Severity Of Difficulties Research Articles

The Role of Paternal Accommodation of Paediatric OCD Symptoms: Patterns and Implications for Treatment Outcomes

Family accommodation (FA) refers to the participation of family members in obsessive-compulsive disorder (OCD) rituals. Most studies have focused on maternal accommodation; consequently, little is known about fathers’ accommodation of OCD. The current study aims to extend the existing literature by examining maternal versus paternal accommodation of OCD symptoms.The sample consisted of 209 children with OCD (Mean [M] age = 14.1 years) and their parents (NMothers = 209, NFathers = 209) who had completed the Family Accommodation Scale- Parent Report (FAS-PR). Paired t-test and chi-square analyses were used to compare FA of OCD symptoms between mothers and fathers. Linear regression was used to examine correlates of maternal and paternal FA and its impact on treatment outcomes.Mothers reported significantly higher levels of daily FA than fathers. Correlates of maternal and paternal accommodation included OCD symptom severity, emotional and behavioral difficulties, and parent psychopathology. Both maternal and paternal FA significantly predicted worse treatment outcomes.Both mothers and fathers accommodate child OCD symptoms with high frequency, and in similar ways. Although mothers accommodate to a greater extent than fathers, both maternal and paternal involvement in rituals are a significant predictor of the child’s treatment response. Results emphasise the need to consider the whole family system, including fathers, in understanding and treating OCD in children.

Malnutrition And Disability: Evaluating Factors Influencing Severe Malnutrition In Children With Cerebral Palsy In Lusaka, Zambia

The aim of this study was to identify the main risk factors associated with severe malnutrition in children with CP. An unmatched case control study was used to compare 33 children with CP presenting with severe malnutrition (WAZ ≤ -3 SD) against 66 non malnourished CP children (WAZ ≥ -2SD) at the University Teaching Hospital in Lusaka. Risk factors for severe malnutrition in children with CP were determined with bivariate and multiple logistic regression. A p-value of < 0.05 was considered significant at 95% confidence interval. After adjusting for other variables , factors that remained statistically significant (p-value < 0.05) included the following: use of unflushed pit latrine toilet (p=0.0119); bilateral CP (p=0.0054); GMFCS level 4 or 5 (p=0.0001); history of illness in the past six months (p=0.0241); swallowing difficulties (p=0.0006); tonic bite (p= 0.0011no weight gain in the past 2 to 3 months (p=0.0001); dependent on feeding (p=0.0061); feeds only on semisolids or liquids (p=0.0231); taking more than 30 minutes feeding (p=0.0381); fed for ≤ 3 times/day (0.0025); child opening bowels after 3 or more days (0.0057); caregiver concerned about child’s feeding difficulties (p=0.0076); not likely to be fed Irish potatoes (p=0.0008) and Fish (p=0.0001). The risk factors identified in the current study are related to the child’s severity and feeding difficulties including caregiver caring practices.

Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

ABSTRACT Background: There is ongoing debate as to whether emotion regulation problems should be improved first in order to profit from trauma-focused treatment, or will diminish after successful trauma processing. Objective: To enhance our understanding about the importance of emotion regulation difficulties in relation to treatment outcomes of trauma-focused therapy of adult patients with severe PTSD, whereby we made a distinction between people who reported sexual abuse before the age of 12, those who were 12 years or older at the onset of the abuse, individuals who met the criteria for the dissociative subtype of PTSD, and those who did not. Methods: Sixty-two patients with severe PTSD were treated using an intensive eight-day treatment programme, combining two first-line trauma-focused treatments for PTSD (i.e. prolonged exposure and EMDR therapy) without preceding interventions that targeted emotion regulation difficulties. PTSD symptom scores (CAPS-5) and emotion regulation difficulties (DERS) were assessed at pre-treatment, post-treatment, and six month follow-up. Results: PTSD severity and emotion regulation difficulties significantly decreased following trauma-focused treatment. While PTSD severity scores significantly increased from post-treatment until six month follow-up, emotion regulation difficulties did not. Treatment response and relapse was not predicted by emotion-regulation difficulties. Survivors of childhood sexual abuse before the age of 12 and those who were sexually abused later in life improved equally well with regard to emotion regulation difficulties. Individuals who fulfilled criteria of the dissociative subtype of PTSD showed a similar decrease on emotion regulation difficulties during treatment than those who did not. Conclusion: The results support the notion that the severity of emotion regulation difficulties is not associated with worse trauma-focused treatment outcomes for PTSD nor with relapse after completing treatment. Further, emotion regulation difficulties improved after trauma-focused treatment, even for individuals who had been exposed to early childhood sexual trauma and individuals with dissociative subtype.

Orthopantomographic analysis of the intraosseus position of the maxillary canines

The aim of this work was to analyse the intraosseous position of the maxillary canine in orthodontic patients. It was an exploratory pilot study prior to the next research work to develop a predictive model based on a regression analysis initially including a large number of variables. 105 subjects from 6 to 12 years from both genders were included in this study. Four variables were used. The study showed that there was no marked gender dimorphism concerning the intrabony position of the canine; the latter is quite similar on both sides, and the older the age, the smaller the angulation of the canine. The values obtained for the angulation of the canine, its depth of impaction, its position in relation to the lateral incisor and the premolars, correspond to an average impaction severity and treatment difficulties.

Self-reported impulsivity in women with borderline personality disorder: the role of childhood maltreatment severity and emotion regulation difficulties

BackgroundChildhood maltreatment, such as severe emotional, physical, and sexual abuse and neglect, has been linked to impulse control problems and dysfunctional emotional coping. In borderline personality disorder (BPD), a history of childhood maltreatment may worsen difficulties in emotion regulation, which may in turn give rise to impulsive behaviours. The aim of this self-report study was to investigate associations between childhood maltreatment severity, emotion regulation difficulties, and impulsivity in women with BPD compared to healthy and clinical controls.MethodsSixty-one female patients with BPD, 57 clinical controls (CC, women with Attention Deficit Hyperactivity Disorder and/or Substance Use Disorder, without BPD), and 60 female healthy controls (HC) completed self-report scales on childhood trauma (Childhood Trauma Questionnaire, CTQ), difficulties in emotion regulation (Difficulties in Emotion Regulation Scale, DERS), and impulsivity (UPPS Impulsive Behaviour Scale). A conditional process analysis was performed to investigate whether emotion dysregulation statistically mediated the effect of childhood maltreatment severity on impulsivity depending on group (BPD vs. CC vs. HC).ResultsChildhood maltreatment, particularly emotional maltreatment, was positively associated with impulsivity and emotion regulation difficulties across all groups. Difficulties in emotion regulation statistically mediated the effect of childhood maltreatment on impulsivity in BPD, but not in the other groups.ConclusionIn the context of current conceptualizations of BPD and previous research, findings suggest that problems with emotion regulation may be related to a history of childhood maltreatment, which may in turn enhance impulsivity. Targeting emotion dysregulation in psychotherapy and discussing it in relation to childhood maltreatment can help decreasing impulsive behaviors in individuals with BPD. Given the correlational design of our study which does not allow causal conclusions, future studies have to employ prospective, experimental designs and include larger sample sizes to corroborate associations between childhood maltreatment, emotion dysregulation, and impulsivity.

Buffering against maladaptive perfectionism in bipolar disorder: The role of self-compassion

BackgroundMaladaptive perfectionism is a transdiagnostic risk and maintaining factor for a range of mental health conditions, including bipolar disorder (BD). Self-compassion represents a potential protective factor against maladaptive perfectionism, however no studies to date have examined the relationship of these constructs in BD. The aim of the present study was to examine associations between maladaptive perfectionism, self-compassion and symptoms among individuals with BD. MethodsBaseline data were collected from 302 participants with a DSM-IV diagnosis of BD participating in an international randomised controlled trial. Participants completed measures of maladaptive perfectionism, self-compassion, symptom severity and emotion regulation difficulties. Clinician-administered measures of depression and mania severity were additionally collected. Correlation and mediation analyses were conducted. ResultsMaladaptive perfectionism was positively associated with depression, anxiety and emotion regulation difficulties. Lower levels of self-compassion correlated with greater self-reported depression, anxiety and emotion regulation difficulties. Self-compassion partially mediated relationships between maladaptive perfectionism, depression, anxiety and emotion regulation difficulties. LimitationsThe cross-sectional design limits conclusions about causal relationships between study variables. Results may not be generalizable to other BD populations. The role of maladaptive perfectionism and self-compassion in elevated mood states of BD remains unclear. ConclusionSelf-compassion represents one mechanism through which maladaptive perfectionism influences symptoms of depression, anxiety and emotion regulation difficulties in BD. Self-compassion represents a modifiable treatment target; individuals with BD exhibiting maladaptive perfectionistic tendencies may benefit from interventions fostering self-compassion.

Validation of a self-reported instrument to assess work-related difficulties in patients with migraine: the HEADWORK questionnaire

BackgroundThe degree to which work-related difficulties are recognized in headache research is poor and often carried out with inadequate information such as “reduced ability to work as usual”, which do not capture at all the variety of difficulties and the factors that impact over them. The aim of this paper is to present the validation of the HEADWORK questionnaire, which addresses the amount and severity of difficulties in work-related tasks and the factors that impact over them.MethodsWe developed a set of items based on a previous literature review and patients’ focus groups and tested it on a wide set of patients with episodic and chronic migraine attending eight different Italian headache centers. HEADWORK factor structure was assessed with exploratory and confirmatory factor analysis; internal consistency and construct validity were addressed as well.ResultsThe validation sample (N = 373) was mostly composed of patients with episodic migraine without aura (64.3%) and of females (81%). Factor analysis retrieved two different scales: “Work-related difficulties”, composed of eleven items which explain 67.1% of the total variance, and “Factors contributing to work difficulties”, composed of six items which explain 52.1% of the total variance. Both HEADWORK subscales have good measurement properties, with higher scores being associated to higher disability, lower quality of life, lower productivity, higher headache frequency and pain intensity.ConclusionsHEADWORK is a 17-item, two-scale questionnaire addressing the impact of migraine on work-related difficulties in terms of difficulties in general or specific skills, and the factors contributing to these difficulties, defined as negative impact on work tasks. It can be used to address disability weights for the purpose of calculating the burden of migraine, and to assess the balance between therapeutic and side effects of medication on productivity.

Influence of Multiple Traumatic Event Types on Mental Health Outcomes: Does Count Matter?

The experience of potentially traumatizing events (PTEs) may be associated with conflicting outcomes: individuals may experience greater psychological distress (dose-response theory), or individuals may become more resilient against repeated PTEs (stress-inoculation theory). With limited empirical data comparing these theories, we examined the relationships between the count of lifetime PTE types and psychological outcomes [posttraumatic stress disorder (PTSD), depression, impaired distress tolerance] using linear and quadratic regressions. A linear relationship would support the dose-response theory, and a quadratic relationship would support the stress-inoculation theory. We also explored whether there was a threshold number of PTE types fostering resiliency before an increase of distressing outcomes. The sample included 123 (68.30% female) treatment-seeking patients at a community mental health center participating in a larger study (Contractor et al. in Psychiatry Research, 252, 252215–252222, 2017). Linear regression results indicated number of PTE types significantly predicted increasing PTSD and depression severity and distress tolerance difficulties. Quadratic regression model results were not significant. ROC analyses indicated exposure to at least 3.5 PTE types predicted PTSD with moderate accuracy. In conclusion, the dose-response theory was supported, with results indicating there may be a threshold count of lifetime PTE types (> 3) influencing traumatic stress outcomes.

An evaluation of play therapy for children and young people with intellectual disabilities

ABSTRACTChildren and young people with intellectual disabilities are more likely to experience emotional, behavioural, or mental health difficulties, including a combination of these health problems. There are risks that existing interventions may not be accessible or effective for this group. This program evaluation explored the effectiveness of child-centred play therapy, a developmentally appropriate mental health intervention, for a single group of 42 children with intellectual disabilities aged 4 to 16 years with emotional, behavioural, or mental health difficulties. The intervention was provided by seven therapists trained in the same play therapy protocol and procedures. Parents rated children's emotional and behavioural difficulties before and after play therapy using the Strengths and Difficulties Questionnaire. Statistically significant improvement to children's prosocial skills, emotional and behavioural difficulties, and the impact of these difficulties on everyday life was found at the completion of child-centred play therapy. Children with high-priority referral needs were found to have made greater levels of change. However, with increasing severity of difficulties, children required more time in therapy. A higher level of play therapy training predicted greater prosocial skill development for children and a reduced impact of difficulties on their daily life. This evaluation demonstrated that play therapy may be an effective intervention to use with children with intellectual disabilities and emotional and behavioural difficulties, and warrants further consideration for research and practice by the disability and mental health sectors.

Bidirectional Associations Between Child Sleep Problems and Internalizing and Externalizing Difficulties From Preschool to Early Adolescence

Although multiple cross-sectional and longitudinal studies have established that sleep problems and behavioral difficulties are associated in children, the directionality of this association and whether sleep problems are differentially associated with different types of childhood behavioral difficulties are unclear. Understanding these associations will inform the focus and timing of interventions. To determine whether longitudinal and reciprocal associations exist between child sleep problems and externalizing, internalizing, or both behavioral difficulties. Prospective cohort study using nationally representative data from the first 5 waves (2004, 2006, 2008, 2010, and 2012) of the kindergarten cohort (4983 children aged 4-5 years in 2004) collected for the Longitudinal Study of Australian Children. Associations were evaluated using cross-lagged structural equation model analyses performed from May 25, 2016, to September 20, 2017. Child sleep problems and internalizing and externalizing behavioral difficulties. Sleep problems were defined using parent-reported child sleep problem severity and specific difficulties (ie, difficulty getting to sleep at night, not happy sleeping alone, waking during the night, and restless sleep) on 4 or more nights of the week. Child behavioral difficulties were defined using the parent-reported Strengths and Difficulties Questionnaire for externalizing difficulties (conduct problems and hyperactivity/inattention subscales) and internalizing difficulties (emotional problems subscale). The 4983 children enrolled in 2004 had a mean (SD) age of 4.7 (0.2) years and comprised a similar percentage of boys (2536 [50.9%]) and girls. In 2012, 3956 children (79.4%) aged 12 to 13 years were retained. Significant bidirectional associations were detected between sleep problems and externalizing difficulties during the elementary school transition period, with greater sleep problems associated with later externalizing behavior and vice versa (cross-lagged path coefficient, 0.04 [95% CI, 0.01-0.08] to 0.09 [95% CI, 0.06-0.13]). Although sleep was a significant driver of later internalizing difficulties (coefficient, 0.10 [95% CI, 0.07-0.14] to 0.16 [95% CI, 0.12-0.19]), the reverse association was not significant. In the final model that included all 3 constructs, the associations were attenuated but remained significant over time. These results suggest that future studies should investigate whether implementing sleep problem intervention decreases the occurrence of both externalizing and internalizing difficulties. Interventions targeting externalizing, but not internalizing, difficulties may benefit childhood sleep.

Sleep disturbance mediates the relationship between injury severity and executive function difficulties in children 18 months following traumatic brain injury

Sleep disturbance mediates the relationship between injury severity and executive function difficulties in children 18 months following traumatic brain injury

Changes in severity of psychosocial difficulties in adolescents accessing specialist mental healthcare in England (2009–2014)

In England, clinicians and professional organisations report that higher numbers of adolescents with more severe psychosocial difficulties are accessing specialist services. A lack of national data on patterns of access to specialist services means there is limited information to inform policy. We examined whether severity of psychosocial difficulties in adolescents accessing mental healthcare has changed over time. Adolescents seen in specialist child mental healthcare in 2009 vs. 2014 were matched on demographics and problem types using propensity score matching; final sample N = 2776 adolescents. We found: 1) stability over time in overall severity of difficulties, 2) an increase in severity of young women's emotional problems, and 3) a decrease in adolescents' conduct problems. The findings suggest the intriguing possibility that the criteria for accessing mental healthcare are not universally rising, but rather the patterns in access to specialist services may mirror epidemiological changes in severity of psychosocial difficulties in the population.

Depression severity and concentration difficulties are independently associated with HRQOL in patients with unipolar depressive disorders.

Cognitive impairment is a core feature of major depressive disorder (MDD), and dysfunctions in this area strongly contribute to MDD-associated disability. Whether cognitive impairment has an independent clinical course and a unique impact on HRQOL is still debated. We sought to characterize the relationship between depression severity and HRQOL, evaluating the burden of concentration difficulties on HRQOL. Six hundred ninety-twopatients with unipolar depressive disorders recruited in 19 Italian centers answered a self-administered survey (SF-12 questionnaire, socio-demographic information). A psychiatrist completed a standardized data collection form encompassing a depression severity scale (MADRS) and clinical information. There was a strong graded association between the severity of depressive symptoms and both the physical (ω 2=0.13; p<0.01) and mental (ω 2=0.34; p<0.01) SF-12 domains. Additionally, we observed a strong association between concentration difficulties and all HRQOL outcomes independent of other symptoms of depression and robust to adjustment for possible confounders. Our data corroborate previous findings suggesting that cognitive impairment is a feature of unipolar depressive disorders partially independent of the severity of other symptoms, and may represent a specific target of therapy with a strong impact on patients' functioning and quality of life.

Risk of mental disorders and difficulties or conflict in relationships in young adults

IntroductionHigher risk of mental health problems has been linked with problems in relationships, including the experience of relational conflict with significant others and peers. Conversely, positive relations with others have been established as a key factor of psychological well being.ObjectivesWe hypothesized that psychological maladjustment will be related to the number, nature and severity of relational stressors. Furthermore, there would be a higher likelihood of risk of mental disorders for those who experience more relational hardships and of greater severity. Positive relations with others will protect from risk of mental health problems.MethodA total of 4461 university students completed a health and well-being survey, including the GHQ-12 (centesimal and 3-point cut-off scores), Ryff psychological well-being scale and a scale of 25 life stressors. Indexes of number and severity of difficulties in relationships were calculated with 10 items including romantic partners, friends, family, and classmates.ResultsCorrelations were significant. Logistic regression showed a risk effect for all stressors with OR values above 1.32. Overall perceived severity had the highest value (OR = 2.38, 95% CI = 2.16–2.61) and amongst the 10 stressors, gender related abuse/violence was also the highest (OR = 1.90, 95% CI = 1.73–2.09). Positive relations showed a protective effect (OR = 0.60, 95% CI = 0.56–0.54).ConclusionsFindings can inform health promotion, prevention and therapeutic interventions so as to improve the quality of personal relationship and conflict management skills, and to strengthen well-being associated with positive relations with others. Academic institutions committed to student welfare and the promotion of healthy environments should play a major role in young adults’ mental health.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Children referred for evaluation for ADHD: comorbidity profiles and characteristics associated with a positive diagnosis.

The symptoms of attention-deficit/hyperactivity disorder (ADHD) are non-specific, and a range of possible causes and comorbidities need to be considered in children referred for assessment. To examine the factors associated with ADHD diagnosis following multidisciplinary assessment. Children underwent multidisciplinary evaluation including parent and teacher questionnaires; semi-structured interview to screen for internalizing and externalizing diagnoses; paediatric, psychology and special education assessments; and case conference. Predictors of ADHD diagnosis were examined in univariable and multivariable logistic regression models. Data from 190 assessments (82% male, mean age 6.8 years) were included. ADHD was diagnosed in 132 (70%) cases, of which 77% had one or more comorbidities. In children not diagnosed with ADHD, 60% had one or more alternate diagnosis made. Teacher-reported ADHD symptom severity and learning difficulties were the strongest predictors of ADHD diagnosis. The pattern of comorbid/alternative diagnoses was similar between those diagnosed with ADHD and those not diagnosed with ADHD. Direct report from teachers is the most critical element of the clinical dataset for the evaluation for ADHD. These findings emphasize the importance of cross-situational impairment to ADHD diagnosis. The frequency and similarity of diagnoses in both groups highlight the overlapping nature of childhood developmental disorders, and the importance of evaluating for comorbid disorders regardless of the primary diagnosis.

Stigma as a key determinant of health-related quality of life in Parkinson's disease.

People with Parkinson's disease (PD) may experience stigma due to their visible features of movement and communication difficulties. This paper aimed to examine the role of experienced stigma in health-related quality of life (QOL), after controlling for personal and clinical characteristics. This is a preliminary analysis of a subset of baseline data from the Social Self-Management of Parkinson's Disease Study (SocM-PD), an ongoing 3-year prospective cohort study. Seventy-three people with PD (M age=65.72, 29 women) participated in this study. Hierarchical multiple regression analyses were used to determine the role of stigma in QOL, after controlling for gender, disease severity, depression, and motor difficulties of daily living. Significant correlations were found between QOL with gender (r=.26), disease severity (r=.38), depression (r=.65), motor difficulties of daily living (r=.71), and stigma (r=.83). After controlling for the significant covariates, stigma made a significant and unique contribution to the explanation of QOL by 13.7% (p<0.001). A final hierarchical multiple regression with stigma and the 4 covariates revealed an overall model that explained 77.8% of the total variance of QOL (F [5, 63]=48.79, p<0.001). Experienced stigma appears to be a key determinant of QOL in people with PD. The results suggest the importance of further understanding stigma in PD to develop possible intervention strategies. Future work is also needed to verify the results with a larger and longitudinal dataset of the SocM-PD.

The Role of Emotion Regulation Difficulties in the Relation Between PTSD Symptoms and the Learned Association Between Trauma-Related and Cocaine Cues

ABSTRACTBackground: PTSD and cocaine dependence frequently co-occur. However, few studies have specifically examined the functional relation between trauma-related distress and cocaine use and none have examined the extent to which PTSD is associated with a learned association between trauma cues and cocaine or the underlying role of emotion regulation difficulties in this relation. Objectives: Thus, this study used a novel version of the Implicit Association Test (IAT) to examine the relation of PTSD symptoms to the strength of the trauma-cocaine cue association and the role of specific emotion regulation difficulties in this relation. Methods: A sample of 42 cocaine-dependent inpatients with a history of interpersonal traumatic exposure were recruited. Participants completed a series of questionnaires assessing PTSD symptom severity and emotion regulation difficulties. Participants then completed the IAT. Results: Results revealed a significant indirect relation of PTSD symptom severity to the strength of the trauma-cocaine cue association through the specific emotion regulation dimension of difficulties controlling impulsive behaviors when distressed. Conclusion/Importance: Results build upon extant research suggesting that factors related to emotional responding and regulation may underlie the relation between trauma-cue exposure and responses to cocaine cues among cocaine dependent patients with PTSD. The finding that PTSD symptom severity is associated with the strength of the trauma-cocaine cue association through one particular dimension of emotion regulation difficulties, difficulties controlling impulsive behaviors when distressed, highlight the potential utility of interventions focused on improving emotion regulation and impulse control abilities among trauma-exposed cocaine dependent patients.

The Association between Sleep Disturbances and Depression among Firefighters: Emotion Dysregulation as an Explanatory Factor.

To investigate emotion regulation difficulties in association with self-reported insomnia symptoms, nightmares, and depression symptoms in a sample of current and retired firefighters. A total of 880 current and retired United States firefighters completed a web-based survey of firefighter behavioral health. Self-report measures included the Center for Epidemiologic Studies Depression Scale, Insomnia Severity Index, PTSD Checklist, and Difficulties in Emotion Regulation Scale. A notable portion of participants reported clinically significant depression symptoms (39.6%) and insomnia symptoms (52.7%), as well as nightmare problems (19.2%), each of which demonstrated a strong association with emotion regulation difficulties (rs = 0.56-0.80). Bootstrapped mediation analyses revealed that the indirect effects of overall emotion regulation difficulties were significant both for the relationship between insomnia and depression (95% CI: 0.385-0.566) and nightmares and depression (95% CI: 1.445-2.365). Limited access to emotion regulation strategies emerged as the strongest, significant indirect effect for both relationships (insomnia 95% CI: 0.136-0.335; nightmares 95% CI: 0.887-1.931). Findings extend previous affective neuroscience research by providing evidence that insomnia and nightmares may influence depression symptoms specifically through the pathway of explicit emotion regulation difficulties. Sleep disturbances may impair the ability to access and leverage emotion regulation strategies effectively, thus conferring risk for negative affect and depression.

Developmental Screening Among Children Born Preterm in a High-Risk Follow-Up Clinic.

The psychometric properties of two formats of developmental screening tools that may be used in follow-up clinics providing primary care to children born preterm are presented. 28 children born extremely preterm (<27 weeks) attending a high-risk clinic at the time of their 18-24 month visit were administered the Child Development Review, Brigance Early Head Start Screen II, and Bayley Scales of Infant and Toddler Development-Third Edition. Both screeners identified the majority of the sample as at-risk. The Brigance Screen II more accurately identified children at-risk compared with the Child Developmental Review (sensitivity: 1.00 and 0.44; specificity: 0.60 and 0.80; positive predictive value: 79% and 80%; negative predictive value: 100% and 44%, respectively). Screening assessments using direct skills assessment may be an efficient and effective method of identifying children with developmental delays, particularly high-frequency but lower severity difficulties, in high-risk follow-up care settings.

A survey on feasibility of ICF-CY use to describe persisting difficulties in executing tasks and activities of children and adolescent with disability in Italy

BackgroundThe criterion for the provision of disability benefits to people under 18 in Italy is the presence of persistent difficulties in carrying out the duties and functions of their own age; however, no national guidelines are available to support the Disability Commissions in assessing such difficulties. ObjectiveThis study identified the different kinds of persisting difficulties in performing tasks and activities of children and adolescents with disability in Italy. MethodsWe used a protocol based on a selection of 55 categories taken from the Activity and Participation components of the International Classification of Functioning, Disability and Health – Children and Youth version. Problems were represented dividing children by age groups, and categories were selected as relevant if reported by 20% of the cases as very severe/complete problems. A count-based methodology was chosen and categories were counted at the level of domain, showing differences related to age groups. Count-based complexity and severity indexes were calculated, reflecting the global amount of problems and the portion of very severe/complete ones. ResultsOut of 415 children with disability enrolled in the study, 290 had persisting difficulties, with those referring to domestic life, major life areas and learning being the most common, and with specific age-related trends. The highest number of problems was reported for children in the 4–6 year age group. ConclusionsOur approach is meant to foster a way toward understanding disability and functioning as a continuum, based on the amount and severity of difficulties that children may have, as opposed to a categorical, diagnosis-based approach.