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AIMS: The study sought to 1) characterize the types and frequency of session-level adaptations made to multiple evidence-based practices (EBPs) and 2) identify therapist-, client- and session-level predictors of adaptations. METHOD: Within the community implementation of multiple EBPs, 103 community mental health therapists reported on 731 therapy sessions for 280 clients. Therapists indicated whether they adapted EBPs in specific sessions and described adaptations in open-ended responses. Responses were coded using the Augmenting and Reducing adaptations framework. Multilevel logistic regression analyses examined predictors of Augmenting and Reducing adaptations. RESULTS: Therapists reported making adaptations in 59% of sessions. Augmenting adaptations were reported more frequently than Reducing adaptations. Multilevel models showed that greater therapist openness to EBPs, younger child age, and presenting problems were associated with Augmenting adaptations. Child presenting problem of externalizing problems predicted fewer Reducing adaptations compared to internalizing problems. CONCLUSION: This study extends the growing research examining adaptations within the context of system-driven implementation of multiple EBPs by applying the Augmenting and Reducing adaptation framework to the session-level.

The Top Problems assessment is an idiographic measure of client concerns that may allow clinicians to identify early treatment response. Few studies have examined early response to evidence-based therapies using Top Problems. We collected weekly Top Problems ratings from 95 youth with emotional disorders who received treatment using the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/UP-A). We assessed Top Problems rating change from session 1 to session 4, the role of pre-treatment variables in early Top Problems rating change, and the role of early Top Problems rating change in post-treatment symptom outcomes. Top Problems ratings decreased significantly from session 1 to session 4. Younger child age and higher parent cognitive flexibility were associated with early Top Problems improvement. Controlling for pre-treatment, early Top Problems rating change did not explain the variance in post-treatment outcomes. Future research should examine Top Problems trajectories over treatment course.

Despite difficulties in reading and writing, some research suggests that dyslexia may be related to higher levels of creativity. However, this pattern is not consistently observed. The current research sought to ascertain whether individuals with clinically diagnosed dyslexia exhibit higher creativity than controls through a meta-analysis. Fourteen studies that assessed the creativity of 397 individuals with clinically diagnosed dyslexia and 453 controls were reviewed. Random-effects meta-analysis revealed an overall non-significant difference in creativity scores between those with dyslexia and controls. Additionally, method factors such as the type of creativity task and whether intelligence was controlled for, as well as sample-related factors such as gender, did not explain differences in the dyslexia-creativity relationship. Nonetheless, individuals with dyslexia significantly outperformed controls in creativity scores in adult samples, but not in younger child/adolescent samples. Overall, the current findings provide limited support for the idea that individuals with dyslexia are more creative, and that past evidence of this relationship may be limited to adult samples.

Objectives Our aim in this study was to identify patient-level barriers to attending pediatric type 1 diabetes mellitus (T1DM) clinic and to better understand the demographic and clinical characteristics of these reporting barriers. Methods Patients were recruited from pediatric T1DM clinics throughout British Columbia. Barriers to attending clinic were identified through a survey. Demographic and clinical characteristics of patients who reported difficulty attending clinic appointments were compared with those who did not. Results Of the 197 study participants, 31% reported difficulty attending appointments. Commonly reported barriers were distance to clinic and missing work. Younger child age and residing in northern regions increased the odds of reporting a barrier, whereas residing on Vancouver Island decreased odds of reporting a barrier. There were no differences in glycated hemoglobin levels between the 2 groups. Conclusions Approximately 1 in 3 patients identified challenges in attending T1DM appointments in British Columbia. Further research is needed to determine whether similar challenges exist in other provinces.

Background Mothers with lifelong care responsibilities might involuntarily be non-employed or work part-time, both of which are defined as “underemployment.” This study aimed to investigate who these underemployed mothers are and what are the factors associated with such employment hardship when having a child with intellectual disability (ID). Method An interview survey was conducted in 2011 in two local authorities of Taiwan on 876 working-age mothers with a child with intellectual disability; 514 of them were working part-time/non-employed and chosen as participants of this study. Results The mothers with a younger child with intellectual disability, a higher level of education, a lower level of family income and more family members with disabilities were more likely to be underemployed compared with the mothers who were voluntarily working part-time/non-employed. Conclusions The underemployed mothers were more likely to have financial difficulty and heavy caregiving loads; their employment hardship should be of concern for policymakers. peerReviewed

PURPOSE To evaluate the current vision screening criteria regarding amblyopia and refractive errors, with emphasis on screening limits and retesting, in Region Vastra Gotaland (VGR), Sweden. Visual acuity (VA) screening is performed by nurses at primary healthcare centres (PHCs) in 4-year-old children and at school in 6- or 7-year-old children. Children with VA 0.19 logMAR) at either eye are referred. If VA is 0.65 in one or both eyes, a retest is performed by nurses at PHCs and schools, the children are then referred if VA is 0.10 logMAR). METHODS We included all children aged ≥5 and

Cognitive-behavioral therapy (CBT) protocols for anxiety disorders have been shown to have efficacy with older children and adolescents; however, only recently have investigators begun to adapt and pilot such interventions for younger children. This article reviews data suggesting that even very young children can benefit from CBT for anxiety, discusses some of the necessary developmental adaptations when working with children of preschool and early elementary school age, and reviews studies that have implemented CBT for anxiety disorders with youngsters in this age range. The authors conclude with recommendations for future directions for research in this area.

A sample of 917 children, aged 7 to 17 years, their parents, and their teachers each completed the appropriate version of the Strengths and Difficulties Questionnaire (SDQ), and 120 from each group did so again 2 weeks later. The results indicate that the SDQ demonstrates sound interinformant and test-retest reliability. Younger children, whose self-reports have not been assessed in previous studies, were reliable in their responding, although not as reliable as older children by these measures. However, the internal reliability of the various subscales, in particular, the peer problems subscale, is questionable for both older and younger child respondents. Overall the findings suggest that the SDQ's use may be extended cautiously to include self-report from younger children.

BACKGROUND Children living with a smoker experience increased environmental tobacco smoke (ETS) exposure, even when the smoker refrains from smoking inside the house, compared to children not living with a smoker. Given the risks of ETS in children, it was hypothesized that households with children are less likely than those without children to experience home ETS exposure. DESIGN Cross-sectional analysis of the Canadian Community Health Survey 2009-2010 for the association between children aged

The effects of trauma in children are amply documented. This paper investigated the relationship between children's age and posttraumatic clusters of symptoms 30 months after the end of the Gulf War and the mother's reaction to the trauma 6 and 30 months after the war. Fifty-one children aged 6 to 8 years (3 to 5 years during the war) and their mothers were interviewed. Results showed no age differences in the various posttraumatic symptoms of the children. Correlations between the children's posttraumatic symptoms and both the general and the specific posttraumatic symptoms of their mothers were positive and significant in the 6-year-olds, positive and nonsignificant in the 7-year-olds, and nonsignificant and mostly negative in the 8-year-olds. These findings may reflect the developmental changes that render the older child more autonomous and the younger child rigidly attached to the mother after a traumatic event.

Objective. The purpose of this study was to determine the effect of the presence of passenger airbags on places where children sit when traveling in motor vehicles. Methodology. An observational and driver interview survey of 503 passenger vehicles was conducted in five New England states at randomly selected long- and short-distance travel sites during the summer of 1998. Each vehicle was occupied by at least 1 child Results. Controlling for the effects of the driver and vehicle characteristics, children Conclusions. Some New England drivers are protecting children from the risks of passenger airbags by seating them in the rear. There remains, however, a substantial number of children who are being exposed to the risk of passenger airbag deployment.

Pre-school siblings' comments about, and behaviour towards, their older, learning-disabled brothers and sisters are reported. Initially, some of the very young siblings want to be similar, and attempt to imitate their brothers and sisters, particularly if he or she is also physically disabled; this may be because of the immediate visibility of physical disability, which makes it appear interesting and important to the younger child. Before they are 2 years old, children are able to recognize that their older brothers and sisters are different, and often imitate the parents' behaviour towards the older child.

Acne vulgaris is classically considered a disease of adolescence. Although it most commonly occurs and has been best studied in that age group, it can develop at any time during childhood. It is important that health care practitioners recognize the manifestations of neonatal, infantile and childhood acne, as well as the differential diagnosis and best therapeutic approach in the younger child. Acneiform eruptions in infants and toddlers can occasionally be associated with scarring or with other significant disorders that may be life-threatening. In this article, the authors draw on their own clinical experience as well as the available literature to suggest an age-based approach to managing acne in children from the neonatal period through age 11 years.

This study identified and quantified rambling and trembling properties of the postural control system of children 4–12 years of age. Forty five children of varying ages (4-, 8-, and 12-years) and 15 adults stood upright on a force plate and performed 5 trials with and 5 trials without vision with each trial lasting 30 s. Center of pressure, rambling, trembling, mean sway amplitude, and predominant frequency were obtained. Results revealed that the displacement of the center of pressure and overall rambling trajectories were age-related with younger children swaying more than older children and adults. Similarly, overall trembling trajectories for younger children were larger compared with older children and adults. These results suggested that a younger child’s larger body sway mostly results from difficulties using sensory information when estimating overall body position and velocity in an upright stance and is less a result from the noise in the postural control system.

This paper reflects on issues raised by work with children in an ongoing child mobility study in three sub-Saharan African countries: Ghana, Malawi and South Africa. There are now 70 school pupils of varying ages involved in the project, but the paper is particularly concerned with the participation of those children 14 years and under. We examine the significant ethical issues associated with working with younger child researchers, and linked questions concerning the spaces open to them in African contexts where local cultural constructions of childhood and associated economic imperatives (which commonly drive family and household endeavour) help shape the attitudes of adults to children’s rights and responsibilities and inter-generational power relations.

Objective To analyze the characteristics of post-tonsillectomy bleeding and its management comparing with adults. Methods A retrospective chart review of 1489 patients who underwent tonsillectomy in our institution (June 2003–June 2006). Results Post-tonsillectomy bleeding rate was 3.1%, 2.5% and 10.8% in younger children (age ≤ 11 years), older children (12 ≤ age ≤ 15 years) and adults (age > 15 years), respectively. Although adults showed an unimodal peak time for onset of post-tonsillectomy bleeding, children showed a bimodal peak time. In the younger child group, all of the 28 bleeders had spontaneous hemostasis. However, in the older child group, there was no spontaneous hemostasis. Bleeding was controlled under local anesthesia in 3 patients and 2 patients required general anesthesia for bleeding control. In the adult group, spontaneous cessation of bleeding occurred in 25 patients (60.9%) and hemostasis under local or general anesthesia was performed in 16 (39.1%) patients. Conclusions Post-tonsillectomy bleeding occurred more frequently in adults than in children. Spontaneous hemostasis was more prevalent in children than in adults. Post-tonsillectomy bleeding in the younger child group was controlled with close observation alone.

In the 1980s home care, in contrast to hospital care, was reported substantially to reduce costs for third-party payers who provided funding for technology-assisted children. Savings were realized primarily because parents substituted for nurses, eliminating or reducing those costs. Third-party payers' savings thus were directly related to the number of hours parents assumed care. Because home care relies on parents doing some of the work of nurses, decisions regarding nursing hours must consider family factors in addition to medical factors. We evaluated the number of nursing hours 31 Minnesota families with technology-assisted children received, as well as the factors that determined the allotment of nursing hours. Most families (96.8%) received some hours of nursing hours. Most families (96.8%) received some hours of professional nursing care per day, and 16.1% received 24-hour care. Multiple regression, however, showed that family factors, rather than the child's medical condition, influenced the number of hours, with married, lower-income families with a younger child receiving the fewest. Further discussion and study are recommended to understand more fully the impact family factors have on the allotment of nursing hours and home care costs.

This paper analyzes the radio frequencies (RF) exposure in the head tissues of children using a cellular handset or RF sources (a dipole and a generic handset) at 900, 1800, 2100 and 2400 MHz. Based on magnetic resonance imaging, child head models have been developed. The maximum specific absorption rate (SAR) over 10 g in the head has been analyzed in seven child and six adult heterogeneous head models. The influence of the variability in the same age class is carried out using models based on a morphing technique. The SAR over 1 g in specific tissues has also been assessed in the different types of child and adult head models. Comparisons are performed but nevertheless need to be confirmed since they have been derived from data sets of limited size. The simulations that have been performed show that the differences between the maximum SAR over 10 g estimated in the head models of the adults and the ones of the children are small compared to the standard deviations. But they indicate that the maximum SAR in 1 g of peripheral brain tissues of the child models aged between 5 and 8 years is about two times higher than in adult models. This difference is not observed for the child models of children above 8 years old: the maximum SAR in 1 g of peripheral brain tissues is about the same as the one in adult models. Such differences can be explained by the lower thicknesses of pinna, skin and skull of the younger child models.

Geleophysic dysplasia is an autosomal recessive short-limbed, dysmorphic syndrome. The condition is frequently associated with cardiac valvular disease, which may result in secondary hypertrophy and cardiac failure. We describe two distantly related Pakistani children with classical features of geleophysic dysplasia. Pulmonary stenosis was recognized in both within a few months of birth. The younger child shows no signs of cardiac decompensation at the age of 7 years whilst her older cousin has developed a significant pulmonary gradient requiring surgical intervention in the second decade of life. The natural history of his disorder highlights that the cardiac involvement seen in apparently stable forms of geleophysic dysplasia is frequently progressive.

Enzyme replacement therapy is widely used as treatment for mucopolysaccharidosis I (MPS I), and there is evidence that this produces improvement in certain clinical domains. There does appear to be variation in the response of clinical features to treatment once these are established. In a reported sibling pair, when enzyme replacement therapy was commenced pre-symptomatically in the younger child, the natural history of the condition appeared to be affected. We present data from three siblings treated with enzyme replacement therapy at different ages which supports this finding.

The acquisition of reading is a complex neurobiologic process. Identifying the most effective instruction and remedial intervention methods for children at risk of developing reading problems and for those who are already struggling is equally complex. This article aims to provide the clinician with a review of more current findings on the prevention and remediation of reading problems in children, along with an approach to considering the diagnosis and treatment of a child with dyslexia. The first part of the review describes interventions targeted at preventing reading difficulties in the at-risk younger child. The second part of the review discusses the efficacy of approaches to treat the older, reading-disabled child (“intervention studies”). Factors that impact the response to treatment are also discussed, as are neuroimaging studies that offer insight into how the brain responds to treatment interventions. With appropriate instruction, at-risk readers can become both accurate and fluent readers. In contrast, although intensive, evidence-based remedial interventions can markedly improve reading accuracy in older, reading-disabled children, they have been significantly less effective in closing the fluency gap. Owing to the dynamic course of language development and the changes in language demands over time, even after a child has demonstrated a substantial response to treatment interventions, his or her subsequent progress should be carefully tracked to ensure optimal progress toward the development of functional reading and written language skills. ( J Child Neurol 2004;19:744—758).

When a child with a disability is born, reaction of most parents, regardless of gender, span a range of feelings, starting from denial, shock, anger to, hopefully, at last, reconciliation with the circumstances. Different research studies have shown that most of such parents experience increased levels of stress and extended responsibility due to their new situation, and gender differences do determine the experience and reaction to the situation and also the health and well-being of those affected. Women tend to be more affected by stressful life events in general than men, especially when these events affect individuals with whom they have a relationship, such as family members. Women also report a decreased sense of control in stressful situations*they experience more psychological distress and depression and they tend to use more emotion-focused coping-strategies than men such as verbalizing the problems and seeking support from others. Mothers of children with disabilities experience a higher level of stress and depression than fathers. It has been proven that the depressive symptoms of the mothers increase with the age of the child. This is related to the expectance of the child’s need for care. A younger child is expected to require more care than an older child, having a disability or not. Mothers of children with disabilities also report a higher rate of marital dissatisfaction while the same does not apply to their fathers. The more severe the mother’s subjective perception of the child’s disability, the higher the rate of marital discord reported, which is probably because the more severe the child’s disability, the more time the mother has to spend with the child, leaving very little time left to be spent with her spouse. (Published: 16 April 2014) Citation: Int J Qualitative Stud Health Well-being 2014, 9 : 24343 - http://dx.doi.org/10.3402/qhw.v9.24343

Caring for disabled children has become increasingly the responsibility of parents, even when the medical care is complex. To assess the time commitment required, 133 mothers of disabled children were asked to estimate by specific task categories the extra time required to care for the children. Total average daily care time was reported at 12 hours and 6 minutes, with 6 hours and 30 minutes consumed in "vigilant" tasks (i.e., watching a child who cannot be left alone and/or providing emotional support). Multiple regression analysis showed an increase in total caregiving hours associated with a younger child who was more physically and mentally impaired, and who required more medical treatments. The amount of time required by parents to care for their chronically ill children of necessity results in lost opportunities. Because this burden is experienced primarily by women and because professional nurses could alleviate some of the burden, this issue deserves further study.

Two sisters are presented in whom posterior open bites have developed. Orthodontic treatment was not successful in correcting this aspect of the malocclusion in the older sibling. The younger child developed the same defect, and consequently orthodontic treatment is not being considered.

Mothers told stories to their children, inserting 30 questions about each story under two conditions. In one situation, mothers were alone with their younger child, and in the other condition, an older sibling was also present. During the question-answer interactions, older siblings responded to 60%–65% of all mothers' questions before younger children had a chance to respond and provided direct answers to the questions in 57%–65% of those instances. Mothers responded by producing fewer rephrased questions, fewer questions providing hints and answers, fewer questions functioning as repetitions and expansions, and more directly repeated questions when the older sibling was present. The effect of older siblings' first responses also reduced by half the number of younger children's utterances. The younger children produced fewer noncontent and content answers and more imitated answers in the presence of the older sibling. It is concluded that the presence of older siblings may influence the language young children hear and produce.

Suprapubic aspiration (SPA) was compared with midstream urine collection (MSU) in the diagnosis of urinary tract infection (UTI) in a busy paediatric out-patient department in Northern Nigeria, where usually only one specimen can be taken before starting antimicrobial therapy. SPA in 287 children was compared with 175 MSU collections. Urine was obtained at the first attempt in 260 (91%) SPA's which were easy to perform and safe. MSU collections were more difficult, particularly in the younger child. In 51 cases MSUs were compared with SPAs taken immediately before, and gave an accurate indication of urine infection with no false negative or positive cultures. It is concluded that when only one urine specimen can be collected before starting antimicrobial therapy, a single MSU specimen gives an adequate result if correctly collected and plated out. When accuracy of diagnosis is essential or if a MSU cannot be obtained, SPA is indicated. A white cell count on unspun urine proved to be the most successful sideroom test for urinary tract. Counts in excess of ten cells per mm3 were found in 62% of patients with positive cultures.

Myringotomy can be a simple surgical procedure, but the younger child presents special problems. The type of instrument used, how it is introduced, the modality of anesthesia, and the emotional makeup of the child (and the parent) all need special attention if the operation is to go smoothly for both patient and physician.

Evaluation of 115 children who had irradiation to the liver reveals an increase in abnormality of the parameters studied when large volumes of liver are irradiated or when the liver is irradiated following resection. To some extent, this is dependent on dose but abnormalities have been observed at doses below 2,499 rads and as low as 1,200 rads. Possibly, this may be related to the increased sensitivity of the younger child who generally received these lower dosages.Although evaluation in the chronic phase shows no significant difference of abnormality of age as related to dose, there does appear to be a slight trend in the acute phase of irradiation to implicate sensitivity of children under 1 year.

In the context of an adapted referential communication task the speech of 40 children aged 8-10 years was examined under the listener conditions of speech to a younger child and to a retarded child of the same sex and similar chronological age, relative to initial speech to a peer. Modification, as indexed by an increase in quantity of speech and in semantic coherence was observed in speech to a retarded listener but not to a younger listener, suggesting that the intellectually handicapped children were perceived as being less competent listeners. The effect is interpreted as a result of an active integration programme in a particular school setting and is seen to offer promise for the limited integration of the mildly disabled.

Several aspects of trichotillomania in childhood are described and discussed. Case records of twenty-one children not older than 15 years of age, who were seen in the previous 5 years, were examined. The female/male ratio was 2.5:1 (fifteen girls and six boys); the age range was 2 to 15 years. Although trichotillomania may, at first sight, often impress as an apparently inexplicable persistent habit, further analysis shows that this symptom often develops in a climate of psychosocial stress in the family, e.g., hospitalizations of child or mother, the additional stress inherent in moving to a new house, or developmental problems such as sibling rivalry, inability to focus activities and play in the younger child, and school problems in the older child.

• The 1974 and early-1975 model automobiles are equipped with belt interlock systems that require front outboard seat occupants who weigh more than 21.5 kg (47.3 lb) to wear three-point lap and diagonal upper-torso belts (or wear the lap belt and position upper-torso belt behind them), assuming that the interlock has not been circumvented. Recent legislation has eliminated the interlock requirement, but new models are still likely to be fitted with three-point restraints for the front outboard seating positions. These restraint systems were designed and tested for adult use. Thus, based on the different structure of a younger child and the fact that there is a wide variation of belt orientation, child size, and seating environments, there is legitimate concern that the upper diagonal belt might contribute to injury of the child under certain impact conditions. ( Am J Dis Child 129:946-949, 1975)

The present study investigated children's responses to a peer's childhood depression. Younger children in third and fourth grade and older children in fifth and sixth grade were exposed to one of four films. The four films portrayed a female peer who was either depressed or not depressed and who had experienced numerous recent life stresses or no recent life stress. Overall, children rated the depressed peers as less likeable and attractive, as engaging in fewer positive current and future behaviors, and as needing therapy more than a nondepressed peer. There was a tendency to rate the depressed peer with high life stress more positively than the depressed peer with low life stress; this tendency decreased with age. Girls rated all of the peers and especially the stressed peers more positively than did the boys. The results are discussed in terms of the implications of children's social interaction for the initiation or maintenance of childhood depression.