
  Background Maternal postnatal mental health difficulties have been associated with poor outcomes for children. One mechanism by which parent mental health can impact on children's outcomes is via its effects on parenting behaviour. Method The longitudinal relationships between maternal postnatal distress, parenting warmth, hostility and child well‐being at age seven were examined for 2200 families participating in a population‐based longitudinal study of Australian children. Results The relationship between postnatal distress and children's later emotional–behavioural development was mediated by parenting hostility, but not parenting warmth, even after accounting for concurrent maternal mental health. Postnatal distress was more strongly associated with lower parenting warmth for mothers without a past history of depression compared with mothers with a past history of depression. Conclusions These findings underscore the contribution of early maternal well‐being to later parenting and child outcomes, highlighting the importance of mental health and parenting support in the early parenting years. Implications for policy and practice are discussed.

  January 30, 2013   doi: 10.1111/cch.12028   open full text
• ‘Everybody just thinks I'm weird’: a qualitative exploration of the psychosocial experiences of adolescents with Tourette syndrome.
  R. Wadman, V. Tischler, G. M. Jackson.
  Child Care Health and Development. January 30, 2013
  Background Research suggests Tourette syndrome (TS) can have a negative impact on quality of life. To date, little research has examined the perspectives of young people with this condition in depth. Methods Six 14‐ to 16‐year‐olds with TS took part in semi‐structured interviews to explore the perceived impact of this condition on self and on relationships with others. The transcripts were analysed using interpretative phenomenological analysis. Results The young people felt that TS was a constant presence in their lives, but one they have learnt to cope with well. Most had developed supportive friendships but encountered problems when interacting with the wider peer network. Specific concerns around meeting new people and future employment were voiced. Conclusions The adolescents described specific ways in which TS affects quality of life and social interactions, and the effort it can take to cope effectively with this condition.

  January 30, 2013   doi: 10.1111/cch.12033   open full text
• An investigation of the impact of regular use of the Wii Fit to improve motor and psychosocial outcomes in children with movement difficulties: a pilot study.
  J. Hammond, V. Jones, E. L. Hill, D. Green, I. Male.
  Child Care Health and Development. January 30, 2013
  Background Children with Developmental Co‐ordination Disorder (DCD) experience poor motor and psychosocial outcomes. Interventions are often limited within the healthcare system, and little is known about how technology might be used within schools or homes to promote the motor skills and/or psychosocial development of these children. This study aimed to evaluate whether short, regular school‐based sessions of movement experience using a commercially available home video game console (Nintendo's Wii Fit) would lead to benefits in both motor and psychosocial domains in children with DCD. Methods A randomized crossover controlled trial of children with movement difficulties/DCD was conducted. Children were randomly assigned to an intervention (n = 10) or comparison (n = 8) group. The intervention group spent 10 min thrice weekly for 1 month using Wii Fit during the lunch break, while the comparison group took part in their regular Jump Ahead programme. Pre‐ and post‐intervention assessments considered motor proficiency, self‐perceived ability and satisfaction and parental assessment of emotional and behavioural problems. Results Significant gains were seen in motor proficiency, the child's perception of his/her motor ability and reported emotional well‐being for many, but not all children. Conclusions This study provides preliminary evidence to support the use of the Wii Fit within therapeutic programmes for children with movement difficulties. This simple, popular intervention represents a plausible method to support children's motor and psychosocial development. It is not possible from our data to say which children are most likely to benefit from such a programme and particularly what the dose and duration should be. Further research is required to inform across these and other questions regarding the implementation of virtual reality technologies in therapeutic services for children with movement difficulties.

  January 30, 2013   doi: 10.1111/cch.12029   open full text
• A systematic review of interventions to promote social support and parenting skills in parents with an intellectual disability.
  S. Wilson, K. McKenzie, E. Quayle, G. Murray.
  Child Care Health and Development. January 21, 2013
  The family support needs of parents with an intellectual disability (ID) are relatively unknown. This paper reviewed two types of intervention for parents with ID: those designed to strengthen social relationships and those teaching parenting skills. A literature search was conducted using electronic databases and a limited number of evaluative studies were found. The evidence for interventions aimed at strengthening social relationships was inconclusive; although positive changes were observed, there were limitations in study design which restricted the generalizability of the results. The evidence for parental skills teaching suggested that behavioural based interventions are more effective than less intensive forms such as lesson booklets and the provision of normal services, although these studies also had limitations. There is a need for further large scale controlled studies in this area to provide clearer evidence and to explore additional factors relating to child, parent and family which may impact on outcomes.

  January 21, 2013   doi: 10.1111/cch.12023   open full text
• Maternal and infant predictors of attendance at Neonatal Follow‐Up programmes.
  M. Ballantyne, B. Stevens, A. Guttmann, A. R. Willan, P. Rosenbaum.
  Child Care Health and Development. January 07, 2013
  Background Neonatal Follow‐Up (NFU) programmes provide health services for families of infants at high risk of developmental problems following difficult or extremely premature birth: yet, up to 30% of families do not attend these programmes with their infants. Methods The study objective was to determine maternal and infant factors that predicted attendance at NFU programmes. Utilizing Andersen's Behavioural Model of Health Services Use, a prospective two‐phase multi‐site descriptive cohort study was conducted in three Canadian Neonatal Intensive Care Units (NICU) that refer to two affiliated NFU programmes. In Phase 1, 357 mothers completed standardized questionnaires that addressed maternal and infant factors, prior to their infants’ NICU discharge. In Phase 2, attendance at NFU was followed at three time points over a 12‐month period. Factors of interest included predisposing factors (e.g. demographic characteristics and social context); enabling factors (e.g. social support, travel distance, and income); and infant illness severity (i.e. needs factors). Multivariate logistic regression was used to estimate the odds ratio for each independent factor. Results Mothers parenting alone, experiencing higher levels of worry about maternal alcohol or drug use, or at greater distances from NFU were less likely to attend. Mothers experiencing higher maternal stress at the time of the infant's NICU hospitalization were more likely to attend NFU. No infant factors were predictive of NFU attendance. Conclusions Mothers at risk of not attending NFU programmes with their infants require better identification, triage, referral and additional support to promote engagement with NFU programmes and improved quality of life for their high‐risk infants.

  January 07, 2013   doi: 10.1111/cch.12015   open full text
• Diagnostic nomenclature for foetal alcohol spectrum disorders: the continuing challenge of causality.
  A. R. Miller.
  Child Care Health and Development. January 07, 2013
  Prenatal alcohol exposure is a risk factor for neurologically based cognitive and adaptive disability. Diagnostic nomenclature for prenatally exposed children with cognitive and adaptive disability who lack features for foetal alcohol syndrome (FAS) or partial FAS includes the terms alcohol‐related neurodevelopmental disorder (ARND) and foetal alcohol spectrum disorder(s) (FASD). Although these terms are now widely used, this paper argues that both are problematic. ARND is flawed by unjustifiably turning a risk factor into a causal factor and shrouding the result in terminological ambiguity, while FASD is not appropriate as a clinical label, and its use as a proxy for ARND deflects critical attention from the causal inferencing that is integral to diagnosing children with an alcohol‐related teratogenic condition. Existing nomenclature is at odds with logical and evidence‐based diagnosing and also has implications for interpretation of epidemiological data. Diagnostic nomenclature that is not tightly linked to causal inference is preferable at the present stage of this field's development.

  January 07, 2013   doi: 10.1111/cch.12017   open full text
• Social spaces for young children in hospital.
  V. Lambert, J. Coad, P. Hicks, M. Glacken.
  Child Care Health and Development. January 07, 2013
  Background In the last number of years heightened interest has been attributed to the impact of hospital environments on children's psychosocial well‐being. With policy largely built around adult assumptions, knowledge about what constitutes a child‐friendly hospital environment from young children's perspectives has been lacking. If hospital environments are to aspire to being child friendly then the views of younger aged children must be taken into account. The current study investigated young children's perspectives of hospital social spaces to inform the design of the built environment of a new children's hospital. Methods An exploratory qualitative participatory design was employed. Data were collected through semi‐structured interviews (one‐to‐one and group workshops) which incorporated art‐based activities to actively engage young children. Fifty‐five young children aged 5 to 8 years with various acute and chronic illnesses were recruited from inpatient, outpatient and emergency departments of three children's hospitals. Results Young children want a diversity of readily available, independently accessible, age, gender and developmentally appropriate leisure and entertainment facilities seamlessly integrated throughout the hospital environment. Such activities were invaluable for creating a positive hospital experience for children by combating boredom, enriching choice and control and reducing a sense of isolation through enhanced socialization. When in hospital, young children want to feel socially connected to the internal hospital community as well as to the outside world. Technology can assist to broaden the spectrum of children's social connectivity when in hospital – to home, school and the wider outside world. Conclusion While technology offers many opportunities to support children's psychosocial well‐being when in confined healthcare spaces, the implementation and operation of such services and systems require much further research in the areas of ethics, facilitation, organizational impact and evaluation.

  January 07, 2013   doi: 10.1111/cch.12016   open full text
• Implications of parent and child quality of life assessments for decisions about growth hormone treatment in eligible children.
  S. C. Otero, C. Eiser, N. P. Wright, G. Butler.
  Child Care Health and Development. January 07, 2013
  Objective To determine differences between parents and children in ratings of child health‐related quality of life (HRQL) prior to growth hormone treatment. Method HRQL measures were collected from 144 children and their caregivers. Inclusion criteria were aged between 10 and 16 years, diagnosed with Turner's syndrome, acquired or idiopathic growth hormone deficiency (AGHD or IGHD) and eligible to begin human GH treatment (GHT), or non‐growth hormone deficient (GHD) short stature. Results Parents rated children to have poorer physical and psychosocial HRQL than children rated themselves. Differences depended on the measure used. Parents rated children with IGHD and non‐GHD short stature better than children rated themselves, but they rated children with AGHD or Turner's much worse than children rated themselves in terms of physical but not psychosocial functioning. Conclusions Decisions to prescribe GHT should include children's perspectives of HRQL whenever possible. Differences between parents and children are most likely in conditions that involve more complex medical needs (AGHD and Turner's). Generic and disease‐specific HRQL measures may vary in sensitivity to HRQL differences between groups. More work is required to evaluate HRQL among younger children.

  January 07, 2013   doi: 10.1111/cch.12021   open full text
• Functioning and post‐school transition outcomes for young people with Down syndrome.
  K.‐R. Foley, P. Jacoby, S. Girdler, J. Bourke, T. Pikora, N. Lennox, S. Einfeld, G. Llewellyn, T. R. Parmenter, H. Leonard.
  Child Care Health and Development. January 07, 2013
  Aim To investigate the relationship between functioning and post‐school day occupation for young adults with Down syndrome. Methods Families of young people with Down syndrome (n = 269) aged 15–30 years in 2009 were recruited from the population‐based Down syndrome ‘Needs Opinion Wishes’ database in Western Australia. Questionnaires were mailed to participating families and involved two parts, young person characteristics and family functioning; 203 were returned (75%). Of those families who returned questionnaires, 164 (80.8%) of their young adults had left school. Participation in post‐school day occupations was the main outcome and included; open employment, training, sheltered employment or alternatives to employment (ATE). Results Young adults were reported as participating in open employment (n = 42), training (n = 17), sheltered employment (n = 64) or ATE (n = 41) post‐school. Those who reported better functioning in self‐care, community and communication skills were more likely to be in open employment and/or attending Technical and Further Education compared with those attending sheltered employment and/or ATE after adjusting for age, gender and rural/metropolitan regions. Current health as measured by visits to a general practitioner (GP) and hospitalizations revealed a weak relationship with post‐school day occupations, with increasing likelihood of participating in open employment or training with increasing hospitalizations and GP visits. Conclusions Our analysis shows that functioning in activities of daily living was related to post‐school day occupation. Current health status and behaviour were found to have a weak relationship with post‐school day occupation adjusting for functioning in the final model.

  January 07, 2013   doi: 10.1111/cch.12019   open full text
• Is the cluster risk model of parental adversities better than the cumulative risk model as an indicator of childhood physical abuse?: findings from two representative community surveys.
  E. Fuller‐Thomson, J.‐L. Sawyer.
  Child Care Health and Development. December 19, 2012
  Background Screening strategies for childhood physical abuse (CPA) need to be improved in order to identify those most at risk. This study uses two regionally representative community samples to examine whether a cluster or cumulative model of risk indicators (i.e. parental divorce, parental unemployment, and parental addictions) explains a larger proportion of the variation in CPA. Methods Data were drawn from Statistics Canada's National Population Health Survey (1994–1995) and Canadian Community Health Survey 3.1 (2005). Response rates were greater than 80% in both samples. Each survey had approximately 13 000 respondents aged 18 and over who answered questions about the above adverse childhood experiences. Results A gradient was shown with similar outcomes in each data set. Only 3.4% of adults who experienced none of the three risk indicators reported they had been physically abused during childhood or adolescence. The prevalence of CPA was greater among those who experienced parental divorce alone (8.3%–10.7%), parental unemployment alone (8.9%–9.7%) or parental addictions alone (18.0%–19.5%). When all three risk indicators were present, the prevalence of CPA ranged from 36.0%–41.0% and the age‐sex‐race adjusted odds were greater than 15 times that of individuals with none of the three risk indicators. The cluster model explained a statistically significantly larger proportion of the variation than the cumulative model although the difference between the two models was modest. For the purposes of parsimony, the cumulative model may be the better alternative. Conclusions Adults who were exposed to two or more childhood risk indicators were much more likely to report that they were physically abused during their childhood than those with only one or no risk factors. Medical professionals may use this information on cumulative risk factors to more effectively target screening for potential CPA. Future research should include prospective studies.

  December 19, 2012   doi: 10.1111/cch.12024   open full text
• Diagnostic shortfalls in early childhood chronic stress: a review of the issues.
  B. Klein, J. W. Gorter, P. Rosenbaum.
  Child Care Health and Development. December 05, 2012
  Clinical effects of early childhood chronic stress should be regarded as causing a developmental brain injury. However, current diagnostic constructs fail to capture the associated disabilities in emotional‐behavioural regulation of stress and attachment functions adequately. We first focus on neglect as a prototypical early childhood chronic stressor; next we explore clinical associations of neglect; and finally we cite research pertaining to possible underlying pathophysiology of the effects of early childhood chronic stress. In addition, we discuss diagnostic labels that children with histories of early childhood neglect commonly acquire, and implications for treatment.

  December 05, 2012   doi: 10.1111/cch.12009   open full text
• A systematic literature review of the risk factors associated with children entering public care.
  D. E. Simkiss, N. Stallard, M. Thorogood.
  Child Care Health and Development. December 05, 2012
  Children who enter public care are among the most vulnerable in society. In addition to services for their medical needs, a focus on identifying and intervening with families in need where children are at high risk of entering public care is a public health priority. This paper aims to identify the characteristics of children, their parents or their social circumstances which are associated with children entering public care. The databases searched were CSA Illumina, British Education Index, ChildData, CINAHL, Excerpta Medica, MEDLINE, the Campbell and Cochrane Collaborations, NHS Centre for Reviews and Dissemination, NHS Evidence, Social Care Online and TRIP; from start dates to 7 February 2011. A total of 6417 titles were reviewed. After review, 10 papers with cohort or case–control methodologies met the inclusion criteria and the included papers were appraised using questions from the Critical Appraisal Skills Programme to guide the critique of case–control and cohort studies. A narrative synthesis is used to describe the research identified. Socio‐economic status, maternal age at birth, health risk factors and other factors including learning difficulties, membership of an ethnic minority group and single parenthood are described as risk factors associated with children entering public care. Health risk factors have been explored using databases developed for other purposes such as health insurance or hospital discharge. A number of risk factors for children entering public care are identified from the literature, some were culturally specific and may not generalize. The interaction between different risk factors needs testing in longitudinal data sets.

  December 05, 2012   doi: 10.1111/cch.12010   open full text
• Cross‐cultural validation of the Children's Assessment of Participation and Enjoyment (CAPE) in Spain.
  E. Longo, M. Badia, B. Orgaz, M. A. Verdugo.
  Child Care Health and Development. December 05, 2012
  Background Despite growing interest in the topic of participation, the construct has not yet been assessed in children and adolescents with and without cerebral palsy (CP) in Spain. As there are no available instruments to measure participation in leisure activities which have been adapted in this country, the goal of this study was to validate a Spanish version of the Children's Assessment of Participation and Enjoyment (CAPE). Method The sample comprised 199 children and adolescents with CP and 199 without CP, between 8 and 18 years of age, from seven regions in Spain. The adaptation of the original version of CAPE was carried out through translation and backward translation, and the validity of the instrument was analysed. Construct validity was assessed through the correlation of the diverse CAPE domains and the quality of life domains (KIDSCREEN questionnaire). Discriminant validity was established by comparing children and adolescents with CP and typically developing children and adolescents. For test–retest reliability, the children and adolescents with and without CP completed the CAPE questionnaire twice within 4 weeks. Results The correlations found between the CAPE domains and the quality of life domains show that the CAPE presents construct validity. The CAPE discriminated children and adolescents with CP from those without any disability in the results of participation. According to most CAPE domains, typically developing children and adolescents engage in a greater number of activities than children and adolescents with CP. Test–retest reliability for the Spanish version of CAPE was adequate. Conclusion The study provides a valid instrument to assess the participation of children and adolescents with and without CP who live in Spain.

  December 05, 2012   doi: 10.1111/cch.12012   open full text
• Classifying infants and toddlers with developmental vulnerability: who is most likely to receive early intervention?
  B. M. McManus, A. C. Carle, M. J. Rapport.
  Child Care Health and Development. December 05, 2012
  Background Infants and toddlers with developmental difficulties represent a heterogeneous group who often receives early intervention (EI). Notable population heterogeneity exists and complicates unmet need and effectiveness research. However, a mix of relatively homogeneous clinically policy relevant ‘subgroups’ may create the apparent heterogeneity. To date, methodological challenges have impeded identifying these potential groups and their policy‐relevance. Methods From the 2005–2006 National Survey of Children with Special Health Care Needs, we derived a sample (n = 965) of infants and toddlers with parent‐reported developmental difficulties. We used latent class analysis (LCA) to identify subgroups of developmental vulnerability based upon functional, social and biological characteristics that would make children eligible for EI. Mixture modelling estimated the likelihood of each subgroup receiving parent‐reported EI, controlling for race/ethnicity, child's age, and state of residence. Results LCA identified four distinct subgroups of developmental vulnerability: developmental disability (Group 1), mild developmental delay (Group 2), socially at risk with behaviour problems (Group 3), and socially at risk with functional vision difficulties (Group 4). Black, non‐Hispanic children are significantly more likely than their white counterparts to be in Group 3 (β = 1.52, P = 0.001) or group 4 (β = 1.83, P < 0.001). Compared with children with a mild developmental delay (Group 2), children in group 1 (β = −0.61, P < 0.001), group 3 (β = −0.47, P = 0.001) and group 4 (β = −0.38, P = 0.009) are significantly less likely to receive EI. Conclusions Racial and ethnic differences exist with regard to membership in developmental vulnerability subgroups. Observed inconsistencies in access to EI suggest the need for improved surveillance, referral and outreach.

  December 05, 2012   doi: 10.1111/cch.12013   open full text
• Body mass index, perceived and actual physical competence: the relationship among young children.
  B. C. Spessato, C. Gabbard, L. Robinson, N. C. Valentini.
  Child Care Health and Development. November 30, 2012
  Background The purpose of this study was to examine the relationship between perceived physical competence (PPC), actual motor competence (MC) and body mass index (BMI) in young children. Methods We assessed MC (Test of Gross Motor Development – 2nd Edition), PPC (Pictorial Scale of Perceived Competence and Social Acceptance) and BMI (CDC calculator) of 178 young children ages 4–7 years. Results The linear regression model for the overall sample showed that BMI was a better predictor of PPC than MC. Also, obese children had lower PPC, but showed no differences in MC compared with leaner peers. Conclusions PPC of young obese children was lower than their leaner counterparts, yet their MC was similar. That outcome draws attention to the importance of promoting positive PPC in young children.

  November 30, 2012   doi: 10.1111/cch.12014   open full text
• Respect for autonomy in the healthcare context: observations from a qualitative study of young adults with cerebral palsy.
  E. Racine, D. Larivière‐Bastien, E. Bell, A. Majnemer, M. Shevell.
  Child Care Health and Development. November 30, 2012
  Background Respect for patient autonomy is a cornerstone of contemporary medical ethics and clinical practice. In its different shapes and forms (e.g. being informed, being engaged in discussions and decisions about medical care and being supported in developing healthcare preferences and choices), patient autonomy has been fostered by both paediatric and adult professional societies. The transition from paediatric to adult care creates a complex situation where autonomy for medical decisions shifts to the developing adolescent. More specific challenges to respect for autonomy may be experienced by young adults with cerebral palsy in the transition period where, for example, language and motor impairments may affect communication skills and this may be conflated with cognitive disability. Aim To characterize perspectives towards autonomy in the healthcare context for young adults with cerebral palsy. Method We carried out semi‐structured interviews with 14 young adults (aged 18–25) with cerebral palsy. The audiotaped interviews were transcribed verbatim and analysed using a conventional thematic qualitative content analysis. Results Participants displayed a range of attitudes towards autonomy, suggesting that the value of autonomy is considered in light of competing values and of context. Testimonials from participants demonstrated that both contextual (e.g. ill‐adapted health care, lack of specialized public transport) and relational (e.g. attitudes towards parental involvement in decision making) factors negatively or positively impact autonomy. Conclusion We observed that there were four key elements interwoven in participants' characterization of autonomy: the coupling of decisional and physical autonomy, the influences of family and society on autonomy, the influence of healthcare professionals on autonomy and the need for preparation for autonomy.

  November 30, 2012   doi: 10.1111/cch.12018   open full text
• Was there a plan? End‐of‐life care for children with life‐limiting conditions: a review of multi‐service healthcare records.
  A. J. Beringer, E. J. Heckford.
  Child Care Health and Development. November 30, 2012
  Background Planning for care at the end of life (EoL) is an essential component of support and care for families of children with life‐limiting conditions. The purpose of this review was to compare documented EoL planning with published children's palliative care standards, across a range of children's healthcare services and to assess the impact on practice of written guidelines to support EoL care planning. Method A manual retrospective review of healthcare records using a purpose‐built form. Inclusion criteria were the records of children with a diagnosed life‐limiting or life‐threatening condition, who had died before the age of 18 years, between October 2008 and March 2010, within a defined geographical area served by one or more of the participating services. The sample was 114 sets of notes relating to a cohort of 48 children: 24 girls and 24 boys, the majority of whose deaths were cancer related. Results Examples of good practice were found in the records of individual services. Services had each developed their own systems and documents to support EoL care planning rather than using a unified documentation system. Where documented practice fell short, this was related to a lack of evidence that choice in location of death had been offered, delays in sharing of information between services, and information being buried in the narrative of the notes, making it difficult to find. Conclusions Current documented EoL planning varies between services. Those who are infrequently involved in the provision of EoL care may benefit from support by those for whom this is part of their daily working life. These professionals can help prepare staff to engage families in these difficult but important conversations – and encourage them to document them in a way that can be easily and readily accessed and shared.

  November 30, 2012   doi: 10.1111/cch.12020   open full text
• Caregiving, single parents and cumulative stresses when caring for a child with cancer.
  L. Granek, Z. R. S. Rosenberg‐Yunger, D. Dix, R. J. Klaassen, L. Sung, J. Cairney, A. F. Klassen.
  Child Care Health and Development. November 02, 2012
  Background Single parents whose children have cancer are a marginalized group who report less family centred care, and therefore, less quality cancer care for their children. As such, the aims of this study were to explore how single parents of children with cancer describe their caregiving experiences and to understand their contextual life stressors. Methods A constructivist grounded theory method was used. Qualitative interviews with 29 single parents of children with cancer who were at least 6 months post‐diagnosis were recruited between November 2009 and April 2011 from four hospitals across Canada. Line‐by‐line coding was used to establish codes and themes and constant comparison was used to establish relationships among emerging codes and conceptual themes. Results The first set of findings report on caregiving duties including: emotional tasks, informational tasks and physical tasks. The second set of findings report on the contextual picture of parent's lives including their living conditions, their physical and mental health and their family histories of disruption, trauma and disease. Conclusions Single parents caring for children with cancer were found to experience several cumulative stressors in addition to the current strain of caring for a child with cancer. The synergy of these cumulative stresses with the added strain of caregiving for a child with cancer may have long‐term health and financial implications for parents. Broad‐based policy interventions should focus on relieving the chronic strains associated with being a single parent of a child with cancer.

  November 02, 2012   doi: 10.1111/cch.12008   open full text
• Tackling child health inequalities due to deprivation: using health equity audit to improve and monitor access to a community paediatric service.
  V. Maharaj, F. Rahman, L. Adamson.
  Child Care Health and Development. November 02, 2012
  Background Deprived children constitute a large population with high levels of ill health, and difficulty with access to healthcare contributes to their poor health outcomes. There is debate on how best to engage deprived families and the literature on differential access to paediatric care based on deprivation is limited. Aims To demonstrate that community paediatrics can contribute to reduction of health inequalities by providing services that are accessible to and preferentially used by children whose health is likely to be affected by deprivation. To provide a template for others to improve and monitor equity in their services. Method Long‐term service reconfiguration and health equity audit. We used routinely collected activity data and the Indices of Multiple Deprivation to construct equity profiles of the children using our service, and compared these with the profile of the population aged 0–16 years in the geographical area covered by the service. Results The new patient contact rate for the most deprived children in the population was more than three times that of the least deprived [odds ratio (OR) 3.29, 95% confidence interval (CI) 2.76–3.93]. Deprived children were more than twice as likely to require multi‐agency meetings as part of their medical care (OR 2.28, 95% CI 1.94–2.69). Seventy per cent (3693/5312) of our total contacts were with children in the two most deprived quintiles. There was a marked socio‐economic gradient in all types of contact. Conclusions The model of care used by our community paediatric service successfully engages deprived families, thereby reducing health inequalities due to poor access. Key features are multi‐agency working, removing barriers to access, raising staff awareness and use of health equity audit. Our findings provide support for tackling health inequalities via health services that are available to all, but capable of responding proportionately according to level of need, a model recently described as proportionate universalism.

  November 02, 2012   doi: 10.1111/cch.12011   open full text
• An exploratory study of positive and incongruent communication in young children with type 1 diabetes and their mothers.
  V. Chisholm, L. Atkinson, L. Bayrami, K. Noyes, A. Payne, C. Kelnar.
  Child Care Health and Development. October 08, 2012
  Background The incidence of type 1 diabetes is increasing in young children. However, they are overlooked in treatment adherence and intervention research despite evidence that parents often experience difficulty securing their treatment cooperation, especially with the diet. We investigated positive and incongruent (i.e. the co‐occurrence of contradictory verbal and non‐verbal messages) communication in the mother–child dyad and their association with child adjustment and dietary adherence outcomes. Methods Participants were 23 6‐ to 8‐year‐old children with type 1 diabetes and their mothers. We conducted dietary adherence interviews with mothers and performed nutritional analyses to assess children's consumption of extrinsic sugars (e.g. confectionary). Mothers completed a standardized assessment of child psychological adjustment. Mothers and children engaged in a videotaped problem‐solving task related to the dietary regimen, with maternal and child utterances and non‐verbal behaviours analysed for positive dyadic and incongruent communication. Results Positive dyadic communication correlated with lower levels of child incongruent communication, fewer behavioural problems and better overall adjustment. Higher levels of maternal and child incongruent communication correlated with more behavioural and emotional problems and poorer overall adjustment. Higher levels of maternal incongruent communication correlated with poorer dietary adherence. Conclusions Results converged to form a conceptually and empirically coherent pattern in that behavioural indices of poorer communication in both mother and child consistently correlated with poorer child adjustment outcomes. This study shows that specific features of dyadic, child and maternal communication could be targeted in developmentally sensitive interventions to promote positive communication in the home management of type 1 diabetes care for young children.

  October 08, 2012   doi: 10.1111/cch.12004   open full text
• Effect modification by parental education on the associations of birth order and gender with learning achievement in adolescents.
  C‐C. J. Cheng, W‐L. Wang, Y‐T. Sung, Y‐C. Wang, S‐Y. Su, C‐Y. Li.
  Child Care Health and Development. October 08, 2012
  Background A child's gender and ordinal position within a family have varied implications on his or her personality and cognitive development. However, little is known about whether or not parental educational level may moderate the effects of birth order and gender. Methods Basic Competence Test (BCT) scores of 290 588 young adolescents aged 15–16 years in Taiwan were analysed. Parental educational level was calculated as the highest educational attainment of the subjects’ parents. The multiple linear regression model was used to assess the modification effects of parental educational levels on the associations of interest. Results After controlling for covariates, we noted a clear inverse relationship between birth order and BCT scores in Mandarin, Mathematics and Science. Additionally, boys had significantly lower mean scores in Mandarin, but had significantly higher mean scores in both Mathematics and Science. We also found the significant interactive effects of birth order, gender and parental educational attainment on BCT scores, in which the birth order and gender effects were more evident in higher‐educated families than in lower‐educated ones. Conclusions This large cohort study confirmed that both birth order and gender may pose independent influences on BCT scores; moreover, such influences are significantly modified by parental educational attainment.

  October 08, 2012   doi: 10.1111/j.1365-2214.2012.01427.x   open full text
• Mothers' judgements about their child's weight: distinguishing facts from values.
  K. N. Parkinson, R. F. Drewett, A. R. Jones, A. J. Adamson,.
  Child Care Health and Development. October 08, 2012
  Background Mothers' responses to questionnaire items assessing their child's weight status typically do not correspond to conventional clinical classifications based on body mass index (BMI). From this observation health professionals infer that mothers do not recognize overweight in their child. But the questions used have generally confounded factual judgements with values, so it is not clear whether the mothers are making factual errors, or differ from professionals in their values. Methods Cross‐sectional study of population‐based birth cohort at 6–8 years and their mothers (n = 540). An objective BMI matching task was used to determine the accuracy of mothers' recognition of their child's weight. Mothers matched their child to sex‐ and age‐specific images of children of known BMI ranging from very thin to obese, and chose a descriptor of their child's weight of the kind used in previous research. Results Mothers tended to underestimate their child's BMI on the matching task. Matching errors significantly predicted mothers' description of their child's weight; those who overestimated their child's BMI on the matching task were more likely to say their child was overweight, while those who underestimated it were less likely to, independently of their child's actual BMI. Conclusions Educational programmes aimed at parents of young primary school children need to address separately the factual and the evaluative components of their assessment of child weight.

  October 08, 2012   doi: 10.1111/cch.12000   open full text
• Childhood cruelty to animals in China: the relationship with psychological adjustment and family functioning.
  J. Wong, D. Mellor, B. Richardson, X. Xu.
  Child Care Health and Development. September 13, 2012
  Background The current study broadened the general scope of research conducted on childhood cruelty to animals by examining the association between psychological adjustment, family functioning and animal cruelty in an Eastern context, China. Method The mothers and fathers of 729 children attending primary school in Chengdu, China participated in this study. Each parent completed the Strengths and Difficulties Questionnaire, the Chinese Family Assessment Instrument, and the Children's Attitudes and Behaviours towards Animals questionnaire. Results Findings from an actor partner interdependence model demonstrated that parents' ratings of family functioning and of their child's externalizing coping style predicted only modest amounts of variance in animal cruelty. In particular, parents' ratings of their child's externalizing coping style most consistently predicted animal cruelty. Family functioning, fathers' ratings in particular, played a minor role, more so for boys compared with girls. Conclusion This study provided the first insight into childhood animal cruelty in China, and suggests that further research may enhance our understanding of these phenomena.

  September 13, 2012   doi: 10.1111/cch.12001   open full text
• Verbal definitions of familiar objects in blind children reflect their peculiar perceptual experience.
  A. Vinter, V. Fernandes, O. Orlandi, P. Morgan.
  Child Care Health and Development. September 13, 2012
  Background The aim of the present study was to examine to what extent the verbal definitions of familiar objects produced by blind children reflect their peculiar perceptual experience and, in consequence, differ from those produced by sighted children. Methods Ninety‐six visually impaired children, aged between 6 and 14 years, and 32 age‐matched sighted children had to define 10 words denoting concrete animate or inanimate familiar objects. Results The blind children evoked the tactile and auditory characteristics of objects and expressed personal perceptual experiences in their definitions. The sighted children relied on visual perception, and produced more visually oriented verbalism. In contrast, no differences were observed between children in their propensity to include functional attributes in their verbal definitions. Conclusions The results are discussed in line with embodied views of cognition that postulate mandatory perceptuomotor processing of words during access to their meaning.

  September 13, 2012   doi: 10.1111/cch.12002   open full text
• Co‐occurring development of early childhood communication and motor skills: results from a population‐based longitudinal study.
  M. V. Wang, R. Lekhal, L. E. Aarø, S. Schjølberg.
  Child Care Health and Development. September 13, 2012
  Background Communicative and motor development is frequently found to be associated. In the current study we investigate to what extent communication and motor skills at 1½ years predict skills in the same domains at 3 years of age. Methods This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Heath. Data stem from 62 944 children and their mothers. Mothers completed questionnaires on their child's communication and motor skills at ages 1½ and 3. Associations between communication and motor skills were estimated in a cross‐lagged model with latent variables. Results Early communication skills were correlated with early motor skills (0.72). Stability was high (0.81) across time points for motor skills and somewhat lower (0.40) for communication skills. Early motor skills predicted later communication skills (0.38) whereas early communication skills negatively predicted later motor skills (−0.14). Conclusion Our findings provide support for the hypothesis that these two difficulties are not symptoms of separate disorders, but might rather be different manifestations of a common underlying neurodevelopmental weakness. However, there also seem to be specific developmental pathways for each domain. Besides theoretical interest, more knowledge about the relationship between these early skills might shed light upon early intervention strategies and preventive efforts commonly used with children with problems in these areas. Our findings suggest that the relationship between language and motor skills is not likely to be simple and directional but rather to be complex and multifaceted.

  September 13, 2012   doi: 10.1111/cch.12003   open full text
• The experience of mothers caring for a child with a brain tumour.
  R. I. Shortman, A. Beringer, A. Penn, H. Malson, S. P. Lowis, P. M. Sharples.
  Child Care Health and Development. September 13, 2012
  Background Brain tumours are the second most common form of childhood cancer, accounting for over 20% of all cases in European children. Understanding the impact of diagnosis and treatment of a brain tumour on the family is an essential pre‐requisite to identifying ways to provide effective support. Aim (1) To explore the impact of having a child with a brain tumour on the main caregiver in the family; (2) to describe mothers' experiences of coping with their child's illness, including personal barriers and strengths; and (3) to identify causes of stress and sources of support to inform improvements in care delivery. Method Participants were drawn from a group of caregivers enrolled in a longitudinal study of outcome following diagnosis of a childhood brain tumour. Six caregivers took part, two from each of the high‐, medium‐ and low‐impact groups based on their Impact on Families Scale scores. Semi‐structured interviews were used, with questions covering: (1) impact of the diagnosis on main caregiver and family; (2) personal barriers and strengths; and (3) causes of stress and sources of support. Interviews were transcribed verbatim and coded manually into five themes, which comprised 19 subthemes. Findings Coping methods and provision of help and support were major preoccupations for main caregivers from all impact groups. Caregivers in the high‐impact group reported less conflict. High‐ and medium‐impact group caregivers had experienced less ‘hindrance and heartache’, than those with low impact scores, suggesting that the stress associated with diagnosis and treatment of the tumour may have increased cohesion and acceptance within these families. Conclusion Families of children diagnosed with a brain tumour experience considerable negative impact and may perceive themselves as struggling to cope. Provision of help and support, within and outside the extended family, including from health, education and other services, is perceived as helpful.

  September 13, 2012   doi: 10.1111/cch.12005   open full text
• The contributing role of real‐life hand skill performance in self‐care function of children with and without disabilities.
  C.‐W. Chien, T. Brown, R. McDonald, M.‐L. Yu.
  Child Care Health and Development. August 29, 2012
  Background Children's hand skills when performing in real‐life contexts have been commonly thought as a possible determinant of their self‐care function; however, there is a paucity of research investigating this potential predictive relationship. The purpose of this study was to provide evidence regarding whether children's real‐life hand skill performance is contributive to or predictive of their self‐care function by considering other child and cultural factors. Methods A total of 139 typically developing children and 114 with disabilities, ages 2–12 years from Australia and Taiwan, participated in the study. The outcome measures used were the Assessment of Children's Hand Skills (a measure of real‐life hand skill performance) and the Personal Living Skills subscale of the Vineland Adaptive Behavior Scales – Classroom Edition (a measure of self‐care function). Results Hierarchical regression analysis revealed that the children's demographic variables (age, gender, disability status, handedness and cultural context) accounted for 43% of the variance of the self‐care function in the combined group of children with and without disabilities. Age, presence of disability and cultural context were the statistically significant independent factors. However, after the entry of the real‐life hand skill performance factor, the contributing values of age and disability status decreased and the age factor became non‐significant. The hand skill performance factor was found to be the strongest, and its addition led to significant increments of 24.6% of the explained variance for children's self‐care function. Similar results were also found in the regression analyses based on separate groups of typically developing children or those with disabilities. Conclusions The findings provide evidence that children's real‐life hand skill performance is a contributing factor of their self‐care function. The assessment of children's hand skill performance in real‐life contexts is therefore needed.

  August 29, 2012   doi: 10.1111/j.1365-2214.2012.01429.x   open full text
• Lay people's and health professionals’ views about breaking bad news to children.
  M. T. Muñoz Sastre, P. C. Sorum, E. Mullet.
  Child Care Health and Development. August 29, 2012
  Background Bad health news is difficult to communicate, especially when parents must give bad news to their children. Methods We had 170 lay persons, 33 nurses and six physicians in Toulouse, France, judge the appropriateness of the parents’ behaviour in 64 scenarios of parents dealing with this problem. The scenarios were composed according to a four within‐subject orthogonal design: child's age (4, 6, 8 or 10), severity of disease (lethal or worrisome but curable), child's concern or not about his illness and parents’ decision about communicating the news (tell nothing, minimize, tell the truth or ask the physician to tell the truth). Results Cluster analysis revealed four clusters, labelled ‘Always Tell the Truth’ (33%, including a majority of doctors and nurses), ‘Tell Nothing or Minimize’ (16%, with an older average age), ‘Tell the Truth Except in Cases of Incurable Illness’ (22%) and ‘Depends on Child's Characteristics’ (29%). Conclusions Physicians in training and in practice need to be aware that lay people – and likely parents as well – have diverse and complex opinions about when and how parents should give bad health news to their children.

  August 29, 2012   doi: 10.1111/j.1365-2214.2012.01420.x   open full text
• The influence of different forms of early childcare on children's emotional and behavioural development at school entry.
  A. Stein, L.‐E. Malmberg, P. Leach, J. Barnes, K. Sylva,.
  Child Care Health and Development. August 29, 2012
  Background Over the past few decades there has been a dramatic increase in maternal employment and, as a result, an increase in the use of non‐maternal childcare in the early years. The purpose of this longitudinal study was to examine, in a large representative English sample, the influence of different forms of childcare on children's behavioural and emotional development around the age of school entry. Methods A sample of 991 families, originally recruited when the children were 3 months old, was assessed around school entry age at 51 months. The main outcome variable was the children's emotional and behavioural functioning, measured by questionnaire completed by both mothers and teachers. A range of repeated assessments were carried out at different time points, including direct observation of the quality of maternal caregiving and observations of the quality of non‐parental care, and amount of time spent in different forms of care. Results The strongest and most consistent influences on behaviour and emotional problems were derived from the home, including lower socio‐demographic status, poorer maternal caregiving, parental stress/maternal mental health problems, as well as child gender (being a boy). Non‐parental childcare had small effects on child outcome. One finding that did emerge was that children who spent more time in group care, mainly nursery care, were more likely to have behavioural problems, particularly hyperactivity. Conclusions These findings suggest that interventions to enhance children's emotional and behavioural development might best focus on supporting families and augmenting the quality of care in the home.

  August 29, 2012   doi: 10.1111/j.1365-2214.2012.01421.x   open full text
• Unintentional poisoning in young children: does developmental stage predict the type of substance accessed and ingested?
  M. Schmertmann, A. Williamson, D. Black.
  Child Care Health and Development. August 29, 2012
  Background When children aged 0–4 years are analysed together as a group for poisoning risk, important differences for smaller age intervals by medicinal and non‐medicinal substances are masked. These differences have been attributed to child developmental stages but no studies have been conducted that examine the predictive value of child developmental stage for poisoning by substance type, using 3‐month age intervals as a proxy for developmental stage and adjusting for the effect of sex, socio‐economic status and remoteness of residence. Methods A population‐based dataset of unintentional poisoning hospitalizations in children aged 0–4 years was used to predict the type of substance ingested. Associations between the type of substance and age, sex, socio‐economic status and remoteness of residence were measured using multivariate logistic regression. Results Children aged 12–17 months had significantly higher odds of experiencing a non‐medicinal poisoning while children aged 24–41 months had significantly higher odds of experiencing a medicinal poisoning. Males and children from more disadvantaged and outer regional areas had higher odds of experiencing a non‐medicinal poisoning. Conclusions Children aged 0–4 years differ in their stage of development and as a consequence, vary significantly in their ability to access their environment. Our results clearly show that odds of poisoning by medicinal substances compared with non‐medicinal substances change as children age. This study provides evidence that child development predicts the type of substance accessed and ingested.

  August 29, 2012   doi: 10.1111/j.1365-2214.2012.01424.x   open full text
• Descriptive and factor analysis of the Developmental Coordination Disorder Questionnaire (DCDQ‘07) in a population‐based sample of children with and without Developmental Coordination Disorder.
  L. Rivard, C. Missiuna, D. McCauley, J. Cairney.
  Child Care Health and Development. August 29, 2012
  Background The Developmental Coordination Disorder Questionnaire (DCDQ‘07) discriminates children with Developmental Coordination Disorder (DCD) from their peers. Studies employing the DCDQ have typically used clinical samples. To further validate the DCDQ'07, this study: (1) described its distributions in a population‐based sample, and a sample of children with DCD; (2) explored sex and age differences at important cut‐points; and (3) examined its factor structure. Methods This secondary analysis of data collected from 23 schools (n = 3151) included a sample of 3070 children (1526 boys, 1544 girls) and a sample of 122 children (73 boys, 49 girls) who met DCD diagnostic criteria. DCDQ‘07 distributions were described by age and sex. Chi‐square analyses were conducted using three clinically important percentile ranges; a factor analysis explored the construct validity of DCDQ scores. Results Parents of 3070 children (97.4%) completed the questionnaire independently. Significant sex differences were noted in both samples. Significant differences in proportions by sex, and DCDQ means by age were found in the population sample. A three‐factor solution was found, accounting for 70.3% of the variance. Conclusions This is one of the largest studies using the DCDQ'07 with a non‐clinical sample. The three‐factor solution, including item loading, was consistent with previous research. When using DCDQ cut‐offs it is important to consider sex and age.

  August 29, 2012   doi: 10.1111/j.1365-2214.2012.01425.x   open full text
• The effect of post‐natal mental distress amongst Indian and Pakistani mothers living in England on children's behavioural outcomes.
  S. L. Prady, K. E. Kiernan.
  Child Care Health and Development. August 29, 2012
  Background Low socio‐economic status (SES), post‐natal mental distress and parenting impact child mental health and future well‐being. There are unexplained differences in child mental health between South Asian ethnic minority groups living in the UK that may be due to variation in, and differential mediation of, these factors. Methods We used multivariate multiple regression analysis of the effect of symptoms of mental distress, socio‐demographic variables and warmth of parenting on child internalizing and externalizing scores at age seven (measured in 2010) in a population cohort of English children whose mothers were of Indian (n = 211) and Pakistani (n = 260) origin. Results In the fully adjusted models the legacy of mental distress was visible for both internalizing (β coefficient 1.52, P = 0.04) and externalizing (1.68, P = 0.01) behaviour in the Pakistani children, and on the Indian children's internalizing (2.08, P = 0.008) but not externalizing (0.84, P = 0.204) behaviour. Lower SES was associated with worse behavioural scores for the Pakistani children, and warmth of parenting on Indian children's externalizing scores. Conclusions Symptoms of post‐natal mental distress are associated with Indian and Pakistani child outcomes at age seven. The finding that warmth of parenting had a stronger association on Indian children's externalizing scores than mental distress might be explained by differences in the expression of SES on family characteristics and functioning between the two ethnic groups.

  August 29, 2012   doi: 10.1111/j.1365-2214.2012.01426.x   open full text
• Why do Romanian junior high school students start to smoke?
  L. M. Lotrean, I. Mesters, H. Vries.
  Child Care Health and Development. August 29, 2012
  Background Adolescence is a crucial period in the development of smoking behaviour. To develop efficient prevention programmes for teenagers, it is essential to understand why adolescents start to smoke. The objective of this study was to assess the predictors of smoking onset among Romanian junior high school students aged 13–14. Methods The data were obtained from a two‐wave, 9‐month longitudinal study carried out among 504 junior high school non‐smokers from Cluj‐Napoca, Romania. Questionnaires assessed smoking behaviour, attitudes, social influence, self‐efficacy and intention regarding smoking (motivational variables), as well as different sociodemographic features. Results The results from the logistic regression analysis revealed that baseline lower self‐efficacy in refraining from smoking in several social situations, baseline pressures from peers to smoke and baseline intentions to smoke significantly increased the risk of non‐smokers to become smokers at follow‐up 9 months later. Conclusions These findings underline that reinforcing social self‐efficacy to refuse smoking, resisting peer pressures and maintaining negative intentions regarding smoking are essential ingredients for smoking prevention programmes among Romanian junior high school students.

  August 29, 2012   doi: 10.1111/j.1365-2214.2012.01428.x   open full text
• A pilot study to measure marks in children with cerebral palsy using a novel measurement template.
  T. Bennett, D. Jellinek, M. Bennett.
  Child Care Health and Development. August 15, 2012
  Aim The primary aim of this pilot study was to trial a method of assessing bruises in a population of disabled children. If the method was found to be sufficiently robust it would be our intention to undertaking a more extensive observational study. Background Less is known about normal bruising patterns in children with disability than in those without. It is important that the method used to assess bruising is objective and repeatable. In an effort to define and improve repeatability, we employed a novel bruise measurement template which was printed onto transparent acetate sheets. Method Twenty primary school age children, the majority of whom were non‐ambulant and severely disabled with cerebral palsy, underwent full skin examination. The template was used to assess any bruises seen. A comparison was then made between measurements made by experienced paediatricians using the template and using a standard tape measure on a series of bruise images in 25 photographs. Results The majority of children in our pilot were found to have bruises, with one child having 6 and one 7 bruises. This comparative study showed that the two techniques had a very similar precision and that the template was easy to use. Greater precision would require a tighter measurement protocol, whether with a template or a tape measure. Conclusions Further evaluation of the application of such a template would be worthwhile. We would suggest that our finding of some bruising in this population of disabled children is borne in mind whenever bruising is found in a non‐ambulant child.

  August 15, 2012   doi: 10.1111/j.1365-2214.2012.01419.x   open full text
• Problem behaviours of middle school students in eastern China and its associated factors.
  W‐W. Chang, H. Su, J. Wang, C‐C. Wang, X‐W. Shan, Q. Han.
  Child Care Health and Development. August 15, 2012
  Objective To investigate the problem behaviours of middle school students and its associated factors in Anhui province of China, and to provide a theoretical basis for promoting early health education. Methods A cross‐sectional survey was conducted and 4235 middle school students were measured by Prediction Test of Problem Children, Family Environment Scale – Chinese Version, Simple Coping Style Questionnaire, Psychological Sense of School Membership and general state questionnaire. Results The prevalence of problem behaviours in our sample was 4.5%. Using binary logistic regression analysis, we found that family environment, school belonging, coping style, relationship with mother and classmate relationship were associated with problem behaviours of middle school students. Conclusions Poor family environment, poor sense of school belonging, passive acting style were significantly correlated with problem behaviours. There is an urgent need to improve problem behaviours through collaboration among families, schools and society.

  August 15, 2012   doi: 10.1111/j.1365-2214.2012.01417.x   open full text
• Moving from a universal to targeted child health programme: which children receive enhanced care? A population‐based study using routinely available data.
  R. Wood, D. Stockton, H. Brown.
  Child Care Health and Development. August 15, 2012
  Background There is a current emphasis on ‘progressive universal’ delivery of the UK child health programme, with a core universal service complemented by enhanced support provided according to need. In Scotland, a three‐category indicator of need, the ‘Health Plan Indicator’ (HPI) is used to identify children requiring enhanced support from the child health programme to facilitate this. Methods Routine child health programme and hospital delivery records for a cohort of 36 871 Scottish children were used to explore the factors associated with being identified as requiring enhanced child health programme support using multilevel logistic regression modelling. Results The following factors were all independently associated with an increased likelihood of being assessed as requiring enhanced support: (i) deprivation; (ii) young maternal age, maternal smoking and drug misuse; (iii) a previous stillbirth; (iv) prematurity; (v) being small for gestational age; (vi) no breastfeeding, admission to a special care baby unit; and (vii) medical, social or developmental concerns about the baby. There was a tendency for children living in areas with higher Health Visitor staffing levels to be more likely to be assessed as requiring enhanced support but this effect was not statistically significant. There was significant residual variation between areas in the likelihood of children being assessed as requiring enhanced support. Discussion This study suggests Health Visitors take a complex range of factors into account when assessing which children require enhanced support from the child health programme. Health Visitors’ workload may influence the likelihood of them identifying children as requiring enhanced support but this requires further clarification. There are clear differences between areas in allocation of the different HPI categories. Further work is required to explore the relationship between being identified as in need of enhanced support, the care actually provided to children, and their outcomes.

  August 15, 2012   doi: 10.1111/j.1365-2214.2012.01423.x   open full text
• Body esteem, peer difficulties and perceptions of physical health in overweight and obese urban children aged 5 to 7 years.
  N. A. Williams, J. Fournier, M. Coday, P. A. Richey, F. A. Tylavsky, M. E. Hare.
  Child Care Health and Development. August 08, 2012
  Objective To determine whether there is an association between body mass index (BMI) and body esteem in young overweight and obese urban children, and to test peer relationship difficulties and perceived physical health as mediators of this relationship. Methods Child self‐reported body esteem, and parent‐reported child peer relationship difficulties (being bullied by peers and peer rejection) and physical health perceptions were obtained from 218 overweight and obese children aged 5–7 years (81% racial/ethnic minority, M BMI = 25.3) and their primary caregivers. Results Higher BMI was associated with lower body esteem for both girls and boys. This relation was mediated by poor physical health for boys but not for girls. Peer relationship difficulties did not mediate the observed association between BMI and body esteem in either group; however, girls with higher BMI experienced more bullying and being bullied by peers was associated with lower body esteem in girls. Conclusions Intervening with perceptions of physical health may buffer overweight and obese boys from developing low body esteem in early childhood.

  August 08, 2012   doi: 10.1111/j.1365-2214.2012.01401.x   open full text
• Development of an outcome measurement system for service planning for children and youth with special needs.
  M. K. Kertoy, D. J. Russell, P. Rosenbaum, S. Jaffer, M. Law, D. McCauley, J. W. Gorter.
  Child Care Health and Development. July 30, 2012
  Aim This study described the process used in developing an outcome measurement framework for system planning to improve services for children and youth with special needs and their families in a Canadian province. The study reports the results of several parent‐completed measures, which would be useful in service planning as well as the acceptability and utility of these measures for use by families and service centres. Methods/results Development of a theoretical framework, consultation with key stakeholders, testing the utility of selected outcome measures and initial dissemination of results were critical elements in the successful development of an outcome system. Consultation with stakeholders confirmed use of the International Classification of Functioning, Disability and Health and the child‐within‐family‐within community model as theoretical frameworks while building valuable partnerships and identifying potential barriers to implementation. Pilot testing showed three outcome measures were feasible for families to complete and the measures provided information about services for children that was valuable to families as well as service providers. Gaps in service delivery were identified and the need for better communication between service providers and communities to facilitate integrated services was highlighted. Conclusion The findings from this study can be used to implement an outcome measurement system for children with special needs and may serve as a resource for international researchers who are working to develop valid tools as well as outcome systems that are useful for system planning.

  July 30, 2012   doi: 10.1111/j.1365-2214.2012.01409.x   open full text
• Reliability and validity of a new instrument to measure tolerance of everyday risk for children.
  A. Hill, A. C. Bundy.
  Child Care Health and Development. July 30, 2012
  BackgroundA modicum of everyday risk provides opportunities for children to extend the limits of their competence. However, increasingly negative perceptions of risk have led to risk‐averse behaviours in adults, including severely restricting children's play. The degree to which risk in play is tolerated by adults impacts on the lives and experiences of children. However, no measure of adult tolerance to everyday risk exists. The purpose of this study was to develop a valid and reliable instrument examining adults’ tolerances of risk during children's play.MethodsA 31‐item survey of risk tolerance was developed based on a Norwegian model of risky play; 100 parents and teachers of children aged 3 to 13 years completed the instrument. Data were subjected to Rasch analysis. Psychometric properties of the data were examined.ResultsIterative analyses produced an instrument with goodness of fit statistics in the acceptable range, a logical item hierarchy, person separation index >2 and reliability index of 0.87. There was a strong positive relationship between participants’ self‐perceived risk tolerance and scores on the instrument, and between the age of the child and scores on the instrument.ConclusionsThe Tolerance of Risk in Play Scale (TRiPS) yields valid and reliable data for measuring the success of interventions to change adults’ everyday risk beliefs, and for exploring the impact of adults’ risk tolerance on children's play and development.

  July 30, 2012   doi: 10.1111/j.1365-2214.2012.01414.x   open full text
• The rationale and pilot study of a new paediatric dental patient request form to improve communication and outcomes of dental appointments.
  L. M. Jones, T. J. Huggins.
  Child Care Health and Development. July 30, 2012
  BackgroundChildren's unhappy visits to the dentist can negatively impact lifelong oral health. A possible intervention is to enhance empathy in the child patient–dental practitioner relationship through communication. The present paper presents a new instrument, the Survey of Anxiety and Information for Dentists (SAID), which targets children's dental anxiety, coping preferences and dental neglect, and offers children a change to request information and engage in treatment planning.MethodFive children's focus groups pilot tested the content, wording and response format of a prototype patient request form, the SAID. Participants were 34 10‐ to 13‐year‐old children who individually completed the form then discussed it item by item in their small groups.ResultsChildren had no difficulty completing most items. They identified ambiguities, and items that were meaningless to them, and proposed a new item asking the dentist about their job. Children were polarized over the response format, but they were emphatic about passing the form directly to the dentist, and not to a receptionist or assistant, stressing the importance of having a conversation with their dentist.ConclusionsBefore the pilot, dentists had expressed concerns about the potential for words in the SAID‐provoking negative feelings. Children, however, wanted and needed facts, so requested that dentists use plain language, not euphemisms, to describe problems and treatment options. We report their selected practical suggestions. SAID‐informed negotiated care may promote more patient cooperation and satisfaction at appointments, and more attention to oral hygiene between appointments.

  July 30, 2012   doi: 10.1111/j.1365-2214.2012.01416.x   open full text
• Psychosocial and somatic outcomes of sleep problems in children: a 4‐year follow‐up study.
  P. Simola, K. Liukkonen, A. Pitkäranta, T. Pirinen, E. T. Aronen.
  Child Care Health and Development. July 09, 2012
  BackgroundInadequate sleep in children relates to medical and psychosocial problems. However, not much is known about the effects of sleep problems persisting from pre‐school to school age on somatic and psychosocial symptoms.ObjectivesTo examine the associations between sleep disturbances and psychosocial symptoms, somatic complaints, medical problems at school age.MethodsThis was a population‐based 4‐year follow‐up study of sleep problems in Finnish children (n = 470). Parents filled in Sleep Disturbance Scale for Children during pre‐school and school years. Children were categorized into four groups: no sleep problems, sleep problems only at pre‐school or only at school age, and persistent sleep problems. At follow‐up the parents filled in Child Behavior Checklist and a background questionnaire.ResultsThe children with persistent sleep problems (9%) had a 16‐fold risk of having psychosocial symptoms on subclinical/clinical range compared with the children without sleep problems. The psychosocial symptoms that were related strongest to prolonged sleep problems were aggression, social and attention problems, and anxious/depressed mood. Also, somatic complaints (ninefold risk) and medical problems (P < 0.001) were typical for children with persistent sleep problems.ConclusionsPersistent sleep problems in children associate with high levels of psychosocial, somatic and medical problems. In paediatric health care more attention should be paid to recognizing, monitoring of the persistence and treatment of sleep problems before school transition period.

  July 09, 2012   doi: 10.1111/j.1365-2214.2012.01412.x   open full text
• Catch the wave! Time‐window sequential analysis of alertness stimulation in individuals with profound intellectual and multiple disabilities.
  V. S. Munde, C. Vlaskamp, B. Maes, A. J. J. M. Ruijssenaars.
  Child Care Health and Development. July 09, 2012
  BackgroundWhile optimally activities are provided at those moments when the individual with profound intellectual and multiple disabilities (PIMD) is ‘focused on the environment’ or ‘alert’, detailed information about the impact that the design and timing of the activity has on alertness is lacking. Therefore, the aim of the present study is to shed light on the sequential relationship between different stimuli and alertness levels in individuals with PIMD.MethodVideo observations were conducted for 24 participants during one‐on‐one interactions with a direct support person in multisensory environments. Time‐window sequential analyses were conducted for the 120 s following four different stimuli.ResultsFor the different stimuli, different patterns in terms of alertness became apparent. Following visual stimuli, the alertness levels of the individuals with PIMD changed in waves of about 20 s from ‘active alert’ to ‘passive alert’. While auditory and tactile stimuli led to ‘alert’ reactions shortly after the stimulation, alertness levels decreased between seconds 20 and 120. Reactions to vestibular stimuli were only visible after 60 s; these were ‘active alert’ or ‘withdrawn’.ConclusionsThe results of the present study show that individuals with PIMD show their reactions to stimuli only slightly, so that ‘waves’ might reflect the optimal alertness pattern for learning and development. Consequently, it is especially important that direct support persons follow and stimulate these individual ‘waves’ in the activities they provide to their clients.

  July 09, 2012   doi: 10.1111/j.1365-2214.2012.01415.x   open full text
• Expressed emotion as an assessment of family environment with mothers and fathers of 1‐year‐old children.
  L. Psychogiou, E. Netsi, V. Sethna, P. G. Ramchandani.
  Child Care Health and Development. July 09, 2012
  BackgroundHigh levels of expressed emotion (EE) in parents have been found to put children at risk for emotional and behavioural problems. However, the majority of existing studies have focused on mothers of school‐aged children and adolescents rather than younger children, and have only rarely included fathers.MethodsThe present study examined the reliability of EE in mothers and fathers of 1‐year old children. It also investigated whether depression and marital problems in the postnatal period predicted EE toward the child at 12 months. EE was assessed with the Preschool Five Minute Speech Sample in 163 families.ResultsThe rater–interrater and code–recode reliability was high for most EE dimensions. Mothers and fathers were found to display quite similar EE scores. Regression analyses showed that depression and couple relationship significantly predicted EE in mothers, but not fathers.ConclusionsThe findings suggest that EE provides a reliable and useful assessment of the family environment in families of young children.

  July 09, 2012   doi: 10.1111/j.1365-2214.2012.01402.x   open full text
• Significant impact of recurrent respiratory tract infections in children with Down syndrome.
  R. H. J. Verstegen, H. B. M. Gameren‐Oosterom, M. Fekkes, E. Dusseldorp, E. Vries, J. P. Wouwe.
  Child Care Health and Development. July 09, 2012
  ObjectiveParents and health professionals believe that recurrent respiratory tract infections (RRTI) have a large impact on children with Down syndrome (DS). We studied the relation between parent‐reported RRTI and development, behaviour and health‐related quality of life (HRQoL) in 8‐year‐old children with DS.MethodDuring a 3‐year period, 325 children with DS were recruited for inclusion in this observational study. Parents were asked to fill in the Child Behavior Checklist and TNO‐AZL Children's Quality of Life Parent Form. A psychological assistant administrated the McCarthy Scales of Children's Abilities. The children were divided into a group with presence of RRTI (RRTI +) and a group without RRTI (RRTI −), on the basis of parental report. Linear regression analyses were performed to assess the effect of RRTI, while correcting for the influence of confounders.ResultsCompared with RRTI − children (n = 176), RRTI + children (n = 149, 46%) showed decreased mental and motor development (mean developmental age 3.67 vs. 4.08 years), more behavioural problems and lower scores on most HRQoL scales (P < 0.05). Moreover, school enrolment is less favourable in RRTI + children.ConclusionIn 8‐year‐olds with DS, the children with parent‐reported RRTI show more delayed development, more behavioural problems and lower HRQoL compared with the children without RRTI. Although this association does not prove a causal relationship, further studies should focus on this, because RRTI are potentially preventable.

  July 09, 2012   doi: 10.1111/j.1365-2214.2012.01413.x   open full text
• Diagnosing autistic spectrum disorder in the age of austerity.
  K. Karim, L. Cook, M. O'Reilly.
  Child Care Health and Development. June 20, 2012
  BackgroundDiagnosing autistic spectrum disorder is a challenge, typically involving myriad professionals. In the current climate we explore how diagnosis is managed in the real world by professionals.MethodsUsing semi‐structured interviews we thematically analyse data from psychiatrists, paediatricians and educational psychologists.ResultsWhile there is some consistency across and within these groups there are also a number of variances, and several important issues are highlighted. These include the problem of time and resources, the issue of location for diagnosis, the value of diagnostic tools and schedules, the need for supporting information, the difficulty of multi‐agency working, the relevance of a physical examination and the eventual diagnostic label.ConclusionsIn the current economic climate and considering changes in guidelines there is a need to evaluate current service provision and enhance services. However, attention needs to be paid to the practical and realistic application of the suggested guidance.

  June 20, 2012   doi: 10.1111/j.1365-2214.2012.01410.x   open full text
• Does biological maturity actually confound gender‐related differences in physical activity in preadolescence?
  B. C. Guinhouya, S. J. Fairclough, D. Zitouni, H. Samouda, C. Vilhelm, H. Zgaya, C. Beaufort, M. Lemdani, H. Hubert.
  Child Care Health and Development. June 19, 2012
  AimTo examine: (i) if maturity‐related gender differences in moderate‐to‐vigorous physical activity (MVPA) depend on how maturity status is defined and measured; and (ii) the influence of maturity level on compliance with PA recommendations.MethodsThe study involved 253 children (139 boys) aged 9.9 ± 0.9 years, with mean stature and weight of 1.39 ± 0.08 m and 35.8 ± 8.8 kg respectively. Their PA was evaluated using an Actigraph accelerometer (Model 7164). Maturity was assessed using the estimated age at peak height velocity (APHV) and a standardized APHV by gender (i.e. centred APHV).ResultsBoys engaged in significantly more MVPA than girls (P < 0.0001). There was a significant correlation between the centred APHV and MVPA in boys (r = 0.20; P = 0.016), but not in girls (r = 0.13; P = 0.155). An ancova controlling for the estimated APHV showed no significant interactions between gender and APHV, and the main effect of gender on MVPA was negated. Conversely, there was a significant main effect of APHV on MVPA (F 1,249 = 6.12; P = 0.014; η p 2 = 0.024). Only 9.1% of children met the PA recommendations, including 14.4% of boys and 2.6% of girls (P < 0.01). This observation also applies in both pre‐APHV (12.7% of boys vs. 2.4% of girls, P < 0.001) and post‐APHV children (23.8% of boys vs. 3.4% of girls, P < 0.0001). No differences in PA guidelines were observed between pre‐APHV and post‐APHV children.ConclusionsAmong prepubescent children, the influence of biological maturity on gender differences in PA may be a function of how maturity status is determined. The most physically active prepubescent children were those who were on time according to APHV.

  June 19, 2012   doi: 10.1111/j.1365-2214.2012.01407.x   open full text
• Validation of a home‐based neurodevelopmental screening tool for under 2‐year‐old children in Bangladesh.
  N. Z. Khan, H. Muslima, A. B. Shilpi, D. Begum, S. Akhtar, M. Parveen, S. Ferdous, H. McConachie, G. L. Darmstadt.
  Child Care Health and Development. June 08, 2012
  Background  Home‐based screening to identify young children at risk for neurodevelopmental impairments (NDIs) is needed to guide the targeting of child neurodevelopmental intervention services in Bangladesh. This study aimed to validate such a tool for children under age 2 years.Methods  A Developmental Screening Questionnaire was administered to mothers of children aged 0–<2 years in an urban community. Inter‐rater reliability among the interviewers, who were high school graduates, was determined. All children who were screen positive and a proportion of screen negatives were subsequently assessed for NDIs by professionals. Sensitivity and specificity were calculated by comparing screening with assessment results.Results  Mean kappa coefficient of agreement among interviewers was 0.95. A total of 197 children were screened, of whom 17% screened positive. Fifty‐one children, including 24 screen negatives, were assessed for NDIs. Screen‐positivity was significantly different between income groups (P= 0.019), and higher in stunted children (odds ratio = 5.76, 95% confidence interval = 1.72–19.28), indicating good discriminant validity Specificity was excellent (84–100%) for all developmental domains. Sensitivity was 100% for vision and hearing; 70% for speech; and 63%, 53%, 48%, and 45% for gross motor, behaviour, fine motor and cognitive impairments, respectively.Conclusion  A tool for screening <2‐year‐old children at risk for NDIs showed high specificity; and was able to identify all children at risk for vision and hearing impairments, nearly three‐fourths with speech impairments, two‐thirds with gross motor impairments, and about half with behavioural, cognitive and fine motor impairments. The Developmental Screening Questionnaire tool has potential for use by frontline workers to screen large populations and to link to definitive assessment as well as intervention services.

  June 08, 2012   doi: 10.1111/j.1365-2214.2012.01393.x   open full text
• Do Chinese parents with HIV tell their children the truth? A qualitative preliminary study of parental HIV disclosure in China.
  Y. Zhou, L. Zhang, X. Li, L. Kaljee.
  Child Care Health and Development. June 08, 2012
  Background  With the extended lifespan of people living with human immunodeficiency virus (HIV) due to the advent of antiretroviral therapy, the disclosure of HIV serostatus to their uninfected children is becoming more critical. However, limited data are available regarding parental HIV disclosure to children in China. We explore patterns of parental HIV disclosure and the reasons for disclosure or non‐disclosure to children.Methods  A preliminary study was conducted using open‐ended questions in Guangxi, China in 2011 with 39 parents living with HIV.Results  A majority of participants (77%) had not disclosed their HIV serostatus to their children. Participants who voluntarily disclosed tended to be older and were more likely to disclose to their adult children. Among parents who disclosed, reasons included a need for emotional and financial support, as well as feelings of obligation to their children. Among non‐disclosing parents, primary reasons included concerns that children were too young to understand, fear of being stigmatized, and fear of increased psychological burden to children.Conclusions  Few parents with HIV disclosed their HIV status to their children. These data indicate the need for future research to explore disclosure issues in relation to children's age and the implementation of developmentally appropriate interventions and support systems for parents and children affected by HIV in China.

  June 08, 2012   doi: 10.1111/j.1365-2214.2012.01394.x   open full text
• ‘It is life threatening but I don't mind’. A qualitative study using photo elicitation interviews to explore adolescents' experiences of renal replacement therapies.
  F. Wells, D. Ritchie, A. C. McPherson.
  Child Care Health and Development. June 08, 2012
  Background  Renal replacement therapy (RRT) transforms the life prospects of young people with established renal failure. However, these treatments can have significant physiological and psychological implications for adolescents as they prepare to transition into adulthood. Health policies increasingly emphasize children and youth's active participation and consultation as users of health services, yet studies infrequently seek their experiences directly. Methods  Adolescents receiving RRT in a large UK teaching hospital took photographs illustrating the impact of their condition and treatment on their lives. Qualitative photo elicitation interviews were conducted to explore the significance of the images and the young person's experiences. Interviews were analysed using descriptive thematic analysis. Results  Ten young people aged 13–17 years participated. Themes identified were: (1) understanding and acceptance of treatment; (2) living in a non‐functioning body; (3) impact upon daily life; (4) sources of support. Young people found treatments challenging and experienced significant impact on relationships and daily routines. Yet, health was prioritized over body image and participants demonstrated great emotional resilience. Young people valued support from family and friends, although were wary of disclosing their condition in case it resulted in being highlighted as different. Young people reported hospital staff as being caring and professional, but their biggest virtue appeared to be their willingness to treat the young people as ‘normal’. Conclusions  Young people engaged readily with the research, and frankly described the impact of RRT on their everyday lives. Service providers must ensure that adolescents' developmental needs are met as traditional tasks of adolescence may lose priority. However, it is also clear that young people's ability to cope with treatments should not be underestimated.

  June 08, 2012   doi: 10.1111/j.1365-2214.2012.01399.x   open full text
• Psychological distress and mental health service contact of unaccompanied asylum‐seeking children.
  E. Sanchez‐Cao, T. Kramer, M. Hodes.
  Child Care Health and Development. June 07, 2012
  BackgroundEvidence is emerging that psychological problems, particularly symptoms of depression and post‐traumatic stress disorder, are more prevalent in unaccompanied asylum‐seeking children (UASC) than their accompanied peers. However, little is known about help seeking and mental health service (MHS) utilization in this group, and how this relates to their psychological needs. This study aims to describe the level of psychological distress among a group of UASC and the pattern of MHS contact.MethodSocio‐demographic data on 71 UASC residing in London was obtained and self‐report questionnaires were completed regarding trauma events (Harvard Trauma Questionnaire), general psychological distress [Strengths and Difficulties Questionnaire (SDQ)], post‐traumatic stress symptoms (Impact of Event Scale), depressive symptoms (Birleson Depression Self‐Rating Scale for Children) and contact with MHS (Attitudes to Health and Services Questionnaire).ResultsUASC were mainly male (n = 48, 67.6%), Black African (n = 39, 54.9%) and their median age was 17 years (interquartile range = 15; 17). They had been living in the UK for a median of 18 months. Eight (11.3%) scored on the SDQ borderline/abnormal range for total symptoms, but this was 21 (29.6%) using the SDQ emotional subscale. Forty‐seven (66.2%) were at high risk for post‐traumatic stress disorder and nine (12.7%) at high risk for depressive disorder. Only 12 (17%) had MHS contact. Predictors of MHS contact were depressive symptoms and duration of time in the UK.ConclusionsUASC had a high level of emotional symptoms, especially post‐traumatic stress symptoms. However, only a small proportion of UASC were in contact with MHS. This suggests a high level of MHS under‐utilization, and reasons for this are discussed.

  June 07, 2012   doi: 10.1111/j.1365-2214.2012.01406.x   open full text
• The impact of children's perception of an activity as play rather than not play on emotional well‐being.
  J. Howard, K. McInnes.
  Child Care Health and Development. June 05, 2012
  BackgroundAs an important aspect of health and development, a number of policy and practice initiatives across education, health and social care are aimed at increasing children's emotional well‐being. Links have been made between young children's emotional well‐being and play although empirical evidence is limited. This paper demonstrates that when children perceive an activity as play, they show more signs of emotional well‐being than when they perceive the same activity as not play.MethodsOne hundred and twenty‐nine children aged between 3 and 5 years participated in the study. The cues children use to differentiate play and not play were used to create an activity session that was ‘like play’ and an activity session that was ‘not like play’. The activity itself remained constant. Children were allocated to either of the activity session types alternately and emotional well‐being was measured using the Leuvens Involvement Scale.ResultsThere was a significant difference in the level of emotional well‐being displayed by children in the two activity session types. Children who undertook the ‘like play’ activity scored significantly higher than children who undertook the same activity but ‘not like play’. Detailed observational analysis also showed increased behavioural indicators relating to emotional well‐being among children participating in the ‘like play’ rather than ‘not like play’ activity session.ConclusionChildren demonstrate increased emotional well‐being when they perceive an activity as play rather than not play. Findings support the proposition that play can be seen as an observable behaviour but also as a mental state. As well as providing important evidence as to the value of play for enhancing children's emotional well‐being, findings are discussed in relation to professional practice in children's services. The paper highlights the training needs of practitioners to enable them to understand children's views about play and use this information to create playful situations which maximize the developmental potential of play.

  June 05, 2012   doi: 10.1111/j.1365-2214.2012.01405.x   open full text
• Maternal perceptions of children's weight status.
  L. Lopes, R. Santos, B. Pereira, V. Lopes.
  Child Care Health and Development. April 20, 2012
  Background  Several studies have addressed mothers' perceptions of their children's weight status; however, there is no investigation on Portuguese children (a country with one of the highest levels of children's overweight and obesity in Europe). The aim of this study was to quantify maternal misclassification of child weight status in a sample of Portuguese children aged 9 to 12 years, according to gender, family income, and maternal weight status, education level and age.Methods  Data were collected in a school‐based study (school year 2009/2010) in northern Portugal with 499 urban children (236 girls; 47.3%). Body mass index was calculated from measurements of height and weight [body mass (kg)/height (m2)]. Mothers' perceptions of child's weight status, age, height and weight were accessed by a questionnaire. Children's age, gender and socio‐economic status were extracted from the schools' administrative record systems. Cohen's Kappa was used to analyse the misperceptions and the agreement between children's objectively measured weight status and mothers' perception of their child's weight status.Results  The prevalence of underweight, overweight and obesity in children was 4.6%, 25.5% and 6.4%, respectively. A proportion of 65.2% of underweight and 61.6% of overweight/obese children were misclassified by their mothers. For the majority of variables presented, the values of agreement were fair (k ranged from 0.257 to 0.486), but were statistically significant. Significant differences in the percentages of mothers who correctly classified their children's weight status were only found among the most educated in the overweight/obese group and among the normal‐weight mothers in the underweight group.Conclusions  Many mothers do not properly recognize their children's weight status and frequently underestimate their children's body size.

  April 20, 2012   doi: 10.1111/j.1365-2214.2012.01380.x   open full text
• Finding out what matters: validity of quality of life measurement in young people with ASD.
  L. Tavernor, E. Barron, J. Rodgers, H. McConachie.
  Child Care Health and Development. April 20, 2012
  Background  Compared with other conditions there has been a lack of focus on quality of life (QoL) as an outcome measure for children and young people with Autism Spectrum Disorder (ASD). This pilot study aimed to evaluate the validity of existing QoL questionnaires for use with children with ASD aged 8–12 years. Methods  A literature review (1990–2011) identified the PedsQL (Pediatric Quality of Life Inventory) and Kidscreen as robust measures used with children with neurodevelopmental disorders. These measures were completed by 10 children and 11 parents. In addition semi‐structured interviews were conducted with 10 parents and four children to explore their experience of completing the QoL questionnaires. Results  Young people with ASD, and their parents, report lower child QoL compared with a normative sample. Framework analysis of the data highlighted six key themes which may affect the validity of generic QoL measures when administered within an ASD sample and which warrant further investigation. Conclusions  Our results indicate that a new condition‐specific measure of QoL, grounded in ASD children's own perspectives of their lives, is needed and that such a measure should assess experiences of anxiety and access to special interests when measuring QoL of children with ASD. Active involvement of young people and their families is critical for the development of a theoretical framework for QoL within ASD, and any future development of an ASD‐specific measure.

  April 20, 2012   doi: 10.1111/j.1365-2214.2012.01377.x   open full text
• Quality of life domains affected in children with developmental coordination disorder: a systematic review.
  J. G. Zwicker, S. R. Harris, A. F. Klassen.
  Child Care Health and Development. April 20, 2012
  The quality of life (QOL) of children with developmental coordination disorder (DCD) is largely unknown, but evidence suggests that multiple QOL domains are affected by the disorder. While DCD is primarily considered a motor disorder, multiple studies have reported psychological and social concerns in children with this condition. Our primary aim was to present the current state of the evidence regarding the physical, psychological, and social QOL domains that can be affected in children with DCD. Systematic review of articles from seven databases through November 2010 (MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, CDSR, DARE) was conducted. Search terms included developmental coordination disorder, dyspraxia, quality of life, life satisfaction, well‐being, activities of daily living, and participation. Two independent reviewers screened titles, abstracts, and full‐text articles. Studies meeting the following criteria were selected: (1) sample comprised solely of individuals with coordination difficulties consistent with DCD; (2) outcome measures related to physical, psychological, or socials domains of QOL; and (3) articles published in English. Data were extracted by one author and verified by a second. Outcomes were categorized according to physical, psychological and social domains of QOL and study quality was rated by case definitions of DCD based on diagnostic criteria as per the Diagnostic and Statistical Manual – 4th edition. Forty‐one articles were included. Most studies reported significantly poorer results in physical, psychological and social functioning in children with DCD compared with peers. Despite the impact of DCD on multiple domains, only one study used a QOL measure as an outcome. Although DCD impacts several QOL domains, the QOL of children with this disorder remains largely unknown. The next critical step is for clinicians and researchers to use QOL measures to gather information on how DCD may affect the QOL of children with this disorder.

  April 20, 2012   doi: 10.1111/j.1365-2214.2012.01379.x   open full text
• Parent–adolescent dyads: association of parental autonomy support and parent–adolescent shared diabetes care responsibility.
  K. M. Hanna, C. J. Dashiff, T. E. Stump, M. T. Weaver.
  Child Care Health and Development. March 01, 2012
  Purpose  Parent–adolescent shared responsibility for diabetes care is advocated by experts to achieve beneficial diabetes and psychosocial outcomes for adolescents with type 1 diabetes. Parental autonomy support may be a way to facilitate this sharing. In this dyadic study, we examined parental diabetes‐specific autonomy support experienced by adolescents with type 1 diabetes and their parents (n= 89 dyads), and its association with their experience of shared diabetes care responsibility.Methods  Path analysis was used to test an Actor–Partner Interdependence Model for parental autonomy support effects on shared responsibility. This was a secondary analysis of data from 89 parent–early/mid‐adolescent dyads.Results  Actor effects were identified. Parents' and adolescents' perceptions of parental autonomy support were associated with their respective reports of shared diabetes care responsibility. One partner effect was identified. Adolescents' reports of parental autonomy support were associated with parents' reports of shared responsibility. Parents and adolescents held similar views of autonomy support but discrepant views of shared responsibility. Older adolescents perceived less parental autonomy support.Conclusion  Increasing parental autonomy support may facilitate parent–adolescent sharing of diabetes care responsibility. Adolescent and parent perceptions influence each other and need to be considered when working with them to strengthen parental autonomy support.

  March 01, 2012   doi: 10.1111/j.1365-2214.2012.01373.x   open full text
• Quality of life in newly diagnosed children with specific learning disabilities (SpLD) and differences from typically developing children: a study of child and parent reports.
  M. Ginieri‐Coccossis, V. Rotsika, S. Skevington, S. Papaevangelou, M. Malliori, V. Tomaras, A. Kokkevi.
  Child Care Health and Development. February 28, 2012
  Introduction  Research on quality of life (QoL) of school children with specific learning disabilities (SpLD) and their parents is scarce. The present study explores QoL deficits in newly diagnosed children with SpLD and their parents, in comparison to a similar age group of typically developing children. Possible associations between parental and child QoL were statistically explored in both groups of children. Methods  70 newly diagnosed children with SpLD [International Classification of Diseases‐10 (ICD‐10) criteria] (38 boys, 32 girls, mean age 10.1 years) and a control group of 69 typically developing children of the same age (40 boys, 29 girls, mean age 10.6 years) were recruited. Children were of normal intelligence quotient, attending mainstream schools. Their parents were also recruited so a child's scores could be associated with corresponding parental scores (mother or father). Children's QoL was assessed by the German questionnaire for measuring quality of life in children and adolescents (KINDLR) questionnaire and parental QoL by World Health Organization Quality of Life brief questionnaire (WHOQOL‐BREF) of the World Health Organization. Results  Children with SpLD in comparison to typically developing children reported according to the KINDLR measurement poorer emotional well‐being, lower self‐esteem and satisfaction in their relationships with family and friends. Surprisingly, school functioning was not reported by these children as an area of concern. Parents of children with SpLD indicated experiencing lower satisfaction in the WHOQOL‐BREF domains of social relationships and environment. Correlational and regression analysis with parental–child QoL scores provided evidence that in the SpLD group, parental scores on WHOQOL‐BREF social relationships and psychological health domains could be predictors of the child's emotional well‐being, satisfaction with family, friends and school functioning. Stepwise regression analysis verified the effect of parents' WHOQOL‐BREF social relationships domain on several dimensions of children's KINDLR QoL. Conclusions  The results may suggest certain significant effects of the SpLD condition on newly diagnosed children's QoL. Emotional and social deficits seem to be experienced by this cohort of children and their parents. Investigation into the possible interrelationships between parental and child QoL seems to indicate that parental social wellbeing may to a certain extend influence some dimensions of the child's QoL. The findings are useful for policy making and specialized interventions for children with SpLD and their families.

  February 28, 2012   doi: 10.1111/j.1365-2214.2012.01369.x   open full text
• Autism in Glasgow: cumulative incidence and the effects of referral age, deprivation and geographical location.
  M. Campbell, L. Reynolds, J. Cunningham, H. Minnis, C. G. Gillberg.
  Child Care Health and Development. November 01, 2011
  Background  Referrals to the Greater Glasgow Community Autism Team (CAT) made before the child's sixth birthday were analysed to obtain an estimation of the proportion of children in Greater Glasgow with childhood autism and investigate whether there were any variations in diagnosis rates, or in age at referral and diagnosis, depending on deprivation or geographical location.Methods  An analysis was made of the database recording referrals to Greater Glasgow CAT, between 2004 and 2007 inclusive, of children referred by age 6 years, comprising 584 cases. Cumulative incidence was calculated for childhood autism. Ages at referral and diagnosis were also analysed.Results  For this subset of children, there were 246 diagnosed cases of childhood autism, a cumulative incidence from 2004 until 2007 of 11.1 per year per 10 000 children aged 0–6 years. Of children with an eventual diagnosis of autism by age 6, 72% were referred by the age of 4 years. Deprivation was found to have an association with referral and diagnostic rates, with higher rates seen in the most deprived. There was geographical variation in the cumulative incidence of autism.Conclusion  Given that the populations were not known to differ in any manner that would lead to a true variation, the geographical variation in the cumulative incidence of autism in children up to 6 years in Greater Glasgow observed in this study is likely to represent differences in the care pathway between areas. Such differences may also explain the observed association with deprivation. Reasons for the variation are being explored.

  November 01, 2011   doi: 10.1111/j.1365-2214.2011.01340.x   open full text
• Child development and disability in resource poor settings.
  M. Ellis.
  Child Care Health and Development. June 16, 2010
  There is no abstract available for this paper.

  June 16, 2010   doi: 10.1111/j.1365-2214.2010.01139.x   open full text