Assessment of Growth in Pediatric Syrian Refugee Populations in Jordan

Background Externally displaced pediatric Syrian refugees are at risk of adverse developmental health outcomes in the setting of food insecurity. To evaluate the impact of displacement on nutritional status of Syrian children, this study describes the prevalence of malnutrition of Syrian children residing in Jordan. Methods A retrospective cross-sectional analysis of data from patient records < 18 years of age from the Syrian American Medical Society's (SAMS) January 2019 mission trip to Jordan was performed. Prevalence of stunting, severe wasting, wasting, overweight, and underweight were calculated using the World Health Organization (WHO) definitions. Results Overall, 392 Syrian children were included. In the 0 to 59 months group (n = 191), prevalence of stunting was 13.9% (n = 165), severe wasting 4.2% (n = 165), wasting 6% (n = 165), overweight 16.4% (n = 165), and underweight 5.3% (n = 190). In the > 59 months group (n = 201), prevalence of stunting was 7.2% (n = 194), severe wasting 3.6% (n = 194), wasting 5.2% (n = 194), overweight 6.7% (n = 194), and underweight 4.6% (n = 153). Age group was significantly associated with stunting (odds ratio [OR] = 2.08,9 5% CI 1.03 to 4.19) and overweight (OR = 2.72; 95% CI 1.36 to 5.47) with increased odds of each in the 0–59 months group. Conclusion The findings suggest evidence of higher prevalence of malnutrition in Syrian children compared with prior assessments and greater impact on the younger cohort. In 0 to 59 months' old Syrian children, stunting and wasting were of medium severity and overweight was of high severity. This may reflect food insecurity in the setting of ongoing conflict, strain on resources, and evolving refugee policies, acknowledging study limitations. Syrian refugee children living in Jordan experience wasting and stunting. Comprehensive assessment of current nutritional status of Syrian children is needed. Access to adequate and nutritious food is paramount.

111 The Prevalence of Asthma in Canadian Kindergarten Children and its Association with their Developmental Health: A Population-Level Cross-Sectional Study

Primary Subject area Epidemiology Background Asthma, the most common chronic illness affecting Canadian youth, can profoundly and adversely impact a child’s quality of life. Previous studies have shown a diagnosis of asthma can influence a child’s physical and socio-emotional functioning. Current data on asthma prevalence rates among Canadian children is scarce, and it is still unclear how this diagnosis impacts their development at school entry. Objectives The goals of the current study were to 1) examine the prevalence of teacher-reported asthma in Canadian kindergarten children, and 2) investigate the association between asthma and children’s concurrent developmental health. Design/Methods A cross sectional, population-level study of kindergarten children diagnosed with asthma as reported on the Early Development Instrument (EDI), was carried out in Canada from 2010-2015. Children’s developmental health in kindergarten was measured with the EDI. This 103-item questionnaire is completed by teachers for their students aged 4-6 years and covers demographic information, as well as five different domains of development. Descriptive statistics were examined for children with and without asthma. The level of statistical significance was adjusted using a Bonferroni correction to account for multiple hypothesis testing. The chi-square and one-way ANOVA statistics, as well as effect sizes (Cramer’s V, and eta squared) were reported for all descriptive analyses. Results 958 children (0.002% of the final analytical sample) were identified as having a teacher-reported diagnosis of asthma. Compared to their peers, children with asthma were significantly more likely to: be male (68.2% vs 51.2%); have a special needs designation (19.0% vs 3.6%); have a functional impairment (53.5% vs 15.9%); be identified by their teachers as needing further developmental assessment (32.3% vs. 13.1%); and miss, on average, 3 more days of school than their peers (9.44 vs. 6.71). They were also more likely to fall below a vulnerability threshold on one or more of the developmental domains (55.9% vs. 28.8%, Figure 1). Conclusion It is likely that the EDI captures only severe cases of asthma, as parents are more likely to disclose their child’s illness to teachers if it may influence their ability to function in a classroom. As such, children with asthma, especially those with severe forms, may require additional support. A partnership in which physicians provide preventative care, and teachers provide academic and classroom assistance, may help to ensure the optimal development of children with asthma, and close gaps between them and their peers.

Screen Time and Developmental Health: Results from an Early Childhood Study in Canada

Background: Research has shown that longer hours of screen time are negatively associated with children's healthy development. Whereas most research has focused on school-age children, less is known about this association in early childhood. To fill this gap, our goal was to examine the association between screen time and developmental health in preschool-aged children.Methods: This study draws from a data linkage on children (N = 2983; Mean age = 5.2, SD = 0.3 years, 51% male) in British Columbia (BC), Canada, who entered Kindergarten in public elementary schools in 2019. Parent reports on children's screen time, health behaviors, demographics, and family income collected upon kindergarten entry (09/2019), were linked to teacher reports on children's developmental health, collected halfway through the school year (02/2020). Screen time was assessed with the Childhood Experiences Questionnaire. Developmental vulnerability versus developmental health in five domains (physical, social, emotional, language and cognition, and communication skills) was measured with the Early Development Instrument. Results: Logistic regression analyses using generalized estimating equation showed that children with more than one hour of daily screen time were more likely to be vulnerable in all five developmental health domains: physical health and wellbeing (odds ratio [OR] =1.41; 95% confidence interval [CI], 0.99 - 2.0; p=0.058), social competence (OR=1.60; 95% CI, 1.16 – 2.2; p=0.004), emotional maturity (OR=1.29; 95% CI, 0.96 - 1.73; p=0.097), language and cognitive development (OR=1.81; 95% CI, 1.19 - 2.74; p=0.006) and communication skills (OR=1.60; 95% CI, 1.1 – 2.34; p=0.015) compared to children reporting up to one hour of screen time/day. An interaction effect between income and screen time on developmental health outcomes was non-significant. Results were adjusted for child demographics, family income, and other health behaviors. Conclusion: Daily screen time that exceeds the recommended one-hour limit for young children, as suggested by the Canadian 24-hrs Movement Guidelines for Children and Youth [1, 2] is negatively associated with developmental health outcomes in early childhood. Screen-based activities should thus be limited for young children. Future research needs to examine the underlying mechanisms through which screen time is linked to developmental vulnerabilities.

Population-Level Data on Child Development at School Entry Reflecting Social Determinants of Health: A Narrative Review of Studies Using the Early Development Instrument

Background: The Early Development Instrument (EDI) was developed as a population-level assessment of children’s developmental health at school entry. EDI data collection has created unprecedented opportunities for population-level studies on children’s developmental outcomes. The goal of this narrative review was to synthesize research using the EDI to describe how it contributes to expanding the understanding of the impacts of social determinants on child development and how it applies to special populations. Methods: Select studies published in peer-reviewed scientific journals between 2015 and 2020 and incorporating the social determinants of health perspectives were chosen to highlight the capability of the EDI to monitor children’s developmental health and contribute knowledge in the area of early childhood development. Results: A number of studies have examined the association between several social determinants of health and children’s developmental outcomes, including hard-to-reach and low-frequency populations of children. The EDI has also been used to evaluate programs and interventions in different countries. Conclusions: The ability of the EDI to monitor children’s developmental outcomes in various populations has been consistently demonstrated. The EDI, by virtue of its comprehensive breadth and census-like collection, widens the scope of research relating to early childhood development and its social determinants of health.

Interformat Reliability of Web-Based Parent-Rated Questionnaires for Assessing Neurodevelopmental Disorders Among Preschoolers: Cross-sectional Community Study

Background Early detection and intervention for neurodevelopmental disorders are effective. Several types of paper questionnaires have been developed to assess these conditions in early childhood; however, the psychometric equivalence between the web-based and the paper versions of these questionnaires is unknown. Objective This study examined the interformat reliability of the web-based parent-rated version of the Autism Spectrum Screening Questionnaire (ASSQ), Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS), Developmental Coordination Disorder Questionnaire 2007 (DCDQ), and Strengths and Difficulties Questionnaire (SDQ) among Japanese preschoolers in a community developmental health check-up setting. Methods A set of paper-based questionnaires were distributed for voluntary completion to parents of children aged 5 years. The package of the paper format questionnaires included the ASSQ, ADHD-RS, DCDQ, parent-reported SDQ (P-SDQ), and several additional demographic questions. Responses were received from 508 parents of children who agreed to participate in the study. After 3 months, 300 parents, who were among the initial responders, were randomly selected and asked to complete the web-based versions of these questionnaires. A total of 140 parents replied to the web-based format and were included as a final sample in this study. Results We obtained the McDonald ω coefficients for both the web-based and paper formats of the ASSQ (web-based: ω=.90; paper: ω=.86), ADHD-RS total and subscales (web-based: ω=.88-.94; paper: ω=.87-.93), DCDQ total and subscales (web-based: ω=.82-.94; paper: ω=.74-.92), and P-SDQ total and subscales (web-based: ω=.55-.81; paper: ω=.52-.80). The intraclass correlation coefficients between the web-based and paper formats were all significant at the 99.9% confidence level: ASSQ (r=0.66, P<.001); ADHD-RS total and subscales (r=0.66-0.74, P<.001); DCDQ total and subscales (r=0.66-0.71, P<.001); P-SDQ Total Difficulties and subscales (r=0.55-0.73, P<.001). There were no significant differences between the web-based and paper formats for total mean score of the ASSQ (P=.76), total (P=.12) and subscale (P=.11-.47) mean scores of DCDQ, and the P-SDQ Total Difficulties mean score (P=.20) and mean subscale scores (P=.28-.79). Although significant differences were found between the web-based and paper formats for mean ADHD-RS scores (total: t132=2.83, P=.005; Inattention subscale: t133=2.15, P=.03; Hyperactivity/Impulsivity subscale: t133=3.21, P=.002), the effect sizes were small (Cohen d=0.18-0.22). Conclusions These results suggest that the web-based versions of the ASSQ, ADHD-RS, DCDQ, and P-SDQ were equivalent, with the same level of internal consistency and intrarater reliability as the paper versions, indicating the applicability of the web-based versions of these questionnaires for assessing neurodevelopmental disorders.

Interformat Reliability of Web-Based Parent-Rated Questionnaires Assessing for Neurodevelopmental Disorders among Preschoolers: A Community Developmental Health Check-up Setting Study (Preprint)

BACKGROUND Early detection and intervention for neurodevelopmental disorders are effective. Several paper types of questionnaires have been developed to assess these conditions in early childhood. However, the psychometric equivalence between the web and the paper versions of these questionnaires is unknown. OBJECTIVE This study examined the interformat reliability of the web-based parent-rated version of the Autism Spectrum Screening Questionnaire (ASSQ), Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS), Developmental Coordination Disorder Questionnaire’07 (DCDQ), and Strengths and Difficulties Questionnaire (SDQ) among Japanese preschoolers in a community developmental health check-up setting. METHODS A set of paper-based questionnaires were distributed for voluntary completion to parents of children aged 5 years. The package of the paper form questionnaires included the ASSQ, ADHD-RS, DCDQ, Parent-reported SDQ (P-SDQ), and several additional demographic questions. Responses were received from 508 parents of children who agreed to participate in the study. After 3 months, 300 parents of children, who were among the initial responders, were randomly selected and asked to complete the web-based versions of these questionnaires voluntarily. A total of 140 parents of children replied to the web form and were included as a final sample in this study. RESULTS We obtained Cronbach’s alphas for both the web and paper forms of the ASSQ (web=.88, paper=.84), ADHD-RS total and subscales (web=.87-.94, paper=.86-.92), DCDQ total and subscales (web=.81-.93, paper=.74-.91), and P-SDQ Total Difficulties and subscales (web=.52-.80, paper=.51-.79). The intraclass correlation coefficients between the web and paper forms of each questionnaire were all significant at the 99.9% confidence level. (ASSQ: r=.66; ADHD-RS total and subscales: r=.66-74; DCDQ total and subscales: r=.66-.71; P-SDQ Total Difficulties and subscales: r=.55-.73). There were no significant differences between the web and paper forms for the total mean score of the ASSQ, total and subscale mean scores of DCDQ, and the P-SDQ Total Difficulties mean score and mean subscale scores. While significant differences were found between the web and paper forms for the mean scores on the ADHD-RS (Total: t132=2.83, P=.005; Inattention: t133=2.15, P=.03; Hyperactivity/Impulsivity: t133=3.21, P=.002), the effect sizes were small (Cohen d=.18-.22). CONCLUSIONS These results suggest that the web versions of the ASSQ, ADHD-RS, DCDQ, and P-SDQ had the same level of internal consistency, intra-rater reliability, and equality as the paper versions. These results indicate the web applicability of these questionnaires for assessing neurodevelopmental disorders.

Post-Traumatic Growth as Positive Personality Change: Challenges, Opportunities and Recommendations

Posttraumatic growth typically refers to enduring positive psychological change experienced as a result of adversity, trauma, or highly challenging life circumstances. Critics have challenged insights from much of the prior research on this topic, pinpointing its significant methodological limitations. In response to these critiques, we propose that posttraumatic growth can be more accurately captured in terms of personality change—an approach that affords a more rigorous examination of the phenomenon.We outline a set of conceptual and methodological questions and considerations for future work on the topic of post-traumatic growth.We provide a series of recommendations for researchers from across the disciplines of clinical/counseling, developmental, health, personality, and social psychology and beyond, who are interested in improving the quality of research examining resilience and growth in the context of adversity.We are hopeful that these recommendations will pave the way for a more accurate understanding of the ubiquity, durability and causal processes underlying post-traumatic growth.

‘Intervening early’: agendas and rationalisations for children’s developmental health

Background:Despite broad scientific consensus about the importance of the early years in the lifelong health and wellbeing of children, there is debate about whether and how healthcare professionals can optimise early child development through monitoring or screening. The evidence in support of a systematic population-level intervention is disputed, which is reflected in the diversity of approaches to developmental screening internationally. Methods:Using a case-study design, and interpretive qualitative methods, we explored how Canadian experts in child health (n=39): a) rationalise why they do, or would, pursue population-level developmental screening; b) articulate the policy goals of such an intervention, and; c) justify the practice with reference to evidence. Findings:Respondents identified three distinct framings, or policy agendas, for what developmental screening can and should seek to achieve, specifically: 1) as medical intervention, facilitating the early identification of health risk or disorder; 2) as social intervention, providing an opportunity for communication and connection with parents for all children; and 3) as political intervention, staking a claim for early child health on the broader political agenda. Discussion and conclusions:Each agenda is justified by distinct types of evidence, posing a challenge to simplistic models of evidence-based policymaking, and demonstrating that evidence is not just an input, but a contested part of a dynamic and political policymaking process.

Child modern slavery, trafficking and health: a practical review of factors contributing to children’s vulnerability and the potential impacts of severe exploitation on health

Child trafficking is a form of modern slavery, a rapidly growing, mutating and multifaceted system of severe human exploitation, violence against children, child abuse and child rights violations. Modern slavery and human trafficking (MSHT) represents a major global public health concern with victims exposed to profound short-term and long-term physical, mental, psychological, developmental and even generational risks to health. Children with increased vulnerability to MSHT, victims (in active exploitation) and survivors (post-MSHT exploitation) are attending healthcare settings, presenting critical windows of opportunity for safeguarding and health intervention.Recognition of child modern slavery victims can be very challenging. Healthcare providers benefit from understanding the diversity of potential physical, mental, behavioural and developmental health presentations, and the complexity of children’s responses to threat, fear, manipulation, deception and abuse.Healthcare professionals are also encouraged to have influence, where possible, beyond the care of individual patients. Research, health insights, advocacy and promotion of MSHT survivor input enhances the collaborative development of evidence-based approaches to prevention, intervention and aftercare of affected children and families.