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D'Arcy E, Burnett T, Capstick E, Elder C, Slee O, Girdler S, Scott M, Milbourn B. The Well-being and Support Needs of Australian Caregivers of Neurodiverse Children. J Autism Dev Disord 2024; 54:1857-1869. [PMID: 36757543 PMCID: PMC9909132 DOI: 10.1007/s10803-023-05910-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
Caregivers of children with neurodiverse needs are known to experience challenges and hardship due to the increased needs of the child and the lack of support available. This study aimed to explore the support needs and well-being of caregivers of children with neurodiverse needs in Australia. Sixty-six caregivers participated in an online survey asking questions about support needs. The results highlighted five main themes that caregivers commonly experienced including: barriers to community engagement, impact on close relationships, negative impact on mental health and identity, financial hardship, and identified support needs. Findings identified multiple unmet needs existing amongst caregivers and further emphasises the importance of addressing these needs to improve the quality of life of caregivers of children with neurodiverse needs.
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Affiliation(s)
- Emily D'Arcy
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Tayah Burnett
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Emily Capstick
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Catherine Elder
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Olivia Slee
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Sonya Girdler
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Melissa Scott
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Ben Milbourn
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia.
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St John BM, Ausderau KK. Changes in Caregiver Outcomes After Participation in the Engaged Eaters Program: A Caregiver-Mediated Feeding Intervention for Autistic Children and Their Families. Am J Occup Ther 2024; 78:7803205040. [PMID: 38640088 PMCID: PMC11117462 DOI: 10.5014/ajot.2024.050444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024] Open
Abstract
IMPORTANCE Caregivers are essential partners in caregiver-mediated interventions that build on family routines and practices. Research identifying how participation as an intervention partner influences caregivers' outcomes, including stress and self-efficacy, is scarce. OBJECTIVE To evaluate caregiver outcomes (stress, self-efficacy, and positive feeding responses and confidence) after participation in the Engaged Eaters Program. DESIGN Quasi-experimental pretest-posttest design. SETTING In-home via telehealth. PARTICIPANTS Fourteen primary caregivers of an autistic child (ages 2-7 yr) with feeding challenges. INTERVENTION The Engaged Eaters Program-Telehealth, a caregiver-mediated 6-mo in-home telehealth feeding intervention for autistic children ages 2 to 7 yr that included 24 intervention visits, eight caregiver training modules, and consultation with a dietician. OUTCOMES AND MEASURES Relationships between child feeding challenge severity and caregiver outcomes and individual differences in caregivers' intervention responses were evaluated. We assessed caregivers' stress (Parenting Stress Index, Fourth Edition Short Form), self-efficacy (Parent Sense of Competence Scale), Positive Feeding Responses and Confidence (PFRC; composite score of items from other assessments), and individual intervention response using pre- to postintervention change in scores. RESULTS Exploration of individual differences revealed that only caregivers with intake PFRC scores below the mean made significant improvements by the end of the intervention. No significant group-level changes were identified for stress, self-efficacy, or PFRC. Feeding challenge severity was not significantly related to caregiver outcomes. CONCLUSIONS AND RELEVANCE The results emphasize the importance of considering baseline practices, efficacy, and caregiver confidence when engaging caregivers in intervention. Future research should explore the nuanced relationship between caregiver outcomes and child characteristics. Plain-Language Summary: Caregivers are essential partners with feeding interventions that build on family routines and practices. When working with caregivers, occupational therapists should consider caregivers' readiness for and responses to an intervention because intervention practices may differentially affect caregivers' parenting practices, confidence, and self-efficacy. Caregivers' responses may also affect the overall effectiveness of a caregiver-mediated intervention. Positionality Statement: The term caregiver-mediated in used throughout this article in place of parent-mediated to be inclusive of all types of caregivers.
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Affiliation(s)
- Brittany M St John
- Brittany M. St. John, PhD, MPH, OTR/L, is Postdoctoral Fellow, Department of Kinesiology, Occupational Therapy Program, University of Wisconsin-Madison;
| | - Karla K Ausderau
- Karla K. Ausderau, PhD, OTR/L, FAOTA, is Associate Professor, Department of Kinesiology, Occupational Therapy Program, and Waisman Center, University of Wisconsin-Madison
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Hladik L, St John BM, Korbel A, Nelson N, Umana M, Kant S, Ausderau KK. "Giving Me the Self-Confidence to Tackle It": Mothers' Experiences Participating In The Engaged Eaters Program, A Caregiver-Mediated Feeding Intervention. J Autism Dev Disord 2024:10.1007/s10803-024-06250-4. [PMID: 38400894 DOI: 10.1007/s10803-024-06250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/26/2024]
Abstract
The purpose of this study was to understand caregivers' experience of participating in a caregiver-mediated in-home feeding intervention, the Engaged Eaters Program, for their young autistic child. This qualitative study utilized a thematic approach to analyze post-intervention semi-structured interviews with thirteen mothers of autistic children between the ages of 2 to 7 years after they participated in the intervention. Interview questions focused on the child and family experience, what worked well, what could be improved, and how the intervention integrated into family routines. Four major themes were identified: In-Home Intervention, Parent Skill and Knowledge, Increased Social Participation, and Parent Responsibilities and Challenges. Sub-themes provided descriptions of learning practical tools to support their child, increasing self-efficacy, and impacts on family life. Mothers described an increase in tangible skills that were easily practiced in the home environment that improved their confidence and self-efficacy in feeding their children. They also described how participation did require more work and time commitment for them beyond their regular responsibilities. The caregiver experience is essential to understand for intervention effectiveness while simultaneously addressing child, caregiver, and family needs. By focusing on the mothers' experiences, individualized needs, and self-efficacy, we were able to better understand how integrating an intervention into the family context and daily routines may be beneficial for the whole family.
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Affiliation(s)
- Libby Hladik
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Brittany M St John
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Allie Korbel
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Nicole Nelson
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Molly Umana
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Shannon Kant
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Karla K Ausderau
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA.
- Waisman Center, University of Wisconsin at Madison, Madison, WI, USA.
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Almendingen A, Pilkington P. Parenting Self-Efficacy and Psychological Distress in Parents of Children with an Autism Spectrum Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-05939-2. [PMID: 37142902 DOI: 10.1007/s10803-023-05939-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/06/2023]
Abstract
Research suggests that challenges associated with raising a child with an Autism Spectrum Disorder (ASD) can increase parents' risk for diminished parenting self-efficacy (PSE) and psychological wellbeing. The present study aimed to explore interrelationships between noteworthy predictors of PSE and parental psychological distress, including parental mastery beliefs and the co-parenting relationship amongst 122 Australian parents of children with autism. Results indicated that greater mastery beliefs and more favourable co-parenting relationships predicted greater PSE, and higher PSE predicted less psychological distress. PSE significantly mediated relationships between mastery beliefs and psychological distress, and between the co-parenting relationship and psychological distress. Findings have implications that can aid professionals to more effectively support parents raising children on the autism spectrum.
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Affiliation(s)
- Alexander Almendingen
- Parenting Research Centre, 8/699 Collins Street, 3000, Melbourne, VIC, Australia.
- School of Behavioural and Health Sciences, Australian Catholic University, 155 Victoria Parade, 3065, Fitzroy, VIC, Australia.
| | - Pamela Pilkington
- School of Behavioural and Health Sciences, Australian Catholic University, 155 Victoria Parade, 3065, Fitzroy, VIC, Australia
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Lee K, Godina F, Pike D. A Social Turn-Taking, Parent Mediated Learning Intervention for a Young Child with Autism: Findings of a Pilot Telehealth Study. EARLY CHILDHOOD EDUCATION JOURNAL 2023:1-13. [PMID: 37360607 PMCID: PMC10060940 DOI: 10.1007/s10643-023-01467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 06/28/2023]
Abstract
Social turn taking, a preverbal social communication competency often difficult for young children with autism, may be foundational to joint attention when included as a component of interventions for children with autism. In this study, social turn-taking was promoted through a parent mediated learning approach to intervention in a telehealth setting. Following a mixed-methods design, the present study explored the results of this new intervention model for a toddler with autism. The study also sought to understand any changes in the parent-child relationship because of the intervention. Findings indicate that the intervention supported the child's social communication competencies, including social turn-taking, joint attention, and facial focusing. Qualitative data revealed improvements in the parent-child relationship. These preliminary results lend support for promoting social turn-taking in interventions for children with autism, as well as for following developmental, parent-driven approaches to intervention. Studies with larger sample sizes are needed to understand these findings further. Implications for practice and research in early intervention are presented.
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Affiliation(s)
- Kwangwon Lee
- Center for Early Childhood Education, Eastern Connecticut State University, 83 Windham St, Willimantic, CT 06226 USA
| | - Fatima Godina
- Center for Early Childhood Education, Eastern Connecticut State University, 83 Windham St, Willimantic, CT 06226 USA
| | - Delaney Pike
- Center for Early Childhood Education, Eastern Connecticut State University, 83 Windham St, Willimantic, CT 06226 USA
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Weitlauf AS, Broderick N, Alacia Stainbrook J, Slaughter JC, Taylor JL, Herrington CG, Nicholson AG, Santulli M, Dorris K, Garrett LJ, Hopton M, Kinsman A, Morton M, Vogel A, Dykens EM, Pablo Juárez A, Warren ZE. A Longitudinal RCT of P-ESDM With and Without Parental Mindfulness Based Stress Reduction: Impact on Child Outcomes. J Autism Dev Disord 2022; 52:5403-5413. [PMID: 35040001 PMCID: PMC9289080 DOI: 10.1007/s10803-021-05399-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
This randomized controlled trial (NCT03889821) examined Mindfulness Based Stress Reduction (MBSR) in conjunction with the Parent-implemented Early Start Denver Model (P-ESDM). A previous report described improved metrics of parental distress (Weitlauf et al. in Pediatrics 145(Supplement 1):S81-S92, 2020). This manuscript examines child outcomes. 63 children with ASD (< 36 months) and their parents received 12 P-ESDM sessions. Half of parents also received MBSR. Longitudinal examination of whole sample means revealed modest improvements in autism severity, cognitive, and adaptive skills. There was not a significant time × group interaction for children whose parents received MBSR. Future work should examine more proximal markers of child or dyadic change to enhance understanding of the impact of providing direct treatment for parents as part of early intervention initiatives.
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Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Neill Broderick
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Alacia Stainbrook
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Julie Lounds Taylor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amy G Nicholson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madeline Santulli
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin Dorris
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Michelle Hopton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Kinsman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary Morton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ashley Vogel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elisabeth M Dykens
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - A Pablo Juárez
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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Jurek L, Leadbitter K, Falissard B, Colin C, Touzet S, Geoffray MM. Parental experience of parent-mediated intervention for children with ASD: A systematic review and qualitative evidence synthesis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:647-666. [PMID: 35899918 DOI: 10.1177/13623613221112204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT The effectiveness of parent-mediated interventions in the field of autism spectrum disorder is well documented but information on the experience of parents involved in parent-mediated interventions is limited.This study is the first synthesis of evidence concerning the experience of parents involved in parent-mediated interventions. It synthesizes the voice of 345 parents across the world into four general themes: barriers to implementation and logistical issues, feeling overwhelmed and stressed (a need for support), facilitators of implementation, and empowerment in the parent and improvement in the child.The findings of our study provide evidence that parent-mediated interventions should be adapted to the needs of each family. Specific care and support should be offered to parents in addition to parent-mediated interventions. Our study, however, highlights which outcomes are important to parents and should be considered in future studies.
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Affiliation(s)
- Lucie Jurek
- Centre Hospitalier Le Vinatier, France.,RESHAPE, Research on Healthcare Performance, U1290, Claude Bernard Lyon 1 University (CBL1), France
| | | | - Bruno Falissard
- Centre de Recherche en Epidémiologie et en Santé des Populations, INSERM U1018, Université Paris-Saclay, France
| | - Cyrille Colin
- RESHAPE, Research on Healthcare Performance, U1290, Claude Bernard Lyon 1 University (CBL1), France.,Hospices Civils de Lyon, France
| | - Sandrine Touzet
- Hospices Civils de Lyon, France.,Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE) UMR T9405, Université Claude Bernard Lyon 1, France
| | - Marie-Maude Geoffray
- Centre Hospitalier Le Vinatier, France.,RESHAPE, Research on Healthcare Performance, U1290, Claude Bernard Lyon 1 University (CBL1), France
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Schertz HH, Liu X, Odom SL, Baggett KM. Parents' application of mediated learning principles as predictors of toddler social initiations. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1536-1549. [PMID: 34825577 DOI: 10.1177/13623613211061128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Little is known about what parents can do to promote initiating joint attention for their toddlers with autism. Initiating joint attention is important because it is an indicator of social motivation and is associated with later communication ability. In this study, parents applied mediated learning principles to help their toddlers engage with them socially. The principles included helping their child focus on social interaction, giving meaning to the social elements of interaction (and de-emphasizing nonsocial elements), and helping their toddlers understand their own social ability by encouraging. At the end of the intervention period, we compared two groups. One group received the Joint Attention Mediated Learning intervention and the other received community-based early intervention services. We found that the Joint Attention Mediated Learning participants applied mediated learning principles more often than the other group. Then, we explored how parents' application of mediated learning principles related to toddler initiating joint attention and found that parents who were successful in applying the principles had toddlers who were more likely to show initiating joint attention. Our findings indicate that the mediated learning process shows promise as a way to promote early social learning, although other elements of the Joint Attention Mediated Learning intervention, such as actively engaging parents in the learning process, may have also contributed to both child and parent learning.
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Wainer AL, Arnold ZE, Leonczyk C, Valluripalli Soorya L. Examining a stepped-care telehealth program for parents of young children with autism: a proof-of-concept trial. Mol Autism 2021; 12:32. [PMID: 33964979 PMCID: PMC8105688 DOI: 10.1186/s13229-021-00443-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Intervention during the first years of life for children with autism spectrum disorder (ASD) may have the strongest impact on long-term brain development and functioning. Yet, barriers such as a shortage of trained professionals contribute to significant delays in service. The goal of this proof-of-concept study was to explore strategies that support timely and equitable deployment of ASD-specific interventions. Methods This 15-week, randomized proof-of-concept study explored the acceptability of a digital parent mediated intervention online reciprocal imitation training (RIT; a naturalistic developmental behavioral intervention) and compared it to a treatment as usual (TAU) control on parent and child outcomes. Eligible children were between 18 and 60 months, met the cutoff for ASD on the Autism Diagnostic Observation Schedule-2nd Edition and demonstrate significant social imitation deficits. Primary outcomes include the acceptability of RIT (Scale of Treatment Perceptions) and the feasibility of the Online RIT digital intervention (online RIT attributes). Secondary outcomes included parent fidelity (RIT parent fidelity form) and parental self-efficacy (Early Intervention Parenting Self-Efficacy Scale). Exploratory outcome measures included child social communication (Social Communication Checklist), child imitation skills (Unstructured Imitation Assessment), and family quality of life (Beach Center Family Quality of Life Scale). Results Twenty participants were randomized in a 1:1 fashion. The acceptability and feasibility of RIT and the Online RIT digital intervention were rated highly. Among the secondary outcomes, there were significant group differences in parent fidelity (p < .001) and self-efficacy (p = .029). On exploratory outcomes, there were group differences in child social communication (p = .048). There were no significant group differences in imitation ability (p = .05) or family quality of life (p = .22). Limitations There are several limitations with this study, including the small sample size as well as lack of data on enactment and website engagement. This study was not able to address questions related to which variables predict program engagement and treatment response, which will be critical for determining which families may benefit from such a stepped-care delivery model. Conclusions Overall, the Online RIT program delivered in a stepped-care format shows strong acceptability and holds promise as an innovative delivery model. Trial registration ClinicalTrials.gov, NCT04467073. Registered 10 July 2020- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04467073
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Affiliation(s)
- Allison L Wainer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA.
| | - Zachary E Arnold
- Department of Psychology, University of Alabama At Birmingham, 1300 University Blvd., Birmingham, AL, 35233, USA
| | - Caroline Leonczyk
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA
| | - Latha Valluripalli Soorya
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA
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