Child Psychosocial Outcomes Research Articles

Quality of life and psychosocial outcomes in children with severe acute asthma and their parents.

ObjectivesTo prospectively evaluate quality of life (QoL) and psychosocial outcomes in children with severe acute asthma (SAA) after pediatric intensive care (PICU) admission compared to children with SAA who were admitted to a general ward (GW). In addition, we assessed posttraumatic stress (PTS) and asthma‐related QoL in the parents.MethodsA preplanned follow‐up of 3 to 9 months of our nationwide prospective multicenter study, in which children with SAA admitted to a Dutch PICU (n = 110) or GW (n = 111) were enrolled between 2016 and 2018. Asthma‐related QoL, PTS symptoms, emotional and behavioral problems, and social impact in children and/or parents were assessed with validated web‐based questionnaires.ResultsWe included 100 children after PICU and 103 after GW admission, with a response rate of 50% for the questionnaires. Median time to follow‐up was 5 months (range: 1‐12 months). Time to reach full schooldays after admission was significantly longer in the PICU group (mean of 10 vs 4 days, P = .001). Parents in the PICU group reported more PTS symptoms (intrusion P = .01, avoidance P = .01, arousal P = .02) compared to the GW group.ConclusionNo significant differences were found between PICU and GW children on self‐reported outcome domains, except for the time to reach full schooldays. PICU parents reported PTS symptoms more often than the GW group. Therefore, monitoring asthma symptoms and psychosocial screening of children and parents after PICU admission should both be part of standard care after SAA. This should identify those who are at risk for developing PTSD, to timely provide appropriate interventions.

The Influence of Role Models on the Sedentary Behaviour Patterns of Primary School-Aged Children and Associations with Psychosocial Aspects of Health.

Background: High levels of sedentary behaviour (SB) are associated with poor health outcomes in children, but the effects on mental health are less clear. This study explored the relationship between SB and psychosocial aspects of health in children, and what influence key role models, including parents and schoolteachers, have on the SB levels of children. Methods: Physical activity (PA) and SB were measured using accelerometery in 101 children, 113 parents and 9 teachers. Children were aged 9 or 10 years old and in fourth grade. Child psychosocial outcomes were assessed using the Rosenberg Self-Esteem Scale and the Strengths and Difficulties Questionnaire. Results: Children engaged in a high volume of SB (9.6 h/day) but interrupted SB often. They accumulated less than 11,000 steps per day, and thus, many may not meet the recommended daily levels of PA. No associations were found between child SB and teacher SB during the school day or child SB and parent SB during the after-school period. No association was found between SB and self-esteem, although children with a higher body mass index had a higher number of emotional and behavioural difficulties. Conclusions: Although there was no indication that children’s SB was linked to that of parents and teachers, or that SB was associated with self-esteem or behavioural problems, school children were highly sedentary and insufficiently physically active. Therefore, there is a need to explore school practices and curriculum delivery methods, as well as school and home environments, to reduce the volume of SB children engage in.

Parental Discipline and Child Psychosocial Outcomes in Iraq and Kurdistan: Evidence From a Nationally Representative Sample.

Few empirical studies have been conducted on populations in the Middle-East, particularly in Iraq and Iraqi Kurdistan, regarding the relationships between the type of discipline used by caregivers and its subsequent effect on children. Our analyses, which are based on data from the Iraq Multi-Cluster Survey 2018, replicate the prior work of scholars using Western samples, and suggest that variation in parental practices pertaining to the discipline of children is a robust predictor of several negative psychosocial outcomes among Iraqi and Kurdish youth. Specifically, we found that children who were subjected to various forms of violent physical discipline, psychological aggression, and neglectful parenting were more likely to exhibit an array of symptoms of psychosocial disorder, relative to measures of adequate parenting. Our analyses also provide strong support for the presence of comorbid psychosocial outcomes among Iraqi and Kurdish youth that stem from differences in the practice of parental discipline. The results of the current study are discussed regarding both theoretical and practical applications. The study's limitations are also addressed and suggestions for future research on the discipline-outcome nexus are given.

Quality of life and mental health in amblyopic children treated with and without occlusion therapy

To assess the long-term (≥1year) psychosocial effects of occlusion therapy in children with refractive amblyopia and their caregivers. Multiple self-reported questionnaires were used to investigate HRQoL, anxiety, depression, and stress in a cross-sectional study of children with refractive amblyopia and their caregivers. Children were divided into two subgroups: those treated with glasses only and those treated with both glasses and occlusion therapy who had stopped wearing a patch at least 1year earlier. A total of 79 children were included: 32 in the refraction-only group and 47 in the glasses+occlusion group. Median age of subjects was 12years (IQR=3.0). Mean age of the 79 caregivers was 41.9±5.0years. No significant differences were found for any of the psychosocial outcomes analyzed between children treated with glasses and patching and those treated with glasses only. The differences remained insignificant between children according to age of first occlusion (<6 vs≥6years). The only significant (but not clinically relevant) difference observed for caregivers was a higher score in the depression dimension of the Hospital Anxiety and Depression Scale for caregivers of children treated with glasses only (P=0.036; effect size=0.23). In our study cohort, patching was not associated with long-term negative psychosocial outcomes in children with refractive amblyopia treated with occlusion therapy.

Association of long-term child growth and developmental outcomes with metformin vs insulin treatment for gestational diabetes

Importance Metformin is an emerging option for treating gestational diabetes (GDM). However, because metformin crosses the placenta, patients and clinicians are concerned with its long-term effect on child health. Objective To estimate the association of treating GDM with metformin vs insulin with child growth and development. Design, Setting, and Participants Population-based cohort study of New Zealand women treated with metformin or insulin for GDM from 2005 to 2012 and their children. This study linked national health care data to create a cohort of mothers and their children, including data from maternity care, pharmaceutical dispensing, hospitalizations, demographic records, and the B4 School Check (B4SC) preschool health assessment. Women treated pharmacologically with metformin or insulin during pregnancy were included. We excluded pregnancies with evidence of diabetes and deliveries prior to 2013. Liveborn infants were linked to their B4SC results. Data were analyzed between January 2017 and May 2018. Exposures Pharmacologic treatment for GDM with metformin or insulin, measured using pharmaceutical claims data. Main Outcomes and Measures Child growth (weight and height) and Strengths and Difficulties Questionnaire (SDQ) scores for behavioral development. All outcomes were derived from the B4SC screening program. Linear and log-binomial regression with inverse probability of treatment weighting was used to estimate the association of child growth and psychosocial outcomes with metformin vs insulin treatment for GDM. Results In both treatment groups, the mean (SD) maternal age was 32 (5) years. A large proportion of mothers who were treated with insulin identified as New Zealand European (867 [44.9%]) while 576 mothers who were treated with metformin (28.9%) identified as New Zealand European. Approximately one-third of mothers who were treated with metformin (n = 639) identified as Asian. We identified 3928 pregnancies treated with metformin (n = 1996) or insulin (n = 1932). After adjustment, we observed no meaningful difference in weight for heightzscores between children exposed to metformin compared with insulin (mean difference, –0.10; 95% CI, −0.20 to 0.01). Risk of being 85th percentile or greater for weight for height was similar between treatment groups (adjusted risk ratio, 0.92; 95% CI, 0.83-1.02). Mean SDQ scores were not meaningfully different between the treatment groups, Children of metformin-treated mothers were not significantly more likely to have parent-reported SDQ scores of 14 or more (adjusted risk ratio, 1.13; 95% CI, 0.88-1.46) than those of insulin-treated mothers. Conclusions and Relevance Our study compares long-term outcomes among school-aged children following maternal use of metformin vs insulin treatment for GDM. Children of metformin-treated mothers were indistinguishable on growth and developmental assessments from those of insulin-treated mothers. These results will help inform future GDM treatment guidelines.

Relationship between paternal psychological distress and involvement in childcare among fathers of preschool-aged children: mediating effect of maternal psychological distress

BackgroundThe role of the father as a co-caregiver is becoming increasingly important across cultures. Parental psychological distress is an influencing factor of maladaptive parenting behaviors and negative psychosocial outcomes in children. Considerable research has focused on psychological distress in parents, commonly experienced during the childrearing years; however, the relationship between paternal psychological distress and fathers’ involvement in childcare has been less studied. This study aimed to examine this relationship.MethodsThis study explored the relationship between parental psychological distress and fathers’ involvement in childcare by analyzing data from 1541 children and their parents from the 2011 Panel Study on Korean Children. Psychological distress was assessed using the Kessler 6-Item Psychological Distress Scale. Fathers’ involvement in childcare was measured in terms of the quality and quantity of involvement, using a Father’s Childcare Involvement Scale completed by mothers and the daily hours spent by fathers in childcare.ResultsThe mean scores for paternal and maternal psychological distress were 5.26 ± 4.20 and 5.79 ± 4.42, respectively; for the quality of fathers’ involvement in childcare, 14.46 ± 2.63; and for the quantity of fathers’ involvement, 2.53 ± 1.62. Paternal psychological distress was significantly correlated with maternal psychological distress and fathers’ involvement in childcare. Maternal psychological distress demonstrated a partial mediating effect on the relationship between paternal psychological distress and the quality of fathers’ involvement in childcare for preschool-aged children (β = −.085, p < .001); this effect was significant (Sobel test; Z = 3.13, p = .002). Further, maternal psychological distress demonstrated a complete mediating effect on the relationship between paternal psychological distress and the quantity of fathers’ involvement in childcare (β = −.065, p = .018); this effect too was significant (Sobel test; Z = 2.38, p = .018).ConclusionsPaternal psychological distress influenced the quality and quantity of fathers’ involvement in childcare and was mediated by maternal psychological distress. To promote fathers’ involvement in childcare, a family-centered approach for childcare should reflect the triadic interaction of father–mother–child. These findings have implications for primary health professionals, as well as policymakers who design community health programs for early childhood.

Interventions and practice models for improving health and psychosocial outcomes of children and young people in out-of-home care: protocol for a systematic review

IntroductionChildren and young people placed in out-of-home care (OoHC) are often affected by a history of trauma and adverse childhood experiences. Trauma in early childhood can impact on children’s health...

Maternal adult attachment styles and mother–child transmissions of social skills and self-esteem

ABSTRACT Grounded in principles of attachment theory and social learning theory, the goal of this study was to investigate how maternal attachment styles relate to both parent and child psychosocial outcomes. Specifically, we examined maternal self-esteem and social skills as mediators in the relationship between maternal adult attachment styles and child social skills and self-esteem. Data were collected from 229 (N = 458) mother–child dyads who completed measures on attachment styles, social skills, and self-esteem. The results showed significant indirect effects from maternal secure and preoccupied attachments to child social skills via mother social skills. The results also showed an indirect link from maternal secure attachment to child self-esteem through mother self-esteem.

Systematic Review of Father Involvement and Child Outcomes in Pediatric Chronic Illness Populations

The overall objective of this paper was to systematically review and synthesize the emerging literature investigating the role of father involvement in pediatric outcomes among chronic illness populations. This review sought to answer the following questions: (1) what measures are used to assess father involvement in pediatric chronic illness populations, and who is the respondent, and (2) how is father involvement associated with child psychosocial and health related outcomes in pediatric chronic illness populations? Databases were searched using a key word search strategy. Articles were screened according to exclusion criteria, resulting in 15 identified articles that included a pediatric illness population, and assessed both father involvement and a child outcome variable. Qualitative analysis revealed that several measures have been used to assess father involvement in pediatric chronic illness populations. As a whole, the majority of findings indicate that better outcomes are associated with more father involvement in illness and non-illness related activities, and higher father-child relationship quality. Contradictory findings may be due to the quality of the involvement being assessed, or the possibility that father's become more involved with illness tasks in response to their child's poorer health outcomes. Future research should include the development and use of psychometrically sound measures of father involvement and employ more diverse samples with rigorous methodology.

An evaluation of an integrated fluency and resilience program for early developmental stuttering disorders

PurposeThe temperament construct of effortful control, an index of self-regulation and resilience, has been found to be predictive of stuttering severity in children and is a potential indicator of clinical prognosis. Evidence supports early intervention for preschool stuttering, and the successful effect of parents as agents of change in their children’s stuttering therapy. However, no previous studies have trained parents to improve self-regulation in their children as a component of stuttering therapy. This study aimed to explore the effects of addressing self-regulation, as a component of stuttering treatment, on child fluency as well as parent and child psychosocial outcomes. MethodsThis study implemented a preliminary parent administered resilience component in conjunction with stuttering therapy for children who stutter, and compared outcomes to a cohort of children who stutter who received stuttering therapy only. Twenty-eight children who stutter were randomly allocated to one of the two treatment groups. Dependent variables tested pre- and post-treatment included stuttered speech severity, parenting practices, and child resilience indicators. Outcomes were compared between groups at post treatment. ResultsStuttered speech severity decreased in both treatment groups. A reduction in behavioural and emotional problems, and increase in resilience was observed in the children who stutter whose parents received the additional resilience component of therapy. Furthermore, a significant improvement in parenting practices was demonstrated in this group. No significant changes in emotional and behavioural problems in children or parents were observed in the group of children who received fluency therapy only. ConclusionResults demonstrate that implementation of the resilience component was successful in positively shifting parenting practices and increasing behavioural resilience in children who stutter. This has clinical implications for successfully managing fluency while concurrently targeting the concomitant behavioural and emotional impacts of the disorder on both children and parents, potentially a key future prognostic indicator of the maintenance of fluency outcomes.

The Relationship Between Paternal Characteristics and Child Psychosocial Functioning in a Sample of Men Arrested for Domestic Violence

It is estimated that upward of 15.5 million children live in homes where they are exposed to physical and psychological intimate partner violence (IPV). Research indicates that IPV can have deleterious effects on children, including a variety of psychosocial problems, although there is much variability in outcomes of children exposed to IPV. Individual characteristics of the parents involved in IPV may be an important predictor of negative psychosocial outcomes for children. The current study expanded upon prior research and examined the simultaneous associations of paternal characteristics, including paternal IPV perpetration, and child psychosocial functioning (i.e., externalizing, internalizing, and attentional problems) among 153 men arrested for domestic violence and court ordered to attend batterer intervention programs. Analyses examined the relations between paternal alcohol and drug use, antisocial personality traits, hostility, posttraumatic stress symptoms, distress tolerance, IPV perpetration, and men's ratings of their child's psychosocial functioning. Results indicated that poor overall child psychosocial functioning was positively related to paternal antisocial personality symptoms and hostility. Subscale analyses revealed that child attentional problems were positively related to paternal hostility. Child externalizing problems were positively associated with paternal antisocial personality symptoms. The implications of these findings for future research and intervention are discussed.

Psychosocial Outcomes of Children and Adolescents With Severe Congenital Heart Defect: A Systematic Review and Meta-Analysis.

Over the past 20 years, there has been a growing interest in the psychosocial outcomes of children and adolescents born with a congenital heart defect (CHD). This systematic review and meta-analysis aims to appraise and synthesize current literature on the psychosocial outcomes of children and adolescents with severe CHD. A search of studies examining psychosocial outcomes in children and adolescents with severe CHD was performed. Meta-analyses were used to calculate the prevalence of psychosocial impairments and the standardized mean differences between cases and controls. Results that were not included in the meta-analysis were collated using descriptive statistics. A total of 16 studies were included in this review, and results were summarized according to three domains: behavior, social cognition, and self-esteem. Results from a meta-analysis identified that 25% of children and adolescents with CHD presented behavioral problems. Children and adolescents with CHD had more problematic behavior than healthy peers (standardized mean difference; g = 0.71). Young people with CHD had significantly more difficulties inferring on the mental states of others (standardized mean difference; g = 0.72). In contrast, identifying the emotions of others and self-esteem was not statistically different from healthy controls. This review and meta-analysis provides evidence to support the presence of psychosocial difficulties in children and adolescents born with a severe CHD giving grounds for the systematic assessment of behavior and social cognition during their clinical follow-up.

Patterns of parental emotion-related discourse and links with children's problem behaviors: A person-centered approach.

Research demonstrates that parents' emotion-related discourse during reminiscing shapes children's psychosocial outcomes, yet little is known about how different forms of parental emotion-related discourse work in combination. The present study takes a person-centered approach to better understand the relation of multiple forms of parental emotion discourse during reminiscing with problem behaviors in early childhood, as well as child influences on parents' emotion discourse during reminiscing. Specifically, we simultaneously examine three forms of parents' emotion-related discourse (emotion coaching and dismissing, emotion explanations, and elaboration) using cluster analysis to determine parents' patterns of these three discourse forms during discussion about past events. Parents and their preschool-aged children (n = 154) completed a parent-child reminiscing task. Transcripts were coded for emotion coaching and dismissing, emotion explanations, and elaboration. Parents reported on children's internalizing and externalizing behaviors, temperament, and gender, and children completed a language assessment. Cluster analyses revealed three parental discourse patterns: elaboration/negative emotion emphasis, positive and negative emotion emphasis, and low emotion discourse. Children's receptive language was associated with parents' membership in the low emotion discourse cluster. Children's temperament and gender were unrelated to parental emotion-related discourse patterns. Parents in the positive and negative emotion emphasis cluster had children with fewer internalizing behaviors compared to both other clusters, and parents in the elaboration/negative emotion emphasis cluster had children with more internalizing behaviors compared to both other clusters. Findings support the utility of a person-centered approach in providing a holistic view of parents' use of multiple emotion socialization strategies during reminiscing. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Determinants of Psycho-Social Adaptation in the Spanish Second Generation: A Fixed-Effects Analysis

This analysis seeks to establish the key causal determinants of four psycho-social outcomes of children of immigrants — educational aspirations, educational expectations, perceptions of discrimination, and national self-identity — through first-differencing fixed-effects models. Using longitudinal data from the Spanish ILSEG study, we find that both increased identification with the host country and reported experiences of discrimination in it significantly increase educational ambition over time. Reduced experiences of discrimination facilitate increased identification with the host society, while such identification leads to less perceived hostility. Birthplace proves to be the strongest predictor of national self-identity.

Psychosocial outcomes in cancer-bereaved children and adolescents: A systematic review.

Due to the unique importance of parental and sibling relationships and concurrently existing developmental challenges, the loss of a parent or sibling due to cancer is a highly stressful event for children and adolescents. This is the first systematic review that integrates findings on psychosocial outcomes after parental or sibling cancer bereavement. A systematic search of Web of Science, PubMed, PsycINFO, and PubPsych was conducted, last in December 2017. Quantitative studies on psychosocial outcomes of children and adolescents who lost a parent or sibling due to cancer were included. Twenty-four studies (N=10 parental and N=14 sibling bereavement), based on 13 projects, were included. Ten projects had cross-sectional designs. Only 2 projects used large, population-based samples and nonbereaved comparison groups. Outcomes were partially measured by single-item questions. Bereaved children and adolescents showed similar levels of depression and anxiety compared with nonbereaved or norms. Severe behavioral problems were found rarely. However, in 2 large, population-based studies, about half of the bereaved individuals reported unresolved grief. Bereaved adolescents had a higher risk for self-injury compared with the general population in one large, population-based study. Communication with health-care professionals, family, and other people; social support; distress during illness; age; gender; and time because loss were associated with psychosocial bereavement outcomes. Results indicate a high level of adjustment in cancer-bereaved children and adolescents. A modifiable risk factor for adverse psychosocial consequences is poor communication. Prospective designs, representative samples, and validated instruments, eg, for prolonged grief, are suggested for future research.

Adjustment of refugee children and adolescents in Australia: outcomes from wave three of the Building a New Life in Australia study

BackgroundHigh-income countries like Australia play a vital role in resettling refugees from around the world, half of whom are children and adolescents. Informed by an ecological framework, this study examined the post-migration adjustment of refugee children and adolescents 2–3 years after arrival to Australia. We aimed to estimate the overall rate of adjustment among young refugees and explore associations with adjustment and factors across individual, family, school, and community domains, using a large and broadly representative sample.MethodsData were drawn from Wave 3 of the Building a New Life in Australia (BNLA) study, a nationally representative, longitudinal study of settlement among humanitarian migrants in Australia. Caregivers of refugee children aged 5–17 (N = 694 children and adolescents) were interviewed about their children’s physical health and activity, school absenteeism and achievement, family structure and parenting style, and community and neighbourhood environment. Parent and child forms of the Strengths and Difficulties Questionnaire (SDQ) were completed by caregivers and older children to assess social and emotional adjustment.ResultsSound adjustment according to the SDQ was observed regularly among young refugees, with 76-94% (across gender and age) falling within normative ranges. Comparison with community data for young people showed that young refugees had comparable or higher adjustment levels than generally seen in the community. However, young refugees as a group did report greater peer difficulties. Bivariate and multivariate linear regression analyses showed that better reported physical health and school achievement were associated with higher adjustment. Furthermore, higher school absenteeism and endorsement of a hostile parenting style were associated with lower adjustment.ConclusionsThis is the first study to report on child psychosocial outcomes from the large, representative longitudinal BNLA study. Our findings indicate sound adjustment for the majority of young refugees resettled in Australia. Further research should examine the nature of associations between variables identified in this study. Overall, treating mental health problems early remains a priority in resettlement. Initiatives to enhance parental capability, physical health, school achievement and participation could assist to improve settlement outcomes for young refugees.

Reduced Postburn Hypertrophic Scarring and Improved Physical Recovery With Yearlong Administration of Oxandrolone and Propranolol.

Massive burns induce a hypermetabolic response that leads to total body wasting and impaired physical and psychosocial recovery. The administration of propranolol or oxandrolone positively affects postburn metabolism and growth. The combined administration of oxandrolone and propranolol (OxProp) for 1 year restores growth in children with large burns. Here, we investigated whether the combined administration of OxProp for 1 year would reduce scarring and improve quality of life compared with control. Children with large burns (n = 480) were enrolled into this institutional review board-approved study; patients were randomized to control (n = 226) or administration of OxProp (n = 126) for 1 year postburn. Assessments were conducted at discharge and 6, 12, and 24 months postburn. Scar biopsies were obtained for histology. Physical scar assessments and patient reported outcome measures of physical and psychosocial function were obtained. Reductions in cellularity, vascular structures, inflammation, and abnormal collagen (P < 0.05) occurred in OxProp-treated scars. With OxProp, scar severity was attenuated and pliability increased (both P < 0.05). Analyses of patient-reported outcomes showed improved general and emotional health within the OxProp-treated group (P < 0.05). Here, we have shown improvements in objective and subjective measures of scarring and an increase in overall patient-reported physical function. The combined administration of OxProp for up to a year after burn injury should be considered for the reduction of postburn scarring and improvement of long-term psychosocial outcomes in children with massive burns.

A Meta-Analysis of Parenting Practices and Child Psychosocial Outcomes in Trauma-Informed Parenting Interventions after Violence Exposure.

Over half of all youth are exposed to violence, which a growing body of literature suggests is associated with a broad range of negative developmental outcomes over the life course. However, best practices for supportingparenting are not widely applied to parents with children exposed to violence-related trauma. This meta-analyses seeks to synthesize the literature base of trauma-informed parenting interventions to better understand their potential impact on parenting and child outcomes. Specifically, 21 trauma-informed parenting interventions were identified that quantitatively assessed intervention effects on parenting and child outcomes. Six meta-analyses were conducted to assess intervention effects on (1) positive parenting practices, (2) negative parenting practices, (3) parenting stress, (4) children's internalizing problems, (5) children's externalizing problems, and (6) trauma symptoms, respectively. Moderate to large effect sizes were found for positive parenting practices (d = 0.62) as well as child internalizing problems, externalizing problems, and trauma symptoms (d = 0.48-0.59). Validity tests indicated robust findings for positive parenting and for all child outcomes. Additional moderator analyses support the importance of informed intervention design, showing differential findings by trauma type as well as by duration of the intervention. These findings indicate the value of evidence-based parenting interventions for violence-related trauma and support models of trauma-informed care that situate treatment in the broader social context, particularly the family. Results are discussed with respect to which parenting practices hold the most promise for supporting children exposed to violence-related trauma.

Preliminary Efficacy of a Friendly Constraint-Induced Therapy (Friendly-CIT) Program on Motor and Psychosocial Outcomes in Children with Cerebral Palsy

ABSTRACTAims: Constraint-induced therapy (CIT) is effective, but concerns have been repeatedly raised regarding the generalizability, feasibility, and potentially intrusive nature of restraining a child's unimpaired upper limb. We examined the feasibility and efficacy of friendly-CIT, which uses home-based model, a caregiver-determined schedule, and gentle restraint, in children with cerebral palsy. Methods: In a one-group pre-post intervention trial, 15 children (median of age = 8 years, 4 months) participated in 8 weeks of friendly-CIT (36 hours). Motor and psychosocial outcomes were investigated. Results: Participants showed significant improvement on the manual dexterity subtest of the Bruininks-Oseretsky Test of Motor Proficiency (p = 0.004); the how often (p = 0.01) and how well (p = 0.02) scales of the Revised Pediatric Motor Activity Log; and the functional skills score on the Chinese version of the Pediatric Evaluation of Disability Inventory (p = 0.002). For psychosocial outcomes, children with CP consistently demonstrated high engagement and increased playfulness (p < 0.0001) during the 8-week intervention. Parents showed no change in stress status and high satisfaction with friendly-CIT. Conclusion: Friendly-CIT is feasible and promising for improving a child's motor and psychosocial outcomes without increasing parental stress.

Improved outcomes for paediatric renal transplant recipients

Pre-emptive living donor renal transplantation improves the morbidity and mortality of children with end stage kidney disease and is widely accepted as the gold standard for renal replacement therapy. As the accessibility to transplantation improves, its success is underpinned by the evolving importance of renal allograft matching and the principles of the immune mechanisms that lead the host response to engraftment. This coupled with the development of immunosuppressive protocols which have improved the renal allograft survival and simultaneous refinement of surgical expertise, allowing progressively younger children to undergo successful transplantation. Most importantly, advances have collectively improved the neurocognitive and psychosocial outcomes for children. However, despite great innovations, significant hurdles remain with improving outcomes for chronic allograft dysfunction and improving renal allograft survival. Unsurprisingly, best practice guidelines are debated with a growing shift from protocol based towards individualised therapy. In addition, immunosuppressive regimens are commonly associated with a significant increase in adverse effects, which correlates with a decline in adherence. Looking forwards, the global burden of transplantation outweighs the number of potential donors, therefore the legislative framework becomes more important to protect vulnerable individuals. This review explores transformative power of transplantation alongside the predicted challenges ahead.