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Background: Children with inflammatory bowel disease (IBD) experience extraintestinal side effects including altered body composition, impaired muscle strength, and aerobic capacity. Exercise training may remedy these issues. Purpose: To assess the feasibility, safety, participant satisfaction, and efficacy of a training program for youth with IBD. Methods: Children with IBD completed 16 weeks of training (2 supervised + 1 home sessions per week). Feasibility was assessed by tracking recruitment, adherence, and compliance rates. Safety was assessed by tracking symptoms and adverse events. Posttraining interviews gauged satisfaction. Circulating inflammatory markers, body composition, muscle strength, aerobic fitness, and habitual physical activity were measured at baseline, midtraining (8 wk), and posttraining. Results: Eleven youth were recruited and 10 completed the study. Participants adhered to 28 (1) of 32 prescribed supervised sessions and 8 (4) of 16 prescribed home sessions. There were no adverse events, and overall feedback on training was positive. Posttraining, we observed an increase in lean mass (+2.4 [1.1] kg), bone density (+0.0124 [0.015] g·cm−2), aerobic fitness (+2.8 [5.7] mL·kg LM−1· min−1), and vigorous physical activity levels (+13.09 [8.95] min·h−1) but no change in inflammation or muscle strength. Conclusion: Supervised exercise training is feasible, safe, and effective for youth with IBD and should be encouraged. [ABSTRACT FROM AUTHOR]

Machiavellianism is an antisocial interpersonal style involving the use of manipulative, deceptive, and coercive behaviors in the pursuit of self-interest. Although widely studied as a "dark" personality trait in adults, relatively little is known about the developmental correlates of Machiavellian tendencies earlier in life. The present study addressed this knowledge gap by examining associations between Machiavellian behavior and three theoretically relevant social–emotional domains—prosocial emotions, emotion recognition skills, and self-control—in a community sample of 7- and 11-year-old Canadian children (N = 300, 50% female). Of particular interest was the extent to which individual differences in social–emotional capacities were uniquely associated with Machiavellian behavior after controlling for aggression, a relatively well-studied antisocial behavior in childhood. Parents reported on children's Machiavellian behavior and aggression. Social–emotional correlates were assessed via parent and child reports, behavioral tasks, and physiological assessments. Machiavellian behavior and aggression were similarly associated with lower parent-reported prosocial emotions and self-control. Machiavellian (but not aggressive) behavior was associated with lower child-reported guilt (a prosocial emotion), higher resting skin conductance levels (reflecting a general tendency for higher arousal), and better anger recognition. Semipartial correlational analyses indicated that these patterns of association with Machiavellian behaviors held independent of aggression. These findings indicate that, by middle childhood, Machiavellian behavior constitutes a distinct form of antisocial conduct that is associated with a unique social–emotional risk profile. Public Significance Statement: By middle childhood, Machiavellian behaviors such as manipulation, deception, and coercion are distinct from aggression in terms of their occurrence and associations with other domains of social–emotional functioning (e.g., prosocial emotions, emotion recognition ability, self-control). This suggests that traditional prevention and intervention programs targeting aggressive and violent tendencies may be less effective at curbing more subtle and self-serving forms of antisocial conduct. [ABSTRACT FROM AUTHOR]

Preschool programs for socially vulnerable children are believed to affect school readiness and language development but infrequently include follow-up to adolescence; observational measurement of receptive vocabulary is rare. The purpose of this longitudinal cohort study (55 children and 41 parents) was to report the trajectory of receptive vocabulary development for socially vulnerable children of diverse ethnicities (Indigenous, other Canadian-born, and Immigrant) who participated in a two-generation preschool program. English receptive vocabulary scores were measured at 5-time points: (a) program intake, (b) program exit, (c) age 7 years, (d) age 10 years, and (e) adolescence, using the Peabody Picture Vocabulary Test – Third Edition (PPVT-III). For all children, PPVT-III scores increased the most between program intake and exit and positive changes were sustained until adolescence. When the sample was examined by gender, PPVT-III scores were higher for boys than girls at all time points. When the sample was examined by ethnicity, other Canadian-born children scored higher than Indigenous and Immigrant children at all time points. Immigrant children scored lowest until age 7 years, and at age 10 years and adolescence scored higher than Indigenous children. Using mixed-effects modeling, PPVT-III scores increased when English was the primary language spoken at home at intake. PPVT-III scores increased slightly as caregiver age and caregiver Adverse Childhood Experiences score increased. PPVT-III scores were lower for Immigrant girls and Indigenous boys than other sub-groups of children. Differential effects of the two-generation preschool program by gender and ethnicity suggest tailoring programming to increase equitability of receptive vocabulary development for immigrant girls and Indigenous boys. Children with intergenerational adversity may require additional support. [ABSTRACT FROM AUTHOR]

Objective: To describe shoulder-related injury rates (IRs), types, severity, mechanisms, and risk factors in youth ice hockey players during games and practices. Design: Secondary analysis of data from a 5-year prospective cohort study, Safe-to-Play (2013-2018). Setting: Canadian youth ice hockey. Participants: Overall, 6584 player-seasons (representing 4417 individual players) participated. During this period, 118 shoulder-related games and 12 practice injuries were reported. Assessment of Risk Factors: An exploratory multivariable mixed-effects Poisson regression model examined the risk factors of body checking policy, weight, biological sex, history of injury in the past 12 months, and level of play. Main Outcome Measures: Injury surveillance data were collected from 2013 to 2018. Injury rates with 95% confidence interval (CI) were estimated using Poisson regression. Results: The shoulder IR was 0.35 injuries/1000 game-hours (95% CI, 0.24-0.49). Two-thirds of game injuries (n = 80, 70%) resulted in.8 days of time-loss, and more than one-third (n = 44, 39%) resulted in >8 days of time-loss. An 83% lower rate of shoulder injury was associated with policy prohibiting body checking compared with leagues allowing body checking (incidence rate ratio [IRR], 0.17; 95% CI, 0.09-0.33). A higher shoulder IR was observed for those who reported any injury in the last 12-months compared with those with no history (IRR, 2.00; 95% CI, 1.33-3.01). Conclusions: Most shoulder injuries resulted in more than 1 week of time-loss. Risk factors for shoulder injury included participation in a body-checking league and recent history of injury. Further study of prevention strategies specific to the shoulder may merit further consideration in ice hockey. [ABSTRACT FROM AUTHOR]

This study investigates associations between initial levels and change in the quality of the relationships youth with intellectual disabilities (ID) share with their parents and teachers, and changes in their levels of depression over time. A sample of 395 youth with mild (48.3%) and moderate (51.7%) ID, aged between 11 and 22 (M = 15.69), were recruited in Canada (n = 142) and Australia (n = 253). Youth completed self-report measures of relationship quality and depression twice over a one-year period. Initial levels of warmth (β = −.109) and conflict (β = −.302) predicted decreases in depression. Increases in warmth predicted decreases in depression (β = −.179), while increases in conflict predicted increases in depression (β =.268). Discrepancies between youth relationships with their parents and teachers predicted decreases in depression (βwarmth = −.732; βconflict = −.608). [ABSTRACT FROM AUTHOR]

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Innovative therapeutic approaches are needed to alleviate the burden of life-limiting, rare, and chronic conditions affecting children, adolescents, and young adults (CAYA). This includes a need for improved access to both clinical research and to non-approved or off-label therapies, together with, ultimately, more therapies achieving regulatory approval in Canada. The single patient study (SPS), also known as an open label individual patient (OLIP) study, was introduced by Health Canada to open access to non-marketed drugs where a clinical trial is not readily available, but the drug is considered too investigational to be managed on a standard Special Access Program. SPS is designed for patients who have a serious or life-threatening condition and have exhausted available treatment options. Our report summarizes this relatively new development in the Canadian regulatory environment and highlights the opportunities and challenges as identified by regulators, pharmaceutical representatives, academic researchers, and patient/parent advocates. [ABSTRACT FROM AUTHOR]

While paediatric care providers are often the first point of contact for children or youth experiencing mental health challenges, they may lack the resources (e.g. access to a multidisciplinary team) or training to adequately identify or manage such problems. This joint statement describes the key roles and competencies required to assess and address child and youth mental health problems, and the factors that optimize outcomes in this age group. Evidence-informed guidance on screening for and discussing mental health concerns with young people and families is provided. Preventive and therapeutic interventions with demonstrated efficacy in community care settings are discussed. This foundational statement also focuses on the changes to medical education, health systems, and health policy that are needed to improve clinical practice and advocacy efforts in Canada, including appropriate remuneration models, stepped-care approaches, targeted government funding, and professional training and education. [ABSTRACT FROM AUTHOR]

This study analyzes the previous literature on the online safety of children and youth under "the 4Cs risk framework" concerning contact, content, conduct, and contract risks. It then conducts a comparative study of Australia, Canada, and the UK, comparing their institutions, governance, and government-led programs. Relevant research in Childhood Education Studies is insufficient both in quantity and quality. To minimize the four major online risks for children and youth in cyberspace, it is necessary to maintain a regulatory approach to the online exposure of children under the age of 13. Moreover, the global society should respond together to these online risks with "multi-level" policymaking under a "multi-stakeholder approach". At the international level, multilateral discussion within the OECD and under UN subsidiaries should continue to lead international cooperation. At the domestic level, a special agency in charge of online safety for children and youth should be established in each country, encompassing all relevant stakeholders, including educators and digital firms. At the school and family levels, both parents and teachers need to work together in facilitating digital literacy education, providing proper guidelines for the online activities of children and youth, and helping them to become more satisfied and productive users in the digital era. [ABSTRACT FROM AUTHOR]

For children and youth, the COVID-19 pandemic surfaced at a critical time in their development. Children have experienced extended disruptions to routines including in-person schooling, physical activities, and social interactions—things that bring meaning and structure to their daily lives. We estimated the prevalence of anxiety and depression symptoms of children and youth and their experiences of health-related quality of life (HRQoL), during the first year of the pandemic, and identified factors related to these outcomes. Further, we examined these effects among ethnocultural minority families. We conducted an online survey (March–July 2021) with 510 children and youth aged 8–18 years and their parents/caregivers. The sample was representative of the targeted population. We modelled the relationship between anxiety, depression (measured using the Revised Child Anxiety and Depression Scale), HRQoL (measured using KIDSCREEN-10), and sociodemographic, behavioural, and COVID-19-contributing factors using binary logistic regression. A priori-selected moderating effects of sociodemographic characteristics and self-identified ethnocultural minority groups on the outcomes were tested. The point-in-time prevalence of medium-to-high anxiety symptoms and depression symptoms was 10.19% and 9.26%, respectively. Almost half (49.15%) reported low-to-moderate HRQoL. Children reporting medium-to-high anxiety symptoms, depression symptoms, and low-to-moderate HRQoL were more likely to be aged 8–11 years, 16–18 years, ethnocultural minority participants, living in rural/urban areas, having good/fair MH before COVID-19, experiencing household conflicts, having less physical activity, and having ≥3 h of recreational screen time. Those who had more people living at home and ≥8 h of sleep reported low anxiety and depression symptoms. Ethnocultural minority 16–18-year-olds were more likely to report low-to-moderate HRQoL, compared to 12–15-year-olds. Additionally, 8–11-year-olds, 16–18-year-olds with immigrant parents, and 16–18-year-olds with Canadian-born parents were more likely to report low–moderate HRQoL, compared to 12–15-year-olds. Children and youth MH and HRQoL were impacted during the pandemic. Adverse MH outcomes were evident among ethnocultural minority families. Our results reveal the need to prioritize children's MH and to build equity-driven, targeted interventions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the associations of passive (ie, television) and active (ie, electronic games, computer use) screen time (ST) with perceived school performance of adolescents across gender. METHODS: Data were from the 2014 Health Behaviour in School-aged Children survey conducted across 38 European countries and Canada. Perceived school performance was assessed using an item and dichotomized as high (good/very good) versus the remainder (average/below-average as reference). Participants reported hours per day of time spent watching television, playing electronic games, and using a computer in their free time. Multilevel logistic regression was used to estimate the associations. RESULTS: A total of 197,439 adolescents (average age 13.6 [standard deviation 1.63] years; 51% girls) were analyzed. Multivariable modeling showed that engaging in >2 h/d of ST was progressively and adversely associated with high performance in both boys and girls. Adolescents reporting >4 h/d of television time (≤1 h/d as reference) had 32% lower odds in boys (odds ratio [OR] 0.68; 95% confidence interval [CI]: 0.65-0.71) and 39% lower odds in girls (OR 0.61; 95% CI, 0.58-0.65) of reporting high performance. Playing electronic games for >4 h/d was associated with high performance with odds being 38% lower in boys (OR 0.62; 95% CI, 0.59-0.66) and 45% lower in girls (OR 0.55; 95% CI, 0.52-0.57). Sex differences in the estimates were mixed. CONCLUSIONS: High screen use, whether active or passive, was adversely associated with perceived high school performance, with association estimates being slightly stronger in girls than boys, and for mentally active than passive screen use. Discouraging high levels of screen use of any type could be beneficial to school performance. [ABSTRACT FROM AUTHOR]

Background: Del Nido cardioplegia (DNc) was designed for superior myocardial protection during cardiopulmonary bypass (CPB). We conducted a retrospective review to explore if DNc was associated with increase in systemic ventricle dysfunction (sVD) following pediatric CPB. Methods and Results: This single-center, retrospective study included 1534 patients undergoing CPB between 2013 and 2016, 997 prior to center-wide conversion to DNc and 537 following. The primary outcome was new postoperative ≥moderate sVD by echocardiogram. Secondary outcomes included sVD of any severity and right ventricular dysfunction. Data was evaluated by interrupted time-series analysis. Groups had similar cardiac diagnoses and surgical complexity. Del Nido cardioplegia was associated with longer median (IQR) CPB [117 (84–158) vs 108 (81–154), p = 0.04], and aortic cross-clamp [83 (55–119) vs 76 (53–106), p = 0.03], and fewer cardioplegia doses [2 (1–2) vs 3 (2–4), p < 0.0001]. Mortality was similar in both groups. Frequency of sVD was unchanged following DNc, including predetermine subgroups (neonates, infants, and prolonged cross-clamp). Logistic regression showed a significant rise in right ventricular dysfunction (OR 5.886 [95% CI: 0.588, 11.185], p = 0.03) but similar slope. Conclusions: Use of DNc was not associated with increased in reported sVD, and provided similar myocardical protection to the systemic ventricle compared to conventional cardioplegia but may possibly impact right ventricular function. Studies evaluating quantitative systolic and diastolic function are needed. [ABSTRACT FROM AUTHOR]

Acquired Brain Injury (ABI) is the leading cause of death and disability in children, yet educators report a lack of knowledge about ABI and supporting students with ABI. With no formal learning about ABI, education professionals may turn to the internet for information. To find online resources about supporting students with ABI, in any format, available freely and publicly, aimed toward elementary educators and that could be applied in a Canadian context. We performed an environmental scan using keyword Google searches, key websites, and expert recommendations. The search was performed twice: 2018 and 2021. 96 resources were included after screening. The resources were published by organizations in the United States (n = 57), Canada (n = 19), United Kingdom (n = 16), Australia (n = 3) and New Zealand (n = 1). Traumatic brain injury and concussion were the most commonly addressed type of ABI, and Short Fact/Information sheets were the most common resource format. Between 2018 and 2021, 13 previously included resource links were no longer accessible. This scan suggests that there are many online resources available to educators in a variety of formats, and that information online can be transient. Future studies should evaluate the accuracy and quality of the resources available. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth. Methods: Fifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels. Results: Twenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains. Conclusion: There is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth. [ABSTRACT FROM AUTHOR]

Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of anxiety disorders. Both statements offer evidence-informed guidance to support paediatric health care providers (HCPs) making decisions around the care of children and adolescents with these conditions. The objectives of Part 1, which focuses on assessment and diagnosis, are to: (1) review the epidemiology and clinical characteristics of anxiety disorders and (2) describe a process for assessment of anxiety disorders. Specific topics are reviewed, including prevalence, differential diagnosis, co-occurring conditions, and the process of assessment. Approaches are offered for standardized screening, history-taking, and observation. Associated features and indicators that distinguish anxiety disorders from developmentally appropriate fears, worries, and anxious feelings are considered. Note that when the word 'parent' (singular or plural) is used, it includes any primary caregiver and every configuration of family. [ABSTRACT FROM AUTHOR]

Aims To quantify thoracic lymphatic burden in paediatric Fontan patients using MRI and correlate with clinical status. Methods and results Paediatric Fontan patients (<18-years-old) with clinical cardiac MRI that had routine lymphatic 3D T2 fast spin echo (FSE) imaging performed from May 2017 to October 2019 were included. 'Lymphatic burden' was quantified by thresholding-based segmentation of the 3D T2 FSE maximum intensity projection image and indexed to body surface area, performed by two independent readers blinded to patient status. There were 48 patients (27 males) with median age at MRI of 12.9 (9.4–14.7) years, time from Fontan surgery to MRI of 9.1 (5.9–10.4) years, and follow-up time post-Fontan surgery of 9.4 (6.6–11.0) years. Intraclass correlation coefficient between two observers for lymphatic burden was 0.96 (0.94–0.98). Greater lymphatic burden correlated with post-Fontan operation hospital length of stay and duration of chest tube drainage (r s = 0.416, P = 0.004 and r s = 0.439, P = 0.002). Median lymphatic burden was greater in patients with chylous effusions immediately post-Fontan (178 (118–393) vs. 113 (46–190) mL/m2, P = 0.028), and in patients with composite adverse Fontan status (n = 13) defined by heart failure (n = 3), transplant assessment (n = 2), recurrent effusions (n = 6), Fontan thrombus (n = 2), and/or PLE (n = 6) post-Fontan (435 (137–822) vs. 114 (51–178) mL/m2, P = 0.003). Lymphatic burden > 600 mL/m2 was associated with late adverse Fontan status with sensitivity of 57% and specificity of 95%. Conclusion Quantification of MR lymphatic burden is a reliable tool to assess the lymphatics post-Fontan and is associated with clinical status. [ABSTRACT FROM AUTHOR]

Background: Children with chronic kidney disease (CKD) generally have worse educational and psychosocial outcomes compared with their healthy peers. This can impair their ability to manage their treatment, which in turn can have long-term health consequences through to adulthood. We attempted to capture the experiences of children with CKD and to describe the perspectives of their parents and caregivers on access to educational and psychosocial support. Methods: Children with CKD (n = 34) and their caregivers (n = 62) were sampled via focus groups from pediatric hospitals in Australia, Canada, and the USA. Sixteen focus groups were convened and the transcripts were analyzed thematically. Results: We identified four themes: disruption to self-esteem and identity (emotional turmoil of adolescence, wrestling with the sick self, powerlessness to alleviate child's suffering, balancing normality and protection); disadvantaged by lack of empathy and acceptance (alienated by ignorance, bearing the burden alone); a hidden and inaccessible support system (excluded from formal psychological support, falling behind due to being denied special considerations); and building resilience (finding partners in the journey, moving towards acceptance of the illness, re-establishing childhood). Conclusions: Children with CKD and their caregivers encountered many barriers in accessing psychosocial and educational support and felt extremely disempowered and isolated as a consequence. Improved availability and access to psychosocial and educational interventions are needed to improve the wellbeing and educational advancement of children with CKD. A higher resolution version of the Graphical abstract is available as Supplementary information. [ABSTRACT FROM AUTHOR]

The article discusses a cross-sectional study conducted in Ontario which found a 139 percent increase in pediatric eating disorder hospitalizations from 2002 to 2019.

OBJECTIVES: To determine the association between early screen time (7-10 days postinjury) and postconcussion symptom severity in children and adolescents with concussion, as compared to those with orthopedic injury (OI). METHODS: This was a planned secondary analysis of a prospective longitudinal cohort study. Participants were 633 children and adolescents with acute concussion and 334 with OI aged 8 to 16, recruited from 5 Canadian pediatric emergency departments. Postconcussion symptoms were measured using the Health and Behavior Inventory at 7 to 10 days, weekly for 3 months, and biweekly from 3 to 6 months postinjury. Screen time was measured by using the Healthy Lifestyle Behavior Questionnaire. Generalized least squares models were fit for 4 Health and Behavior Inventory outcomes (self- and parent-reported cognitive and somatic symptoms), with predictors including screen time, covariates associated with concussion recovery, and 2 3-way interactions (self- and parent-reported screen time with group and time postinjury). RESULTS: Screen time was a significant but nonlinear moderator of group differences in postconcussion symptom severity for parent-reported somatic (P = .01) and self-reported cognitive symptoms (P = .03). Low and high screen time were both associated with relatively more severe symptoms in the concussion group compared to the OI group during the first 30 days postinjury but not after 30 days. Other risk factors and health behaviors had stronger associations with symptom severity than screen time. CONCLUSIONS: The association of early screen time with postconcussion symptoms is not linear. Recommending moderation in screen time may be the best approach to clinical management. [ABSTRACT FROM AUTHOR]

Background: Appropriate and timely consideration of ethical, legal, organizational, and social issues in universal preventive programs for eating disorders (UPPED) are relevant for the approval, funding and implementation of health‐policy decision making. Objective: To identify and analyse the ethical, legal, organizational, and social aspects involved in interventions aimed at the universal prevention of eating disorders (ED) in children, pre‐adolescents and adolescents in the school settings. Method: A scoping review of the literature was carried out. MEDLINE, EMBASE, CENTRAL, PsycINFO, and Social Science Citation Index were searched for studies published in English or Spanish. The quality of the studies was assessed using specific scales for each study design. Results: Fourteen studies were included: one scoping review; four narrative reviews, six observational studies, two qualitative studies, and one mixed methods study. Results were narratively synthesised according to: (1) equity; (2) gender perspective; (3) potential harm; (4) participants and facilitators profile; (5) feasibility; and (6) acceptability. Conclusions: Interactive programs with relevant contents for participants have greater acceptability. Programs focussed on developing competencies can reduce the risk of potential harm. Incorporating a gender perspective contributes to improving equity. Teachers with prior training in ED are well suited as facilitators of these programs. Key points: EDs can lead to health problems such as increased mental morbidity, heart and kidney disease, and increased mortality. In addition, the economic impact of EDs is highUniversal preventive programs for ED are of particular interest, since they constitute an efficient approach for early preventionThe consideration of ethical, legal, organisational and social issues in universal preventive programmes for eating disorders are relevant to the approval, funding and implementation of health policy decisionsTeachers with prior training in ED are well suited as facilitators of these programsA research need arising from the study is to assess whether population‐focussed or universal programmes work better and whether there is any ethical, legal, organisational and social impact [ABSTRACT FROM AUTHOR]

This single‐arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2‐day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self‐efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12‐month post‐workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self‐efficacy (B = −0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans‐diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment. [ABSTRACT FROM AUTHOR]

Background: The Canadian 24-Hour Movement Guidelines for Children and Youth (“Guidelines”) not only pioneered the notion of an integrated movement continuum from sleep to vigorous-intensity physical activity but also introduced a new branded Guideline visual identity. Objectives: This study evaluated youths’ (N = 46) attention to and thoughts about the Guidelines and the brand. Design: A cross-sectional between-participants randomized intervention design was used. Sample: Canadian youth between 10 and 17 years of age comprised the study sample. Interventions: Participants were randomly assigned to view either branded Guidelines (n = 26) or unbranded Guidelines (n = 20). Youths’ eye-movements (e.g., dwell time, fixation count) were recorded during Guideline viewing. Participants completed a follow-up survey assessing brand perceptions and Guideline cognitions. Results: The branded Guidelines neither drew greater overall attention nor led to more positive brand perceptions or Guideline cognitions compared to the unbranded Guidelines. Conclusions: Exploratory analyses provide valuable, yet preliminary insight into how branding and Guideline content may shape how Guidelines are perceived and acted upon. These findings inform an agenda for future health education resources. [ABSTRACT FROM AUTHOR]

It has long been established that bullying has many negative impacts on the mental health of adolescents. Young people who are victimized by bullying may cope by drawing on available assets to protect themselves from harm. One such asset with ancient roots but with the potential for contemporary application is the concept of spiritual health—the idea that the connections in our lives (whether to ourselves, others, nature, or something transcendent) affect our well-being. In this study, we examined 12,593 Canadians aged 11–15 years to determine the effects of being victimized by bullying on their mental health, as measured by frequent subjective health complaints. We then explored whether strong spiritual health connections were effect modifiers that buffer such negative pathways, thereby acting as protective health assets. Data were obtained from the 2017/18 Canadian Health Behaviour in School-aged Children study. Generalized linear regression models were used to estimate associations and evaluate effect modification in different age and gender groups. Approximately 21% of participants reported being victimized by bullying. Strength of "connections to self" (i.e., a sense of meaning/purpose or joy and happiness in one's life) was found to act as an effect modifier, but in girls alone. Contrary to expectations of a buffering effect, the strongest associations between victimization and frequent health complaints were identified for girls with high connections to self. Relative risks for poor mental health among these highly self-connected girls were 1.63 [95% CI: 1.26–2.12] and 1.25 [1.06–1.47] for younger and older girls, respectively. We interpreted this unexpected finding in light of cognitive theories of trauma, which suggest that adverse events may lead to worse health outcomes among those who place particular value on their world being meaningful, controllable or benevolent. Implications for clinical intervention and health promotion are considered. [ABSTRACT FROM AUTHOR]

There are currently no universal evidence-based nutrition guidelines that address the gluten-free (GF) diet for children/youth (4–18 years). A GF food guide was created to help children/youth with coeliac disease (CD) and their families navigate the complexities of following a GF diet. Guide formation was based on pre-guide stakeholder consultations and an evaluation of nutrient intake and dietary patterns. The study objective was to conduct an evaluation on guide content, layout, feasibility and dissemination strategies from end-stakeholder users (children/youth with CD, parents/caregivers and health care professionals). This is a cross-sectional study using a multi-method approach of virtual focus groups and an online survey to conduct stakeholder evaluations. Stakeholders included children/youth (4–18 years), their parents/caregivers in the coeliac community (n 273) and health care professionals (n 80) with both paediatric and CD experience from across Canada. Thematic analysis was performed on focus group responses and open-ended survey questions until thematic saturation was achieved. χ2 and Fisher's exact statistical analyses were performed on demographic and close-ended survey questions. Stakeholders positively perceived the guide for content, layout, feasibility, ethnicity and usability. Stakeholders found the material visually appealing and engaging with belief that it could effectively be used in multi-ethnic community and clinical-based settings. Guide revisions were made in response to stakeholder consultations to improve food selection (e.g. child-friendly foods), language (e.g. clarity) and layout (e.g. organisation). The evaluation by end-stakeholders provided practical and patient-focused feedback on the guide to enable successful uptake in community and clinical-based settings. [ABSTRACT FROM AUTHOR]

In children, the mechanisms implicated in deterioration of glucose homeostasis versus reversion to normal glucose tolerance (NGT) remain uncertain. We aimed to describe the natural history of dysglycemia from childhood to late adolescence and to identify its early determinants. We used baseline (8–10 years, n = 630), 1st follow‐up (10–12 years, n = 564) and 2nd follow‐up (15–17 years, n = 377) data from the QUALITY cohort of White Canadian children with parental obesity. Children underwent a 2‐h oral glucose tolerance test at each cycle with plasma glucose and insulin measured at 0/30/60/90/120 min. American Diabetes Association criteria defined dysglycemia (impaired fasting glucose, impaired glucose tolerance or type 2 diabetes). Longitudinal patterns of insulin sensitivity and beta‐cell function were estimated using generalized additive mixed models. Model averaging identified biological, sociodemographic and lifestyle‐related determinants of dysglycemia. Of the children NGT at baseline, 66 (21%) developed dysglycemia without reverting to NGT. Among children with dysglycemia at baseline, 24 (73%) reverted to NGT. In children with dysglycemia at 1st follow‐up, 18 (53%) later reverted to NGT. Among biological, sociodemographic and lifestyle determinants at 8–10 years, only fasting and 2‐h glucose were associated with developing dysglycemia (odds ratio [95% CI] per 1 mmol/L increase: 4.50 [1.06; 19.02] and 1.74 [1.11; 2.73], respectively). Beta‐cell function decreased by 40% in children with overweight or obesity. In conclusion, up to 75% of children with dysglycemia reverted to NGT during puberty. Children with higher fasting and 2‐h glucose were at higher risk for progression to dysglycemia, while no demographic/lifestyle determinants were identified. [ABSTRACT FROM AUTHOR]

Purpose: The Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study is quantifying the association between cumulative radiation exposure from fetal and/or childhood medical imaging and subsequent cancer risk. This manuscript describes the study cohorts and research methods. Methods: The RIC Study is a longitudinal study of children in two retrospective cohorts from 6 U.S. healthcare systems and from Ontario, Canada over the period 1995–2017. The fetal-exposure cohort includes children whose mothers were enrolled in the healthcare system during their entire pregnancy and followed to age 20. The childhood-exposure cohort includes children born into the system and followed while continuously enrolled. Imaging utilization was determined using administrative data. Computed tomography (CT) parameters were collected to estimate individualized patient organ dosimetry. Organ dose libraries for average exposures were constructed for radiography, fluoroscopy, and angiography, while diagnostic radiopharmaceutical biokinetic models were applied to estimate organ doses received in nuclear medicine procedures. Cancers were ascertained from local and state/provincial cancer registry linkages. Results: The fetal-exposure cohort includes 3,474,000 children among whom 6,606 cancers (2394 leukemias) were diagnosed over 37,659,582 person-years; 0.5% had in utero exposure to CT, 4.0% radiography, 0.5% fluoroscopy, 0.04% angiography, 0.2% nuclear medicine. The childhood-exposure cohort includes 3,724,632 children in whom 6,358 cancers (2,372 leukemias) were diagnosed over 36,190,027 person-years; 5.9% were exposed to CT, 61.1% radiography, 6.0% fluoroscopy, 0.4% angiography, 1.5% nuclear medicine. Conclusion: The RIC Study is poised to be the largest study addressing risk of childhood and adolescent cancer associated with ionizing radiation from medical imaging, estimated with individualized patient organ dosimetry. [ABSTRACT FROM AUTHOR]

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Background We assess the impact of the 2017 American Academy of Pediatrics (AAP) guidelines on the prevalence of high blood pressure (BP) in generally healthy Canadian children and identify risk factors associated with high BP (elevated, stage 1, or stage 2 at a single visit). Methods A cohort of 7,387 children aged 6 to 18 years in the Canadian Health Measures Survey (CHMS, 2007 to 2015) had BPTru oscillometry with centiles and stages assigned using both the 2017 AAP guidelines and the 2004 Fourth Report from the National Institute of Health/National Heart Lung and Blood Institute (NIH/NHLBI). Results Although both shifted upwards significantly, mean population systolic BP and diastolic BP percentiles are now 24.2 (95% confidence interval: 23.3 to 25.2) and 46.4 (45.3 to 47.6). As a result, the population prevalence of high BP increased from 4.5% (3.9 to 5.2, NIH/NHLBI) to 5.8% (5.0 to 6.6, AAP), less than in US children measured by auscultation (14.2%, 13.4 to 15.0). Children with high BP were more likely to be overweight/obese, to be exposed to prenatal/household smoking, and to have hypertriglyceridemia, without differences in dietary salt, infant breastfeeding, neonatal hospitalizations, or exercise frequency. Conclusion The 2017 AAP guidelines increase the prevalence of high BP in Canadian children; Canadian prevalence appears lower than in the USA. This may reflect differences in measurement methods or in the prevalence of childhood overweight/obesity between countries, that is, 31.1% (28.9 to 33.3) versus 40.6% (39.5 to 42.0), respectively. Those with high BP were more likely to have other cardiac risk factors, including overweight/obesity, prenatal/household smoking exposure, and hypertriglyceridemia. [ABSTRACT FROM AUTHOR]

We analyse the effects of constructions and mobilisations of childhood, generation and girl heroism in 30 Canadian editorials written in response to 2019 climate change protests. We discuss how the editorials strategically position—and sometimes dismiss—young activists through discourses of childhood innocence, becoming and social participation. Second, we focus on how the editorials mobilise generation to emphasise either generational division or cross‐generational solidarity. Finally, we problematise the editorials' concentration on individualised girl heroism. We thus contextualise and deconstruct truth statements around age, generation and heroism, emphasising instead their effects and the potential for certain narratives to better recognise the diversity and solidarity in climate change activism. [ABSTRACT FROM AUTHOR]

COVID-19 restrictions have necessitated child/youth mental health providers to shift towards virtually delivering services to patients' homes rather than hospitals and community mental health clinics. There is scant guidance available for clinicians on how to address unique considerations for the virtual mental healthcare of children and youth as clinicians rapidly shift their practices away from in-person care in the context of the COVID-19 pandemic. Therefore, we bridge this gap by discussing a six-pillar framework developed at Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada, for delivering direct to patient virtual mental healthcare to children, youth and their families. We also offer a discussion of the advantages, disadvantages, and future implications of such services. [ABSTRACT FROM AUTHOR]

Background: Despite its controversial nature, the use of recreational marijuana and cannabis-derived products continue to increase in popularity. Cannabis consumption is currently legal in certain American states as well as Canada, and it is also frequently used by Canadian youth. However, cannabis use during childhood and adolescence can contribute to significant harm. Materials andMethods: A review of current literature regarding the impacts of cannabis consumption among Canadian youth was conducted. Medline, Cochrane, Embase and PubMed databases were utilized to identify journal articles published within 10 years that highlighted the impacts of cannabis consumption in its different forms among the North American pediatric population. Results: Our review identified harms include structural and functional impairments in the developing brain, the development of mental health conditions such as depression and anxiety, impaired road safety while driving under the influence of cannabis, and the significant consequences of accidental ingestion of cannabis products by children. We also ascertained that cannabis cessation strategies that employed an affective model, which explores the root causes of adolescents turning to cannabis, are most effective in reducing substance use among adolescents. Conclusions: In light of the recent legalization of cannabis in Canada, the purpose of this article was to provide background on cannabis consumption and its legalization in Canada, the impacts of cannabis on Canadian youth, and evidence-based strategies to help mitigate them. [ABSTRACT FROM AUTHOR]

Background Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers' a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids. Methods A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were 'unsure'; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were 'unsure'. Caregivers' primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department ; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use. Conclusions Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers' fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To estimate associations between kindergarten readiness and academic, psychological, and health risks by end of high school. METHODS: This study is based on 966 Canadian children. At age 5, trained examiners assessed child number knowledge and receptive vocabulary. Teachers reported kindergarten classroom engagement. At age 17, participants reported academic grades, school connectedness, anxiety sensitivity, substance abuse, physical activity involvement, and height and weight. High school dropout risk was also estimated for each participant on the basis of grades, school engagement, and grade retention. RESULTS: Kindergarten math skills contributed to better end-of high school grades (β = .17, P < .01) and lower dropout risk (β = 2.20, P < .001), whereas receptive vocabulary predicted lower anxiety sensitivity (β = 2.11, P < .01). Kindergarten classroom engagement predicted higher end of high school grades (β = .17, P < .001), lower dropout risk (β = 2.20, P < .01), better school connectedness (β = .15, P < .01), lower risk of substance abuse (β = 2.21, P < .001), and more physical activity involvement (β = .09, P < .05). Kindergarten classroom engagement was also associated with a 65% reduction (odds ratio = 0.35) in the odds of being overweight at age of 17. Analyses were adjusted for key child (sex, weight per gestational age, nonverbal IQ, and internalizing and externalizing behaviors) and family (parental involvement, maternal depression and immigrant status, family configuration, and socioeconomic status) characteristics. CONCLUSIONS: Early childhood readiness forecasts a protective edge by emerging adulthood. With these findings, we build links between education and health indicators, suggesting that children who start school prepared gain a lifestyle advantage. Promoting kindergarten readiness could reduce the health burden generated by high school dropout. [ABSTRACT FROM AUTHOR]

Objective: The primary objective is to evaluate the feasibility (safety and acceptability) of implementing early active rehabilitation (AR) for concussion management in youth with symptoms persisting 2 weeks after injury. A secondary and exploratory objective was to estimate the potential efficacy of early AR compared with standard AR. We hypothesize that AR at 2-weeks postconcussion will be safe and acceptable to patients. Design: Randomized clinical trial. Setting: The Montreal Children's Hospital of the McGill University Health Center (MCH-MUHC), a tertiary care pediatric teaching hospital affiliated with McGill University in Montreal, Canada. Participants: Twenty youth aged 9 to 17 years old with postconcussion symptoms for at least 2 weeks. Intervention: Active rehabilitation (aerobic exercise, coordination drills, visualization, and education/reassurance) was administered by physiotherapists in-person, and then continued as a home program. Methods: Twenty participants were randomized to either early AR (initiated 2 weeks after injury) or standard AR (initiated 4 weeks after injury). Results: Two adverse events (one in each group) were identified through an online survey more than one-month postconcussion. Postconcussion symptoms decreased over time for both groups. Conclusions: The results from this pilot study indicate that a full clinical trial estimating the efficacy of early AR (starting 2 weeks after injury) is feasible. Further study is needed to determine the superiority of this strategy over current treatment approaches. [ABSTRACT FROM AUTHOR]

Word reading is a fundamental skill in reading and one of the building blocks of reading comprehension. Theories have posited that for second language (L2) learners, word reading skills are related if the children have sufficient experience in the L2 and are literate in the first language (L1). The L1 and L2 reading, phonological awareness skills, and morphological awareness skills of Syrian refugee children who speak Arabic and English were measured. These children were recent immigrants with limited L2 skills and varying levels of L1 education that was often not commensurate with their ages. Within- and across-language skills were examined in 96 children, ages 6 to 13 years. Results showed that phonological awareness and morphological awareness were strong within-language variables related to reading. Additionally, Arabic phonological awareness and morphological processing were strongly related to English word reading. Commonality analyses for variables within constructs (e.g., phonological awareness, morphological awareness) but across languages (Arabic and English) in relation to English word reading showed that in addition to unique variance contributed by the variables, there was a high degree of overlapping variance. [ABSTRACT FROM AUTHOR]

Background Children with adrenal suppression (AS), a potential side effect of glucocorticoids (GCs) may be asymptomatic, present with nonspecific signs and symptoms or with adrenal crisis. Asymptomatic AS (AAS) can only be diagnosed through screening. Identifying and treating asymptomatic patients before symptoms develop may reduce morbidity. Screening guidelines for AS are lacking. Consequently, screening practices are highly variable. Objective To assess (1) the screening practices for and recognition of paediatric AAS among clinicians in Canada and (2) the educational impact of a 2-year surveillance program of symptomatic AS cases. Methods Before and after a 2-year Canadian Paediatric Surveillance Program (CPSP) study of symptomatic AS, participants were surveyed through the CPSP. The prestudy survey was sent to 2,548 participants in March 2010 and the poststudy survey was sent to 2,465 participants in April 2013. Results Response rates were 32% for the prestudy survey and 21% for the poststudy survey. Between the pre- and poststudy surveys, the percentage of physicians who reported routinely screening patients on GCs for AS increased from 10% to 21% and the percentage who reported having a screening policy in their office/centre increased from 6% to 11%. There was no significant change in the percentage of physicians who had diagnosed a child/youth with AAS in the preceding year. Conclusion Frequency of screening for AAS increased following the 2-year study but remains low. Development of a clinical practice guideline should increase both awareness of asymptomatic AS among Canadian paediatricians and the identification of AAS, before symptoms develop. [ABSTRACT FROM AUTHOR]

Objectives Electronic cigarettes and fluid (e-cigarettes, e-fluid) are hazardous materials that when inhaled or ingested may pose significant health risks to children and adolescents. The objective of this work was to explore the spectrum of injury related to e-cigarette exposure among Canadian children and adolescents. Methods A one-time survey was sent to all paediatricians in Canada. Information was collected on children and adolescents who presented with e-cigarette exposure (inhalation and ingestion cases) in the previous 12 months. Questions included the number of injuries and symptoms, in addition to age, sex, treatment setting, intentional e-cigarette use, and how the products were accessed. Results A total of 520 surveys were completed and returned, identifying 35 cases. Symptoms related to inhalation were present in 30 cases and in 5 ingestion cases (5 unintentional, 0 intentional). For inhalation cases, most were male, ages 15 to 19 years, who sought treatment for nausea/vomiting, cough, throat irritation, or acute nicotine toxicity in an outpatient clinic/office. Most inhalation cases reported e-cigarette use 2 to 3 days/week, and e-cigarettes purchases from a mall kiosk/store. For ingestion cases, most were male, ages 1 to 4 years presenting to an emergency department with nausea/vomiting, cough, or respiratory irritation. Younger cases accessed e-fluid at home, older cases purchased in a mall kiosk/store. E-fluid flavours reported consumed were fruit, candy, and tobacco. Conclusions E-cigarettes, recently introduced into the North American market are hazardous to children and adolescents. Given the low response rate to the survey, further investigation into the true burden of injury, as well as the risks that e-cigarettes pose, together with ways to reduce exposure, is needed. [ABSTRACT FROM AUTHOR]

Background: Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0–17 years) and present, explain, substantiate, and discuss the final Consensus Statement. Methods: The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada's Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan. Results: Evidence from the literature reviews provided substantial support for the importance of family on children's movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in this pursuit. Conclusion: Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders. [ABSTRACT FROM AUTHOR]

Background: Exposure to stressful life events is an established risk factor for the development of adolescent mental disorder. Growing evidence also suggests that neighbourhood social environments, including strong social cohesion, could have a protective effect on mental health. However, little is known about how neighbourhood social cohesion may buffer against the effects of stressful life events on adolescent mental health. Our aim was to assess whether neighbourhood social cohesion modifies the association between stressful life events and adolescent mental health outcomes. Methods: Data were drawn from a nationally-representative prospective sample of Canadian adolescents, including 5183 adolescents aged 12/13 years at T1 and 14/15 years at T2. Caregivers reported neighbourhood social cohesion at T1, and exposure to stressful life events between T1 and T2. Symptoms of mental health and behaviour problems were self-reported by adolescents at T1 and T2. Multivariable logistic regression was used to determine whether the relationship between stressful life events and outcomes was modified by neighbourhood social cohesion. Results: Associations between stressful life events and adolescent outcomes were statistically significantly lower in neighbourhoods with greater social cohesion for: depression/anxiety (high cohesion OR = 0.98 v. low cohesion OR = 3.11), suicidal ideation (ORhigh = 1.30 v. ORlow = 5.25), aggression/conduct disorder (ORhigh = 1.09 v. ORlow = 4.27), and property offence (ORhigh = 1.21 v. ORlow = 4.21). Conclusions: Greater neighbourhood social cohesion appeared to buffer the effects of stressful life events on several domains of adolescent mental health. This potentially presents a target for public health intervention to improve adolescent mental health and behavioural outcomes. [ABSTRACT FROM AUTHOR]

The article discusses a study that aimed to establish Canadian Aerobic Fitness Test (mCAFT) cut-points to identify potential clustered cardiometabolic risk among children aged 9 to 13 years and youth aged 14 to 17 years. Cardiorespiratory fitness was measured using mCAFT for estimating peak oxygen consumption. Results suggest that the mCAFT cut-points can help identify children and youth at risk of poor cardiometabolic health in public health surveillance, clinical and school-based settings.

Antidepressant prescribing for Canadian children is increasing, with fluoxetine, a selective serotonin reuptake inhibitor (SSRI), the most frequently prescribed medication, which was not surprising. However, there is also an increase in prescribing of tricyclic antidepressants (TCAs), which, for a pediatric population, is unexpected. And most often, the TCAs — which are toxic at high doses — are being prescribed for a condition other than depression. According to a study published in the Journal of Child and Adolescent Psychopharmacology, one of the only ones looking at antidepressant prescribing in Canada for children following the 2004 warning of suicidal ideation, which was followed by a decrease in prescribing and a subsequent increase in suicides, antidepressant prescribing is on the increase. [ABSTRACT FROM AUTHOR]

Background Narcolepsy is a sleep disorder with no cure with onset typically during adolescence. Caring for an adolescent with a lifelong medical condition can negatively impact family structure, cohesion, relationships, and overall functioning. The primary objective of this study was to evaluate family functioning in a cohort of adolescents with narcolepsy using the PedsQL Family Impact Module. The secondary objective was to compare family functioning in adolescents with narcolepsy to adolescents with chronic pain based on published data. Methods This was a cross-sectional study of adolescents (aged 10 to 18 years) with narcolepsy. The narcolepsy group was recruited from The Hospital for Sick Children in Toronto, Canada. Family functioning was assessed by the PedsQL family impact module total scores, which was completed by the patient's caregiver. The PedsQL family impact module yields a total scale which encompasses parent health-related quality of life, daily activities, family relationships, communication, and worry subscales. Lower scores suggest poorer family functioning. Secondary data analyses were used to compare participants' family functioning to a cohort of adolescents with chronic pain. Results Thirty adolescents with narcolepsy participated (mean age=13.8 ± 2.2 years, 76.7% male). Family functioning was impaired in this cohort of adolescents with narcolepsy and similar to adolescents with chronic pain (64.0 ± 19.8 versus 64.7 ± 19.5; P=0.849). Conclusion Family functioning is impaired in adolescents with narcolepsy. Clinical teams should assess family functioning at routine clinic visits by asking about concerns and challenges related to caring for an adolescent with narcolepsy and providing resources and support as needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: The objective of this study was to examine individual and concurrent associations between meeting the Canadian 24-Hour Movement Guidelines for Children and Youth (9-11 hours of sleep per night, ≤2 hours of recreational screen time (ST) per day, and at least 60 minutes of moderate to vigorous physical activity per day) and dimensions of impulsivity. METHODS: Data from this cross-sectional observational study were part of the first annual curated release of the Adolescent Brain Cognitive Development Study. Participants included 4524 children between the ages of 8 and 11 years. RESULTS: In analyses, it was shown that adherence to individual movement behavior recommendations as well as combinations of adherence to movement behavior recommendations were associated with each dimension of impulsivity. Meeting all 3 movement behavior recommendations was associated with lower positive urgency (95% confidence interval [CI]: -0.12 to -0.05), negative urgency (95% CI: -0.04 to -0.08), Behavioral Inhibition System (95% CI: -0.08 to -0.01), greater perseverance (95% CI: 0.09 to 0.15), and better scores on delay-discounting (95% CI: 0.57 to 0.94). Meeting the ST and sleep recommendations was associated with less impulsive behaviors on all dimensions of impulsivity: negative urgency (95% CI: -0.20 to -0.10), positive urgency (95% CI: -0.16 to -0.08), perseverance (95% CI: 0.06 to 0.15), Behavioral Inhibition System (95% CI: -0.15 to -0.03), Behavioral Activation System (BAS) reward responsiveness (95% CI: -0.04 to -0.05), BAS drive (95% CI: -0.14 to -0.06), BAS fun-seeking (95% CI: -0.15 to -0.17), and delay-discounting task (95% CI: 0.68 to 0.97). CONCLUSIONS: Findings support efforts to determine if limiting recreational ST while promoting adequate sleep enhances the treatment and prevention of impulsivity-related disorders. [ABSTRACT FROM AUTHOR]

Our aim was to assess the developmental activities that best define elite players in female soccer in one of the top nations for female soccer in the world. In addition to measurement of career practice hours in soccer and other sports, we quantified hours engaged in activities judged high in challenge. Adult National-team (n = 21) and lesser-skilled Varsity (n = 24) female soccer players in Canada provided career estimates of hours in soccer and other sports during childhood and adolescence. Subjective ratings of challenge were provided for each activity across development, providing an indication of practice quality. Both groups engaged in more coach-led soccer activities (practice, competition) than soccer play and spent the majority of their time in childhood in soccer compared to other sports. National players participated in more play that was more challenging and engaged in more moderate to high challenge practice, when compared to Varsity players. The importance of early engagement in soccer specific developmental activities for elite female soccer players in Canada was highlighted, as previously reported in male players. However, hours in soccer play during childhood were low in both groups and were lower than estimates from male players. Although the data do not fit squarely with any one pathway, they are mostly consistent with an early specialization route. • National & Varsity women soccer players competing at the highest levels took part. • Elite groups were distinguished by childhood self-directed play not practice. • Relative to practice hours and to men, hours in play were low (<25% in childhood). • National players engaged in more hours of soccer activities rated challenging. • Like male players, women started young and showed majority engagement in soccer. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Mental illnesses affect >15% of Canadian adolescents. New preventive strategies are critically needed. We examined the associations of meeting established recommendations for diet, physical activity, sleep, and sedentary behavior in childhood with mental illness in adolescence. METHODS: Population-based prospective study (n = 3436) linking 2011 health behavior survey data of 10- to 11-year-olds with administrative health data from 2011 to 2014. Lifestyle behaviors were measured with the Harvard Food Frequency Questionnaire and self- and parental-proxy reports, expressed as meeting recommendations for vegetables and fruit, grain products, milk and alternatives, meat and alternatives, added sugar, saturated fat, sleep, screen time, and physical activity. Mental illness was defined by physician-diagnosed internalizing, externalizing, and other psychiatric conditions. Negative binomial regression was used to determine the independent and cumulative associations of meeting lifestyle recommendations with physician visits for mental illnesses. RESULTS: Of all participants, 12%, 67%, and 21% met 1 to 3, 4 to 6, and 7 to 9 recommendations, respectively, and 15% had a mental illness diagnosis during follow-up. Compared with meeting 1 to 3 recommendations, meeting 7 to 9 recommendations was associated with 56% (95% confidence interval: 38%--69%) fewer physician visits for mental illness during followup. Every additional recommendation met was associated with 15% fewer physician visits for mental illnesses (95% confidence interval: 9%-21%). CONCLUSIONS: Mental illness in adolescence is associated with compliance to lifestyle recommendations in childhood, with stronger associations seen when more recommendations are met. Emphasizing lifestyle recommendations in pediatric practice may reduce the future burden of mental illness. [ABSTRACT FROM AUTHOR]

LINKages, a nonprofit organization, aims to bridge the gap between older and younger generations by building intergenerational programs for youth and older adults. The objective of this project was to explore the influence of the LINKages intergenerational program on: a) older adults’ affect and levels of engagement, and b) youth volunteers’ experiences of engagement and perceptions of older adults. An exploratory case study design was used to address the study objectives. Sixty-five residents from four residential care homes and 87 youth volunteers in the LINKages program participated. Data were collected over 7 months. Statistically significant improvements in students’ perceptions of older adults and their experiences of engagement were found following their participation in the LINKages program. Participation also resulted in positive benefits for residents based on their observed levels of engagement and positive affect. [ABSTRACT FROM AUTHOR]

Purpose: To (1) determine the association between exposure to maternal depressive symptoms in childhood and offspring suicide-related thoughts (SRT) and attempts (SA) in youth and young adults and (2) identify effect measure modifiers (offspring sex, family structure, maternal perceived social support, and social cohesion) of the association in 1.Method: A cohort was constructed by linking all cycles from the National Longitudinal Survey of Children and Youth, a Canadian nationally representative survey, from 1994 to 2009 in 16,903 subjects 0 to 25 years. Exposure to maternal-reported depressive symptoms was measured when offspring were between 0 and 10 years. Offspring self-reported incident and recurrent SRT and SA were measured between 11 and 25 years. Time-to-event models under a counting process framework were used to estimate adjusted hazard ratios (HR) and relative rates (RR) and 95% confidence intervals (CI). Effect measure modifiers were examined across adjusted stratum-specific estimates.Results: In offspring exposed to maternal depressive symptoms, the adjusted rates of incident SRT and SA (HR: 1.67, 95% CI 1.37, 2.08; HR: 1.93, 95% CI 1.43, 2.50) and of recurrent SRT and SA (RR: 1.61, 95% CI 1.33, 1.96; RR: 1.87, 95% CI 1.40, 2.36) were significantly elevated compared to non-exposed offspring. The stratum-specific rates of incident and recurrent SRT and SA were significantly elevated in females but not in males.Conclusions: Girls exposed to maternal depressive symptoms in childhood are a target group for childhood suicide preventive strategies. Family-based preventions, and strategies to identify and effectively treat maternal depressive episodes could be beneficial for suicide prevention in offspring. [ABSTRACT FROM AUTHOR]

The Child and Youth Resilience Measure (CYRM) is one of the most popular measures of resilience. In this paper, we investigate the CYRM using Rasch analysis to explore and improve its psychometric properties, leading to a more robust measure of resilience.Cross-sectional data were obtained from a questionnaire administered to n = 408 individuals in Canada aged 11-19 who were participating in the Pathways to Resilience study. Rasch analysis was applied to these data, resulting in the production of a 17-item, 2-subscale CYRM-R, consisting of intra/interpersonal and caregiver resilience subscales. The subscales demonstrated good fit to the Rasch model by satisfying requirements of unidimensionality, good fit statistics and internal reliability, and a lack of item bias and problematic local dependency. The person separation indices also indicated that the subscales had good ability to differentiate between individuals of varying levels of resilience. In sum, the CYRM-R is a 2-subscale, 17-item Rasch-validated measure of resilience with robust psychometric properties. This revised measure is recommended for researchers and practitioners who are interested in measuring resilience across diverse cultures and contexts. [ABSTRACT FROM AUTHOR]