Meaningful outcomes for children and their caregivers attending a paediatric brain centre

AIM

To identify meaningful outcomes of children and their caregivers attending a paediatric brain centre.

METHOD

We compiled a long list of outcomes of health and functioning of children with brain-related disorders such as cerebral palsy, spina bifida, (genetic) neurodevelopmental disorders, and acquired brain injury. We incorporated three perspectives: patients, health care professionals, and published outcome sets. An aggregated list was categorized using the International Classification of Functioning, Disability, and Health: Children and Youth version in a patient validation survey for children and parent-caregivers to prioritize outcomes. Outcomes were considered meaningful when ranked 'very important' by 70% or more of the participants.

RESULTS

We identified 104 outcomes from the three perspectives. After categorizing, 59 outcomes were included in the survey. Thirty-three surveys were completed by children (n = 4), caregivers (n = 24), and parent-caregivers together with their child (n = 5). Respondents prioritized 27 meaningful outcomes covering various aspects of health and functioning: emotional well-being, quality of life, mental and sensory functions, pain, physical health, and activities (communication, mobility, self-care, interpersonal relationships). Parent-caregiver concerns and environmental factors were newly identified outcomes.

INTERPRETATION

Children and parent-caregivers identified meaningful outcomes covering various aspects of health and functioning, including caregiver concerns and environmental factors. We propose including those in future outcome sets for children with neurodisability.

WHAT THIS PAPER ADDS

Outcomes that children with brain-related disorders and their parent-caregivers consider to be the most meaningful cover a wide range of aspects of functioning. Involving these children and their parent-caregivers resulted in the identification of important outcomes that were not covered by professionals and the literature. Parent-caregiver-related factors (coping, burden of care) and environmental factors (support, attitudes, and [health care] services) were identified as meaningful.

Perspectives of Swiss Paediatric Health Care Professionals on Factors Influencing Physical Activity Participation in Children with Disabilities

AIM

Investigation of the perspectives of paediatric health care professionals (PHCPs) in Switzerland regarding factors that influence participation in physical activity programs for children and adolescents with disabilities or chronic conditions (CADCCs). Evaluation of self-reported exercise counselling behavior of those professionals.

METHOD

A cross-sectional survey was used to collect the opinions of 171 PHCPs working with CADCCs using a structured questionnaire. The information obtained was evaluated by performing a combined quantitative and qualitative statistical analysis.

RESULTS

PHCPs in Switzerland think that CADCC do not get enough physical activity and see the underlying reasons in lacking information/knowledge and organizational factors. We found that the level of knowledge about disability sports opportunities among PHCPs has a positive influence on their exercise counselling behaviour.

CONCLUSIONS

We propose three approaches to increase the level of physical activity in CADCC: Establishing personalized exercise counseling, intensifying information about disability sports programmes towards PHCPs, and improving inclusion and integration in PE lessons or regular sports clubs.

"Kind of empowered": Perceptions of socio-emotional development in children driving ride-on cars

PURPOSE/OBJECTIVE

Early powered mobility (PM) experiences can be essential facilitators of self-initiated mobility, socialization, and exploration for young children with disabilities. Cerebral palsy (CP) and developmental delay are two of the most common diagnoses associated with motor disability in young children with 1 in 345 children diagnosed with CP and 1 in 6 with developmental delay in the US. The purpose of this study was to explore the longitudinal experiences and caregiver perceptions of socio-emotional development in particular, in young children with disabilities during modified ride-on car (ROC) use.

RESEARCH METHOD/DESIGN

A qualitative, grounded theory approach was used. Semi-structured interviews were conducted with 15 families (children ages 1-4 with CP or developmental delay) at baseline, 6 months (as able due to COVID), and 1 year following ROC introduction. Data were coded independently by three researchers using constant comparison until data saturation occurred and themes emerged.

RESULTS

Four themes emerged from the data: "Leveling the Playing Field," "Breaking Down Barriers," "Fun and Work: ROC as Toy and Therapy Device," and "Mobility is a Pathway to Autonomy." Conclusions/Implication: Children and caregivers viewed ROCs as both fun and therapeutic, consistently identifying perceived benefits for children's socio-emotional development. This qualitative study provides a better understanding of the complexities and impact of ROCs on children and their families in the socio-emotional domain and may help facilitate clinical decision-making when introducing PM to young children with disabilities as part of a multimodal approach to early intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Deaf and hearing children: A comparison of face perception

Deaf and hearing adults perceive faces differently. This study investigates whether these differences are acquired during childhood development. We characterized facial perception in deaf and hearing children aged 7-17 using a perceptual discrimination task. Configural and featural information was manipulated in the eye and mouth facial regions. Participants were asked whether two faces presented simultaneously were different. Deaf and hearing children performed better in featural than configural discriminations and in mouth than eye discriminations. Compared with children with typical hearing, deaf children performed better in featural and mouth judgments but had longer reaction times with strongest effects at 7-8 and 13-14 years old. Type and location contributed jointly in deaf children's face perception with different configural but similar featural discriminations in mouth and eye locations. However, children with typical hearing showed different featural and configural judgments in both locations. Thus, featural and configural information effects on location processing differ between the two groups.

Association between Participation of Children with Disabilities and the Child, Family, and Environmental Factors in Shanghai, China: A Cross-Sectional Study

Participation is essential to a child's health and well-being, whereas children with disabilities may lack the associated benefits because of physical restrictions. This study aims to examine the association between the participation of children with disabilities and the child, family, and environmental factors. A total of 433 children with disabilities aged 3-18 and their family caregivers were included. Three binary logistic regression models were respectively established to identify the significant factors associated with children's home, school, and community participation. Our main empirical results showed that among 433 children with disabilities, 44.3%, 47.6%, and 58.7% of them never or seldom participated in home, school, and community activities. Child and family factors were found to be dominantly associated with children's participation, and significant factors associated with the home, school, and community participation of children were different, including children's disability type, sleep problems and emotional stability, caregivers' education, mental HRQOL, rehabilitation belief, and number of children in the family. These results highlight that the participation of children with disabilities in mainland China urgently needs to be enhanced, and further research might be focused on validating the causal relationships between participation and significant child and family factors identified in this study.

A Blueprint for Change: Guiding Principles for a System of Services for Children and Youth With Special Health Care Needs and Their Families

Children and youth with special health care needs (CYSHCN) and their families continue to face challenges in accessing health care and other services in an integrated, family-centered, evidence-informed, culturally responsive system. More than 12 million, or almost 86%, of CYSHCN ages 1-17 years do not have access to a well-functioning system of services. Further, the inequities experienced by CYSHCN and their families, particularly those in under-resourced communities, highlight the critical need to address social determinants of health and our nation's approach to delivering health care. To advance the system and prioritize well-being and optimal health for CYSHCN, the Health Resources and Services Administration's Maternal and Child Health Bureau, with input from diverse stakeholders, developed a set of core principles and actionable strategies for the field. This article presents principles and strategies in the Blueprint for Change: Guiding Principles for a System of Services for CYSHCN and Their Families (Blueprint for Change), which acknowledges the comprehensive needs of CYSHCN, a changing health care system, and the disparities experienced by many CYSHCN. Four critical areas drive the Blueprint for Change: health equity, family and child well-being and quality of life, access to services, and financing of services. Although discussed separately, these critical areas are inherently interconnected and intend to move the field forward at the community, state, and federal levels. Addressing these critical areas requires a concerted, holistic, and integrated approach that will help us achieve the goal that CYSHCN enjoy a full life from childhood through adulthood and thrive in a system that supports their families and their social, health, and emotional needs, ensuring their dignity, autonomy, independence, and active participation in their communities.

[Sleep quality and mental well-being of mothers caring for children with disabilities and requiring oxygen therapy and night care at home]

Objectives　This study aimed to 1) determine what kind of care for children with disabilities is related to the mothers' sleep and mental well-being and 2) objectively measure the sleep state of mothers responsible for children with disabilities.Methods　A self-administered questionnaire was distributed to 180 mothers of children enrolled in the Special Needs Education School in prefecture A. Amongst these, nine who provided consent underwent objective sleep measurements using actigraphy. The questionnaire investigated the lifestyle and the type of care needed for children with disabilities and their influence on the mothers. Subjective sleep quality (Pittsburgh Sleep Quality Index) and mental well-being status (General Health Questionnaire) of the mothers were also evaluated. Logistic regression analysis was performed to analyze the background factors affecting sleep quality and mental health.Results　Of the 180 participants, 84 (46.7%) provided valid responses. Fifty-two (64.2%) and 34 (42.0%) individuals subjectively reported poor sleep quality and poor mental well-being, respectively. Mothers having responsibilities of oxygen therapy and night care reported significantly poor sleep quality and mental well-being. Moreover, objective sleep measurements showed that the changes in the child's physical condition, such as ventilator management, epileptic seizures, and fever, resulted in prolonged waking times and affected the sleep efficiency of the mother.Conclusion　Responsibilities toward providing oxygen therapy and night care for their children with disabilities influenced the sleep quality and mental well-being of the mothers. Thus, it is important to provide support to mothers caring such disabled children.

Family and personal factors associated with the participation of children with special needs in leisure activities: A Turkish perspective

OBJECTIVE

The primary aims of the current study were to describe the participation patterns in leisure activities of children between the ages of 6 and 15 years with special needs and to analyze family behavior and personal factors that affect participation.

MATERIAL AND METHODS

Overall, 112 children with special needs aged 6-15 years and their families participated in the present study. Children's sociodemographic characteristics, participation patterns in leisure activities, family behavior, and quality of life were evaluated.

RESULTS

In this study, it was observed that children participated in recreational activities the most and in physical activities the least. Most of the families reported that they did not have an influence on determining the activity. The findings showed correlations between leisure activities and age, gender, and socioeconomic status (p < 0.05).

CONCLUSION

The findings suggest that (a) children's participation in activities outside the home and (b) family guidance are insufficient. Thus, rehabilitation professionals can inform families about activities appropriate for children, positive family behavior, and social support programs.

Adjusting the family's life: A grounded theory of caring for children with special healthcare needs in rural areas, Thailand

This study aims to understand the experiences of families of children with special healthcare needs in rural areas in Thailand. Grounded theory (GT) was employed to understand families' experiences when caring for children with special healthcare needs (CSHCN) in rural areas. Forty-three family members from thirty-four families with CSHCN participated in in-depth interviews. Interviews were recorded and transcribed. The constant comparative method was used for data analysis and coding analysis. Adjusting family's life was the emergent theory which included experiencing negative effects, managing in home environment, integrating care into a community health system, and maintaining family normalization. This study describes the process that families undergo in trying to care for CSHCN while managing their lives to maintain a sense of normalcy. This theory provides some intervention opportunities for health care professionals when dealing with the complexities in their homes, communities and other ambulatory settings throughout the disease trajectory, and also indicates the importance of taking into consideration the family's cultural background.

Assessment of Have Problems and Care Burdens of Mothers with Handicapped Children in COVID-19 Pandemic

In the study, it was aimed to evaluate the problems and care burden of mothers who have a handicapped child in the pandemic process. The population of the descriptive study consisted of the mothers of the children who came to the rehabilitation center (n = 230), and the sampling consisted of the mothers who wanted to participate in the study (n = 216). The research data were collected through social media and the data were analyzed using the mean, standard deviation, percentage and frequency measurements, independent sample t test, Oneway anova, Kruskal wallis tests in the SPSS program. In the study, Burden Interview Scale (BIS) scores of the mothers who stated that the educational status of their child was adversely affected in the pandemic, stated that they were worried that there would be someone to take care of my child if I died, stated that the child's health checks were interrupted, stated that they did not send their child to school due to the fear of COVID-19, and reported that they had a problem in reaching the health institution was determined were significantly higher than. Mothers with handicapped children stated that their children experienced difficulties in important situations such as health checks and educations during the pandemic period. In addition, it was found that the care burden of these mothers was higher. During the pandemic period, it is necessary to make and support new regulations in accordance with the disability of these special children with state policies as well as healthcare professionals.

COVID-19 impact on psychological outcomes of parents, siblings and children with intellectual disability: longitudinal before and during lockdown design

BACKGROUND

Parents of children with intellectual disability (ID) report comparatively lower levels of well-being than parents of children without ID. Similarly, children with ID, and to a lesser extent their siblings, are reported to show comparatively higher levels of behaviour and emotional problems. Psychological problems may be accentuated by restrictions associated with the COVID-19 pandemic, due to increased social, caring and economic stressors and reduced social support. However, existing studies have not been able to examine the impact of COVID-19 restrictions accounting for pre-COVID levels of well-being in these families. In a naturalistic design, we examined outcomes for parents, siblings and children with ID in a two-wave longitudinal study where Wave 2 data were gathered for some families before and some during COVID-19 restrictions.

METHODS

Parents of children with ID who took part in a Wave 2 survey pre-lockdown (n = 294) and during/post-lockdown (n = 103) completed a number of measures about their well-being and the behaviour and emotional problems of both their child with ID and their nearest-in-age sibling. These same measures had also been completed for all families 2-3 years previously in Wave 1 of the study.

RESULTS

After accounting for covariates including family socio-economic circumstances, pre-lockdown and post-lockdown groups did not differ on Waves 1 to 2 change for measures of parental psychological distress, life satisfaction, the impact of caregiving on their lives or perceived positive gains; nor child or sibling internalising or externalising behaviour problems.

CONCLUSIONS

Findings of the current study indicate that during and shortly after the COVID-19 lockdown in the United Kingdom, well-being in families of children with an ID (as reported by parents) was at similar levels compared with prior to the lockdown period.

Development of Proxy and Self-report Burn Model System Pediatric Itch Interference Scales: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study

Pruritus is a commonly reported symptom after burn injury. Valid and reliable scales to measure itch in pediatric burn survivors are important for treatment and epidemiological studies. This study sought to develop psychometrically sound, publicly available self- and proxy-report measures of itch for use in pediatric burn survivors suitable for use in research and clinical practice. A panel of burn experts developed a definition of itch interference and a set of parallel self- and proxy-report candidate items that covered important activities affected by itch. Candidate items were evaluated in cognitive interviews with pediatric burn survivors (n = 4) and proxies (n = 2). Items were translated to Spanish and administered in both English and Spanish to a sample (N = 264) of pediatric burn survivors and/or their proxy enrolled in the Burn Model System (BMS) longitudinal database. The mean age of the pediatric sample was 13 years and average time since burn 5 years. The final itch interference measures each included 5 parallel items calibrated using a one-parameter graded response item response theory model, with a mean of 50 representing the average itch interference of the sample. Reliability of the scores is excellent between the mean and two standard deviations above. Initial analyses provide support for validity of the score. Concordance between the self- and proxy-report scores was moderate (ICC = 0.68). The results support the reliability and validity of the itch scale in children and youth with burn injury. The new BMS Pediatric Itch Interference scales are freely and publicly available at https://burndata.washington.edu/itch.

Anxiety, meaning in life, self-efficacy and resilience in families with one or more members with special educational needs and disability during COVID-19 pandemic in Greece

BACKGROUND

According to World Health Organization, the COVID-19 pandemic sweeps across the world inducing considerable fear, worry and concern in the population.

AIMS

This study explores anxiety, meaning in life, self-efficacy and resilience in university students belonging to families with one or more members with SEND during the COVID-19 pandemic in Greece, the differences between participants and the regression coefficients.

METHODS & PROCEDURES

Study population consisted of 61 participants, aged 20-58 years. A Self-report Questionnaire, the Spielberger State-Trait Anxiety Inventory, the Meaning in Life Questionnaire, the General Self-Efficacy Scale, the Resilience Scale and the Brief Resilience Scale were used for data collection.

OUTCOMES & RESULTS

Participants presented higher levels of anxiety, meaning in life (presence), general self-efficacy and resilience (than average scale). Parents had higher values than university students in state anxiety, state-trait anxiety (total), meaning in life (presence) and resilience. Individuals with higher levels of resilience and meaning in life had lower anxiety levels. A significant correlation was observed for the regression coefficients according to pathway analysis.

CONCLUSIONS AND IMPLICATIONS

Families having members with SEND, although experiencing difficult situations and anxiety due to the unprecedented conditions of the pandemic, activate mechanisms, such as self-efficacy, meaning in life and resilience, to maintain their balance and mental health.

The exposure of children with and without disabilities to violent parental discipline: Cross-sectional surveys in 17 middle- and low-income countries

BACKGROUND

Children with disabilities in high-income countries are more likely than their peers to be exposed to violence. To date, only two studies have reported nationally robust data on the association between child disabilities and exposure to violent parental discipline.

OBJECTIVE

To estimate prevalence rates and adjusted rate ratios of exposure to violent parental discipline among children with and without disabilities in middle- and low-income countries.

PARTICIPANTS AND SETTING

Nationally representative samples involving a total of 206,147 children aged 2-14 from 17 countries.

METHODS

Secondary analysis of data collected in UNICEF's Multiple Indicator Cluster Surveys.

RESULTS

Children with disabilities were at significantly greater risk of exposure than children without disabilities to all eight forms of violent parental discipline and the total number of forms they were exposed to. For what could be considered the most abusive form of violent discipline (beating a child up 'as hard as one could') they were 71 % more likely to have been exposed in the previous month than other children (age and gender adjusted prevalence rate ratio = 1.71 (95 %CI 1.64-1.78), p < 0.001). Children with functioning difficulties related to poorer mental health or cognitive functioning were at significantly greater risk of exposure to violent parental discipline. In contrast, children with impairments related to sensory functioning, mobility and expressive communication were at no greater risk of exposure than children without disabilities.

CONCLUSIONS

Children with disabilities are at greater risk of exposure to all forms of violent parental discipline than children without disabilities in middle- and low-income countries.

Peer victimization and its relationship to self-esteem in children with mild intellectual disability and borderline intellectual functioning in regular and special schools: An exploratory study in urban Bengaluru

The Research in the field of mental health and educational needs of children with intellectual disabilities has increased over the years. However, the focus on milder disabilities such as mild intellectual disability and borderline intellectual functioning (MBID; intelligence quotient: 50-85) is still limited. The current study aimed at understanding peer victimization and its relationship to the self-esteem of children with MBID in regular and special schools. The study utilized a cross-sectional research design with a sample of 40 children who met the inclusion criteria. On analysis, the results showed that peer victimization was more common in regular schools (U = 51, p ≤ 0.001), wherein the peer victimization had a significant negative correlation with their self-esteem (r = -0.536, p ≤ 0.001). Overall, the findings implied the need for promotion of inclusive education in regular schools by sensitization against peer victimization of children with disabilities.

The psychosocial and economic impacts on female caregivers and families caring for children with a disability in Belu District, Indonesia

The current study aimed to understand psychosocial and economic impacts of female caregivers and families caring for children with a disability in Belu district, Indonesia. A qualitative inquiry employing one-on-one in-depth interviews was used to collect data from participants (n = 22). Data analysis was guided by a framework analysis for qualitative research. Social implications framework and the economic consequence of disease and injury framework were used to guide the conceptualisation, analysis and discussion of the findings. Findings indicated that female caregivers of children with a disability experienced significant psychosocial challenges. These included feeling frustrated, sad, angry, worried, inferior and insecure due to rejection of their children by other kids with no disability. Poor physical conditions of and negative labelling given to their children and the fear of what the future held for their children with a disability added yet another layer of psychosocial challenges experienced by these women. Separation or divorce and reduced social interaction and engagement in the community were expressed social impact loaded to these women resulting from poor acceptability of the children by their fathers, increased time spent caring and discriminatory and stigmatising attitudes against their children with a disability. The participants also experienced economic impacts, such as increased health and transport expenses, loss of jobs and productivity, and lack of savings. The findings indicate the need for programs and interventions addressing the needs of mothers or female caregivers and families with disabled children. Further studies with large number of participants covering mothers, fathers and caregivers to understand broader experiences and the need of caring for children with a disability are recommended.

Principles of disability support in rural and remote Australia: Lessons from parents and carers

This study describes the understanding, experiences and expectations of families living in rural and remote Australia regarding core concepts relating to disability service provision, including person-centred practice (PCP), family-centred practice (FCP), transdisciplinary practice (TDP), choice, control, inclusion, and equity. Thirteen parents or carers, each with a child with an intellectual disability aged between 6 and 16 years, living in rural and remote areas as described by the Australian Standard Geographical Classification - Remoteness Area (ASGC-RA) and Modified Monash Model (MMM) - were recruited through distribution of flyers (hard copies or by email) to clinicians, schools, and advocacy agencies. Semi-structured interviews were conducted with participants either in-person or via telephone between July and October 2015. Data were analysed using thematic analysis. Participants reported that their understanding of many of the disability principles (PCP, FCP, choice, control, inclusion, and equity) was different from providers, and that many providers struggled to understand families, and therefore they did not share meaning of the principles of best practice disability supports. Families did not identify transdisciplinary practice as a core issue or tenet of effective service delivery. Families also reported experiences of missing out on services, feeling a sense of isolation in their communities, struggling to access skilled therapists, and difficulty finding supports and goals that were relevant to their child. The quality of supports that these families accessed was often below the standard that they expected. They did not expect that support standards will change in rural and remote Australia, so many have very low expectations of the National Disability Insurance Scheme (NDIS) in the future. Although more data will need to be collected as the NDIS and its markets mature, these data show that many rural and remote participants and their supporters have a variety of concerns about how they will access quality allied health services through the Scheme.

Health challenges of mothers with special needs children in Pakistan and the importance of integrating health social workers

There is concern that mothers of special needs children in developing countries like Pakistan are neglected populations facing hidden health challenges. The aim of this study was to investigate the kinds of health challenges mothers experience and to highlight the role of health social workers in supporting the needs of mothers. Twenty-one mothers were sampled across three cities and findings were analyzed through a thematic content analysis approach. Findings revealed that mothers faced significant and salient challenges under eight sub-categories of mental health and six sub-categories of physical health. We recommend that health social workers collaborate with healthcare practitioners to improve health services for mothers and also coordinate with other social workers, community members, and policymakers for improving both social and structural support for special needs families.

Global prevalence estimates of three chronic musculoskeletal conditions: club foot, juvenile idiopathic arthritis and juvenile systemic lupus erythematosus

BACKGROUND

Musculoskeletal (MSK) conditions are a major source of morbidity and disability. There is a lack of global comparable data on the burden of MSK conditions in children and young people. Our aim was to estimate the global prevalence of three MSK conditions - Talipes Equinovarus (Clubfoot), Juvenile Idiopathic Arthritis (JIA) and Juvenile Systemic Lupus Erythematosus (JSLE).

METHODS

Using reported prevalence rates, age-stratified population data within the World Bank Data Bank in 2017 and United Nations country classification, we estimated the prevalence of these MSK conditions in < 5 year olds (clubfoot) and < 16 year olds (JIA and JSLE) across the world.

RESULTS

We estimated that in 2017, there were ~ 675,061 < 5 year olds with clubfoot among 675,100,000 < 5 year olds, ~ 2,069,246 < 16 year olds with JIA and ~ 206,931 < 16 year olds with JSLE per 2,069,000,000 < 16 year olds, totalling ~ 2,951,238 with one of these conditions. Disease prevalence was greatest in Asia (South Asia), followed by Africa, Americas, Europe and Oceania.

CONCLUSIONS

An estimated 3 million children and young people globally are currently living with either clubfoot, JIA or JSLE; many in Asia and Africa. Further work is needed urgently to engage with global stakeholders to work together to improve access to effective care for the many who are affected and reduce the otherwise adverse lifelong impact on their health, quality of life and the impact on society.

Exploring factors influencing the use of an eHealth intervention for families of children with hearing loss: An application of the COM-B model

BACKGROUND

Prior to developing a successful eHealth intervention, it is important that we explore stakeholders' capacity to adapt to eHealth.

OBJECTIVE

To explore what factors influence the use eHealth services from the perspectives of families of children with hearing loss and professionals who support families as they transition into early intervention.

METHODS

A qualitative study incorporating semi-structured in-depth interviews was conducted with families (n = 17) and professionals (n = 11). Interview topic guides were developed based on the COM-B model of behaviour change to explore barriers and facilitators related to capability, opportunity, and motivation.

RESULTS

The COM-B model captured several factors that may influence the use eHealth interventions for families of children with hearing loss. The capability factors included computer literacy and familiarity with social media. The opportunity factors were access to online resources, reliable Internet, and affordable equipment. Professionals' and families' preferences and a culture of face-to-face services were also identified as barriers for using eHealth. The motivation factors included families' and professionals' confidence in using technology and beliefs that there were benefits (e.g., saving travel) associated with using eHealth services. In contrast, beliefs that eHealth may be difficult to set up and not able to replace in-person communication identified as barriers to families and professionals adopting eHealth interventions.

CONCLUSION

Findings of this study indicated that implementation of an eHealth intervention could be facilitated by addressing the barriers in stakeholders' capabilities, opportunities (e.g., equipment and social support), and motivation (e.g., negative beliefs about eHealth) before developing eHealth services.

Twice Exceptional Students: Gifts and Talents, the Performing Arts, and Juvenile Delinquency

There is an increasing attention to the phenomenon referred to as "twice exceptional" ("2e") children, namely, children who demonstrate both exceptional abilities and disabilities. In this essay, this concept is applied to delinquency and/or emotional-behavior disorder and gifts (talents) in the performance arts, exploring the presence of this association and the support for it in the literature. The essay asserts that this association does exist, qualifies these youth as another category of 2e students, and calls for research on the manifestation, etiology, and development of this co-occurrence.

A Meta-analysis of Challenging Behavior Interventions for Students with Developmental Disabilities in Inclusive School Settings

Challenging behavior is a significant barrier in accessing the general education curriculum for students with developmental disabilities. This necessitates the identification of evidence-based practices for addressing challenging behavior in inclusive settings. The purpose of our meta-analysis is to (a) quantify the magnitude of effect of interventions targeting the reduction of challenging behavior in students with developmental disabilities in inclusive educational settings and (b) determine if participant and intervention characteristics moderate intervention effects. A systematic search of academic databases was conducted to identify studies, which were evaluated for methodological rigor and analyzed for effects using Tau-U. Results indicate a strong overall effect of .94 (95% CI [.87, 1]) and moderating variables associated with behavior topography, interventionist, and intervention components were identified.

1000 Families Study, a UK multiwave cohort investigating the well-being of families of children with intellectual disabilities: cohort profile

PURPOSE

The 1000 Families Study is a large, UK-based, cohort of families of children with intellectual disability (ID). The main use of the cohort data will be to describe and explore correlates of the well-being of families of children with ID, including parents and siblings, using cross-sectional and (eventually) longitudinal analyses. The present cohort profile intends to describe the achieved cohort.

PARTICIPANTS

Over 1000 families of UK children with ID aged between 4 and 15 years 11 months (total n=1184) have been recruited. The mean age of the cohort was 9.01 years old. The cohort includes more boys (61.8%) than girls (27.0%; missing 11.1%). Parents reported that 45.5% (n=539) of the children have autism. Most respondents were a female primary caregiver (84.9%), and 78.0% were the biological mother of the cohort child with ID. The largest ethnic group for primary caregivers was White British (78.5%), over half were married and living with their partner (53.3%) and 39.3% were educated to degree level.

FINDINGS TO DATE

Data were collected on family, parental and child well-being, as well as demographic information. Wave 1 data collection took place between November 2015 and January 2017, primarily through online questionnaires. Telephone interviews were also completed by 644 primary caregivers.

FUTURE PLANS

Wave 2 data collection is ongoing and the research team will continue following up these families in subsequent waves, subject to funding availability. Results will be used to inform policy and practice on family and child well-being in families of children with ID. As this cohort profile aims to describe the cohort, future publications will explore relevant research questions and report key findings related to family well-being.

Health-Related Quality of Life in Children With Low Language or Congenital Hearing Loss, as Measured by the PedsQL and Health Utility Index Mark 3

OBJECTIVES

To examine health-related quality of life (HRQoL) in young children with low language or congenital hearing loss and to explore the value of assessing HRQoL by concurrently administering 2 HRQoL instruments in populations of children.

METHODS

Data were from 2 Australian community-based studies: Language for Learning (children with typical and low language at age 4 years, n = 1012) and the Statewide Comparison of Outcomes study (children with hearing loss, n = 108). HRQoL was measured using the parent-reported Health Utilities Index Mark 3 (HUI3) and the Pediatrics Quality of Life Inventory 4.0 (PedsQL) generic core scale. Agreement between the HRQoL instruments was assessed using intraclass correlation and Bland-Altman plots.

RESULTS

Children with low language and with hearing loss had lower HRQoL than children with normal language; the worst HRQoL was experienced by children with both. The lower HRQoL was mainly due to impaired school functioning (PedsQL) and speech and cognition (HUI3). Children with hearing loss also had impaired physical and social functioning (PedsQL), vision, hearing, dexterity, and ambulation (HUI3). Correlations between instruments were poor to moderate, with low agreement.

CONCLUSIONS

Children with low language and congenital hearing loss might benefit from interventions targeting overall health and well-being, not just their impairments. The HUI3 and PedsQL each seemed to provide unique information and thus may supplement each other in assessing HRQoL of young children, including those with low language or congenital hearing loss.

Shame, Suffering, and Believing in the Family: The Experiences of Grandmothers of a Grandchild With a Developmental Delay or Disability in the Context of Chinese Culture

Grandparents are primary resources of caregiving support for parents worldwide, regardless of the cultural background. In Chinese societies, grandmothers often fill the role of supportive caregiver. However, a knowledge gap in the literature exists about how Chinese culture influences caregiving for grandmothers of grandchildren with a disability, particularly in Taiwan. This phenomenological study explored the lived experience of grandmothers caring for a grandchild with a developmental delay or disability in the context of Chinese culture. Twenty-five grandmothers were interviewed. When grandmothers learned of their grandchild's disability, they experienced suffering, which was compounded by the stigma attached to persons with a disability in Chinese cultures, and they also experienced shame and fear of social rejection. Grandmothers' belief in the importance of family gave meaning to their suffering and prompted them to find new ways to deal with everyday difficulties. These findings can guide nurses and health care professionals responsible for supporting grandmothers caring for a child with a disability in the context of Chinese culture.

Parental Beliefs and Feelings about Autism Spectrum Disorder in Iran

BACKGROUND

This study provides information on beliefs that parents of children with autism hold in Iran. The main focus is on their beliefs about the cause and the way that this condition is explained based on the first signs that made them be concerned for their children.

METHOD

To attain the aims of this study, 43 parents of children with ASD (27 mothers and 16 fathers) were recruited and interviewed in two sessions in their home. A mixed method approach was used to understand Iranian parents' reaction to receive diagnosis for their children.

RESULTS

Based on findings for the identification, description, and treatment of ASD in Iran, it is argued that since Iranian parents had their special justification regarding their experience with ASD, early child development and interventions must be understood within cultural context. Culturally informed research on ASD is vital to boost awareness of the importance of understanding parental concerns and their need for educational and psychological services in countries in which autism is less known, undiagnosed, misdiagnosed, or even stigmatized. Understanding the difference in ASD meaning across cultures urges stakeholders such as service providers and policymakers to accept and appreciate cultural and individual diversities in the present century.

Caring for the Youngest Students: The ABCs of Preschool Nursing

Caring for the preschool population presents unique challenges for the school nurse. These challenges are multiplied when the population includes those with special needs. Challenges include multiple risks to safety related to developmental stage, increased prevalence of infectious diseases due to the development of the child's immune system, management of chronic disease because of the student's ability to comprehend and follow directions, and many social and emotional issues. Using evidence-based strategies, the preschool nurse can gain the confidence to care for the youngest students.

Language nutrition for language health in children with disorders: a scoping review

The quantity and quality of child-directed speech-language nutrition-provided to typically-developing children is associated with language outcomes-language health. Limited information is available about child-directed speech to children at biological risk of language impairments. We conducted a scoping review on caregiver child-directed speech for children with three clinical conditions associated with language impairments-preterm birth, intellectual disability, and autism-addressing three questions: (1) How does child-directed speech to these children differ from speech to typically-developing children? (2) What are the associations between child-directed speech and child language outcomes? (3) How convincing are intervention studies that aim to improve child-directed speech and thereby facilitate children's language development? We identified 635 potential studies and reviewed 57 meeting study criteria. Child-directed speech to children with all conditions was comparable to speech to language-matched children; caregivers were more directive toward children with disorders. Most associations between child-directed speech and outcomes were positive. However, several interventions had minimal effects on child language. Trials with large samples, intensive interventions, and multiple data sources are needed to evaluate child-directed speech as a means to prevent language impairment. Clinicians should counsel caregivers to use high quality child-directed speech and responsive communication styles with children with these conditions.

The Unmet Needs of Parents of Highly Dependent Children with Cerebral Palsy

The overall care for children with cerebral palsy (CP) is challenging to the family which causes significant impacts to their livelihood. There is limited qualitative research that reports the unmet needs of parents with physically disabled children, especially highly dependent CP. The aim of this study was to explore the unmet needs of parents of highly dependent children with CP. A qualitative study using semi-structured face to face interviews was carried out among nine parents of children with CP with gross motor classification function score (GMFCS) levels III, IV, and V. The interviews were tape-recorded and transcribed verbatim. Transcribed data was analysed using thematic analysis method. Several unmet needs were highlighted by the parents; namely the needs in receiving information regarding CP conditions, getting psychological and financial support and explaining the child's condition to strangers. In addition, parents expressed the need for better support from the social welfare department, as well as in effectively organising family functioning. The findings of this study indicate that there is a need for the healthcare professionals to develop suitable strategies to assist the parents of highly dependent children with CP in fulfilling their specific needs. The role of relevant agencies should be optimised in addressing this area of concern.

A Pilot Acceptability Study of an 'AllPlay Pre-Learn' Day Program to Facilitate Participation in Organised Physical Activity for Children with Disabilities

In a mixed-methods design, the current study aimed to evaluate the acceptability of a junior Australian rules football program across two ‘AllPlay Pre-Learn’ days for children aged 5–11 years with disabilities, based on parent and child responses. Three online surveys were created by health professionals based on existing participation models. Surveys were completed by parents immediately before (n = 23), after the ‘Pre-Learn’ days (n = 15) and following the conclusion of the community version of the program (n = 13). Quantitative findings indicated significant improvements in child ratings around enjoyment of the sport. Qualitative analyses generated three themes around enjoyment in a low-stress environment; the education provided around the sport for parents/children; and, contemplation about playing the football program within their community. Four families (22% of the original attendees) went on to play the sport within a community setting. Despite acknowledged limitations, this study demonstrates preliminary evidence in support of an ‘AllPlay Pre-Learn’ day as a stepping stone to facilitate later participation in a football program within a child’s community. Increased participation would allow children to experience the benefits associated with sport participation, such as motor and social skill development.

Family-centered practices and the parental well-being of young children with disabilities and developmental delay

BACKGROUND

Research evidence from studies in North America on the relationships between family-centered practices, parents' self-efficacy beliefs, parenting confidence and competence beliefs, and parents' psychological well-being was used to confirm or disconfirm the same relationships in two studies in Spain.

AIMS

The aim of Study 1 was to determine if results from studies in North America could be replicated in Spain and the aim of Study 2 was to determine if results from Study 1 could be replicated with a second sample of families in Spain.

METHODS AND PROCEDURES

A survey including the study measures was used to obtain data needed to evaluate the relationships among the variables of interest. The participants were 105 family members in Study 1 and 310 family members in Study 2 recruited from nine early childhood intervention programs. Structural equation modeling was used to test the direct and indirect effects of the study variables on parents' well-being.

OUTCOMES AND RESULTS

Results showed that family-centered practices were directly related to both self-efficacy beliefs and parenting beliefs, and indirectly related to parents' psychological well-being mediated by belief appraisals.

CONCLUSION AND IMPLICATIONS

The pattern of results was similar to those reported in other studies of family-centered practices. Results indicated that the use of family-centered practices can have positive effects on parent well-being beyond that associated with different types of belief appraisals.

Attachment of family to child with disability

The development of attachment during the perinatal and/or postnatal periods between a child their mother, father and family as whole can be observed. This attachment provides the child with the safety and security feelings and may provide satisfaction to the mother and other family members. In children with physical and mental developmental disability, attachment may be challenged immediately after birth. It is typically recovered after a certain period. The authors describe the development of attachment of family members to children with somatic, mental or social disability based on an analysis of nine case reports. They conclude that the attachment of parents/mothers to their child with a disability is typically established after a certain period of time only. In the first period, there is a caregiving attitude of the mother even though the period of the origination of this tie takes place later. The mother is most frequently the person establishing attachment. However, this is not always the rule. In our cases, there were two fathers, who made the attachment earlier than respective mothers. Attachment was also evident in some grandparents and siblings. The parents, mostly the fathers, can lose the attachment established. Analysis of the degree of attachment to the child by parents may be complicated due to difficulty in assessing the extent and degree of the attachment of children with severe disabilities to their parents.

Age-sensitive associations of segmental and suprasegmental perception with sentence-level language skills in Mandarin-speaking children with cochlear implants

BACKGROUND AND AIM

It remains unclear how recognition of segmental and suprasegmental phonemes contributes to sentence-level language processing skills in Mandarin-speaking children with cochlear implants (CIs). Our study examined the influence of implantation age on the recognition of consonants, lexical tones and sentences respectively, and more importantly, the contribution of phonological skills to sentence repetition accuracy in Mandarin-speaking children with CIs.

METHODS

The participants were three groups of prelingually deaf children who received cochlear implants at various ages and their age-matched controls with normal hearing. Three tasks were administered to assess their consonant perception, lexical tone recognition and language skills in open-set sentence repetition.

RESULTS

Children with CIs lagged behind NH peers in all the three tests, and performances on segmental, suprasegmental and sentence-level processing were differentially modulated by implantation age. Furthermore, performances on recognition of consonants and lexical tones were significant predictors of sentence repetition accuracy in the children with CIs.

CONCLUSION

Overall, segmental and suprasegmental perception as well as sentence-level processing is impaired in Mandarin-speaking children with CIs compared with age-matched children with NH. In children with CIs recognition of segmental and suprasegmental phonemes at the lower level predicts sentence repetition accuracy at the higher level. More importantly, implantation age plays an important role in the development of phonological skills and higher-order language skills, suggesting that age-appropriate aural rehabilitation and speech intervention programs need to be developed in order to better help CI users who receive CIs at different ages.

Deliberate Self-Harm Among Chinese Children with Different Types and Severity of Disabilities

Background: The aims of this study were to determine the prevalence of deliberate self-harm (DSH) and to compare the risk of self-harm in Chinese children with different types and severity of disabilities. Methods: Participants were 1300 children aged 6–17 years in Beijing, China; 650 children with disabilities and 650 healthy peers matched on age, gender and residence district. Questionnaires were completed anonymously by parents or children if the age or disability made it necessary. The associations between the disability type, severity and DSH were examined using the Chi-square testing and logistic regression models. Results: Children with a single disability or multiple disabilities had statistically higher rates of DSH than children without disabilities (15.6% and 39.7% compared to 10.9%). The prevalence of DSH was associated with the severity of disability, being 36.2% among children with level 1 (the most severe) disability, 19.8% among children with level 2 disability, and 9.2% among children with level 3 + 4 disability. The multivariable odds ratio (OR) of DSH among children with any disability was statistically higher than that among children without a disability (OR = 2.40; 95% CI = 1.71, 3.36; p < 0.05). Children with multiple disabilities (OR = 6.89; 95% CI: 4.24–11.20) and level 1 severity of disability (OR = 6.11; 95% CI: 3.91–9.56) had the highest risk of DSH. Conclusions: This study clearly demonstrated associations between the severity and type of disability and DSH. This finding highlights the importance of DSH in children with disabilities, and underlines the importance of the prevention of DSH among a vulnerable pediatric population in China.

Healthy for Life Pilot Study: A Multicomponent School and Home Based Physical Activity Intervention for Disadvantaged Children

The study aimed to develop and evaluate a multicomponent school and home based physical activity (PA) intervention in children in grades 3–7 (aged 8–13 years) and determine the psychological variables that influence PA; 10 × 1 h school-based training sessions, a home-based activity program and 4 × 1 h lifestyle workshops for parents. PA was assessed at an intervention and nearby control school using accelerometers and self-report at 3-time points: baseline, post intervention and 10-week follow-up. Self-efficacy, self-management strategies, enjoyment, perceived barriers to PA, outcome-expectancy and social support were evaluated. The study showed 73% of the children with complete data sets at the intervention school (n = 27) did not increase device measured moderate to vigorous PA (MVPA) in the after-school period (3 p.m. to 6 p.m.) or over the whole day or during school break time immediately following the intervention or at follow-up, as compared to 70% of children with complete data sets at the control school (n = 35; p > 0.05 for all). Overall, 59% of boys attained more than double the recommended 120 min of MVPA each day compared to 42% of girls (p = 0.013). At the baseline, children’s self-reported PA in the intervention school positively correlated with: outcome expectancy (R = 0.240, p = 0.015), enjoyment (R = 0.339, p < 0.001), self-efficacy (R = 0.399, p < 0.001), self-management (R = 0.617, p < 0.001), social support at home (R = 0.406, p < 0.001), and social support at school (R = 0.407, p < 0.001). Similar relationships were observed after the intervention and at follow-up. Focus groups with the children, parents and interviews with teachers identified areas for improvement of the intervention. In conclusion, while the multifaceted approach to improve PA was ineffective over the time span of the study, important predictors of PA in this sample of disadvantaged children were identified.

Oral Care Experiences of Latino Parents/Caregivers with Children with Autism and with Typically Developing Children

As a result of various barriers, several pediatric populations are at risk for poor oral health, including children with disabilities and children from under-represented populations, such as Latinos. To this end, this study aimed to better understand the factors that affect the oral health experiences of 32 Latino parents/caregivers from 18 families (n = 8 with a typically developing child and n = 10 with a child with Autism). Using a qualitative descriptive methodology, each family was interviewed twice. Interviews were audio-recorded, transcribed verbatim, and coded thematically to identify the individual, social, systemic, and culturally rooted factors contributing to oral health disparities in the families. The three themes that arose were "Why would I want to start trouble?": Latino parents' dissatisfaction with dental treatments, costs, and fear of the dentist and health care providers because of their ethnic minority status as key factors inhibiting receipt of dental care; "We have to put our children first": prioritizing the oral care activities of their children over their own individual oral care needs; and "We always keep baking soda around": familial and cultural influences on oral care habits. Understanding the oral health beliefs and experiences of Latino parents and caregivers of children with and without autism is critical for developing targeted prevention and intervention programs and reducing oral health disparities.

Social support and post-crisis growth among mothers of children with autism spectrum disorder and mothers of children with down syndrome

BACKGROUND

Raising a child with special needs challenges mothers in complicated ways, yet, alongside these difficulties, there is evidence for maternal post-crisis growth. Social support is one element that may contribute to growth.

AIMS

This study explores the relationship between social support and post-crisis growth, examines type of disability as a mediating variable between support and growth, and, looks at the relations between subtypes of support and growth.

METHODS & PROCEDURES

Participants included 99 mothers of children with Autism Spectrum Disorder (ASD) and 119 mothers of children with Down Syndrome (DS). Mothers completed three self-report questionnaires: demographic, Multidimensional Scale of Perceived Social Support, and the Stress-Related Growth Scale.

RESULTS

Social support was found to predict maternal post-crisis growth with type of disability serving as a mediating variable between them, such that social support contributes to post-crisis growth only among mothers of children with ASD. In addition, results revealed various correlations between types of support and types of growth.

CONCLUSIONS & IMPLICATIONS

The findings indicate that compared to DS, characteristics of ASD may contribute to less maternal post-crisis growth, and that social support serves as an important predictor for growth in this group. Finding ways to increase social support for mothers of children with ASD thus gains additional importance.

Examining relationships between child skills and potential key components of an evidence-based practice in ASD

BACKGROUND

Research in autism spectrum disorders (ASD) has identified a need to understand key components of complex evidence-based practices (EBP). One approach involves examining the relationship between component use and child behavior.

AIMS

This study provides initial evidence for identifying key components in a specific EBP, Pivotal Response Training (PRT). We examined which components were related to child response and evaluated relationships between provider characteristics, child characteristics and component intensity.

METHODS

Trained coders reviewed archival videos (n = 278) for PRT fidelity and child behavior. We completed multi-level regression and latent profile analysis to examine relationships between intensity of individual or combinations of PRT components and child behavior, and moderators of component use.

RESULTS

Analyses indicated differential relationships between specific components and child behaviors which may support methods of altering intensity of components to individualize intervention. Profile analysis suggested relatively intensive use of most PRT components, especially antecedent strategies, may maximize child responsivity. Providers with postgraduate education trended toward higher intensity component use. Child characteristics did not moderate use.

IMPLICATIONS

Careful examination of key components of ASD interventions may helps clarify the mechanisms of action. Recommendations specific to PRT implementation and use of the methodology for other interventions are discussed.

Pediatric palliative care in the medical neighborhood for children with medical complexity

Children with medical complexity (CMC) are a medically fragile pediatric population that experience severe chronic illnesses resulting in significant health care needs, functional limitations, and health care utilization, and are at the highest risk for morbidity and mortality among all children. Furthermore, families and parents of CMC experience significant caregiver hardships and diminished quality of life. The field of pediatric palliative care has grown in recent years, in part to address the physical and psychosocial issues inherent to the care of these chronically ill children. However, as the prevalence and long-term survival of CMC increases with medical advancements, the demand for pediatric palliative care will likely exceed the capacity of current and future pediatric palliative care specialists. Therefore, alternative strategies to ensure access to essential aspects of palliative care must be considered. This article focuses on why and how high-quality palliative care should be integrated into the patient- and family-centered medical home, the ideal care delivery model for CMC and their families. We first discuss how palliative care principles naturally align with and complement the goals of the CMC medical home. Next, we detail what actions pediatric palliative care specialists can take to best support the CMC medical home as "medical neighbors." Lastly, we describe the fundamental aspects of pediatric palliative care that all clinicians caring for CMC should be able to provide, referred to as "primary pediatric palliative care." (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impacts of early powered mobility provision on disability identity: A case study

BACKGROUND/PURPOSE

Providing powered mobility technology to people with disabilities is a common rehabilitation practice. However, the relationship between powered mobility introduction and identity development, when considered in the context of lived experiences of children with disabilities and their families, is not well understood. Investigating this relationship is timely given the emergence of alternative, community-based early mobility opportunities using adapted mobility toys whose impact may contrast experiences using powered wheelchairs typically provided in rehabilitation settings.

METHOD

Using a qualitative, ethnographic case study approach, in-depth interview and field observation data were collected with 2 children and families, 1 who received a traditional powered wheelchair and the other who received an adapted mobility toy. A grounded theory approach guided the data analysis, and emerging themes were discussed until consensus was reached between Heather Feldner and families.

RESULTS

Findings revealed four themes: (1) dys/function of mobility technology; (2) daily Life, play, and participation; (3) emerging self/advocacy; and (4) complex family/industry interplay.

CONCLUSION

Similarities and differences were present within the situated experiences of each family. Experiences were foregrounded by instances of emerging identity development throughout provision processes that were influenced by caregiver perceptions of disability (positive vs. negative), aesthetics and function (medical vs. adventure), and perceived intent of the devices (an opportunity for freedom vs. prolonging need for undesired mobility equipment). These findings highlight the varied dynamics and spheres of influence this transaction may have on the developing identity of children with disabilities, which may ultimately help inform future models of provision and rehabilitation practices. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effect of mobile technology featuring visual scene displays and just-in-time programming on communication turns by preadolescent and adolescent beginning communicators

PURPOSE

Visual scene displays (VSDs) and just-in-time programming supports are augmentative and alternative communication (AAC) technology features with theoretical benefits for beginning communicators of all ages. The goal of the current study was to evaluate the effects of a communication application (app) on mobile technology that supported the just-in-time programming of VSDs on the communication of preadolescents and adolescents who were beginning communicators.

METHOD

A single-subject multiple-baseline across participant design was employed to evaluate the effect of the AAC app with VSDs programmed just-in-time by the researcher on the communication turns expressed by five preadolescents and adolescents (9-18 years old) who were beginning communicators.

RESULT

All five participants demonstrated marked increases in the frequency of their communication turns after the onset intervention.

CONCLUSION

Just-in-time programming support and VSDs are two features that may positively impact communication for beginning communicators in preadolescence and adolescence. Apps with these features allow partners to quickly and easily capture photos of meaningful and motivating events and provide them immediately as VSDs with relevant vocabulary to support communication in response to beginning communicators' interests.

The impact of temporomandibular joint arthritis on functional disability and global health in patients with juvenile idiopathic arthritis

OBJECTIVES

The objective of the study was to evaluate the impact of temporomandibular joint (TMJ) arthritis on the functional disability and quality of life in patients affected by juvenile idiopathic arthritis (JIA).

MATERIALS AND METHODS

Sixty-two consecutive patients with JIA with or without TMJ arthritis and 35 healthy control subjects were enrolled in the study. The demographic data, disease activity and clinical characteristics were obtained from all patients. The functional disability was assessed using the Italian version of the Childhood Health Assessment Questionnaire (C-HAQ). The oral health-related quality of life (OHRQoL) was assessed using the Child Perception Questionnaire (CPQ11-14). Possible determining factors of TMJ arthritis comprised demographic, disease characteristics and scores derived from questionnaires that were assessed by a uni and multivariable logistic regression analysis.

RESULTS

Compared with patients without TMJs arthritis, JIA patients with TMJ arthritis presented higher functional disability. The multivariable logistic regression analysis performed showed that female subjects (OR = 1.5, P = 0.041), with a JIA duration over 3.9 years (OR = 2.7, P = 0.033) and presenting higher C-HAQ and CPQ11-14 scores (OR = 2.7, P = 0.012 and OR = 2.9, P = 0.015, respectively) were the greatest determining factors for TMJ arthritis.

CONCLUSIONS

JIA patients with TMJ arthritis presented higher functional disability and lower OHRQoL scores compared with JIA patients without TMJ arthritis. TMJ arthritis was strongly associated with JIA duration and activity, especially in female patients.

Disability differentials in educational attainment in England: primary and secondary effects

Childhood disability has been largely overlooked in social stratification and life course research. As a result, we know remarkably little about mechanisms behind well-documented disability differentials in educational outcomes. This study investigates educational transitions of disabled youth using data from the Longitudinal Study of Young People in England. We draw on social stratification literature on primary and secondary effects as well as that on stigma and labelling in order to explain disabled young people's educational outcomes. We find that disability differentials in transition rates to full-time academic upper secondary education and to university are largely the result of primary effects, reflected in differences in school performance between disabled and non-disabled young people. However, we also find evidence for secondary effects, with similarly achieving disabled young people less likely to pursue full-time academic upper secondary education compared to their non-disabled peers. We examine the extent to which these effects can be explained by disabled youth's suppressed educational expectations as well as their experiences of being bullied at school, which we link to the stigma experienced by disabled young people and their families. We find that educational expectations play an important role at crucial transitions in the English school system, while the effect of bullying is considerably smaller. By drawing attention to different social processes contributing to disability differentials in attainment, our study moves beyond medical models that implicitly assume a naturalized association of disability with poor educational outcomes, and demonstrates the parallels of disability with other ascriptive inequalities.

Systematic Review and Meta-analysis of Stepping Stones Triple P for Parents of Children with Disabilities

The aim of this systematic review and meta-analysis was to examine the effectiveness of Stepping Stones Triple P (SSTP) parent training programs on child behavior problems and parenting outcomes in families of children with developmental disabilities. Sixteen suitable studies including data from over 900 families were identified in a search for English language published and unpublished controlled outcome studies. SSTP has five levels on a graded continuum of increasing intensity targeting families with differing degrees of treatment need from low intensity media-based parenting information campaigns at level 1, through brief interventions at levels 2 and 3, to more intensive parent training and family therapy interventions at levels 4 and 5. Analyses were conducted on the combination of all levels of SSTP and separately for each level. For combined levels, significant overall effect sizes were found for parent-reported child problems (d = 0.46), researcher observed child behavior (d = 0.51), parenting style (d = 0.70), parenting satisfaction/self-efficacy (d = 0.44), parental adjustment (d = 0.27), and coparental relationship (d = 0.26), but not researcher-observed parent behavior. Strong support was found for level 4 SSTP as an effective intervention for improving child and parent outcomes in families of children with disabilities who have clinically significant problems. Less intensive SSTP interventions for cases with circumscribed difficulties yielded fewer significant treatment effects, and there were relatively few studies of such interventions.

"A child who is hidden has no rights": Responses to violence against children with disabilities

BACKGROUND

There is an urgent need to understand how best to prevent and respond to violence against children with disabilities as they are at a high risk for violence because they are marginalized, isolated, and targeted and have little power within their communities.

OBJECTIVE

Guided by social-ecological theory, this study explores responses to violence against children with disabilities, including preventative measures and treatment of victims in the West African countries of Guinea, Niger, Sierra Leone, and Togo.

PARTICIPANTS

Participants were recruited using purposive and snowball sampling from the following three groups: disability stakeholders including representatives from local, national, and international organizations and governments; community members including parents, teachers, and leaders; and children with disabilities.

METHODS

A qualitative study design guided data generation, that included document analysis, semi-structured interviews, and focus groups across the four countries. In total, 419 people participated. Of those participants, 191 took part in an interview and the rest participated in one of 55 focus groups.

FINDINGS

Responses to disability-based violence are driven at the mesosystem and exosystem levels. Prevailing views indicated that national level policies and laws are not always considered part of solutions, communities are leading responses to violence, and children with disabilities are hidden at home or in institutions for both their own and their family's safety. Conclusions The findings can inform development of prevention and intervention programs that will protect children with disabilities from violence in contexts with high levels of disability stigma, social conflict, violence, and poverty.