scholarly journals A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCT

2021 ◽  
Vol 25 (29) ◽  
pp. 1-84
Author(s):  
Christine O’Farrelly ◽  
Beth Barker ◽  
Hilary Watt ◽  
Daphne Babalis ◽  
Marian Bakermans-Kranenburg ◽  
...  
Keyword(s):  
At Risk ◽  
Confidence Interval ◽  
Usual Care ◽  
Service Use ◽  
Child Behaviour ◽  
Strengths And Difficulties Questionnaire ◽  
Behaviour Problems ◽  
Child Behaviour Checklist ◽  
Strengths And Difficulties

Background Behaviour problems emerge early in childhood and place children at risk for later psychopathology. Objectives To evaluate the clinical effectiveness and cost-effectiveness of a parenting intervention to prevent enduring behaviour problems in young children. Design A pragmatic, assessor-blinded, multisite, two-arm, parallel-group randomised controlled trial. Setting Health visiting services in six NHS trusts in England. Participants A total of 300 at-risk children aged 12–36 months and their parents/caregivers. Interventions Families were allocated in a 1 : 1 ratio to six sessions of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) plus usual care or usual care alone. Main outcome measures The primary outcome was the Preschool Parental Account of Children’s Symptoms, which is a structured interview of behaviour symptoms. Secondary outcomes included caregiver-reported total problems on the Child Behaviour Checklist and the Strengths and Difficulties Questionnaire. The intervention effect was estimated using linear regression. Health and social care service use was recorded using the Child and Adolescent Service Use Schedule and cost-effectiveness was explored using the Preschool Parental Account of Children’s Symptoms. Results In total, 300 families were randomised: 151 to VIPP-SD plus usual care and 149 to usual care alone. Follow-up data were available for 286 (VIPP-SD, n = 140; usual care, n = 146) participants and 282 (VIPP-SD, n = 140; usual care, n = 142) participants at 5 and 24 months, respectively. At the post-treatment (primary outcome) follow-up, a group difference of 2.03 on Preschool Parental Account of Children’s Symptoms (95% confidence interval 0.06 to 4.01; p = 0.04) indicated a positive treatment effect on behaviour problems (Cohen’s d = 0.20, 95% confidence interval 0.01 to 0.40). The effect was strongest for children’s conduct [1.61, 95% confidence interval 0.44 to 2.78; p = 0.007 (d = 0.30, 95% confidence interval 0.08 to 0.51)] versus attention deficit hyperactivity disorder symptoms [0.29, 95% confidence interval –1.06 to 1.65; p = 0.67 (d = 0.05, 95% confidence interval –0.17 to 0.27)]. The Child Behaviour Checklist [3.24, 95% confidence interval –0.06 to 6.54; p = 0.05 (d = 0.15, 95% confidence interval 0.00 to 0.31)] and the Strengths and Difficulties Questionnaire [0.93, 95% confidence interval –0.03 to 1.9; p = 0.06 (d = 0.18, 95% confidence interval –0.01 to 0.36)] demonstrated similar positive treatment effects to those found for the Preschool Parental Account of Children’s Symptoms. At 24 months, the group difference on the Preschool Parental Account of Children’s Symptoms was 1.73 [95% confidence interval –0.24 to 3.71; p = 0.08 (d = 0.17, 95% confidence interval –0.02 to 0.37)]; the effect remained strongest for conduct [1.07, 95% confidence interval –0.06 to 2.20; p = 0.06 (d = 0.20, 95% confidence interval –0.01 to 0.42)] versus attention deficit hyperactivity disorder symptoms [0.62, 95% confidence interval –0.60 to 1.84; p = 0.32 (d = 0.10, 95% confidence interval –0.10 to 0.30)], with little evidence of an effect on the Child Behaviour Checklist and the Strengths and Difficulties Questionnaire. The primary economic analysis showed better outcomes in the VIPP-SD group at 24 months, but also higher costs than the usual-care group (adjusted mean difference £1450, 95% confidence interval £619 to £2281). No treatment- or trial-related adverse events were reported. The probability of VIPP-SD being cost-effective compared with usual care at the 24-month follow-up increased as willingness to pay for improvements on the Preschool Parental Account of Children’s Symptoms increased, with VIPP-SD having the higher probability of being cost-effective at willingness-to-pay values above £800 per 1-point improvement on the Preschool Parental Account of Children’s Symptoms. Limitations The proportion of participants with graduate-level qualifications was higher than among the general public. Conclusions VIPP-SD is effective in reducing behaviour problems in young children when delivered by health visiting teams. Most of the effect of VIPP-SD appears to be retained over 24 months. However, we can be less certain about its value for money. Trial registration Current Controlled Trials ISRCTN58327365. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 29. See the NIHR Journals Library website for further project information.

scholarly journals Factor structure of the SDQ and longitudinal associations from pre-school to pre-teen in New Zealand

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247932
Author(s):  
John M. D. Thompson ◽  
Rebecca F. Slykerman ◽  
Clare R. Wall ◽  
Rinki Murphy ◽  
Edwin A. Mitchell ◽  
...  
Keyword(s):  
Factor Analysis ◽  
New Zealand ◽  
Factor Structure ◽  
Internal Consistency ◽  
Strengths And Difficulties Questionnaire ◽  
Self Report ◽  
Time Points ◽  
Strengths And Difficulties ◽  
Over Time

Objective The objective of this study was to assess the validity of the Strengths and Difficulties Questionnaire in a cohort of New Zealand children followed from birth to the age of eleven. The study also aimed to assess the stability of the child data in relation to behavioural outcomes during this period. Methods Children in the Auckland Birthweight Collaborative Study were assessed at approximately 3½, 7 and 11 years of age. At all time-points parents completed the parent version of the Strengths and Difficulties Questionnaire, and the children themselves completed the self-report version at 11 years of age. The validity and internal consistency were assessed using exploratory factor analysis, Cronbach’s alpha, and McDonald’s Omega. Cross tabulations and Chi-square statistics were used to determine whether Total Difficulty scores, as per accepted cut-offs, remained stable over time (between normal and abnormal/borderline categories). Results The factor structure remained relatively consistent across all three time-points, though several questions did not load as per the originally published factor analysis at the earliest age. The internal consistency of the Strengths and Difficulties Questionnaire was good at all time-points and for parent- and child-completed versions. There was low agreement in the total scores between time points. Conclusions The factor analysis shows that the Strengths and Difficulties Questionnaire has a similar factor structure, particularly in older ages, to that previously published and shows good internal consistency. At the pre-school follow up, a larger than expected proportion of children were identified with high scores, particularly in the conduct sub-scale. Children’s behaviour changes over time, with only poor to moderate agreement between those identified as abnormal or borderline over the longitudinal follow up.

scholarly journals Radiation-related Adverse Effects of CT-guided Implantation of 125I Seeds for Thoracic Recurrent and/or Metastatic Malignancy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Zhe Ji ◽  
Yuliang Jiang ◽  
Fuxin Guo ◽  
Ran Peng ◽  
Haitao Sun ◽  
...  
Keyword(s):  
Spinal Cord ◽  
At Risk ◽  
Adverse Effects ◽  
Confidence Interval ◽  
Organs At Risk ◽  
Radiation Dermatitis ◽  
Ct Guided ◽  
Upper Limit ◽  
Iodine 125

Abstract During radioactive Iodine-125 seed implantation (RISI), Iodine-125 radionuclide is implanted directly into a lesion and kills tumor cells by steadily emitting radiation. In our study, we analyzed the adverse effects of RISI for thoracic malignancy, and investigated the safety, dosage, and adverse effects of RISI for these cases. Between June 2007 and January 2018, 77 patients with thoracic recurrent and/or metastatic tumors who underwent CT-guided RISI were enrolled. Radiation-related adverse effects were analyzed, including pneumonia, esophagitis, hemorrhage, fistula, skin injury, heart injury, and spinal cord injury. We used the Common Terminology Criteria for Adverse Events (CTCAE) v4.03 to evaluate adverse effects and analyzed the relationship between adverse effects and dosimetric parameters of organs at risk (OAR), including D0.1cc, D2cc, Dmean, and V20. The results of the study were as follows: The median follow-up period was 11 months. The median postoperative dose (D90) was 122 Gy (45.7–241.8 Gy). Three patients (3.9%) showed radiation pneumonitis of grade ≥2. Two patients (2.6%) showed radiation-induced esophagitis of grade ≥2. One patient (1.3%) showed an esophageal fistula. Two patients (2.6%) had a tracheal fistula. Five patients (6.5%) had radiation-related skin reactions. One patient (1.3%) reported chest wall pain, while three (3.9%) showed hemoptysis. No patients showed radiation myelitis or cardiotoxicity. The mean D2cc of organs at risk were 165.7 Gy (lung), 10.61 Gy (esophagus), 10.25 Gy (trachea), 18.07 Gy (blood vessel), 12.64 Gy (heart), 14.77 Gy (spinal cord), 17.47 Gy (skin). Dosimetric parameters, such as D0.1cc, D2cc and Dmean, were higher in patients with toxic reactions (above the upper limit of 95% confidence interval among the overall data). Chi-square test showed that skin D0.1cc > 600 Gy, D2cc > 500 Gy, and Dmean >90 Gy were associated with grade ≥2 radiation dermatitis (p < 0.05), but no clear dose-toxicity correlation was found in other OARs. So, we concluded that the overall incidence of toxicity and adverse effects from RISI for the treatment of thoracic tumors is low. The dose-toxicity characteristics have not been fully defined. Doses within the upper limit of the 95% confidence interval may be considered safe. This was a retrospective analysis, and follow-up period was minimal, indicating possible limitations of this study.

A randomised controlled trial of the Group Stepping Stones Triple P training programme for parents of children with developmental disabilities

2019 ◽  
Vol 24 (4) ◽  
pp. 728-753
Author(s):  
Ailbhe Ruane ◽  
Alan Carr ◽  
Valerie Moffat ◽  
Tania Finn ◽  
Angela Murphy ◽  
...  
Keyword(s):  
Developmental Disabilities ◽  
Controlled Trial ◽  
Child Behaviour ◽  
Self Report ◽  
Behaviour Problems ◽  
Triple P ◽  
Stepping Stones ◽  
Irish Context ◽  
Stepping Stones Triple P

The central aim of this study was to examine the effectiveness of Group Stepping Stones Triple P (GSSTP) in an Irish context for families of children with both developmental disabilities and internalising and externalising behavioural problems. Parents of 84 children (mean age = 5.73; SD = 2.06) with developmental disabilities and co-occurring behaviour problems attending Irish public health services were randomly assigned to a 9-week GSSTP group or a waiting list control (WLC) group. All parents completed self-report measures before (Time 1) and after (Time 2) the programme and parents in the GSSTP group were assessed at 3- to 5-month follow-up (Time 3). At Time 2, clinical improvement and reliable change rates on the primary dependent variables (summary scales of the Developmental Behaviour Checklist and Strengths and Difficulties Questionnaire) were significantly higher in the GSSTP group than in the WLC group. At Time 2, mean scores of the GSSTP group showed significant, small to medium improvements relative to the WLC group on parent-reported child behaviour problems, parenting skills and confidence, and parental adjustment. Most of these improvements were maintained at 3- to 5-month follow-up. These results indicate that GSSTP is a promising intervention for improving child behaviour and parenting outcomes in a mixed-disability group in an Irish context.

Self-harm hospitalised morbidity and mortality risk using a matched population-based cohort design

2017 ◽  
Vol 52 (3) ◽  
pp. 262-270 ◽  
Author(s):  
Rebecca J Mitchell ◽  
Cate M Cameron
Keyword(s):  
At Risk ◽  
Confidence Interval ◽  
Mortality Risk ◽  
Service Use ◽  
Population Based ◽  
Mortality Data ◽  
Post Discharge ◽  
Self Harm ◽  
Rate Ratios ◽  
Hospital Use

Objective: Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. The aim is to quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. Method: A population-based matched cohort using linked hospital and mortality data for individuals ⩾18 years from four Australian jurisdictions. A non-injured comparison cohort was matched on age, gender and residential postcode. Twelve-month pre- and post-index self-harm hospitalisations and mortality were examined. Results: The 11,597 individuals who were hospitalised following self-harm in 2009 experienced 21% higher health service use in the 12 months pre and post the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. There were 133 (39.0%) deaths within 2 weeks of hospital discharge and 342 deaths within 12 months of the index hospitalisation in the self-harm cohort. Adjusted rate ratios for hospital readmission were highest for females (2.86; 95% confidence interval: [2.33, 2.52]) and individuals aged 55–64 years (3.96; 95% confidence interval: [2.79, 5.64]). Conclusion: Improved quantification of the burden of self-harm-related hospital use can inform resource allocation for intervention and after-care services for individuals at risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity, are needed.

One-Year Follow-up of a Parent Management Training for Children with Externalizing Behaviour Problems in the Real World

2009 ◽  
Vol 37 (4) ◽  
pp. 379-396 ◽  
Author(s):  
Christopher Hautmann ◽  
Herbert Hoijtink ◽  
Ilka Eichelberger ◽  
Charlotte Hanisch ◽  
Julia Plück ◽  
...  
Keyword(s):  
Parent Training ◽  
Outcome Measures ◽  
Child Behaviour ◽  
Behaviour Problems ◽  
Problem Behaviour ◽  
Child Behaviour Problems ◽  
Externalizing Behaviour ◽  
One Year ◽  
Externalizing Problem

Background: The long-term effectiveness of parent training for children with externalizing behaviour problems under routine care within the German health care system is unclear. We report the 1-year follow-up results of the parent training component of the Prevention Program for Externalizing Problem Behaviour (PEP) for 270 children aged 3–10 years with externalizing behaviour problems. Method: Outcome measures included child behaviour problems (externalizing behaviour problems, Attention-Deficit/Hyperactivity Disorder symptoms and Oppositional Defiant Disorder symptoms) and parenting (self efficacy of parenting and perceived ability to solve difficult parenting situations). Data were analysed using multilevel modelling. Results: Comparison of the changes during the 3-month waiting and treatment periods revealed significantly stronger treatment effects on all outcome measures, indicating a substantial decrease in child behaviour problems and a significant increase in parenting due to treatment. At 1-year follow-up, initial treatment effects on child behaviour problems were maintained, while parenting continued to improve. Conclusions: Families whose children exhibited externalizing problem behaviour profit from PEP and improvements are maintained for at least one year.

scholarly journals Comorbid pain and migraine chronicity

Neurology ◽  
2017 ◽  
Vol 89 (5) ◽  
pp. 461-468 ◽  
Author(s):  
Ann I. Scher ◽  
Dawn C. Buse ◽  
Kristina M. Fanning ◽  
Amanda M. Kelly ◽  
Dana A. Franznick ◽  
...  
Keyword(s):  
At Risk ◽  
Confidence Interval ◽  
Chronic Migraine ◽  
Longitudinal Design ◽  
Episodic Migraine ◽  
Cross Sectional ◽  
Web Based ◽  
Pain Site

Objective:To identify patterns of noncephalic pain comorbidity in people with episodic migraine (EM; <15 headache-days per month) and chronic migraine (CM; ≥15 headache-days per month) and to examine whether the presence of noncephalic pain is an indicator for the 3-month onset or persistence of CM.Methods:Data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a prospective, web-based study with cross-sectional modules embedded in a longitudinal design, were analyzed at baseline and the 3-month follow-up. Relationships between the number of noncephalic pain sites and 3-month onset of CM or persistent CM were assessed.Results:Of 8,908 eligible respondents, 8,139 (91.4%) had EM and 769 (8.6%) had CM at baseline. At 3 months, the incidence of CM among those with baseline EM was 3.4%. When adjusted for demographics and headache-day frequency, the odds of CM onset among those with baseline EM increased by 30% (95% confidence interval [CI] 1.21–1.40, p < 0.001) for each additional noncephalic pain site at baseline. Among those with CM at baseline, 50.1% had persistent CM at the 3-month follow-up. After adjustment for demographics, individuals with CM were 15% (95% CI 1.07–1.25, p < 0.001) more likely to have persistent CM for each additional noncephalic pain site at baseline.Conclusions:These results suggest that noncephalic pain may be a marker for headache chronicity that could be used to identify people with EM at risk of the onset of CM and people with CM at risk of persistent CM.

scholarly journals The utility of historical electoral roll records and their effect on the association of regularity of GP contact and potentially preventable diabetic hospitalisations

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Rachael Moorin ◽  
David Youens
Keyword(s):  
At Risk ◽  
Service Use ◽  
Economic Status ◽  
Geographic Location ◽  
Limited Information ◽  
Services Research ◽  
Cross Sectional ◽  
Electoral Roll ◽  
Socio Economic Status

ABSTRACTObjectivesCorrectly ascertaining person-time at risk is paramount to longitudinal studies of health services research and relies on the ability to track the status of individuals throughout the study. Administrative health data contain limited information on where study subjects live in the time between episodes of health service use. Accurate ascertainment of person-time at risk is important particularly when it varies differentially across exposure groups or covariates. Historical electoral roll data allows better specification of person-time and also provides longitudinal information on geographic location facilitating the inclusion of accessibility and socio-economic status longitudinally. This study evaluated the utility of Australian historical electoral roll data to capture place of residence throughout the time line of a whole of population longitudinal cohort study over 20 years to better ascertain person-time at risk and changes in socio-economic status (SES).ApproachThe association between regularity of GP contact and potentially preventable hospitalisations (PPHs) in WA was modelled using person-level linked data where the time at risk and socio-economic status for both the exposure (regularity of GP contact) and outcome (PPHs) was assumed to be constant throughout the follow up until death. The analysis was then repeated incorporating historical (longitudinal) electoral roll data. These data partitioned follow up time and socio-economic status according to location of residence within the State to better characterise access and SES and included removal (out-of-State/country migration) and re-enrolment records.ResultsSubstantial differences were found in the number of people at risk (46,625 (13%) of people were never at risk) and person-time at risk (reduction of 473,708 (22%) person-years at risk) when cross-sectional electoral roll and health administrative data were augmented using historical electoral roll data. Substantial changes in residential postcode (up to 25 changes) were observed and these impacted on the accessibility and SES classification across the duration of the study. These changes significantly impacted the magnitude of the relationship between GP contacts on PPHs determined by models.ConclusionsCurrently cross-sectional electoral roll data are available to researchers in WA solely for the purposes of identifying and characterising a cohort at baseline. However these data are longitudinal and contain important information that improve analyses. Information on their utility is important so as to leverage their availability from the Australian Electoral Commission.

Home treatment – insbesondere für expansive Jungen?

2015 ◽  
Vol 43 (3) ◽  
pp. 161-171 ◽  
Author(s):  
Isabel Boege ◽  
Lucia Mayer ◽  
Rainer Muche ◽  
Nicole Corpus ◽  
Renate Schepker ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Global Assessment ◽  
Home Treatment ◽  
Strengths And Difficulties Questionnaire ◽  
Assessment Scale ◽  
Global Assessment Scale ◽  
Stationärer Aufenthalt ◽  
Strengths And Difficulties

Einleitung: Bisher finden sich wenige aussagekräftige Studien zur spezifischen Indikation und Effektivität von Home treatment (HT) bei kinder- und jugendpsychiatrischen Störungsbildern. Methodik: 92 Patienten, im Alter von 5–17 Jahren, wurden in einer Interventionsstudie (primäre Zielgröße: Verweildauer) in eine Interventions- (verkürzter stationärer Aufenthalt, gefolgt von intensivem HT verbunden mit fakultativ nutzbaren Klinikbehandlungselementen) und eine Kontrollgruppe (stationäre Regelbehandlung) randomisiert. Zielgrößen zu T1 (innerhalb von 14 Tagen nach Randomisierung), T2 (Abschluss der Behandlung) und T3 (∅ 8.4 Monats-Follow-up) waren: das psychosoziale Funktionsniveau (Children’s Global Assessment Scale [CGAS], Health of the Nation Outcome Scales for Children and Adolescents [HoNOSCA]), die Schwere der Symptomatik (Strengths and Difficulties Questionnaire [SDQ]) sowie das Ausmaß der Beeinträchtigung (Columbia Impairment Scale [CIS]). Anhand einer multiplen Regressionsanalyse wurde geprüft, inwiefern Behandlungssetting, Störungsbild, Alter oder Geschlecht Einfluss auf Behandlungseffektivität haben können. Ergebnisse: Bei Kindern überwogen externalisierende Störungsbilder, bei Jugendlichen internalisierende Störungsbilder. Patienten der Interventions- und der Kontrollgruppe benannten gleichermaßen einen positiven Behandlungserfolg von T1 nach T2. HT zeigte sich dabei signifikant effektiver bei Jugendlichen (versus Kindern; SDQ p = .017), Jungen (versus Mädchen; CIS p = .009, SDQ p < .001) und externalisierenden Störungsbildern (SDQ p = .005). Schlussfolgerung: Home treatment sollte bei Jungen mit externalisierenden Störungsbildern als Alternative zur stationären Aufnahme erwogen werden.

Langfristige Effekte des Trainings mit aggressiven Kindern

2007 ◽  
Vol 16 (3) ◽  
pp. 143-151 ◽  
Author(s):  
Ulrike Petermann ◽  
Dennis Nitkowski ◽  
Dirk Polchow ◽  
Johanna Pätel ◽  
Stefanie Roos ◽  
...  
Keyword(s):  
Child Behavior ◽  
Child Behavior Checklist ◽  
Strengths And Difficulties Questionnaire ◽  
Sich Eine ◽  
Störung Des Sozialverhaltens ◽  
Strengths And Difficulties

Zusammenfassung. Das Training mit aggressiven Kindern stellt eine etablierte kognitiv-verhaltenstherapeutische Maßnahme zum Abbau aggressiver Verhaltensweisen bei circa sechs- bis 12-jährigen Kindern dar. Im Setting einer Erziehungsberatungsstelle in Nordrhein-Westfalen wurde das Training in der neusten Version ( Petermann & Petermann, 2005 ) an 13 Kindern mit der Diagnose einer Störung des Sozialverhaltens oder einer Störung mit Oppositionellem Trotzverhalten durchgeführt. Die Kinder im Alter von sieben bis 13 Jahren nahmen vier Monate an der Maßnahme teil; nach sechs Monaten erfolgte ein Follow-up. Auf der Basis von Elterneinschätzungen ließ sich eine deutliche Besserung im oppositionellen und aggressiven Verhalten auf der Child Behavior Checklist (CBCL) belegen. Zudem konnte anhand des Strengths and Difficulties Questionnaire (SDQ) eine Abnahme an hyperaktiven Verhaltensweisen sowie eine Verringerung von Schwierigkeiten im Umgang mit anderen Kindern nachgewiesen werden. Die Ergebnisse bestätigen eine nachhaltige Wirksamkeit des Trainings über einen Zeitraum von sechs Monaten.

Sign in / Sign up

Export Citation Format

Share Document