Individual Child Level Research Articles

Is Using the Strengths and Difficulties Questionnaire in a Community Sample the Optimal Way to Assess Mental Health Functioning?

An important characteristic of a screening tool is its discriminant ability or the measure’s accuracy to distinguish between those with and without mental health problems. The current study examined the inter-rater agreement and screening concordance of the parent and teacher versions of SDQ at scale, subscale and item-levels, with the view of identifying the items that have the most informant discrepancies; and determining whether the concordance between parent and teacher reports on some items has the potential to influence decision making. Cross-sectional data from parent and teacher reports of the mental health functioning of a community sample of 299 students with and without disabilities from 75 different primary schools in Perth, Western Australia were analysed. The study found that: a) Intraclass correlations between parent and teacher ratings of children’s mental health using the SDQ at person level was fair on individual child level; b) The SDQ only demonstrated clinical utility when there was agreement between teacher and parent reports using the possible or 90% dichotomisation system; and c) Three individual items had positive likelihood ratio scores indicating clinical utility. Of note was the finding that the negative likelihood ratio or likelihood of disregarding the absence of a condition when both parents and teachers rate the item as absent was not significant. Taken together, these findings suggest that the SDQ is not optimised for use in community samples and that further psychometric evaluation of the SDQ in this context is clearly warranted.

Educational process quality in preschools at the individual child level: findings from a German Study

A large body of research has examined the quality of educational processes in preschools, but it has usually been studied at the group level. Thus, there is a lack of research on the quality of educational processes as experienced by individual children. Therefore, this study investigated the quality of educational processes in preschools at the individual child level. The sample consisted of 133 children attending 51 preschools that were located in two German federal states. Data were collected in spring 2006 (first year in preschool), spring 2007 (second year), and spring 2008 (third year). The findings revealed moderate educational quality with regard to a ‘support of social competencies’ composite, whereas educational quality representing the composites ‘support of cognitive competencies,’ ‘support of early literacy competencies,’ and ‘support of early numeracy competencies’ was virtually inadequate. This applied to the first, second, and third preschool years. In addition, there were some modest, albeit inconsistent, changes in educational process quality over time.

Three-generation model: A family systems framework for the assessment and treatment of veterans with posttraumatic stress disorder and related conditions.

This article describes the three-generation family systems health care model developed at the Veteran and Family Clinic of the Home Base Program, a partnership between the Red Sox Foundation and Massachusetts General Hospital designed to improve treatment engagement of veterans with posttraumatic stress disorder (PTSD) and related conditions, and to provide care to the entire military-connected family. This clinical model was designed to address 3 interdependent facets of the PTSD-affected family system: (a) the multiple attachment relationships that are often strained; (b) the veteran’s family roles, which may be impaired; and (c) the multiple pathways for treatment engagement and amelioration of the veteran’s PTSD-related distress and behaviors within the family system. In addition, we describe the assessment system, designed to probe the interrelationships of individual veteran, couple, parenting, child, and family levels of functioning. Three cases illustrative of the three-generation model’s clinical application, how it can address unmet needs, and its ability to overcome barriers to health care for military families are also discussed.

Surveys of measles vaccination coverage in eastern and southern Africa: a review of quality and methods used.

ObjectiveTo assess the methods used in the evaluation of measles vaccination coverage, identify quality concerns and provide recommendations for improvement.MethodsWe reviewed surveys that were conducted to evaluate supplementary measles immunization activities in eastern and southern Africa during 2012 and 2013. We investigated the organization(s) undertaking each survey, survey design, sample size, the numbers of study clusters and children per study cluster, recording of immunizations and methods of analysis. We documented sampling methods at the level of clusters, households and individual children. We also assessed the length of training for field teams at national and regional levels, the composition of teams and the supervision provided.FindingsThe surveys were conducted in Comoros, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Uganda, Zambia and Zimbabwe. Of the 13 reports we reviewed, there were weaknesses in 10 of them for ethical clearance, 9 for sample size calculation, 6 for sampling methods, 12 for training structures, 13 for supervision structures and 11 for data analysis.ConclusionWe recommend improvements in the documentation of routine and supplementary immunization, via home-based vaccination cards or other records. For surveys conducted after supplementary immunization, a standard protocol is required. Finally, we recommend that standards be developed for report templates and for the technical review of protocols and reports. This would ensure that the results of vaccination coverage surveys are accurate, comparable, reliable and valuable for programme improvement.

Community perceptions and foster care placement: A multi-level analysis

Signs of physical and social disorder in a community have the potential to influence the perceptions about community, which could, in turn, impact the decision making processes involved in child maltreatment investigations. While extant research has demonstrated a link between community context and child maltreatment rates, there is a dearth of research examining the potential relationship between social conditions in a community and the child welfare system's response to allegations of neglect. This study examined the relationship between child- and community-level characteristics and the decision to place a child in foster care. Two data sets were linked, one containing detailed observations of community conditions (e.g., cigarette and alcohol advertisements) and a second with individual child level information about child welfare investigations. Multilevel models allowed for the simultaneous understanding of child- and community-level characteristics. The results indicated strong associations between individual characteristics and foster care placement. The race or ethnicity of the child was a strong predictor of entry into foster care, and young children were much more likely to be placed in foster care than older children. Furthermore, community factors were also associated with placement into foster care. Specifically, the presence of litter and graffiti and the lack of security signage in a neighborhood appeared to impact the decision making process for foster care.

Impact of Child Neglect and Abuse on Adult Mental Health

Child neglect and abuse is a public health priority. Adverse conditions in early life are associated with higher risk of mental disorders. Family conditions and quality of parenting have a significant impact on risk of mental and physical health. Children's exposure to neglect, direct physical and psychological abuse, and growing up in families with domestic violence was particularly damagin. The current review covers four aspects, namely, (i) prevalence of child neglect and abuse in South Asian Association Regional Cooperation (SAARC) countries; (ii) evidence of the lifetime impact of child neglect and abuse on the mental health in the general population and in specific population groups; (iii) the biological changes due to the impact of child neglect and abuse; and (iv) implications of the findings for research and interventions at the level of children, families and community. There is poor documentation of child neglect and abuse. A recent Tata Institute of Social Sciences (TISS) and Action Aid study (2014) in Mumbai city’ covered over 37,059 children, of whom 728 were studied in depth. Torture, beating, forced starving and sexual abuse were observed or heard by (among the) children. Threats from police, theft, hurt, displacement, kidnapping and ghosts were perceived mostly at nights, especially in the sleeping places. In total, 44% had observed abuse, which included torture, beating, forced starving and sexual abuse. In an another report, ‘The Republic's Lost Children’, it was reported that 38% were forced into sex trade; 23% forced into domestic servitude; 4% routed to work at hotels or hospitals; and 3% at the sweetmeat and garment units. The evidence of the long-lasting effects of ‘child neglect and abuse’ are increased rates of mental disorders. Physically abused, emotionally abused and neglected individuals have a higher risk, two to three times, of developing depressive disorders than non-abused individuals. Children with a history of bullying, 40–50 years later, had an increased risk for depression and suicidal thoughts and were likely to have lack of social relationships, lower educational levels and also more likely to be unemployed and earning less. Other significant associations between childhood adversities are occurrence of first-onset and recurrent mania, fatigue syndromes, adult violent offending, and criminality. There is growing evidence of the mediation of the effects of child neglect and abuse are biologically based with associated changes at the level of stress response, changes in brain structures, inflammatory response and neurocognitive functions. There is need for interventions at many levels, starting from documenting the problem, the longitudinal study of neglected children, interventions to remedy the disadvantages at the level of individual children, their families, communities and government policies. This is an urgent need in the SAARC countries.

Children of cancer patients: prevalence and predictors of emotional and behavioral problems.

Children of patients with cancer are at increased risk for developing emotional and behavioral problems. This study explored the prevalence and predictors of emotional and behavioral problems in Children of cancer patients in a multisite research project. A cross-sectional sample of N = 235 families was recruited simultaneously in 5 university medical centers. The participants, including parents (N = 402) and children (N = 324; ages 11-21 years) completed standardized questionnaires. Emotional and behavioral problems in children were measured by the Strengths and Difficulties Questionnaire (SDQ). On the basis of previous research and using a mixed-model approach, child-, parent-, family- and cancer-related variables were examined in addition to socioeconomic status as potential predictors. Descriptive statistics and a multiple random coefficient model were used in the analyses. Compared to norms, Children of cancer patients show increased mean levels of emotional and behavioral symptoms. The best predictor of emotional and behavioral problems from the perspectives of the child, the healthy parent, and the ill parent was general family dysfunction. Although family dysfunction was identified as the main predictor, the analysis revealed that the main part of variance was related to the individual child's level. The results indicate that screening for child mental health problems and family dysfunction in oncological and psychosocial treatment units can identify the families most in need of psychosocial support. Psychological services need to be both family-oriented and child-centered and focus on family dysfunction to prevent mental health problems in children.

Predictors of 2-year cognitive performance after laser surgery for twin-twin transfusion syndrome

The purpose of this study was to determine risk factors for poor cognitive performance among children who are treated with in utero selective laser photocoagulation of communicating vessels for twin-twin transfusion syndrome. This was a prospectively enrolled cohort study. Cognitive performance at age 2 years (±6 weeks) was assessed with the Battelle Developmental Inventory 2nd Edition (BDI-2). Multilevel regression models evaluated risk factors for poor cognitive performance at shared (pregnancy) and individual (child) levels. In additiontodevelopment, blindness, deafness, and cerebral palsy were assessed based on physical examination. A priori power analysis determined that a sample of ≥100 children was required for adequate statistical power (0.80). One hundred children (57 families) were evaluated. Total BDI-2 score was within normal range (mean, 101.3 ± [SD]12.2); 1 child had a BDI-2 score of <70. Individual child-level risk factors for lower BDI-2 included male sex (β= -0.37; P < .01), lower head circumference (β= 0.28; P < .01), and higher diastolic blood pressure (β= -0.29; P < .01). At the pregnancy level, lower maternal education (β= 0.60; P < .001), higher Quintero stage (β= -0.36; P < .01), and lower gestational age at birth (β= 0.30; P < .01) were associated with worse cognitive outcomes. Donor/recipient status, gestational age at surgery, fetal growth restriction, and co-twin fetal death were not risk factors. The rate of neurodevelopmental impairment (blindness, deafness, cerebral palsy, and/or a BDI-2 score <70) was 4%. Overall cognitive performance quotients were in the normal range, with risk factors for poor outcomes seen at the pregnancy and child levels. Clinical and socioeconomic characteristics can identify at-risk children who need additional interventions.

Influence of Perceptions on School Nurse Practices to Prevent Childhood Obesity

Comprehensive childhood obesity prevention (COP) strategies should include increasing school nurse involvement. This study was conducted to determine the influence of key school nurse perceptions (self-efficacy, perceived benefits, and perceived barriers) on participation in COP practices at the individual child and school level. Florida registered nurse (RN) school nurses (n = 171) anonymously completed online or paper questionnaires. Linear regression analyses identified a model of self-efficacy with perceived benefits and barriers that explained 12% and 9.1% (p < .001) of variance in child-level and school-level COP practices, respectively. Self-efficacy explained the most variance in both models (p < .001). Mediation testing identified perceived barriers as a partial mediator of the influence of self-efficacy on child-level practices. These findings support interventions and policy changes to increase self-efficacy and reduce perceived barriers to promote school nurse involvement in preventing childhood obesity.

The Effects of a Comprehensive Early Literacy Project on Preschoolers’ Language and Literacy Skills

The purpose of this study was to examine the effects of a federally funded early literacy project that aimed to promote the school readiness skills of preschool-age children from low income families. Through daily, explicit, and systematic instruction, the project targeted to improve preschoolers’ oral language skills, phonological awareness, print awareness, and alphabet knowledge that aligned with the existing curriculum of the local school district. Data were collected through multiple sources at the individual child level, classroom level, and from the family/home environment. Significant gains were found between pre- and post-tests in child outcomes, classroom environments, instructional practices, parent attitudes toward early literacy, and family involvement in literacy activities. Additionally, classroom organization was identified as a significant predictor for children’s receptive language skills. Limitations of the current study and implications for future research as well as instructional practices were discussed.

Verbal memory after epilepsy surgery in childhood

To investigate verbal memory after epilepsy surgery both group-wise and at the level of individual children, and to assess associations with side of surgery and removal of the temporal lobe. A prospective controlled study in a consecutive sample of 21 children undergoing epilepsy surgery, with comprehensive assessments of verbal memory before surgery and six, 12 and 24 months after surgery. For each patient, two age- and gender-matched controls were tested at similar intervals. Standardized regression-based (SRB) analysis was applied to compare post-surgical change in individual patients with change in controls. Group-wise, average normed scores on verbal memory tests were higher after epilepsy surgery than before, corroborating earlier reports. By dint of empirically based SRB analysis, however, considerable individual differences in post-surgical change were revealed. Children with resections that included the left temporal lobe functioned significantly poorer than predicted on the basis of their pre-surgical performance. In contrast, verbal memory performance after surgery was consistent with pre-surgical baseline in the majority of children with resections that spared the left temporal lobe. Despite cessation of epileptic seizures, verbal memory remains vulnerable in children who required surgery including the left temporal lobe. In most - but not all - children with other types of surgery, post-surgical verbal memory is consistent with their individual pre-surgical base level.

Birth weight and delivery practice in a Vietnamese rural district during 12 year of rapid economic development

BackgroundSince the Doi Moi reform 1986 economic conditions in Vietnam have changed significantly and positive health and health care developments have been observed. International experience shows that improved economic conditions in a country can reduce the risk of perinatal mortality, decrease the risk of low birth weight and increase the mean birth weight in newborns. The Health and Demographic Surveillance Site (HDSS) FilaBavi in Bavi district outside Hanoi city has been operational since 1999. An open cohort of more than 12,000 households (52,000 persons) has been followed primarily with respect to demography, economy and education. The aim of this research is to study trends in birth weight as well as birth and delivery practices over the time period 1999–2010 in FilaBavi in relation to the social and economic development.MethodsInformation about birth weight, sex, place and method of delivery, mother’s age and education as well as household economy of 10,114 children, born from 1999 to 2010, was obtained from the routine data collection in the HDSS.ResultsOver the study period the mean birth weight remained at the same level, about 3,100 g, in spite of increased economic resources and technology development. At the individual child level we found associations between birth weight and household economy as well as the education of the mother. Hospital delivery increased from about 35% to 65% and the use of Caesarian section increased from 2.6% to 10.1%.ConclusionDuring the twelve years studied, household income as well as the use of modern technology increased rapidly. In spite of that, the mean and variation of birth weight did not change systematically. It is suggested that increasing gaps in economic conditions and misallocation of resources, possibly to overuse of technology, are partly responsible.

Schools With Fitter Children Achieve Better Literacy and Numeracy Results: Evidence of a School Cultural Effect

Relationships of academic achievement (government tests) with physical fitness (multistage run), physical activity (pedometers) and percent body fat (dual emission X-ray absorptiometry) were examined at both the aggregate school level and the individual child level using data collected from 757 children in 29 elementary schools. Statistical adjustments included gender, grade and socioeconomic status. Between-school relationships of the academic scores with fitness and physical activity were strong and positive, with some evidence of (negative) relationships with percent body fat. The between-child relationships were weaker, and nonexistent with percent body fat. Stronger between-school than between-child relationships favor the argument that variation in school cultures, characterized by concurrent attention to fitness and academic achievement, might play a more dominant role in explaining these relationships than any direct effect of fitness on academic achievement.

Letter-to-the-Editor : Monitoring Child Undernutrition at National Levels Before and After the Economic and Food Crisis: Data from 20 Countries

Since the global economic and food price crisis began in the second half of 2008, there have been widespread concerns of considerable impact on child undernutrition [1,2] as well as impacts on employment, poverty, and other development indicators associated with child undernutrition [3,4]. Although concerns of deterioration of child nutritional status as a result of the global economic and food price crisis are warranted, whether available evidence supports such claims of impact at national levels remains unclear. Using national survey data from 20 countries, we examined one dimension of the crisis at the individual child level by comparing nationally representative estimates of child nutritional status (i.e., stunting and underweight) before and after 2008 (Table 1).

Child Maltreatment and the Advocacy Role of Professional School Counselors

Recent focus in counseling has been on the expansion of advocacy to disadvantaged and marginalized populations. Utilizing advocacy dispositions and competencies, this article details the school counselor's role in working with maltreated children. Examples are cited for advocacy work at the individual child, school, and broader social levels.

The collection and analysis of data on children with speech, language and communication needs: The challenge to education and health services

The Bercow Report (Bercow, 2008) commissioned by the UK government provided a high status impetus to improve services for children and young people with the full range of speech, language and communication needs (SLCN). A research study commissioned to provide evidence to Bercow (2008) identified both limitations and potential benefits regarding the collection, analysis and use of data on children and young people with SLCN. This article draws on that study of six local authorities and their partner primary care trusts, and on analyses of national statistics. The term ‘speech, language and communication needs’ (SLCN) is shown to be used in England for two different populations: all children with some form of SLCN, whatever the cause, and the more specific group comprising children and young people with primary language difficulties. The article focuses mainly on the latter group and those with autistic spectrum disorder to explore the use of data available on children and the use of these data to aid collaborative planning by education and speech therapy services. It is concluded that local authorities are ‘data rich’ with child level information, but effective use of these data for children with SLCN is limited. Collaborative data collection, analysis and use for policy or individual child level action by education and speech and language therapy services are even less common. Data are necessary to support the evaluation of interventions and provide an appropriate accountability framework. It is argued that effective data use by local authorities and primary care trusts, especially if working collaboratively, has the potential to improve services for children with SLCN.

The Effect of Pupil Absenteeism on Literacy and Numeracy in the Primary School

Although school psychologists are involved in dealing with the problem of pupil absenteeism at both the individual child and whole school level, one of the possible reasons for their involvement, namely the belief that significant absence from school has an effect on attainments, is actually founded on weak evidence. The literature review presented in this article revealed that, in order to determine the effect of absence on attainments, no satisfactory study had hitherto been conducted in which attainments had been measured before and after a period of absence. However, the results of longitudinal research partially conducted by the present author, reported in this article, do show that absence from school has a significant effect on primary school attainments. In particular, it was found that an absence of half a year between the ages of 7- and 11-years-of-age resulted in a reduction of 0.7 of a year and 1 year in reading and mathematics test scores respectively. The article ends with a consideration of the kind of research which still needs to be conducted in order to provide school psychologists with the information they need to deal successfully with pupil absenteeism problems.

Children's mappings of large number words to numerosities

Previous studies have suggested that children's learning of the relation between number words and approximate numerosities depends on their verbal counting ability, and that children exhibit no knowledge of mappings between number words and approximate numerical magnitudes for number words outside their productive verbal counting range. In the present study we used a numerical estimation task to explore children's knowledge of these mappings. We classified children as Level 1 counters (those unable to produce a verbal count list up to 35), Level 2 counters (those who were able to count to 35 but not 60) and Level 3 counters (those who counted to 60 or above) and asked children to estimate the number of items on a card. Although the accuracy of children's estimates depended on counting ability, children at all counting skill levels produced estimates that increased linearly in proportion to the target number, for numerosities both within and beyond their counting range. This result was obtained at the group level (Experiment 1) and at the level of individual children (Experiment 2). These findings provide evidence that even the least skilled counters do exhibit some knowledge of the form of the mapping between large number words and approximate numerosities.

Identifying effective interventions for young children with autism spectrum disorders

Until recently, intervention research for young children with autism has been strongly criticized because of the paucity of well controlled comparative studies and particularly the lack of randomized control trials (RCT’s). Over the last decade, however, there has been a steady improvement of the quality of research in this area. RCT’s, although still relatively rare, have increased in number, and have been used to examine the effectiveness of a range of different treatment approaches, including parent management style; early, intensive behavioural interventions; social communication, joint attention and play programmes, and augmentative communication systems. Well controlled trials, involving closely matched groups of children have also added to our knowledge of treatment effects. The present paper will focus on a series of recent studies, utilizing both randomized and matched case‐control comparison designs. Overall, group results indicate moderate, but encouraging improvements for children involved in each of these interventions. However, at an individual child level, outcome is much more variable, with some children in each programme showing considerable change, others only minor improvements and some showing no improvement, or even deterioration over time. Identification of the children who respond most to specific types of intervention remains a major challenge for research in this field in the future.

The Experience of Adoption (2): The Association between Communicative Openness and Self-Esteem in Adoption

A study of the views of two groups of 11-year-old adopted children (one adopted as babies within the UK, n = 47, the other adopted from Romania, aged between two and 43 months, n = 133) indicates that parents underestimate the difficulty that their children have in talking about adoption. Children who found this harder experienced lower self-esteem at age 11 and were also more likely to feel different from their adoptive families, and both these factors were related to the individual child's level of behavioural or cognitive difficulties. Children in the Romanian sample who had another adopted sibling found it easier to talk about their adoption. In summary, the ease with which children can talk about adoption does appear to be associated with higher self-esteem and the individual child's difficulties, as well as family composition. This article by Celia Beckett, Jenny Castle, Christine Groothues, Amanda Hawkins, Edmund Sonuga-Barke, Emma Colvert, Jana Kreppner, Suzanne Stevens and Michael Rutter follows ‘The experience of adoption (1)’ (Hawkins et al, 2007), which explored intercountry and domestic adoption from the child's point of view.