Child Outcome Measures Research Articles

School performance in children with type 1 diabetes

BackgroundChildhood onset diabetes has broad cognitive and social effects that are likely to impact on the school experience. In turn, educational outcomes are associated with measures of diabetes related health.
 ObjectivesThis study models school outcome measures for children with diabetes in comparison to their non-diabetic peers.
 MethodsWe use education and diabetes data linked and stored in SAIL databank. We have eight academic cohorts of Welsh administrative education data linked to the register of all children diagnosed with Type 1 diabetes in Wales before the age of 15 (The Brecon Cohort). We model the associations for diabetes with both school absence (sessions missed per year) and educational attainment (using high stakes testing at the end of compulsory schooling), adjusting for individual, school and clinic characteristics and clustering.
 Data LinkageWe discuss our approaches to the challenges of linking the education and diabetes register and outline our proposed solution to the governance challenges of linking diabetes related audit data.

Associations between birth registration and early child growth and development: evidence from 31 low- and middle-income countries

BackgroundLack of legal identification documents can impose major challenges for children in low- and middle-income countries (LMICs). The aim of this study was to investigate the association between not having a birth certificate and young children’s physical growth and developmental outcomes in LMICs.MethodsWe combined nationally representative data from the Multiple Indicator Cluster Surveys in 31 LMICs. For our measure of birth registration, primary caregivers reported on whether the child had a birth certificate. Early child outcome measures focused on height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ), weight-for-height z-scores (WHZ), and standardized scores of the Early Childhood Development Index (ECDI) for a subsample of children aged 36–59 months. We used linear regression models with country fixed effects to estimate the relationship between birth registration and child outcomes. In fully adjusted models, we controlled for a variety of child, caregiver, household, and access to child services covariates, including cluster-level fixed effects.ResultsIn the total sample, 34.7% of children aged 0–59 months did not possess a birth certificate. After controlling for covariates, not owning a birth certificate was associated with lower HAZ (β = − 0.18; 95% CI: -0.23, − 0.14), WAZ (β = − 0.10, 95% CI: -0.13, − 0.07), and ECDI z-scores (β = − 0.10; 95% CI: -0.13, − 0.07) among children aged 36–59 months.ConclusionOur findings document links between birth registration and children’s early growth and development outcomes. Efforts to increase birth registration may be promising for promoting early childhood development in LMICs.

Attention and executive functions computer training for attention-deficit/hyperactivity disorder (ADHD): results from a randomized, controlled trial.

Multicenter randomized clinical superiority single-blind trial investigated the effect of a computer training program targeting multiple cognitive functions. Seventy children with ADHD, aged 6-13, were randomized to intervention or control group. The intervention group used ACTIVATE™ for 8weeks and both groups received treatment as usual and were assessed in regard to cognitive functions, symptoms, behavioral and functional outcome measures after 8, 12 and 24weeks. There was no significant effect on the primary outcome, sustained attention (β = - 0.047; CI - 0.247 to 0.153) or the secondary outcomes [parent-rated ADHD-RS, β = - 0.037; CI (- 0.224 to 0.150); teacher-rated-ADHD-RS, β = 0.093; CI (- 0.107 to 0.294); parent-rated-BRIEF, β = - 0.119; CI (- 0.307 to 0.069); and teacher-rated-BRIEF, β = 0.136; CI (- 0.048 to 0.322)]. This multicenter randomized clinical trial found no significant beneficial effects of cognitive training using the computer program ACTIVATE on the primary or secondary outcome measures in children with ADHD. Nevertheless, our study was likely underpowered to detect small to moderate changes.Trial registration ClinicalTrials.gov: NCT01752530, date of registration: December 10, 2012.

Feasibility study of a family- and school-based intervention for child behavior problems in Nepal

BackgroundThis study evaluates the feasibility, acceptability, and outcomes of a combined school- and family-based intervention, delivered by psychosocial counselors, for children with behavior problems in rural Nepal.MethodsForty-one children participated at baseline. Two students moved to another district, meaning 39 children, ages 6–15, participated at both baseline and follow-up. Pre-post evaluation was used to assess behavioral changes over a 4-month follow-up period (n = 39). The primary outcome measure was the Disruptive Behavior International Scale—Nepal version (DBIS-N). The secondary outcome scales included the Child Functional Impairment Scale and the Eyberg Child Behavior Inventory (ECBI). Twelve key informant interviews were conducted with community stakeholders, including teachers, parents, and community members, to assess stakeholders’ perceptions of the intervention.ResultsThe study found that children’s behavior problems as assessed on the DBIS-N were significantly lower at follow-up (M = 13.0, SD = 6.4) than at baseline (M = 20.5, SD = 3.8), p < 0.001, CI [5.57, 9.35]. Similarly, children’s ECBI Intensity scores were significantly lower at follow-up (M = 9.9, SD = 8.5) than at baseline (M = 14.8, SD = 7.7), p < 0.005, 95% CI [1.76, 8.14]. The intervention also significantly improved children’s daily functioning. Parents and teachers involved in the intervention found it acceptable and feasible for delivery to their children and students. Parents and teachers reported improved behaviors among children and the implementation of new behavior management techniques both at home and in the classroom.ConclusionsSignificant change in child outcome measures in this uncontrolled evaluation, alongside qualitative findings suggesting feasibility and acceptability, support moving toward a controlled trial to determine effectiveness.

The young adult Strengths and Difficulties Questionnaire (SDQ) in routine clinical practice

Expansion of the youth mental health sector has exposed a need for an outcome measure for young adults accessing services. The Strengths and Difficulties Questionnaire (SDQ) is a widely used consumer and carer outcome measure for children and adolescents. The aim of this study was to evaluate the psychometric properties of a young adult SDQ. The young adult SDQ was introduced for routine clinical practice at Eastern Health Child and Youth Mental Health Service (EH-CYMHS), complementing the well-established adolescent and child versions. Data for adolescents (aged 12–17) and young adults (aged 18–25) where both self-report and parent SDQs had been completed at entry point to the service were extracted from a two-year period. Overall, paired cases involved 532 adolescents and 125 young adults. Across both self-report and parent SDQs, a similar pattern of results was found between adolescents and young adults on mean scores, inter-scale correlations, internal consistency, and inter-rater agreement. The findings of the current study support the use of the young adult SDQ in public mental health as an instrument whose psychometric properties, to date, appear consistent with those of the adolescent version. Further investigation is warranted.

Outcome measures for children with movement disorders.

The huge contribution of advances in the pediatric neurosciences, improvements in clinical practice, and new therapeutic options, has led to the development of new models of treatment and rehabilitation for dystonia in the last decade. It is now generally agreed that a multidimensional therapeutic approach is needed for children with motor disorders, whose motor function-conceived as a complex perceptive, motor and cognitive process - is impaired at a crucial time in their development, with a fall out on how their various adaptive functions evolve. Neurophysiological studies, modern neuroimaging techniques, and advances in cognitive psychology have all contributed to improving our understanding of the potential effects of treatments in early age - not only on the symptoms, but also on plasticity processes and neuronal reorganization. The International Classification of Functioning, Disability and Health (ICF) promoted by the WHO, and the diffusion of family-centered models of healthcare have underscored the importance of the ecological perspective with a view to providing effective therapies and a satisfactory quality of life for dystonic children and their families. The advances made in this area have made it necessary to study and develope more appropriate treatment outcome measures. In the light of these aspects, there is still not enough literature on the generally-accepted, exhaustive dystonia assessment tools. Given these limits, it might be useful to discuss the strengths and weaknesses of the main tools currently used in this setting.

Reliability and validity of the Brachial Plexus Outcome Measure in children with obstetric brachial plexus palsy

Study DesignClinical measurement and cross-sectional study. IntroductionNumerous scales have been developed to examine activities of daily living and function in children with brachial plexus palsy. The Brachial Plexus Outcome Measure (BPOM) scale was developed in 2012 by Emily S. Ho and contains 14 items that measure activity and self-evaluation. Purpose of the StudyThe aim of the study was to cross-culturally translate the BPOM scale into Turkish and test its measurement properties in children with brachial plexus palsy. MethodsThe scale was translated into Turkish using standard cross-cultural translation procedures. Forty-eight children with obstetric brachial plexus palsy (OBPP) were included in psychometric evaluations. Internal structure consistency and test-retest reliability were measured for reliability analyses. For each item on the scale, Cronbach alpha coefficient and item-total score correlations for all subscales were calculated. The scale was administered at baseline and 1 week later by 2 different physiotherapists to evaluate test-retest reliability. Concurrent construct validity was assessed using Pearson correlations between the OBPP and the Mallet classification system. ResultsEighteen (37.5%) girls and 30 (62%) boys, in total 48 children, whose mean age was 8.7 ± 2.4 (minimum-maximum = 5-14) years were included in the study; 9 (18.9%) have a history of both early microsurgery and tendon transfers and 39 (81.3%) have a history of only tendon transfer. Cronbach alpha ranged from 0.89 to 0.96, and for the whole scale, it was calculated as 0.938. DiscussionTest-retest reliability was high. Moderate correlations were observed between the measures. ConclusionThe Turkish BPOM scale is a valid and reliable measurement for assessing function in children with OBPP in the Turkish population.

Validity and comprehensibility of outcome measures in children with shoulder and elbow disorders: creation of a new Pediatric and Adolescent Shoulder and Elbow Survey (Pedi-ASES)

Valid patient-reported outcomes (PROs) for the shoulder and elbow do not exist for children. We assessed children's comprehension of the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and the American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form, identified response errors, and modified items to create a new pediatric shoulder and elbow PRO. We recruited 50 children (aged 10-18 years) with shoulder or elbow disorders from a children's hospital-based orthopedic clinic for this qualitative study. A trained researcher conducted cognitive interviews to identify children's comprehension of PROs. In phase 1, 40 children were purposefully sampled on the basis of age and gender, interviewed, and audiotaped. A behavioral scientist analyzed transcripts, modified items, and created the Pediatric and Adolescent Shoulder and Elbow Survey (Pedi-ASES). In phase 2, 10 children were interviewed to gather feedback on and to refine the Pedi-ASES. The average interview time was 25 minutes (range, 17-44 minutes). There were 242 comments generated about the QuickDASH; 51% of children struggled with complex terminology, and 35% did not understand "tingling." Children generated 309 comments about the ASES, primarily associated with narcotic medications (65%) and shoulder instability (42%). Time frame and format issues were noted. In phase 2, children found the new PRO easier to comprehend and answer. Modifications were needed in general instruction, language, format, and response mapping in the original PROs. Children had few difficulties with the Pedi-ASES. Designing PROs that are specific to children will enable researchers and clinicians to more accurately assess health status and clinical outcomes.

Healthy Foundations Study: a randomised controlled trial to evaluate biological embedding of early-life experiences

IntroductionAdverse early experiences are associated with long-lasting disruptions in physiology, development and health. These experiences may be ‘biologically embedded’ into molecular and genomic systems that determine later expressions of vulnerability....

PROMs in paediatric knee ligament injury: use the Pedi-IKDC and avoid using adult PROMs.

The aim of this systematic review was to present an evidence-based overview of psychometric properties of patient-reported outcome measures (PROMs) for children with knee ligament injury. A systematic search of literature was performed in PubMed, EMBASE and Cochrane databases. The inclusion criteria were diagnostic studies evaluating psychometric properties (validity, reliability, responsiveness) and comprehensibility of PROMs as well as studies including children (age <18years) with knee ligament injury. The systematic review was performed following the PRISMA statement. Ten studies were included. Eight studies evaluated psychometric properties of PROMs, and two studies analysed comprehensibility of PROMs. The Pedi-IKDC has been evaluated in four studies and has acceptable psychometric properties. The KOOS-Child is evaluated in one study and has acceptable psychometric properties. The use of adult PROMs in children causes problems in comprehensibility. The Pedi-IKDC is an adequate PROM for children with knee ligament injuries. It is valid, reliable and responsive. The KOOS-Child might be an alternative PROM for the Pedi-IKDC, but has only been evaluated in one study. The clinical relevance of the present systematic review is that adult versions of PROMs are not recommended in children and adolescents. III.

Quality of life outcomes following pediatric lung transplantation.

Compared to other solid organs, survival after lung transplantation (LTx) is still poor. Discussions on survival benefits following LTx in children, however, have largely concentrated on medical outcome data. Little research describes quality of life (QoL) of pediatric LTx recipients, which is partly due to the small number of pediatric LTxs performed. Only two centers worldwide performed >10 pediatric LTxs in 2013, making data on QoL in this population difficult to obtain. The primary objective was to examine the impact of LTx on QoL of pediatric recipients. LTx recipients aged 8-17 years and their parents were recruited from a Canadian pediatric transplant centre. Participants completed the PedsQL 4.0 Generic Core Scales, a validated health-related QoL patient-reported outcome measure for children and adolescents, pre-transplant and two times post-transplant. Pre-LTx QoL scores were compared with initial assessment scores post-LTx and changes in QoL over time were described. Correlations between self- and proxy-reports were also discussed. Ten pediatric LTx recipients (six male, mean age = 13.3 years) and their parents were enrolled. Assessments were completed pre-LTx (mean months = 4.8) and two times post-LTx (mean months 8.7 and 24.6, respectively). Pre- and post-transplant total scores differed significantly for both self- and proxy-report, which remained consistent at a second assessment post-transplant (P = 0.018 and 0.028, respectively). Findings highlight the importance of QoL outcomes when exploring LTx as a treatment option. Future research should explore long-term QoL outcomes post-LTx and examine standardized integration of patient-reported outcomes into clinical practice.

The development and evaluation of content validity of the Zambia Spina Bifida Functional Measure: Preliminary studies.

BackgroundVery little is known on outcome measures for children with spina bifida (SB) in Zambia. If rehabilitation professionals managing children with SB in Zambia and other parts of sub-Saharan Africa are to instigate measuring outcomes routinely, a tool has to be made available. The main objective of this study was to develop an appropriate and culturally sensitive instrument for evaluating the impact of the interventions on children with SB in Zambia.MethodsA mixed design method was used for the study. Domains were identified retrospectively and confirmation was done through a systematic review study. Items were generated through semi-structured interviews and focus group discussions. Qualitative data were downloaded, translated into English, transcribed verbatim and presented. These were then placed into categories of the main domains of care deductively through the process of manifest content analysis. Descriptive statistics, alpha coefficient and index of content validity were calculated using SPSS.ResultsSelf-care, mobility and social function were identified as main domains, while participation and communication were sub-domains. A total of 100 statements were generated and 78 items were selected deductively. An alpha coefficient of 0.98 was computed and experts judged the items.ConclusionsThe new functional measure with an acceptable level of content validity titled Zambia Spina Bifida Functional Measure (ZSBFM) was developed. It was designed to evaluate effectiveness of interventions given to children with SB from the age of 6 months to 5 years. Psychometric properties of reliability and construct validity were tested and are reported in another study.

Correlation between the Gait Profile Score and standard clinical outcome measures in children with idiopathic clubfoot

Correlation between the Gait Profile Score and standard clinical outcome measures in children with idiopathic clubfoot

Physical Activity Interventions for Children with Social, Emotional, and Behavioral Disabilities-A Systematic Review.

Perform a systematic review of the available literature regarding the effectiveness of exercise interventions on children with any type of social, emotional, or behavioral disability (SEBD), with attention to a range of physiological, behavioral, and mood outcomes. Six databases were searched using a systematic methodology. References of included studies, as well as relevant reviews, were also examined. The review was limited to studies published since 2000 reporting a quantitative analysis of the effects of a physical activity (PA) intervention on at least 1 behavioral, psychological, or cognitive outcome in children aged 21 and under, diagnosed with a SEBD. Only studies with a control group were included. We identified 24 eligible studies. Studies varied in design, participant characteristics, and intervention characteristics (single-bout vs repeated exposure, duration, intensity level, mode of exercise). Of the 20 behavioral outcome assessments, there was 1 negative finding, 12 null findings, 5 positive findings, and 2 mixed findings. For the 25 executive functioning outcome assessments, there were 5 null findings, 18 positive findings, and 2 mixed findings. For the remaining outcome domains, 1 of 2 studies looking at academic performance, 3 of 6 studies looking at objective neurological measures, and 1 of 3 studies looking at affect outcomes found positive results. All other results were null or mixed. Although additional research is warranted to further understand the mechanisms by which PA affects behavioral and cognitive outcome measures in children with SEBDs, PA offers a safe and alternative form of treatment for this population.

Six minutes walk test outcome measures in children

Background: There are limited numbers of studies on 6 MWT in school going children in India. Objectives were to know gender wise outcome measurements for 6 MWT and its correlation with various anthropometric parameters, to make comparison of results between children of various socio-economic groups. Methods: After a randomized selection of schools a total of 500 children belonging to different socioeconomic status and studying in Government and Private Schools aged between 7-12 years were enrolled in the study. At the start, anthropometric measurements and baseline parameters like HR, BP, SPO2, PEFR, level of dyspnea were recorded and then children were made to walk for 6 minutes. After the walk changes in these parameters were taken as outcome measures.Results: The Mean distance walked in 6 minute was 609 ± 166 m. Boys covered more distance than girls. Heart rate increased from a baseline of 82.73 ± 1.63 to a maximum of 104.32 ± 3.11; heart rate recovery occurred (&gt;90%) at 5 min in both the genders. SBP (systolic blood pressure) increased from baseline 109 ± 2.38 to maximum of 121.86 ± 1.75 at the end of the test, with no significant increase in DBP. The 6 minute walk distance correlated well with higher level of dyspnea. No significant change in oxygen saturation was observed during the test.Conclusions: The study provides data on normal values of 6MWT in healthy children, which may help to evaluate functional capacity and thus predict the morbidity risk in future and to know the effects of therapeutic interventions in the diseased children.

Development of a wheelchair mobility skills test for children and adolescents: combining evidence with clinical expertise

BackgroundWheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Currently, there is no outcome measure available for the evaluation of WMS in children. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. Therefore the objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents.MethodsMixed methods approach. Phase 1: Item identification of WMS items through a systematic review using the ‘COnsensus-based Standards for the selection of health Measurement Instruments’ (COSMIN) recommendations. Phase 2: Item selection and validation of relevant WMS items for children, using a focus group and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing.ResultsPhase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis in phase 2. Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children. Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were excluded in the final version of the UP-WMST due to logistic reasons.ConclusionsThe newly developed 15 item UP-WMST is a validated outcome measure which is easy to administer in children using a manual wheelchair. More research regarding reliability, construct validity and responsiveness is warranted before the UP-WMST can be used in practice.

The use of the EQ-5D-Y health related quality of life outcome measure in children in the Western Cape, South Africa: psychometric properties, feasibility and usefulness - a longitudinal, analytical study

BackgroundThe EQ-5D-Y, an outcome measure of Health Related Quality of Life (HRQoL) in children, was developed by an international task team in 2010. The multinational feasibility, reliability and validity study which followed was undertaken with mainly healthy children. The aim of this study was to investigate the psychometric properties of the EQ-5D-Y when used to assess the HRQoL of children with different health states.MethodA sample of 224 children between eight and twelve years were grouped according to their health state. The groups included 52 acutely ill children, 67 children with either a chronic health condition or disability and 105 mostly healthy, mainstream school children as a comparator. They were assessed at baseline, at three months and at six months. An analysis of the psychometric properties was performed to assess the reliability, validity and responsiveness of the EQ-5D-Y in the different groups of children. Cohen’s kappa, the intraclass correlation coefficient, Pearson Chi-square, Kruskal-Wallis ANOVA and effect size of Wilcoxon Signed-rank test were used to determine the reliability, validity and responsiveness of the instrument.ResultsThe EQ-5D-Y dimensions were found to be reliable on test-retest (kappa varying from 0.365 to 0.653), except for the Usual Activities dimension (kappa 0.199). The Visual Analogue Scale (VAS) was also reliable (ICC = 0.77). Post-hoc analysis indicated that dimensions were able to discriminate between acutely ill and healthy children (all differences p < 0.001). The acutely ill children had the lowest ranked VAS (median 50, range 0–100), indicating worst HRQoL and was the only group significantly different from the other three groups (p < 0.001 in all cases). Convergent validity between all similar EQ-5D-Y and PedsQL, WeeFIM and Faces Pain Scale dimensions was only evident in the acutely ill children. As expected the largest treatment effect was also observed in these children (Wilcoxon Signed-rank test for VAS was 0.43). Six of the nine therapists who took part in the study, found the measure quick and easy to apply, used the information in the management of the child and would continue to use it in future.ConclusionsThe EQ-5D-Y could be used with confidence as an outcome measure for acutely-ill children, but demonstrated poorer psychometric properties in children with no health condition or chronic conditions. It appears to be feasible and useful to include the EQ-5D-Y in routine assessments of children.

Effectiveness of Interventions for Children With Developmental Coordination Disorder in Physical Therapy Contexts: A Systematic Literature Review and Meta-Analysis

Purpose:The purpose of this systematic literature review and meta-analysis is to identify the types of interventions in physical therapy contexts that have been explored in children with developmental coordination disorder, the most common variables being addressed, and whether these interventions are effective. Method:This systematic search of MEDLINE, PEDro, CINAHL, SPORTDiscus, PsycINFO, and Cochrane Library identified interventions in physical therapy contexts for children and adolescents with DCD, and studies were screened using these criteria and assessed using the PEDro and NIH quality assessment scales. AMSTAR was used to evaluate systematic reviews and a meta-analysis was conducted. Results:From the articles reviewed, 29 articles of moderate to good quality were included in the qualitative analysis. Task-oriented approaches as well as motor skill training–based interventions have shown beneficial effects in improving motor function in children with DCD. Data from 14 articles was extracted for inclusion in the meta-analysis, providing support for the effectiveness of physical therapy interventions against inaction. Conclusion:Researchers recommend the use of task-oriented and traditional physical therapy interventions for children with DCD. In addition, interventions in physical therapy contexts need clear goals and outcome measures for individual children.

Development and psychometric properties of the Suicidality: Treatment Occurring in Paediatrics (STOP) Suicidality Assessment Scale (STOP-SAS) in children and adolescents.

BackgroundTo create a self-reported, internet-based questionnaire for the assessment of suicide risk in children and adolescents.MethodsAs part of the EU project ‘Suicidality: Treatment Occurring in Paediatrics’ (STOP project), we developed web-based Patient Reported Outcome Measures (PROMs) for children and adolescents and for proxy reports by parents and clinicians in order to assess suicidality. Based on a literature review, expert panels and focus groups of patients, we developed the items of the STOP Suicidality Assessment Scale (STOP-SAS) in Spanish and English, translated it into four more languages, and optimized it for web-based presentation using the HealthTrackerTM platform. Of the total 19 questions developed for the STOP-SAS, four questions that assess low-level suicidality were identified as screening questions (three of them for use with children, and all four for use with adolescents, parents and clinicians). A total of 395 adolescents, 110 children, 637 parents and 716 clinicians completed the questionnaire using the HealthTrackerTM, allowing us to evaluate the internal consistency and convergent validity of the STOP-SAS with the clinician-rated Columbia Suicide Severity Rating Scale (C-SSRS). Validity was also assessed with the receiver operating characteristic (ROC) area of the STOP-SAS with the C-SSRS.ResultsThe STOP-SAS comprises 19 items in its adolescent, parent, and clinician versions, and 14 items in its children’s version. Good internal consistency was found for adolescents (Cronbach’s alpha: 0.965), children (Cronbach’s alpha: 0.922), parents (Cronbach’s alpha: 0.951) and clinicians (Cronbach’s alpha: 0.955) versions. A strong correlation was found between the STOP-SAS and the C-SSRS for adolescents (r:0.670), parents (r:0.548), clinicians (r:0.863) and children (r:0.654). The ROC area was good for clinicians’ (0.917), adolescents’ (0.834) and parents’ (0.756) versions but only fair (0.683) for children’s version.ConclusionsThe STOP-SAS is a comprehensive, web-based PROM developed on the HealthTrackerTM platform, and co-designed for use by adolescents, children, parents and clinicians. It allows the evaluation of aspects of suicidality and shows good reliability and validity.

Feasibility of Macular Integrity Assessment (MAIA) Microperimetry in Children: Sensitivity, Reliability, and Fixation Stability in Healthy Observers.

To assess the feasibility of macular integrity assessment (MAIA) microperimetry (MP) in children. Also to establish representative outcome measures (differential light sensitivity, fixation stability, test-retest reliability) for children without visual impairment. Thirty-three adults and 33 children (9-12 years) were asked to perform three monocular MAIA examinations within a single session (dominant eye only). Children exhibited poorer test-retest reliability than adults for measures of both mean sensitivity (95% coefficient of repeatability [CoR95] = 2.7 vs. 2.3 dB, P = 0.036) and pointwise sensitivity (CoR95 = 6.2 vs. 5.7 dB, P < 0.001). Mean sensitivity was lower in children (27.6 vs. 29.5 dB, P < 0.001), and fixation stability was poorer (95% bivariate contour ellipse area [BCEA95] = 4.58 vs. 1.14, P < 0.001). Mean sensitivity was negatively correlated with fixation stability (r = -0.44, P < 0.001). Both children and adults exhibited substantial practice effects, with mean sensitivity improving by 0.5 dB (adults) and 0.9 dB (children) between examinations 1 and 2 (P ≤ 0.017). There were no significant differences between examinations 2 and 3 (P ≥ 0.374). Microperimetry is feasible in 9- to 12-year-old children. However, systematically lower sensitivities mean that the classification boundary for "healthy" performance should be lowered in children, pending development of techniques to improve attentiveness/fixation that may reduce or remove this difference. High measurement variability suggests that the results of multiple tests should be averaged when possible. Learning effects are a potential confound, and it is recommended that the results of the first examination be discarded.