Parent-Child Assessment of Strengths and Difficulties of German Children and Adolescents Born With Esophageal Atresia

Introduction/Aim: Children and adolescents with a chronic somatic disease have a higher risk of developing psychological disorders than healthy peers. Therefore, we aim to investigate internalizing and behavioral problems in pediatric patients with esophageal atresia (EA) and compare this sample with German reference values using both childrens' self-reports and parents' proxy reports.Methods: The present cross-sectional study is part of the German-Swedish EA-QOL study developing a condition-specific instrument to assess Health-related Quality of Life in children and adolescents born with EA from both self and proxy perspectives. The current analyses use data from the German sample collected within the field test phase. Participants were enrolled from the Medical School Hannover and “Auf der Bult” Children's Hospital, Hannover. The cooperating clinicians provided the medical records while socio-demographic information was collected through the parent-report within the questionnaires. We used the Strengths and Difficulties Questionnaire (SDQ) to measure internalizing and behavioral problems of children and adolescents born with EA ranging from 2 to 18 years.Results: A total of 51 families participated in the field test phase. Eighty-eight parent reports and 22 child reports were included in the analyses. While the parents' perspective from the SDQ leads to a higher percentage of abnormal or borderline behavior, there is no difference to the reference group from the children's perspective.Conclusion: Incorporating routine psychological assessment into pediatric health care can help improve understanding of the burden of illness, examine treatment outcomes, assess the quality of care, and tailor interventions to meet patient and parent needs. Involving the whole family can help develop appropriate and functional coping strategies. From our point of view, it is necessary to address parental needs and concerns as well in order to provide the best possible holistic development in the family system. The family is the basis for the children's successful development, especially for children with special health care needs.

The Protocol for Child Monitoring Kenya - Infant/Toddler (PCM-IT) version: Construction and validation of a multiple-domain child assessment for use in Early Childhood intervention Programmes

Introduction: The integration of an informative and inclusive monitoring, evaluation and learning process which requires appropriate tools and methods is crucial to the effective implementation of early childhood interventions. Most of the child development assessment tools that have been constructed for use in sub-Saharan Africa consider the need to be affordable and feasibly administered by those with limited previous experience. These tools include the Kilifi Developmental Inventory (KDI), the A-not-B task, the Developmental Milestones Checklist, and the Profile for Socio-Emotional Development (PSED) which each use different approaches such as direct child assessment, observation, and parental reports. Whereas these tools have demonstrated good psychometric properties, each of them focusses either on only one or two child developmental domains, does not adequately measure all aspects of the different domains that are theoretically affected by a risk factor or intervention, or is not in sufficient depth. We therefore constructed a tool that combined these separate measures into one assessment schedule – the Protocol for Child Monitoring – Infant/Toddler version (PCM-IT). We subjected the combined tool to a process of pilot testing and validation to establish its psychometric properties, the feasibility of administration and acceptability.Method: The framework of five aspirations (inclusive, informative, people-centered, dynamic and interactive) that guide effective intervention delivery mechanisms was used to structure the evaluation of the PCM-IT. The piloting of the administration of the PCM-IT was based on a proof-of-concept study with a multi-arm pre-post design in Kibera and Kangemi, while the validation study was carried out in Mathare. The three areas are informal settlements in Nairobi. The results of the pilot study informed the selection of items that were included in the validation study.Results: The timed items were too difficult for the children included in the study and were therefore excluded. Overall, the PCM-IT had excellent reliability levels. Children’s raw sub-scale and overall developmental scores were normally distributed. There were weak to moderate correlations across the different domains. Speed and fluency of administration of items among the assessment team improved with practice and familiarity. The tool was perceived as providing holistic information about a child’s performance. Conclusion: The aspirations of Measurement for Change including the need for a tool development and administration process to be inclusive, informative, people-centered, and dynamic were met to a large extent. The aspiration of being interactive would be better met through an exploration of the use of the tool to engage with families to strengthen the quality of their nurturing care practices.

Canadian Mothers More Responsive Than Cambodian Peers in a Cross-Cultural Assessment of a Breastfeeding Interaction in the First 6 Months: A Preliminary Assessment

Objectives Human milk is the sole recommended food for infants for the first 6 months of life. Although determinants and rates of exclusive breastfeeding differ greatly between high- and low-and-middle-income countries, little is known about whether breastfeeding practices, such as feeding responsiveness, differ across cultures. Responsive feeding practices are based on the cues and responses of a caregiver and infant, and are associated with more intuitive eating patterns later in life. This preliminary assessment aims to assess the responsiveness of the maternal-child interactions during breastfeeding of infants less than 6 months old cross-culturally, in both a high- and lower-middle income country. Methods This preliminary analysis includes 10 mother-infant dyads from Nova Scotia, Canada, who have been age-matched (±4 days) to 10 Cambodian dyads recruited in Kampong Thom province, Cambodia. In both settings, a breastfeeding session was video-recorded in the participant's home and videos scored using the validated, 76-item Nursing Child Assessment Satellite Training (NCAST) Caregiver/Parent-Child Interaction Feeding Scale. Results Infants were between 13 and 23 weeks old, and in both groups were 40% firstborn and 40% male. Cambodian mothers (27.3 ± 3.4 years) were significantly younger than Canadian (32.0 ± 2.3; p = 0.002), and the average length of feed in Cambodia was significantly shorter (5.5 ± 1.6 min v. 7.3 ± 1.3 min; p = 0.02). There was no significant difference between Canadian and Cambodian total NCAST scores. However, Canadian mothers scored significantly higher on three of the four maternal NCAST subscales; subscale I (sensitivity to infant's cues, p = 0.03), subscale III (social-emotional growth fostering, p = 0.01), and subscale IV (cognitive growth fostering, p = 0.02) There were no significant differences in scores for NCAST subscales measuring infant's clarity of cues or responsiveness to their mother. Conclusions These preliminary results indicate differences in feeding responsiveness on the part of mothers during breastfeeding in Canada and Cambodia and could inform future programs to optimize the maternal-child feeding interaction. Funding Sources MSVU Internal Grant, Canadian Institute for Health Research, Research Nova Scotia.

17. Public Law Proceedings Concerning Children

This is the first of two chapters discussing child protection issues—what is often called the public law concerning children. Chapter 17 begins with a consideration of the basic dilemmas of child protection followed by an overview of the development of local authority powers. It explains the current basic legal framework and provisions for local authorities to provide services for families; specific duties and powers; accommodating children in need; and secure accommodation. The chapter ends by focusing on the local authorities’ investigative powers and duties. It covers the general duty of investigation under s 47 of the Children Act 1989; co-operating with other agencies to discharge investigative duties; emergency protection orders; child assessment orders; and police protection.

The untold perspective: Parents’ experiences of the autism spectrum disorder assessment process when the child did not receive a diagnosis

This research explored parents’ lived experience of the autism spectrum disorder assessment process when a diagnosis was not received. Six mothers and one stepfather were interviewed and transcripts were analysed using interpretative phenomenological analysis. The identified themes: ‘My child is different’, The emotional and psychological journey and Understanding the outcome, illustrated issues encountered by parents during the assessment process and parenting a child with autistic-like characteristics but without a valid label. As a previously understudied area, clinical implications at the professional, service and policy level are discussed. Lay abstract Autism is diagnosed by a process of child assessment and parental interview. It has been well-documented by parents of children who received a diagnosis of autism, that the process can be lengthy and cause distress for families. Nevertheless, the outcome often compensated for the difficult assessment journey as it enables families to gain access to further information, support and intervention. However, less is known about the assessment process from parents who undertake the same process but at the end are told their child does not meet the diagnostic criteria, meaning no diagnosis is given. We interviewed six parents in North Wales, whose child did not receive a diagnostic of autism following an assessment. During the interview, parents were asked about their experience of the autism assessment process. We found that parents reflected on their experience according to three themes: (1) parents tried to navigate how they could make sense of their child being different despite not receiving a diagnosis; (2) parents referred to the assessment process as a journey, which encompassed many emotional and psychological components and (3) parents discussed what it was like to hear a non-diagnosis outcome, in terms of feeling relieved, confused and raising questions for the child’s future. These findings are important for professionals working in autism assessment services to help improve the assessment process for families, particularly when the assessment does not result in a diagnosis.

Adverse childhood experiences and transcriptional response in school-age children

This study evaluated whether children with higher adverse childhood experiences (ACE) scores had alterations in immune cell gene expression profiles. RNA sequencing was conducted on dried blood spot samples from 37 generally healthy English-speaking children (age 5–11) who were recruited from well-child visits at a university-affiliated pediatric practice. The Whole Child Assessment was used to assess ACE exposure. Primary analyses examined an a priori-specified composite of 19 pro-inflammatory gene transcripts. Secondary analyses examined a 34-gene composite assessing Type I interferon response, and used Transcript Origin Analyses to identify cellular mechanisms. After controlling for age, body mass index percentile, sex, race/ethnicity, current insurance status, and household smoking exposure, pro-inflammatory gene expression was elevated by 0.094 log2 RNA expression units with each Child-ACE total score point (p = .019). Type I interferon gene expression was similarly upregulated (0.103; p = .008). Transcript origin analyses implicated CD8+ T cell as the primary sources of gene transcripts upregulated, and nonclassical (CD16+) monocytes as sources of downregulated transcripts. These preliminary analyses suggest that parent-reported ACE exposures are associated with increased expression of both inflammatory and interferon gene transcripts in children's circulating blood cells.

Video Intervention Therapy for Primary Caregivers in a Child Psychiatry Unit: A Randomized Feasibility Trial

Background: During child psychiatry hospitalization, working with the families or attachment figures is a challenge, most of the children who are admitted to these units come from multi-problem families, with limited research in this area. Video Feedback (VF) intervention have proved to be a powerful resource to promote parental and child wellbeing in small children and has been used with parents with a psychiatric condition. Parental Reflective Functioning (PRF) is one of the parental abilities that can be improved with VF and could be especially important in coping with conflict and negative emotions in older children. The aim of this study is to implement Video Intervention Therapy (VIT) to enhance PRF in primary caregivers of inpatient psychiatric children. As there is no published research using VF with parents of children with severe psychopathology in a hospitalized context, this becomes a much needed pilot study providing evidence for a larger randomized control trial (RCT). Methods: The study is a single center, two-arm feasibility randomized control trial with a qualitative component. Block randomization was done to generate a 2:1 allocation, leaving more participants in the intervention group. The intervention comprises four modules; every module has both one video-recorded play session and one VIT session (in a group setting) per week. Evaluation of the caregivers included assessments of PRF and wellbeing, child assessment included parent-ratings and clinician-ratings of symptomatology and general functioning. Results: Thirty participants were randomized; eligibility and recruitment rate were 70.6% and 83.3% respectively. Compliance-to-intervention rate was 85% in the VIT group and 90% in the control group. All participants completed entry evaluation and 90% at 3 months follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. Outcome data must be treated with caution due to the small numbers involved, yet indicate that the VIT may have a positive effect in improving parental and child mental health outcomes.Conclusions: VIT for primary caregivers of child inpatient children was feasible to deliver and acceptable for participants, therapist and the staff unit involved, there is sufficient evidence to undertake a full-scale effectiveness RCT.Trial registration: ClinicalTrials.gov, NCT03374904. Registered on 14 December 2017

THE USE AND VALUE OF A CHILD ASSESSMENT TOOL (CAT) IN SOCIAL WORK CHILD ASSESSMENTS

The integration of child-friendly tools during child counselling facilitates effective communication and child participation. However, the use of child-friendly tools in generalist child counselling remains sparse. This paper presents social work students’ perceptions of using a child assessment tool (CAT). While the study adopted a mixed-method approach, this paper reports the findings drawn from the study's qualitative findings. Data collection included individual semi-structured interviews with purposively sampled fourth-level student social workers. The results indicated that using the CAT created a child-friendly environment that facilitated effective child communication and participation during assessments. Using the CAT addresses barriers to child participation during child assessment.