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Background Maternal depression is associated with poor child development and growth in low-income countries. This paper evaluates the effect of a community-based trial providing psychosocial stimulation and food supplements to severely malnourished children on maternal depressive symptoms in Bangladesh. Methods Severely underweight (weight-for-age Z-score < −3) hospitalized children aged 6-24 months ( n = 507), were randomly assigned to: psychosocial stimulation ( PS), food supplementation ( FS), PS+ FS, clinic control ( CC) and hospital control ( CH) at discharge. PS included play sessions with children and parental counselling to mothers during fortnightly follow-up visit at community clinics, conducted by trained play leaders for 6 months. FS involved cereal-based supplements (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplements and growth monitoring. We used Bayley scales, Home Observation for Measurement of Environment ( HOME) inventory and a parenting questionnaire to assess child development, home stimulation and mothers' child-rearing practices, respectively. We assessed mothers' depressive symptoms using a modified version of Centre for Epidemiologic Studies Depression Scale at baseline and at 6 months post intervention. Results Maternal depressive symptoms were significantly lower in the CH group at baseline ( P = 0.014). After 6 months of intervention there was no significant effect of intervention after adjusting for baseline scores and all possible confounders. Maternal depressive symptoms were higher among poorer ( P = 0.06), older ( P = 0.057) and less educated ( P = 0.019) mothers, who were housewives ( P = 0.053), and whose husbands had more unstable jobs ( P = 0.058). At 6 months post intervention, children's cognitive ( P = 0.045) and motor ( P = 0.075) development, HOME ( P = 0.012) and mother's parenting score ( P = 0.057) were higher among mothers with lower depressive symptoms. Conclusion The study did not show a significant effect of the intervention on the level of maternal depressive symptoms. Interventions with higher intensity and/or of longer duration focusing directly on maternal psychosocial functioning are probably needed to reduce maternal depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: With government's proposal of the Healthy China Strategy, universal health has become the focus of increasing attention in China. As a special group, children's health is the basis and start of the national health. The construction of children's healthcare system should be given the priority. This study applied the concept of health equal benefits and conducted a systematic and in‐depth theoretical and empirical research on the children's healthcare system in Beijing, aiming at proposing relevant countermeasures and suggestions such as constructing the path of children's health care system in China. Methods: This study adopted the way of questionnaire on children's basic information, health status, health service demand, insured situation and system satisfaction and then analysed the children's health, healthcare, satisfaction influence factors and their healthcare needs based on a survey in Beijing China. Methods such as descriptive statistics, analysis of variance and logistic regression are adopted to analyse the correlation between factors affecting children's health. Results: The findings show that overall health of the children in Beijing was better. However, there are still problems such as insufficient resource coverage and incorrect cognition in some groups. Their mental health and support need to be put emphasis on. The popularization of medical insurance policies for urban and rural residents in Beijing needs to be further improved. The burden of seeing a doctor is slightly lower than before, and the contribution to protecting children's health is not strong enough. Conclusions: Through the survey of children in Beijing, it can be seen that there are still some problems existing in the healthcare system of children in China from the perspective of equal benefit. This study draws policy attention to the issues of financing, service contents, targets, service level and the degree of social recognition. [ABSTRACT FROM AUTHOR]

Background: Youth with chronic illnesses and their parents make complex medical decisions and also need to develop medical decision‐making skills for transition of care to adult care. The use of inclusive (e.g. 'we decided ...') and exclusive (e.g. 'they decided ...') language in youth and parents' medical decision‐making experiences provides insights into perceptions of engagement. This study assessed youth and parents' perceptions of engagement in medical decision‐making about biologic therapy. Methods: This exploratory mixed‐methods secondary analysis of semistructured interview data included youth with juvenile idiopathic arthritis (JIA) and Crohn's disease (CD) and parents. Iterative qualitative coding of interviews generated themes. Exploratory analyses of variance (ANOVAs) and analyses of covariance (ANCOVAs) investigated differences in language use between youth and parents. Results: Parents used more inclusive language in perceptions of medical decision‐making experiences than youth, which exploratory analyses found significant (p < 0.05). Youth used more exclusive language than parents in perceptions of medical decision‐making. Conclusion: This research suggests that youth with chronic illnesses perceived limited engagement in medical decision‐making, with parents perceiving higher engagement. This presents challenges for youth as they prepare for the transition to adult care. Future research should assess how inclusive and exclusive language use impacts psychosocial and health outcomes. [ABSTRACT FROM AUTHOR]

Background: Participation in daily activities provides many opportunities for children with and without disabilities to improve cognitive, physical and communication abilities; to develop social relationships and to promote adaptive behaviours. The aim of this study is to examine the psychometric properties of the Participation Environment Measure for Children and Youth (PEM‐CY) in Turkish children and youth with and without a disability. Methods: A total of 410 parents of children with (n = 232) and without (n = 178) disabilities, aged 5–17 years, were included in this study. Cronbach's alpha (α) and intraclass correlation coefficients (ICCs) were evaluated for internal consistency and test–retest reliability, respectively. Discriminant validity was determined by comparing the differences in participation and environment scores for disability groups and age intervals with the two‐way analysis of variance (ANOVA) followed by post‐hoc analyses when results were statistically significant. Results: Internal consistency (0.67–0.80) and test–retest reliability (0.67–0.93, p < 0.0001) ranged from moderate to very strong for different summary scores. Discriminant validity of the Turkish version of PEM‐CY was supported by significant differences between children with and without disabilities on participation and environment scales (p < 0.05). We identified some significant age differences, but they did not follow consistently. Conclusions: The Turkish version of the PEM‐CY is a valid and reliable tool to determine the participation and environmental factors in the home, at school and in community settings in Turkish children and youth aged 5–17 years, with and without disabilities. [ABSTRACT FROM AUTHOR]

Background: Children with motor impairments also show poor performance in some executive functions' components. However, there is no consensus on which specific executive subdomain is more impacted. Aim: The objective of this study was to compare executive functions in children with developmental coordination disorder (DCD), at risk for DCD (r‐DCD), and in typically developing (TD) children. Methods and Procedures: A sample of 397 children was assessed using the MABC‐2. Two groups of children were identified; DCD (n = 63) and at r‐DCD (n = 31). A third matched group of children with TD (n = 63) was formed. The MABC‐2 checklist and the WASI tests were used as screening tools. Measures of executive function including verbal and nonverbal tasks for working memory, inhibitory control, and cognitive flexibility were tested. Multivariate analysis of variance followed by analyses of variance and Bonferroni tests were used to verify group effects on executive functions. Results: A significant group effects were found for Working Memory, Λ =.78, F(4, 360) = 10.12, p ≤.001, ηp2 =.12; Inhibitory Control, Λ =.59, F(16, 294) = 5.48, p ≤.001, ηp2 =.23; and Cognitive Flexibility and Inhibitory Control, Λ =.60, F(22, 288) = 3.74, p ≤.001, ηp2 =.22, with moderate effect sizes. The DCD group showed lower scores compared with the TD group on the visuospatial and verbal working memory; inhibitory control and in tasks of cognitive flexibility; the r‐DCD group showed lower scores compared with the TD group for visuospatial working memory and for cognitive flexibility. Conclusions and Implications: Poor performance in several measures of executive functions in children with DCD emphasized the need of motor/executive task‐specific interventions. Furthermore, children at r‐DCD showed low scores in several executive functions; therefore, preventive services should also be provided for this subclinical group. [ABSTRACT FROM AUTHOR]

Background: Family‐centred care (FCC) is considered the best practice in paediatric care but it is not always implemented sufficiently. Effective training programmes that enhance health care providers' knowledge and self‐efficacy have the potential to improve FCC implementation in their daily practice. The goal of the study was to evaluate the sensitivity of the measure of processes of care (MPOC)‐service provider (MPOC‐SP) version and MPOC confidence (MPOC‐Con) in detecting changes following an FCC training. Methods: The MPOC‐Con was developed for this study as a sequel to MPOC‐SP to measure self‐efficacy related to specific FCC practices. Twenty‐four health care providers (occupational and physical therapists, speech pathologist, and special education teacher) participated in a 6‐month FCC provider training. The training included 30 contact hours on FCC principles and techniques through experiential learning, reflective exercises, peer mentoring, and case‐study analyses. The MPOC‐SP and MPOC‐Con were administered preparticipation and postparticipation. Results: Repeated multivariate analysis of variance and reliable change index (RCI) analyses indicated a significant group increase in performance and confidence following the training in two of the four MPOC‐SP factors and in all MPOC‐Con factors, F(1, 7) = 5.17, P = .003, η2 = .68; RCI > 1.96. Individual change patterns in FCC performance indicated patterns of increased, decreased, or stable performance, with the highest increased performances reported for treating people respectfully (79%) and communicating specific information (71%), mostly stable performance in providing general information (75%) and similar levels of increase and stability (41% and 39%, respectively) for interpersonal sensitivity. The Pearson's correlation between MPOC‐SP and MPOC‐Con were significant, moderate‐strong, and positive (r = .42–.69, P < .05). Conclusions: The MPOC‐SP and the MPOC‐Con are sensitive measures suitable for evaluating individual and group changes following training. When designing professional development programmes, managers and educators should consider the interrelation between self‐efficacy and implementing acquired knowledge and skills in FCC. [ABSTRACT FROM AUTHOR]

Introduction: Early home support for language development is critical for later developmental progress. Paediatricians have the opportunity to identify families at risk of failing to provide this support in infancy but often lack simple tools to do so. This study explores the potential of a simple count of sociodemographic risk factors, a cumulative risk (CR) index, to identify families likely to need help in providing literacy support from an early age. Methods: CR scores were calculated for 308 families who completed the STIMQ and MacArthur Communicative Development Inventory (MCDI) at 11–15 months) and 197 (64%) again at 23–37 months. Analysis of variance with linear contrasts examined the effect of CR on the STIMQ and the MCDI at baseline and follow‐up. Correlation analysis explored the relationship between STIMQ and MCDI. Results: At both baseline and follow‐up, CR index showed a significant effect (p<0.006) on the STIMQ along with a significant linear trend for STIMQ scores to decrease as CR increased (p<0.05–0.005). No significant effects of CR effects on MCDI were observed at baseline or follow‐up, whereas MCDI percentiles correlated significantly (p<0.03–0.001) with STIMQ scores (r=0.18–0.26.) at both times. Conclusions: The CR index is a simple tool that can help identify families needing support for providing a language stimulating home environment in the first 2 years before long‐term ill effects of sociodemographic barriers are established. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background This study aimed to evaluate parental perception of neighbourhood environments and safety in association with children's physical activity among primary school children in Klang, Selangor, Malaysia. Methods A total of 250 children (9-12 years of age) and their parents participated in this cross-sectional study. Physical Activity Questionnaire for Older Children and Neighbourhood Environmental Walkability Scale as well as questions on constrained behaviours (avoidance and defensive behaviours) were used to assess the children's physical activity and parental perception of neighbourhood environment and safety, respectively. Results More than one-third (36.0%) of the children were physically inactive compared with only a small percentage (4.8%) who were physically active, with boys achieving higher physical activity levels than girls ( t = 2.564, P = 0.011). For the environmental scale, parents' perception of land-use mix (access) ( r = 0.173, P = 0.006), traffic hazards ( r = −0.152, P = 0.016) and defensive behaviour ( r = −0.024, P = 0.143) correlated significantly with children's physical activity. In multiple linear regression analysis, child's gender ( β = −0.226; P = 0.003), parent's education ( β = 0.140; P = 0.001), household income ( β = 0.151; P = 0.024), land-use mix (access) ( β = 0.134; P = 0.011) and defensive behaviour ( β = −0.017; P = 0.038) were significantly associated with physical activity in children ( R = 0.349, F = 6.760; P < 0.001), contributing 12.2% of the variances in physical activity of the children. Conclusion Results highlight the links between parental perception of neighbourhood environments, safety and constrained behaviours with their children's participation in active play. Interventions aimed to increase actual and perceived safety and reduce perceptions of risk by parents in safe neighbourhoods can be targeted to increase children's physical activity in their local neighbourhoods. [ABSTRACT FROM AUTHOR]

Background Perceptions of the effects of physical activity could facilitate or deter future participation. This study explored the differences between gender and motor competence at 14 years of age in the perceptions of likelihood and importance of physical activity outcomes. Method The sample comprised 1582 14-year-old adolescents (769 girls) from the Western Australian Pregnancy Cohort (Raine) Study. Four motor competence groups were formed from a standardized Neuromuscular Developmental Index score (McCarron 1997). Perceptions of the likelihood and the importance of 15 physical activity outcomes were measured by a questionnaire developed for the NSW Schools Fitness and Physical Activity Survey (Booth et al. 1997). Gender (two) × motor competence (four) analyses of variance and Tukey post hoc were conducted on outcome scores ( P < 0.02) using SPSS version 17. Results Gender differences were found in the perceived likelihood and importance of physical activity outcomes within competition, social friendships and injury domains. Motor competence was significant in the perceived likelihood of physical health ( P < 0.001), psychosocial ( P < 0.009) and competition ( P < 0.002) outcomes, with lower perceptions by the least competent groups. Significantly lower importance was perceived for academic outcomes for 14 year olds categorized with low compared with high motor competence ( P < 0.005). Regardless of motor competence and gender, the same health and fun outcomes were ranked the highest in likelihood and the highest in importance. Conclusion Although level of motor competence at 14 years affected the perceived likelihood of health, social and fun outcomes from future participation in physical activity, adolescents highly valued these outcomes, whereas gender affected competition and winning, outcomes that were less valued. Physical activity that promotes these key and valued outcomes may encourage young people's ongoing involvement in physical activity, especially for those at risk of low participation. [ABSTRACT FROM AUTHOR]

Background: Childhood cancer may radically change the daily lives of young survivors, particularly in school. Depending on the sense they derive from the experience of illness, survivors may go through profound transformations in the way they approach life. Methods: This exploratory study reports on school engagement of cancer survivors by examining their perceptions of benefits and burdens in relation to their illness. Forty-nine young Quebecers, previously diagnosed and treated for leukaemia, completed a questionnaire measuring their school engagement and participated in an interview focusing on the impact of cancer on their lives. Perceptions with regard to the presence and types of benefits and burdens were described and examined in light of participants' characteristics. An analysis of variance explored whether the presence/absence of benefits and burdens were associated with participants' scores regarding school engagement. Results: Most participants mentioned benefits from having had cancer, and in particular benefits at an interpersonal level. Half of the participants mentioned burdens, mainly of a physical and psychological nature. Significant correlations indicated that (i) the older the survivors were, the more likely they were to report benefits in terms of qualities and strengths of character; (ii) the more time had elapsed since their diagnosis, the more survivors were likely to report psychological types of burdens; and (iii) children from single-parent families reported more frequently having appreciated social or recreational activities compared with children from two-parent families. One main effect indicated that school engagement was greater for survivors who perceived the presence of benefits. An interaction effect revealed that the perception of both benefits and burdens predicts the highest scores of school engagement. Conclusions: While the results reveal the promising potential that an optimistic yet realistic disposition has in regard to school engagement, more research is necessary to further our understanding of such a disposition. [ABSTRACT FROM AUTHOR]

Background Adequately developed fundamental movement skills, particularly object control dimensions, are considered essential to learn more complex movement patterns and to increase the likelihood to successfully participate in organized and non-organized sports during later years. Thus, the present randomized controlled trial aimed at improving object control dimensions at an early state in a kindergarten setting. Methods Catching, throwing, kicking, rolling and stationary dribbling were assessed via gross motor development 2 (TGMD-2) testing in 41 normally developed preschoolers. On a cluster-randomized basis [strata: age, sex and body mass index (BMI)], three kindergartens were randomly assigned to an intervention group (n = 22, INT, age: 4.6 ± 1.0 years; BMI: 16.2 ± 1.1 kg/m²) and three to a control group (n = 19,CON: age: 4.5 ± 1.2 years; BMI: 16.8 ± 1.2 kg/m²).Twelve structured training sessions were given within 6 weeks (12 sessions).The total training volume was 330 min. Results Moderate time × group interaction were observed for the total sum score (+22%, P = 0.05) and dribbling (+41%, P = 0.002). Adjusting for baseline differences analyses of covariance did not affect these results. Interestingly, likely to most likely practically worthwhile effects were detected for the total sum score, catching and dribbling. Conclusion Object control dimensions such as dribbling and catching that apparently rely on rhythmical movement patterns and anticipatory eye-hand coordination seem to benefit from short-term object control training. These skills are considered important for successful team-sport participation and appropriate sportive motor development. [ABSTRACT FROM AUTHOR]

Background Previous research has highlighted lack of knowledge, understanding and confidence among parents and teachers responsible for the postural care of children with physical disability. Interventions designed to improve these qualities require a reliable and validated tool to assess pre- and post-intervention levels. Currently, however, no validated measure of postural care confidence (i.e. self-efficacy) exists. Hence, the aim of this research was to develop a reliable and valid questionnaire to assess parents' and teachers' confidence, alongside knowledge and understanding of postural care - the Understanding Knowledge and Confidence in providing POSTural CARe for children with Disabilities (UKC PostCarD) questionnaire. Methods Items were developed by a multidisciplinary team and designed to map onto the content of 'An A-to-Z of Postural Care'. Parents, teachers and therapists assessed items for face validity. Scale reliability was then assessed using Cronbach's alpha and known-group validity was assessed by comparing scores of an 'expert' group (physiotherapists and occupational therapists) with those of a 'non-expert' group (with no formal training in postural care). Results The total scale and all three subscales (understanding and knowledge, confidence and concerns) demonstrated adequate reliability (α > 0.83) and subscale correlations formed a logical pattern (understanding and knowledge correlated positively with confidence and negatively with concerns). Experts' (n = 111) scores were higher than non-experts' (n = 79) for the total scale and all subscales (P < 0.001). Conclusion Findings support the reliability and validity of the UKC PostCarD questionnaire as a measure of understanding, knowledge and confidence in providing postural care for children with disabilities. [ABSTRACT FROM AUTHOR]

Background The consequences of developmental co-ordination disorder (DCD) indicate a need for identification in order to provide adequate intervention. The goals of the study were to investigate DCD prevalence across age bands, gender, race and school performance; the motor difficulties of children with DCD, at-risk and typically developing children in the Movement Assessment Battery for Children (MABC) sub-tests across age bands and gender; and the relationship between motor outcomes, age, gender and socio-economic status (SES) in socially disadvantaged Brazilian children. Methods The MABC was administered to 1056 Brazilian children from 4 to 10 years old. Results Eighteen per cent of the children were screened as probable DCD (=5th percentile) and a further 15% as at risk for DCD (>5th and =15th percentile). Significantly more children were screened with probable DCD at age 9-10 years (AB3: P = 0.00), whereas at risk classification was equally distributed across age bands (P = 0.12). Boys showed lower prevalence than girls of probable DCD and at risk for DCD (P = 0.04). Children (9-10 years) showed higher motor impairment in the manual dexterity test results. Children with probable DCD and at risk of DCD showed, in general, poor performance in balance and manual dexterity tasks. SES was the strongest predictor of motor outcomes, accounting for 21% of the variance in the MABC percentile scores. Conclusions The prevalence of probable and at-risk DCD cases as well as the percentage of female were higher than those found in the previous studies, and low SES enhances the risk of poor motor development. [ABSTRACT FROM AUTHOR]

Background Visual-motor integration ( VMI) is important in children's development because it is associated with the performance of many functional skills. Deficits in VMI have been linked to difficulties in academic performance and functional tasks. Clinical assessment experience of occupational therapists in Singapore suggested that there is a potential difference between the VMI performance of Singaporean and American children. Cross-cultural studies also implied that culture has an influence on a child's VMI performance, as it shapes the activities that a child participates in. The purpose of this study was to (1) explore if there was a difference between the VMI performance of Singaporean and American preschoolers, and (2) determine if there were ethnic differences in the VMI performance of Singaporean preschoolers. Methods The Beery- VMI, which was standardized in America, is commonly used by occupational therapists in Singapore to assess the VMI ability of children. We administered the Beery- VMI (fifth edition) full form test (excluding the supplemental tests) to 385 preschoolers (mean age = 63.3 months) from randomly selected schools in Singapore. We compared the scores of Singaporean preschoolers with those of the American standardization norms using the one-sample t-test. Scores of different ethnic groups among the Singapore population were also compared using a one-way anova, followed by the Bonferroni post-hoc test. Results Singaporean preschoolers and the standardization sample of American children performed significantly differently in all age groups ( P < 0.05). Among the Singapore population, the scores were also significantly different ( P < 0.05) between the (i) Chinese and Malay and (ii) Chinese and Indians ethnic groups. Conclusion Preschoolers from different cultural and ethnic groups had different VMI performance. Certain cultural beliefs and practices may affect VMI performance. Clinicians should exercise caution when using an assessment in communities and cultures outside the ones on which it was standardized. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives This study examined differences in children's psychological and social indicators in non-traditional families in Israel, focusing on fatherless families headed by lesbian mothers and single mothers by choice. Although Israel is considered an industrialized westernized country, centrality of the traditional nuclear family predominates this country. Methods This factorial design study included four family types: lesbian and heterosexual mothers, each in both single and coupled parenthood. Children's measures included the Child Behavior Checklist, perception of peer relations and perceived self-competence. Results Children from single parent as opposed to two-parent families exhibited more externalizing behaviour problems and aggressiveness. Children of lesbian mothers reported more prosocial behaviours and less loneliness than children from heterosexual families. No differences emerged for perceived self-competence across family types. Conclusion Mother's sexual orientation did not affect children's adjustment negatively, whereas single parenthood placed children at greater risk for some difficulties. Implications include the need for apprising health professionals of effects of family types on children's development. [ABSTRACT FROM AUTHOR]

Background To identify profiles of family needs of families of children and youth with cerebral palsy (CP), and determine whether profile membership is related to child, family and service characteristics. Methods Participants were mostly mothers (80%) of 579 children and youth with CP. A family member completed modified version of the Family Needs Survey and questionnaires about their child, family and services. Research assistants determined the Gross Motor Function Classification System levels. K-means cluster analysis identified profiles of needs. Cluster membership was analysed to examine differences in clusters based on selected characteristics. Results Four profiles of needs were identified: Low needs, Needs related to community and financial resources, Needs related to child health condition and High needs. Profile membership was differentiated based on child/youth gross motor function, adaptive behaviour, family relationships, family income, access and effort to co-ordinate services. Conclusion Despite heterogeneity among individuals with CP and their families, four profiles of family needs were identified. In total, 51% of families had low needs suggesting that they are effectively managing their children's health conditions while 11% of families had high needs that may require high levels of services and supports. Service providers are encouraged to partner with families, provide anticipatory guidance and co-ordinate services. [ABSTRACT FROM AUTHOR]

Aim In light of the International Classification of Functioning, and Health (ICF) model, to assess whether parents of children with mild developmental disabilities perceived various environmental factors as barriers to their child's participation, and whether these factors have a unique contribution to the total explained variance of participation, beyond personal factors. Methods Seventy-nine kindergarten children (mean age 5.20 ± 0.52 years old) with mild developmental disabilities and their parents participated in the study. Three questionnaires measuring the child's participation, performance skills and environmental factors were completed by the parents. Results Parents perceived environmental factors as slightly restricting to their child's participation. Associations were found between home and education factors and the dimensions of child participation - independence, enjoyment and parental satisfaction. Although parents perceived human environmental factors as more restricting than physical factors at home, regression analysis revealed that the latter was found to affect the child participation dimension of independence beyond the contribution of personal factors. Interpretation These findings are the first, to our knowledge, to support the contribution of environmental factors to the participation of young children with mild developmental disabilities. The results show that environmental factors have significant slight contribution to child's independence in participation beyond other predictors (i.e. personal factors). Therefore, it is recommended to include environmental restrictions measurement in the child evaluation process to facilitate effective intervention programs. [ABSTRACT FROM AUTHOR]

Background Williams syndrome (WS) is a genetic disorder causing intellectual disability. Children with WS often exhibit various kinds of maladaptive behaviours that affect their social functioning. In order to determine whether these behaviours are syndrome-specific, it would be necessary to compare children with WS with children with other syndromes as well as to provide data on the socio-emotional profile in WS from a variety of cultures. The present study investigated the behavioural profile and its relation to maternal stress in Greek young children with WS in comparison with young children with Down syndrome and typically developing (TD) children. Methods Participants were 60 mothers, 20 in each syndrome group and 20 in the control group. The three groups were matched for mental age. The behavioural profile of the participants was investigated through the Child Behaviour Checklist (1.5-5 years) and maternal stress through the Parental Stress Index. Results In accordance with studies in other cultures, it was found that young children with WS received significantly higher rates in emotional problems and anxiety/depression, compared with both children with Down syndrome and TD children. Moreover, mothers of children with WS reported significantly higher scores in the Total Stress index compared with mothers of TD children. However, in contrast with previous studies, only 25% of children with WS fell into the clinical range in the total Child Behavior Checklist score. Conclusion The consistency of the socio-emotional characteristics of children with WS across cultures and developmental stages implies a strong influence of the genetic phenotype. However, Greek mothers avoided to characterize these behaviours as pathological. Implications of these findings for clinical practice are also discussed. [ABSTRACT FROM AUTHOR]

Background Many rural children in China have been experiencing life without fathers since the 1990s, when their fathers left the rural areas for the urban areas to find a job that would allow them to continue to support their family. However, to date, knowledge and understanding of the effects of the absence of fathers and timing of separation on the mental health of adolescents are limited. Methods A total of 2233 students, ranging in age from 11 to 23 years, from five provinces of China, including 1024 adolescents who experienced the absence of their fathers, were recruited for this study. The data were collected using State-Trait Anxiety Inventory and Rosenberg Self-Esteem Scale, which were self-report questionnaires. Results Findings from a structured questionnaire showed that the subjects who experienced life without fathers have increased state-anxiety ( t=−5.80, P < 0.001) and lower self-esteem ( t= 39.54, P < 0.001) when compared with other subjects, and the above results could be influenced by gender and grade. A limited effect of the timing of separation was found on the mental health of students whose fathers were absent. A significant timing group effect existed for state-anxiety scores [ F(3,992) = 2.26, P= 0.05], and post test also revealed that the self-esteem of female scores in the 0-2 timing group was higher than other timing group's [ F(3,992) = 4.58, P= 0.004]. Conclusion The influence of the absence of fathers on the anxiety and self-esteem of adolescents seems to be more serious than our expectation, and the influence will be different according to the timing of father absence. [ABSTRACT FROM AUTHOR]

Background Few co-morbidity studies have been conducted since the Leeds Consensus Statement on developmental co-ordination disorder (DCD) in 2006. In this Statement, international cut-offs and inclusion criteria were agreed and consequently, the status of DCD changed. Furthermore, most existing co-morbidity studies are small clinical studies, rather than epidemiological studies, resulting in a broad range of co-morbidity rates. DCD has a higher incidence for boys in comparison with girls; questions arise if this preponderance remains the same in combination with other developmental disorders. Therefore, in this study we aimed to determine co-morbidity and gender differences of motor problems in children with a pervasive developmental disorder, a hyperkinetic disorder and/or a speech, language or learning disability. Methods Profiles of 3608 children (mean age: 9 years 1 month) referred to rehabilitation centres for behavioural, developmental and sensorineural disorders were studied. Results Motor problems were reported in one-fifth of the total sample. Co-morbidity of motor problems in specific disorders varied from almost one-fourth to more than one-third. The male/female ratio was significantly higher in children with motor problems and two or more other disorders, compared with children with motor problems and less than two other disorders. Conclusions This study indicates that co-morbidity of motor problems with other clinical disorders is not exceptional and developmental deviance is seldom specific to one domain. However, current co-morbidity studies tend to overestimate the number of children with motor problems. In addition, there may be different patterns of symptoms between the genders. These findings stress the importance of assessing motor skills in children with various developmental disorders. [ABSTRACT FROM AUTHOR]

Background Increasing numbers of children are at-risk for behavioural and emotional disorders, a phenomenon contributing to increased use of pharmacological interventions for paediatric clients. Adverse side effects and other risks associated with pharmacological approaches have helped fuel interest in nutritional interventions for behaviourally at-risk children. Methods The current randomized clinical trial evaluates the efficacy of a neurochemical intervention involving the glutamine and glutamate analogue L-theanine and 5-hydroxytryptophan, the precursor for serotonin, with children adopted from traumatic backgrounds. Results Results include significant increases in urinary levels of the biomarkers for serotonin and gamma-aminobutyric acid, coupled with significant decreases in parent reports of the children's behaviour problems. Conclusions While further research is needed, these initial findings are encouraging and are consistent with a growing number of studies indicating the efficacy of nutritional approaches to help behaviourally at-risk children. [ABSTRACT FROM AUTHOR]

Background The goal of this study was to examine social skills deficits among children with and without prenatal alcohol exposure (PAE) who were both referred to a respite programme. Methods Thirty-seven children with PAE and 23 non-exposed children (aged 3 to 8 years) were evaluated on the Social Skills Rating System (SSRS) by their caregivers and respite workers. Results As compared with the non-exposed children, those with PAE showed more deficits on caregiver ratings of responsibility, hyperactivity, internalizing problems and overall social skills, as well as respite worker ratings of hyperactivity. The social skills among the PAE group were not related to home placement variables. Among both groups, caregivers rated social skills lower than respite workers, and among the PAE group, girls tended to display more social skills deficits than boys. Conclusions The SSRS is useful in identifying unique social skills deficits among children with PAE. [ABSTRACT FROM AUTHOR]

Objectives To assess community-based paediatricians' management of clinical situations, particularly those related to the new morbidity (NM), such as chronic disease, developmental, behavioural, and psychosocial problems, and to identify the main associated factors. Methods The study population included all community-based paediatricians employed by Israel's two largest health maintenance organizations in the central and southern regions of the country ( n= 574; 74% response rate). Using a self-administered questionnaire including 20 vignettes describing common clinical situations (14 related to NM; 6 related to classic paediatrics (CP)), physicians reported how they would manage each situation and how they perceived their role in managing such problems. Results Paediatricians were less likely to take an active role in managing NM-related problems than CP-related problems (68.3% vs. 93.2%; P < 0.001). In most NM situations, when paediatricians regarded the problem as part of their role, they were more likely to either manage the problem by themselves or with the help of other professionals. A multivariable linear regression model, adjusting for demographic, practice and training characteristics indicated the following predictive factors for taking an active role in managing NM ( P < 0.001): practicing in the periphery, consulting with non-medical community-based professionals and combining community and hospital practice. Conclusions To assure comprehensive paediatric care, simultaneous modification of paediatricians' residency training, practice environment and role perception are required. [ABSTRACT FROM AUTHOR]

Haemopoietic stem cell transplantation (HSCT) is a life-saving but intensive procedure associated with potentially severe adverse late effects. We aimed to determine morbidity and health-related quality of life (HRQOL) in a sample of survivors aged 8-18 years at least 1 year post HSCT for paediatric acute leukaemia, compared with a non-transplanted group of survivors matched for age, gender, initial disease and time since treatment. Families (N = 54; HSCT n= 29) recruited from four UK centres completed measures of child behaviour and school attendance, HRQOL and finances. Mothers completed measures of their own well-being. Clinical outcome data were extracted from medical records. Children in the HSCT group had significantly more late effects and had received more tests for vision, bone, dental and skin health, and thyroid, lung, and gonadal function than the non-transplanted group. HRQOL scores for the HSCT group were significantly lower in all domains compared with the non-transplanted group and population norms, but were not significantly related to clinical indices. Mothers in the HSCT group had significantly poorer mental well-being than population norms. Significant morbidity and compromised HRQOL was found in survivors of HSCT. The burden of caring for a child after HSCT has a continuing toll on mothers' well-being.The importance of counselling families about possible long-term consequences is emphasized. [ABSTRACT FROM AUTHOR]

A better understanding of the different domains and characteristics of children's and adolescent's physical activity (PA) could be a strategy to clarify the association of this behaviour with the early development of cardiovascular risk factors. To examine the relationship between leisure time physical activity (LTPA) and sports competition activities (SCA) with high blood pressure (HBP) levels in a sample of children and adolescents from Porto, Portugal. This is a cross-sectional study, which comprised 503 boys and 572 girls, aged 8-17 years old. LTPA and SCA were assed by self-reported. Students were assigned as active and non-active in SCA or LTPA according to their self-reported participation. Participants were classified as HBP when they are above of the last quartile for systolic and/or diastolic BP adjusted for gender and age. Do not be engaged in LTPA (OR: 1.47; 95% CI: 1.12; 1.93) and SCA (OR: 1.36; 95% CI: 1.02; 1.81) was significantly associated with the likelihood of being HBP. However, when cardiorespiratory fitness (CRF) (OR: 1.23; 95% CI: 0.91; 1.67) and body mass index (BMI) (OR: 1.31; 95% CI: 0.98; 1.75) were included on SCA model, the association between SCA with HBP did not showed significant results. Children and adolescents who are not engaged in SCA or LTPA are more likely to be classified as having HBP; however, the relationship between SCA and HBP was dependent of CRF and BMI. Further, PA strategies should take these differences on the relationship between HBP, SCA and LTPA. [ABSTRACT FROM AUTHOR]

Children with developmental disabilities present behaviour problems to a greater extent than do typically developing children. Psychosocial models of child development suggest that parental attributions of child and adult controllability could moderate this relationship between child disability status and behaviour. The influence of parental attributions of adult and child controllability on the relationship between problem behaviours and disability was explored in mothers of children with developmental disabilities (DD) (N = 20) with a mean age of 9 years 3 months (SD 24.6 months), and in mothers of typically developing (TD) children (N = 26) with a mean age of 9 years 4 months (standard deviation 23.7 months). The DD group comprised 11 children with autistic spectrum disorders or other communication impairments, three children with Down Syndrome, one with cerebral palsy, one with attentional problems, and four with specific or complex developmental problems. Child behaviour was measured by the Child Behaviour Checklist. Parental attributions were measured using a modified version of the Parent Attribution Test and mothers were divided into higher and lower controllability groups on the basis of their responses on this test. Multivariate analysis of variance found significant group × adult controllability interaction effects for 'aggressive behaviour', 'rule-breaking behaviour', as well as borderline significant effects for 'social problems' and 'other problems'. Simple effects analysis suggested that when mothers had lower attributions of adult controllability, there were indeed significantly more problem behaviours in the DD group, but when mothers had attributions of higher adult controllability there was no longer any significant difference in problematic behaviour between the two groups. Parental attributions of controllability may moderate the well-established effect of disability on problem behaviour. Implications for parent intervention programmes are discussed. [ABSTRACT FROM AUTHOR]

Aim To explore the frequency with which children and young people participate in social activities with peers, when they are affected by Mucopolysaccharidosis I Hurler Disease (MPS IH) post bone marrow transplant (BMT). This was investigated in relation to patient age, and in comparison with a normative sample. Patient withdrawal, adaptive and social skills are also described in terms of patient age and in comparison with a normative sample. Method Forty-four individuals affected by MPS IH post BMT participated in this investigation. Their ages ranged from 16 months to 25 years. Semi-structured interviews with patients' mothers were utilized, which included the Behaviour Assessment System for Children and a socialization questionnaire. Normative data for the socialization questionnaire were collected from 46 mothers of children not affected by chronic illness or disability. Results A one-wayanova revealed that children not affected by disability or chronic illness (mean = 20.63) participated overall in social activities more frequently than children aged under 12 years (mean = 14.87) and over 12 years (mean = 13.25) who were affected by MPS IH post BMT (F = 21.01, P < 0.001). Young people aged 12 years and over affected by this condition were found to participate in social activities the least. A pattern also emerged, which indicated greater withdrawal and less well-developed adaptive and social skills for MPS IH patients aged 2.5–5 years and 12 years and over, but scores were within the normal range for those aged 6–11 years. Conclusion These data illustrate a lack of social competency and a tendency towards inhibition and withdrawal in this patient group, particularly among the very young children and the adolescents and young adults. Further research is needed to explore these issues longitudinally and to examine the role played by the family, and indeed disability, in the quality and quantity of social interaction experienced by these individuals. [ABSTRACT FROM AUTHOR]

Background The self-concept of children is influenced by developmental co-ordination disorder (DCD). The aim was to determine the most effective method in enhancing motor proficiency and self-concept of 7- to 9-year-old children with DCD. Methods Teachers at nine different schools identified 201 possible DCD candidates. The Movement Assessment Battery for Children identified 58 with DCD (36 boys and 22 girls). Self-concept and anxiety were determined by the Tennessee Self-Concept Scale (Child Form) and Child Anxiety Scale respectively. The children were randomly grouped into four experimental groups [motor intervention (MI), self-concept (SC) enhancing intervention, psycho-motor intervention (P-MI) and a control group (CG)]. A two-way analysis of variance (anova) with a group factor and a repeated measures over time followed by a Bonferroni post hoc analysis and separate one-wayanovas followed by a Tukey post hoc analysis were conducted to determine between-group and within-group differences at the pre-, post- and re-tests. Effect sizes ( d) were calculated to determine the practical significance of statistical differences ( P < 0.05). Results After completion of the intervention programmes, no significant improvement in motor proficiency was found in the SC group, while the MI, P-MI and CG groups improved significantly ( P < 0.01). No further improvements were found after the retention period in all the groups. From the pre-test to retest 2, the MI, P-MI and CG improved ( P < 0.01), while the SC showed lower ( P > 0.05) motor proficiency. A tendency of lower anxiety ( P > 0.05) was found in the SC, while the total self-concept of the P-MI showed the biggest improvement ( P < 0.05). Conclusion Motor proficiency and self-concept of children with DCD benefit from intervention, but both should be addressed for optimal benefits. [ABSTRACT FROM AUTHOR]

Background The United Arab Emirates (UAE) is a country that has undergone remarkable physical, economic and social shifts in its short modern history. And while the economic and structural transformations of the society have been well documented and publicized, information about the changes and transformations of family processes is sparse. This study is one of the first steps towards documenting the changes in family processes, namely those related to childbirth and parenting, as described by three generations of Emirati women. Methods Family triads of Grandmothers, Mothers and married Daughters ( n = 216) were interviewed in local Arabic dialect by Emirati female research assistants. Data were analysed using chi square and Analysis of Variance. Results Generational differences were found between the Grandmothers, Mothers and Daughters in: number of births, maternal age at first birth, location and type of birth attendant, medication during labour and birth, father presence at birth, social support following birth, feeding and weaning of infant, and preventive infant health care. Changes were not found in the proximity to the mother of the infant during sleep. Conclusions The age of first birth has risen for Emirati women and the birth rate may have dropped. Health care has also significantly improved. These results are discussed in relation to government initiatives and physical and social change within the UAE and the Middle East. [ABSTRACT FROM AUTHOR]